Shah Tina, Newcombe Paul, Smeeth Liam, Addo Juliet, Casas Juan P, Whittaker John, Miller Michelle A, Tinworth Lorna, Jeffery Steve, Strazzullo Pasquale, Cappuccio Francesco P, Hingorani Aroon D
Centre for Clinical Pharmacology, University College London, United Kingdom.
Circ Cardiovasc Genet. 2010 Oct;3(5):436-44. doi: 10.1161/CIRCGENETICS.110.957431. Epub 2010 Sep 28.
Eligibility for rosuvastatin treatment for cardiovascular disease prevention includes a C-reactive protein (CRP) concentration >2 mg/L. Most observational studies of CRP and cardiovascular disease have been in Europeans. We evaluated the influence of ancestry on population CRP concentration to assess the implications for statin targeting in non-Europeans.
In a systematic review and meta-analysis among 221 287 people from 89 studies, geometric mean CRP was 2.6 mg/L (95% credible interval, 2.27 to 2.96) in blacks resident in the United States (n=18 585); 2.51 mg/L (95% CI, 1.18 to 2.86) in Hispanics (n=5049); 2.34 mg/L (95% CI, 1.99 to 2.8) in South Asians (n=1053); 2.03 mg/L (95% CI, 1.77 to 2.3) in whites (n=104 949); and 1.01 mg/L (95% CI, 0.88 to 1.18) in East Asians (n=39 521). Differences were not explained by study design or CRP assay and were preserved after adjustment for age and body mass index. At age 60 years, fewer than half of East Asians but more than two thirds of Hispanics were estimated to have CRP values exceeding 2 mg/L. HapMap frequencies of CRP polymorphisms known to associate with CRP concentration but not coronary heart disease events differed by ancestry. In participant data from the Wandsworth Heart and Stroke Study including European, South Asian and African, and Caribbean-descent subjects, body mass index, systolic blood pressure, and smoking contributed to between-group differences in CRP, but the majority of the difference in CRP was unexplained.
Differences in CRP concentration in populations of diverse ancestry are sufficiently large to affect statin eligibility, based on a single CRP threshold of 2 mg/L, and only partially influenced by differences in variables related to cardiovascular risk. A single threshold value of CRP for cardiovascular risk prediction could lead to inequalities in statin eligibility that may not accurately reflect underlying levels of cardiovascular risk.
瑞舒伐他汀用于预防心血管疾病的适用标准包括C反应蛋白（CRP）浓度>2mg/L。大多数关于CRP与心血管疾病的观察性研究都是在欧洲人群中进行的。我们评估了种族对人群CRP浓度的影响，以评估其对非欧洲人群他汀类药物治疗靶点的意义。
在一项对来自89项研究的221287人的系统评价和荟萃分析中，美国黑人（n=18585）的几何平均CRP为2.6mg/L（95%可信区间，2.27至2.96）；西班牙裔（n=5049）为2.51mg/L（95%CI，1.18至2.86）；南亚人（n=1053）为2.34mg/L（95%CI，1.99至2.8）；白人（n=104949）为2.03mg/L（95%CI，1.77至2.3）；东亚人（n=39521）为1.01mg/L（95%CI，0.88至1.18）。差异不能用研究设计或CRP检测方法来解释，在调整年龄和体重指数后仍然存在。在60岁时，估计不到一半的东亚人CRP值超过2mg/L，但超过三分之二的西班牙裔人CRP值超过2mg/L。已知与CRP浓度相关但与冠心病事件无关的CRP多态性的HapMap频率因种族而异。在包括欧洲、南亚、非洲和加勒比血统受试者的旺兹沃思心脏与中风研究的参与者数据中，体重指数、收缩压和吸烟导致了组间CRP的差异，但CRP差异的大部分无法解释。
基于单一的2mg/L CRP阈值，不同种族人群的CRP浓度差异足够大，足以影响他汀类药物的适用标准，且仅部分受心血管风险相关变量差异的影响。用于心血管风险预测的单一CRP阈值可能导致他汀类药物适用标准的不平等，这可能无法准确反映潜在的心血管风险水平。
