National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.
Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
Atherosclerosis. 2018 Aug;275:205-213. doi: 10.1016/j.atherosclerosis.2018.06.817. Epub 2018 Jun 15.
We aimed to assess the association of circulating calprotectin, an inflammation-associated protein, with cardiovascular disease (CVD) risk and determine whether it improves risk prediction.
Plasma calprotectin measurements were made at baseline in 5290 participants in the PREVEND prospective study. Hazard ratios (95% confidence intervals [CI]) for CVD were calculated.
After a median follow-up of 8.3 years, 339 first CVD events were recorded. Calprotectin concentration was correlated with several conventional risk factors as well as with high-sensitivity C-reactive protein (hsCRP) (r = 0.42). Calprotectin was log-linearly associated with CVD risk. The risk for CVD adjusted for conventional cardiovascular risk factors was 1.26 (95% CI, 1.13-1.41) per 1 standard deviation higher baseline log calprotectin, and was 1.24 (95% CI, 1.11-1.39) following further adjustment for triglycerides, body mass index, and other potential confounders. The association remained present after further adjustment for hsCRP 1.15 (95% CI, 1.02-1.30). Comparing extreme quartiles of plasma calprotectin levels, the corresponding adjusted HRs for CVD were 1.96 (1.37-2.82), 1.89 (1.31-2.72), and 1.56 (1.07-2.29). The association of calprotectin with CVD risk did not vary importantly in several relevant clinical subgroups. Adding calprotectin to the Framingham CVD Risk Score was associated with a C-index change (0.0016; p=0.42) difference in -2 log likelihood (p=0.038), IDI (0.0080; p < 0.001), and NRI (4.03%; p=0.024).
There is a log-linear association of calprotectin concentration with risk of CVD, which may be partly dependent on hsCRP. Adding calprotectin to conventional risk factors improves CVD risk assessment using measures of reclassification and -2 log likelihood.
我们旨在评估循环钙卫蛋白（一种与炎症相关的蛋白）与心血管疾病（CVD）风险的关联，并确定其是否能改善风险预测。
在 PREVEND 前瞻性研究的 5290 名参与者中，基线时测量血浆钙卫蛋白水平。计算 CVD 的危害比（95%置信区间[CI]）。
中位随访 8.3 年后，记录到 339 例首发 CVD 事件。钙卫蛋白浓度与多种传统危险因素以及高敏 C 反应蛋白（hsCRP）相关（r=0.42）。钙卫蛋白与 CVD 风险呈对数线性相关。在调整了传统心血管危险因素后，基线时钙卫蛋白每增加 1 个标准差，CVD 风险增加 1.26（95%CI，1.13-1.41），在进一步调整甘油三酯、体重指数和其他潜在混杂因素后，风险增加 1.24（95%CI，1.11-1.39）。在进一步调整 hsCRP 后，该关联仍然存在 1.15（95%CI，1.02-1.30）。比较血浆钙卫蛋白水平的四个极端四分位数，相应的 CVD 调整后 HR 分别为 1.96（1.37-2.82）、1.89（1.31-2.72）和 1.56（1.07-2.29）。钙卫蛋白与 CVD 风险的相关性在几个相关临床亚组中没有显著差异。将钙卫蛋白添加到弗雷明汉 CVD 风险评分中，与 C 指数变化（0.0016；p=0.42）、-2 对数似然（p=0.038）、IDI（0.0080；p<0.001）和 NRI（4.03%；p=0.024）差异有关。
钙卫蛋白浓度与 CVD 风险呈对数线性相关，这可能部分依赖于 hsCRP。将钙卫蛋白添加到传统危险因素中，可以改善使用重新分类和-2 对数似然的 CVD 风险评估。
