Department of Cardiac and Vascular Diseases, Jagiellonian University, The John Paul II Hospital, Krakow, Poland.
Atherosclerosis. 2011 Jan;214(1):185-90. doi: 10.1016/j.atherosclerosis.2010.10.017. Epub 2010 Oct 20.
This prospective study aimed to determine whether carotid intima-media thickness (CIMT) and biomarkers can enhance the predictive value of classic atherosclerosis risk factors (RFs) for cardiovascular (CV) event risk in patients with confirmed atherosclerosis.
Baseline levels of hs-CRP, Tumor Necrosis Factor alpha (TNF-α), Transforming Growth Factor beta (TGF-β), Interleukin-6 (IL-6), Interleukin-10 (IL-10) and Nt-proBNP were measured in 304 subjects (189 men) aged 64.2±9.4 years, with confirmed atherosclerotic occlusive disease. Maximum CIMT values of common, bulb and internal carotid arteries were measured and expressed as mean CIMT value. The incidences of CV death, myocardial infarction (MI), ischemic stroke (IS) and symptomatic lesion progression were recorded.
During 44.7±12.1 months of follow-up, CV events occurred in 61 (20.1%) patients. Age (odds ratio: OR=1.04; p=0.013), diabetes (OR=2.01; p=0.007), LDL-cholesterol>3.35mmol/L (OR=2.03; p=0.007), previous MI (OR=2.14; p=0.003) and previous IS (OR=3.35; p<0.001) were found independent CV event RFs. Adding biomarkers or CIMT to classic RFs revealed that levels of TNF-α>6pg/mL (OR=1.77; p=0.024), hs-CRP>6mg/L (OR=1.69; p=0.009) or CIMT>1.25mm (OR=5.11; p<0.001) were independently associated with CV event risk. While Nt-proBNP was found RF of CV death (OR=1.19; p=0.003) and MI (OR=1.19; p=0.002). In patients with RFs plus TNF-α>6pg/mL and hs-CRP>6mg/L, a 2- and 5-year event-free survival was 8% and 4%, respectively, as compared to 42% and 33% in those with RFs but lower TNF-α and hs-CRP levels. While, CIMT<1.25mm increased a 2- and 5-year CV event-free survival probability to 79% and 73%, respectively, despite classic RFs presence.
Additive value of TNF-α, hs-CRP and CIMT to classic RFs in CV risk stratification was found in patients with confirmed atherosclerosis. Nt-proBNP was found an independent risk factor of CV death and MI.
本前瞻性研究旨在确定颈动脉内膜中层厚度（CIMT）和生物标志物是否可以提高经典动脉粥样硬化危险因素（RFs）对已确诊动脉粥样硬化患者心血管（CV）事件风险的预测价值。
在 304 名年龄为 64.2±9.4 岁、患有确诊动脉粥样硬化闭塞性疾病的患者中，测量了 hs-CRP、肿瘤坏死因子 alpha（TNF-α）、转化生长因子 beta（TGF-β）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）和 Nt-proBNP 的基线水平。测量了颈总、球部和颈内动脉的最大 CIMT 值，并表示为平均 CIMT 值。记录了 CV 死亡、心肌梗死（MI）、缺血性卒中和症状性病变进展的发生率。
在 44.7±12.1 个月的随访中，61 名（20.1%）患者发生了 CV 事件。年龄（比值比：OR=1.04；p=0.013）、糖尿病（OR=2.01；p=0.007）、LDL-胆固醇>3.35mmol/L（OR=2.03；p=0.007）、既往 MI（OR=2.14；p=0.003）和既往 IS（OR=3.35；p<0.001）是独立的 CV 事件 RFs。将生物标志物或 CIMT 添加到经典 RFs 中后发现，TNF-α>6pg/mL（OR=1.77；p=0.024）、hs-CRP>6mg/L（OR=1.69；p=0.009）或 CIMT>1.25mm（OR=5.11；p<0.001）与 CV 事件风险独立相关。而 Nt-proBNP 是 CV 死亡（OR=1.19；p=0.003）和 MI（OR=1.19；p=0.002）的 RF。在 RFs 加上 TNF-α>6pg/mL 和 hs-CRP>6mg/L 的患者中，2 年和 5 年无事件生存率分别为 8%和 4%，而 RFs 但 TNF-α和 hs-CRP 水平较低的患者分别为 42%和 33%。然而，尽管存在经典 RFs，CIMT<1.25mm 仍将 2 年和 5 年的 CV 无事件生存率提高至 79%和 73%。
在已确诊动脉粥样硬化患者中，TNF-α、hs-CRP 和 CIMT 对经典 RFs 在 CV 风险分层中的附加价值。Nt-proBNP 是 CV 死亡和 MI 的独立危险因素。
