急性心肌梗死青年患者炎症标志物与健康状况的性别差异：VIRGO（恢复差异：性别对年轻急性心肌梗死患者结局的影响）研究结果
Sex Differences in Inflammatory Markers and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) Study.
作者信息
Lu Yuan, Zhou Shengfan, Dreyer Rachel P, Spatz Erica S, Geda Mary, Lorenze Nancy P, D'Onofrio Gail, Lichtman Judith H, Spertus John A, Ridker Paul M, Krumholz Harlan M
机构信息
From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (Y.L., S.Z., R.P.D., E.S.S., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (Y.L., S.Z., R.P.D., E.S.S., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (M.G., N.P.L.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Emergency Medicine (R.P.D., G.D.), Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; University of Missouri-Kansas City (J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); and Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2):e003470. doi: 10.1161/CIRCOUTCOMES.116.003470. Epub 2017 Feb 22.
BACKGROUND
Young women (≤55 years of age) with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. Elevated inflammatory markers are associated with an increased risk of cardiovascular outcomes after AMI, but little is known about whether young women have higher inflammatory levels after AMI compared with young men.
METHODS AND RESULTS
We assessed sex differences in post-AMI inflammatory markers and whether such differences account for sex differences in 12-month health status, using data from 2219 adults with AMI, 18 to 55 years of age, in the United States. Inflammatory markers including high-sensitivity C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 were measured 1 month after AMI. Overall, women had higher levels of hsCRP and lipoprotein-associated phospholipase A2 after AMI compared with men, and this remained statistically significant after multivariable adjustment. Regression analyses showed that elevated 1-month hsCRP was associated with poor health status (symptom, function, and quality of life) at 12 months. However, the association between hsCRP and health status became nonsignificant after adjustment for sociodemographics, comorbidities, and treatment factors. Half of these patients had residual inflammatory risk (hsCRP >3 mg/L) compared with a third who had residual cholesterol risk (Low-density lipoprotein cholesterol >100 mg/dL).
CONCLUSIONS
Young women with AMI had higher inflammatory levels compared with young men. Elevated 1-month hsCRP was associated with poor health status at 12 months after AMI, but this was attenuated after adjustment for patient characteristics. Targeted anti-inflammatory treatments are worthy of consideration for secondary prevention in these patients if ongoing trials of anti-inflammatory therapy prove effective.
背景
急性心肌梗死（AMI）的年轻女性（≤55岁）比同龄男性具有更高的死亡风险。炎症标志物升高与AMI后心血管不良结局风险增加相关，但对于AMI后年轻女性的炎症水平是否高于年轻男性知之甚少。
方法与结果
我们使用来自美国2219例年龄在18至55岁的AMI成年患者的数据，评估了AMI后炎症标志物的性别差异，以及这些差异是否解释了12个月健康状况的性别差异。在AMI后1个月测量包括高敏C反应蛋白（hsCRP）和脂蛋白相关磷脂酶A2在内的炎症标志物。总体而言，与男性相比，女性在AMI后的hsCRP和脂蛋白相关磷脂酶A2水平更高，在多变量调整后这一差异仍具有统计学意义。回归分析表明，1个月时hsCRP升高与12个月时的健康状况不佳（症状、功能和生活质量）相关。然而，在调整社会人口统计学、合并症和治疗因素后，hsCRP与健康状况之间的关联变得不显著。这些患者中有一半存在残余炎症风险（hsCRP>3mg/L），而有三分之一存在残余胆固醇风险（低密度脂蛋白胆固醇>100mg/dL）。
结论
与年轻男性相比，患有AMI的年轻女性炎症水平更高。AMI后1个月hsCRP升高与12个月时的健康状况不佳相关，但在调整患者特征后这种关联减弱。如果正在进行的抗炎治疗试验证明有效，针对性的抗炎治疗值得考虑用于这些患者的二级预防。
Zotero 插件