Zhao Qing, Du Jian-Shi, Han Dong-Mei, Ma Ying
Department of Neurology, China-Japan Union Hospital of Jilin University Changchun 130033, Jilin, China.
Department of Vascular Surgery, China-Japan Union Hospital of Jilin University Changchun 130033, Jilin, China.
Int J Clin Exp Med. 2014 Dec 15;7(12):5158-69. eCollection 2014.
An analysis of high-sensitive factor I and C-reactive proteins as biomarkers for coronary artery disease has been performed from 19 anticipated cohort studies that included 21,567 participants having no information about coronary artery disease. Besides, the clinical implications of statin therapy initiated due to assessment of factor I and C-reactive proteins have also been modeled during studies. The measure of risk discrimination (C-index) was increased (by 0.0101) as per the prognostic model for coronary artery disease with respect to sex, smoking status, age, blood pressure, total cholesterol level along with diabetic history characteristic parameters. The C-index was further raised by 0.0045 and 0.0053 when factor I and C-reactive proteins based information were added, respectively which finally predicted 10-year risk categories as: high (> 20%), medium (10% to < 20%), and low (< 10%) risks. We found 2,254 persons (among 15,000 adults (age ≥ 45 years)) would initially be classified as being at medium risk for coronary artery disease when only conventional risk factors were used as calculated risk. Besides, persons with a predicted risk of more than 20% as well as for persons suffering from other risk factors (i.e. diabetes), statin therapy was initiated (irrespective of their decade old predicted risk). We conclude that under current treatment guidelines assessment of factor I and C-reactive proteins levels (as biomarker) in people at medium risk for coronary artery disease could prevent one additional coronary artery disease risk over a period a decade for every 390-500 people screened.
对19项预期队列研究进行了分析,这些研究纳入了21567名无冠心病信息的参与者,以评估高敏因子I和C反应蛋白作为冠心病生物标志物的情况。此外,在研究过程中还对因评估因子I和C反应蛋白而启动他汀类药物治疗的临床意义进行了建模。根据冠心病预后模型,在考虑性别、吸烟状况、年龄、血压、总胆固醇水平以及糖尿病史等特征参数时,风险辨别指标(C指数)增加了(0.0101)。当分别加入基于因子I和C反应蛋白的信息时,C指数进一步提高了0.0045和0.0053,最终预测出10年风险类别为:高风险(>20%)、中风险(10%至<20%)和低风险(<10%)。我们发现,在15000名成年人(年龄≥45岁)中,当仅使用传统风险因素计算风险时,有2254人最初会被归类为冠心病中风险人群。此外,对于预测风险超过20%的人群以及患有其他风险因素(如糖尿病)的人群,无论其十年前预测的风险如何,均启动了他汀类药物治疗。我们得出结论,根据当前治疗指南,对冠心病中风险人群评估因子I和C反应蛋白水平(作为生物标志物),每筛查390 - 500人,在十年期间可额外预防一例冠心病风险。