Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
PLoS One. 2012;7(9):e45907. doi: 10.1371/journal.pone.0045907. Epub 2012 Sep 21.
So far it is unclear whether the association between serum uric acid (SUA), inflammatory cytokines and risk of atherosclerosis is causal or an epiphenomenon. The aim of the project is to investigate the independent prognostic relationship of inflammatory markers and SUA levels with adverse cardiovascular outcomes in a patient population with stable coronary heart disease (CHD).
SUA, C-reactive protein (CRP) and interleukin (IL)-6 were measured at baseline in a cohort of 1,056 patients aged 30-70 years with CHD. Cox proportional hazards model was used to determine the prognostic value of these markers on a combined CVD endpoint during eight year follow-up after adjustment for covariates.
For 1,056 patients with stable coronary heart disease aged 30-70 years (mean age 58.9 years, SD 8.0) follow-up information and serum measurements were complete and n = 151 patients (incidence 21.1 per 1000 patients years) experienced a fatal or non-fatal CVD event during follow-up (p-value = 0.05 for quartiles of SUA, p = 0.002 for quartiles of CRP, p = 0.13 for quartiles of IL-6 in Kaplan-Meier analysis). After adjustment for age, gender and hospital site the hazard ratio (HR) for SUA increased from 1.37 to 1.65 and 2.27 in the second, third, and top quartile, when compared to the bottom one (p for trend <0.0005). The HR for CRP increased from 0.85 to 0.98 and 1.64 in the respective quartiles (p for trend 0.02). After further adjustment for covariates SUA still showed a clear statistically significant relationship with the outcome (p for trend 0.045), whereas CRP did not (p for trend 0.10).
The data suggest that compared to inflammatory markers such as CRP and IL-6 serum uric acid levels may predict future CVD risk in patients with stable CHD with a risk increase even at levels considered normal.
目前尚不清楚血清尿酸（SUA）、炎性细胞因子与动脉粥样硬化风险之间的关联是因果关系还是偶然现象。本项目旨在研究炎性标志物和 SUA 水平与稳定型冠心病（CHD）患者不良心血管结局之间的独立预后关系。
在年龄 30-70 岁的 CHD 患者队列中，于基线时测量 SUA、C 反应蛋白（CRP）和白细胞介素（IL）-6。在调整协变量后，使用 Cox 比例风险模型确定这些标志物在 8 年随访期间对复合 CVD 终点的预后价值。
对于 1056 名年龄 30-70 岁（平均年龄 58.9 岁，SD 8.0）的稳定型冠心病患者，随访信息和血清测量完整，151 名患者（发生率为每 1000 患者年 21.1 例）在随访期间发生致命或非致命的 CVD 事件（SUA 四分位数的 p 值=0.05，CRP 四分位数的 p 值=0.002，IL-6 四分位数的 p 值=0.13，Kaplan-Meier 分析）。在调整年龄、性别和医院部位后，SUA 第二、三、四分位与最低四分位相比，危险比（HR）从 1.37 增加到 1.65 和 2.27（趋势 p<0.0005）。CRP 的 HR 从 0.85 增加到 0.98 和 1.64（趋势 p=0.02）。进一步调整协变量后，SUA 与结局仍呈明显统计学显著相关（趋势 p=0.045），而 CRP 则没有（趋势 p=0.10）。
数据表明，与 CRP 和 IL-6 等炎性标志物相比，SUA 水平可能预测稳定型 CHD 患者未来 CVD 风险，即使在认为正常的水平下，风险也会增加。
