Filardi Pasquale Perrone, Cecere Milena, Savarese Gianluigi, Damore Carmen, Parente Antonio, Conte Sirio, Coutsoumbas Gloria
Dipartimento di Medicina Interna, Scienze Cardiovascolari ed Immunologiche, Università degli Studi Federico II, Napoli.
G Ital Cardiol (Rome). 2010 Dec;11(12 Suppl 3):10S-15S.
The search for new risk markers of cardiovascular (CV) risk is continuous, aimed to improve its estimate. Among them, the measurement of C-reactive protein (CRP) levels seems the most promising one. CV risk evaluation systems as Reynolds score, integrating CPR dosage to classic risk factors, were shown to improve the detection of subjects at higher risk, who deserve a more effective CV prevention. The use of CRP as a guide in primary prevention was tested for the first time in the JUPITER study, a large randomized trial comparing rosuvastatin 20 mg and placebo. Admission criteria were based on the presence of an inflammatory status only (CRP >2 mg/l), aside from CV risk factors (LDL <130 mg/dl). Rosuvastatin 20 mg, compared to placebo, significantly reduced composite primary endpoint (CV mortality, myocardial infarction, ischemic stroke, hospitalization for unstable angina and myocardial revascularization). These results confirmed the continuous relationship between decreased cholesterol level and clinical benefit also in primary prevention. The high prevalence of metabolic syndrome in this study population confirmed the link between this condition and the presence of an inflammatory status, and the high incidence of events occurred in the placebo group suggests an important role of CRP in the detection of subjects at higher CV risk. The greatest reduction of CV events was seen in the subgroup of patient who achieved the "double target" of both decreased lipids and inflammation marker, similarly to PROVE IT-TIMI 22 in secondary prevention. The presence of an inflammatory status may allow the detection of more vulnerable patients, where statin treatment may result in a greater benefit, as both LDL cholesterol and inflammatory status are reduced, and clinical CV events are consequently decreased.
对心血管（CV）风险新的风险标志物的探索一直在持续，目的是改进其评估方法。其中，测量C反应蛋白（CRP）水平似乎是最有前景的一种。像雷诺兹评分这样的CV风险评估系统，将CRP检测纳入经典风险因素，已被证明能改善对高风险受试者的检测，这些受试者值得更有效的CV预防。CRP在一级预防中的应用首次在JUPITER研究中进行了测试，这是一项比较20毫克瑞舒伐他汀和安慰剂的大型随机试验。纳入标准仅基于炎症状态的存在（CRP>2毫克/升），不考虑CV风险因素（低密度脂蛋白<130毫克/分升）。与安慰剂相比，20毫克瑞舒伐他汀显著降低了复合主要终点（CV死亡率、心肌梗死、缺血性中风、不稳定型心绞痛住院和心肌血运重建）。这些结果证实了在一级预防中胆固醇水平降低与临床获益之间的持续关系。该研究人群中代谢综合征的高患病率证实了这种情况与炎症状态存在之间的联系，安慰剂组中发生的高事件发生率表明CRP在检测高CV风险受试者中具有重要作用。与二级预防中的PROVE IT-TIMI 22类似，在实现了血脂和炎症标志物均降低的“双目标”的患者亚组中，CV事件的减少最为显著。炎症状态的存在可能有助于发现更易患病的患者，在这些患者中他汀类药物治疗可能带来更大益处，因为低密度脂蛋白胆固醇和炎症状态均降低，临床CV事件因此减少。
