绝经后妇女中 C 反应蛋白与临床事件及冠状动脉管腔狭窄的不一致关联：来自女性血管造影维生素和雌激素（WAVE）研究的数据。
Discordant association of C-reactive protein with clinical events and coronary luminal narrowing in postmenopausal women: data from the Women's Angiographic Vitamin and Estrogen (WAVE) study.
机构信息
Department of Internal Medicine, Washington Hospital Center, Washington, DC; Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.
出版信息
Clin Cardiol. 2013 Sep;36(9):535-41. doi: 10.1002/clc.22155. Epub 2013 Jun 10.
BACKGROUND
The incidence of cardiovascular events had been shown to be associated with C-reactive protein (CRP). However, it is unclear that the cardiovascular risk associated with CRP is due to progressive coronary narrowing or to other factors such as formation of unstable plaque. This study was designed to determine the effect of baseline CRP on cardiovascular events and on the progression of atherosclerotic narrowing among 423 postmenopausal women with angiographic stenosis between 15% and 75%.
HYPOTHESIS
Baseline CRP levels may affect cardiovascular events and progression of atherosclerotic coronary artery narrowing among postmenopausal women.
METHODS
Baseline and follow-up (2.8 years) angiographic data were analyzed among 320 women. Women were stratified into 4 quartiles according to baseline CRP levels. The changes in lumen diameter and clinical events in each quartile were compared.
RESULTS
The annualized changes in minimal and average lumen diameter in diseased and nondiseased coronary segments were not significantly associated with baseline CRP levels. The composite end point of all-cause mortality and myocardial infarction (MI) increased from 3% (3/107) in the first CRP quartile to 14% (14/98) in fourth CRP quartile (P < 0.001). Similar results were found for cardiovascular death and MI (increased from 1% (2/107) in the first quartile to 11% (11/98) in fourth quartile). The difference remained significant even after adjustment for baseline differences and cardiovascular risk factors.
CONCLUSIONS
Higher baseline CRP was associated with increased risk of clinical events but was not associated with annualized change in luminal diameters. Thus, increased risk of adverse events among patients with higher baseline CRP events was independent of progression of atherosclerosis as measured by change in minimal or average luminal diameter.
背景
已有研究表明，心血管事件的发生率与 C 反应蛋白（CRP）有关。但是，CRP 相关的心血管风险是由于冠状动脉狭窄的进行性进展，还是由于不稳定斑块的形成等其他因素，尚不清楚。本研究旨在确定基线 CRP 对 423 例经血管造影证实狭窄程度在 15%至 75%之间的绝经后妇女的心血管事件和动脉粥样硬化狭窄进展的影响。
假说
基线 CRP 水平可能会影响绝经后妇女的心血管事件和动脉粥样硬化性冠状动脉狭窄的进展。
方法
对 320 例女性的基线和随访（2.8 年）血管造影数据进行了分析。根据基线 CRP 水平将女性分为 4 个四分位组。比较了每个四分位组的管腔直径变化和临床事件。
结果
病变和非病变冠状动脉节段的最小和平均管腔直径的年化变化与基线 CRP 水平无显著相关性。全因死亡率和心肌梗死（MI）的复合终点从 CRP 四分位第 1 组的 3%（3/107）增加到第 4 组的 14%（14/98）（P<0.001）。心血管死亡和 MI 的结果相似（第 1 四分位组为 1%（2/107），第 4 四分位组为 11%（11/98））。即使在校正基线差异和心血管危险因素后，差异仍有统计学意义。
结论
较高的基线 CRP 与临床事件风险增加相关，但与管腔直径的年化变化无关。因此，较高基线 CRP 患者的不良事件风险增加与最小或平均管腔直径变化所测量的动脉粥样硬化进展无关。
Zotero 插件