From the Department of Vascular Medicine (D.F.v.W., J.J.P.K., E.S.G.S.) and Department of Cardiology (S.M.B.), Academic Medical Center, Amsterdam, The Netherlands; MRC Epidemiology Unit, Addenbrookes Hospital, Cambridge, United Kingdom (N.J.W.); and Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (S.A.-A., K.-T.K.).
Arterioscler Thromb Vasc Biol. 2013 Dec;33(12):2888-94. doi: 10.1161/ATVBAHA.113.301736. Epub 2013 Sep 26.
Circulating levels of C-reactive protein (CRP) are associated with an increased risk of coronary artery disease (CAD), stroke, and peripheral artery disease (PAD). Observational and experimental evidence suggest that CRP might differentially predict fatal and nonfatal cardiovascular events. Here, we sought to determine the predictive value of CRP for fatal and nonfatal CAD, stroke, or PAD.
CRP levels were measured in 18 450 apparently healthy participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort. Cox proportional hazards models were used to quantify the association between CRP levels and fatal and nonfatal CAD events, strokes, and PAD events. Bootstrapping was applied to test for significant differences between the risk of fatal and nonfatal events. During 208 485 person-years at risk, 2915 CAD events, 361 strokes, and 657 PAD events occurred. CRP was associated with fatal and nonfatal CAD events and nonfatal PAD events. When adding CRP to predictive risk models for fatal and nonfatal events corrected for known cardiovascular risk factors, the net reclassification index was 2.1% for fatal and 1.9% for nonfatal events. Multivariate adjusted hazard ratios for fatal CAD events (hazard ratio, 1.36; 95% confidence interval, 1.27-1.46) differed significantly (mean difference, 13%; 95% confidence interval, 5.1%-21.9%; P<0.001) from the multivariate adjusted hazard ratio for nonfatal CAD events (hazard ratio, 1.21; 95% confidence interval, 1.15-1.26).
In the EPIC-Norfolk cohort, CRP was associated with fatal and nonfatal CAD events, as well as nonfatal PAD events. Adding CRP to risk stratification models resulted in a small improvement in classification for both fatal and nonfatal events. Importantly, CRP was significantly more strongly associated with fatal CAD events than with nonfatal CAD events.
C 反应蛋白（CRP）的循环水平与冠心病（CAD）、中风和外周动脉疾病（PAD）的风险增加有关。观察性和实验证据表明，CRP 可能对致命和非致命心血管事件有不同的预测作用。在这里，我们试图确定 CRP 对致命和非致命 CAD、中风或 PAD 的预测价值。
在欧洲癌症与营养前瞻性调查（EPIC）-诺福克队列中，对 18450 名看似健康的参与者进行了 CRP 水平测量。Cox 比例风险模型用于量化 CRP 水平与致命和非致命 CAD 事件、中风和 PAD 事件之间的关联。采用自举法检验致命和非致命事件风险的显著差异。在 208485 人年的风险期间，发生了 2915 例 CAD 事件、361 例中风和 657 例 PAD 事件。CRP 与致命和非致命 CAD 事件和非致命 PAD 事件相关。当将 CRP 添加到针对致命和非致命事件的预测风险模型中，并校正已知的心血管危险因素时，致命事件的净重新分类指数为 2.1%，非致命事件的净重新分类指数为 1.9%。致命性 CAD 事件的多变量调整后的危险比（危险比，1.36；95%置信区间，1.27-1.46）与非致命性 CAD 事件的多变量调整后的危险比（危险比，1.21；95%置信区间，1.15-1.26）有显著差异（平均差异，13%；95%置信区间，5.1%-21.9%；P<0.001）。
在 EPIC-Norfolk 队列中，CRP 与致命和非致命 CAD 事件以及非致命性 PAD 事件相关。将 CRP 添加到风险分层模型中可略微提高致命和非致命事件的分类效果。重要的是，CRP 与致命性 CAD 事件的相关性明显强于非致命性 CAD 事件。
