Parrinello Christina M, Lutsey Pamela L, Ballantyne Christie M, Folsom Aaron R, Pankow James S, Selvin Elizabeth
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
Am Heart J. 2015 Aug;170(2):380-9. doi: 10.1016/j.ahj.2015.04.017. Epub 2015 Apr 18.
Single measurements of elevated high-sensitivity C-reactive protein (hs-CRP) are associated with increased risk of diabetes, cardiovascular disease, and mortality. Large increases or sustained elevations in hs-CRP may be associated with even greater risk of these outcomes. The objective of this study was to characterize the association of 6-year change in hs-CRP with incident diabetes, incident cardiovascular events (heart disease, stroke, and heart failure), and mortality.
We included 10,160 ARIC participants with hs-CRP measured at visits 2 (1990-1992) and 4 (1996-1998). Change in hs-CRP was categorized as sustained low/moderate (<3 mg/L at both visits), decreased (≥3 mg/L at visit 2 and <3 mg/L at visit 4), increased (<3 mg/L at visit 2 and ≥3 mg/L at visit 4), and sustained elevated (≥3 mg/L at both visits). Cox proportional hazards models were used to assess the association of 6-year change in hs-CRP with incident diabetes, cardiovascular events, and death during ~15 years after visit 4.
Compared with persons with sustained low/moderate hs-CRP, those with increased or sustained elevated hs-CRP had an increased risk of incident diabetes (hazard ratios [95% CIs] 1.56 [1.38-1.76] and 1.39 [1.25-1.56], respectively), whereas those with deceased hs-CRP did not. Persons with sustained elevated hs-CRP had an increased risk of coronary heart disease, ischemic stroke, heart failure, and mortality (hazard ratios [95% CIs] 1.51 [1.23-1.85], 1.70 [1.32-2.20], 1.60 [1.35-1.89], and 1.52 [1.37-1.69], respectively) compared with those with sustained low/moderate hs-CRP. Associations for sustained elevated hs-CRP were greater than for those with increased hs-CRP over 6 years.
Large increases or sustained elevations in hs-CRP over a 6-year period were associated with a subsequent increased risk of diabetes, and persons with sustained elevations in hs-CRP were at the highest risk for cardiovascular disease and mortality. Two measurements of hs-CRP are better than one for characterizing risk, and large increases are particularly prognostic.
单次高敏C反应蛋白（hs-CRP）升高与糖尿病、心血管疾病及死亡风险增加相关。hs-CRP大幅升高或持续升高可能与这些结局的更高风险相关。本研究的目的是描述hs-CRP的6年变化与新发糖尿病、新发心血管事件（心脏病、中风和心力衰竭）及死亡率之间的关联。
我们纳入了10160名动脉粥样硬化风险社区（ARIC）研究参与者，他们在第2次访视（1990 - 1992年）和第4次访视（1996 - 1998年）时测量了hs-CRP。hs-CRP的变化分为持续低/中度（两次访视时均<3 mg/L）、下降（第2次访视时≥3 mg/L且第4次访视时<3 mg/L）、升高（第2次访视时<3 mg/L且第4次访视时≥3 mg/L）和持续升高（两次访视时均≥3 mg/L）。采用Cox比例风险模型评估hs-CRP的6年变化与第4次访视后约15年期间新发糖尿病、心血管事件及死亡之间的关联。
与hs-CRP持续低/中度的人相比，hs-CRP升高或持续升高的人发生糖尿病的风险增加（风险比[95%置信区间]分别为1.56[1.38 - 1.76]和1.39[1.25 - 1.56]），而hs-CRP下降的人则没有。与hs-CRP持续低/中度的人相比，hs-CRP持续升高的人患冠心病、缺血性中风、心力衰竭及死亡的风险增加（风险比[95%置信区间]分别为1.51[1.23 - 1.85]、1.70[1.32 - 2.20]、1.60[1.35 - 1.89]和1.52[1.37 - 1.69]）。hs-CRP持续升高的关联大于6年内hs-CRP升高的人。
6年内hs-CRP大幅升高或持续升高与随后糖尿病风险增加相关，hs-CRP持续升高的人患心血管疾病和死亡的风险最高。测量两次hs-CRP比测量一次更有助于评估风险，大幅升高尤其具有预后意义。
