Kamath Deepak Y, Xavier Denis, Sigamani Alben, Pais Prem
Division of Clinical Research & Training, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India.
Indian J Med Res. 2015 Sep;142(3):261-8. doi: 10.4103/0971-5916.166582.
The role of low grade systemic inflammation as evidenced by elevated high sensitivity C-reactive protein (hsCRP) levels in the pathogenesis of atherosclerotic vascular disease has been intensely investigated through observational studies and clinical trials in the past two decades. On the basis of evidence that has accrued, hsCRP measurement has been integrated into the Reynolds risk scoring system to predict cardiovascular risk. The JUPITER trial proved the benefit of statins in cardiovascular risk reduction in patients with low grades of systemic inflammation and 'normal' cholesterol levels. However, substantial evidence has been generated from western studies. We, therefore, conducted a scoping review for studies done in India with a view to identify gaps in evidence and make further recommendations. Most Indian studies had small sample sizes and short term follow ups. There were no large population based prospective studies where patients were followed up for long periods of time for major cardiovascular end points. An analysis of the hsCRP level from the control arms of case-control studies derived a mean hsCRP value of 1.88 mg/l, which is higher than the western population where values < 1 mg/l are classified as low cardiovascular risk. Further large prospective cohort studies with longer term follow ups are essential before we can make further recommendations to integrate hsCRP into risk prediction models for cardiovascular disease prevention.
在过去二十年中，通过观察性研究和临床试验，对低级别全身炎症在动脉粥样硬化性血管疾病发病机制中的作用进行了深入研究，这种炎症表现为高敏C反应蛋白（hsCRP）水平升高。基于已积累的证据，hsCRP测量已被纳入雷诺兹风险评分系统以预测心血管风险。JUPITER试验证明了他汀类药物在降低全身炎症程度低且胆固醇水平“正常”的患者心血管风险方面的益处。然而，大量证据来自西方研究。因此，我们对印度开展的研究进行了一项范围综述，以找出证据差距并提出进一步建议。大多数印度研究样本量小且随访时间短。没有基于大样本人群的前瞻性研究，对患者进行长期随访以观察主要心血管终点。对病例对照研究对照组的hsCRP水平分析得出平均hsCRP值为1.88mg/l，这高于西方人群，在西方人群中，hsCRP值<1mg/l被归类为心血管风险低。在我们能够进一步建议将hsCRP纳入心血管疾病预防风险预测模型之前，进一步开展长期随访的大型前瞻性队列研究至关重要。
