School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, UK.
Department of Biostatistics, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, AL, USA.
Eur Heart J. 2018 Oct 21;39(40):3641-3653. doi: 10.1093/eurheartj/ehy533.
Recent findings have demonstrated the important contribution of inflammation to the risk of cardiovascular disease (CVD) in individuals with optimally managed low density lipoprotein cholesterol (LDL-C). We explored relationships between LDL-C, high sensitivity C-reactive protein (hs-CRP), and clinical outcomes in a free-living US population.
We used data from the REasons for Geographical And Racial Differences in Stroke (REGARDS), and selected individuals at 'high risk' for coronary events with a Framingham Coronary Risk Score of ≥10% or atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% in order to explore relationships between low LDL-C [<70 mg/dL (1.8 mmol/L) in comparison to ≥70 mg/dL (1.8 mmol/L)]; hs-CRP <2 compared with ≥2 mg/L and clinical outcomes [all-cause mortality, incident coronary heart disease (CHD), and incident stroke]. To assess the association between the LDL-C and hs-CRP categories and each outcome, a series of incremental Cox proportional hazards models were employed on complete cases. To account for missing observations, the most adjusted model was used to interrogate the data using multiple imputation with chained equations (MICE). In this analysis, 6136 REGARDS high-risk participants were included. In the MICE analysis, participants with high LDL-C (≥70 mg/dL) and low hs-CRP (<2 mg/L) had a lower risk of incident stroke [hazard ratio (HR) 0.69, 0.47-0.997], incident CHD (HR 0.71, 0.53-0.95), and CHD death (HR 0.70, 0.50-0.99) than those in the same LDL-C category high hs-CRP (≥2 mg/L). In participants with high hs-CRP (≥2 mg/dL), low LDL-C [<70 mg/dL (1.8 mmol/L)] was not associated with additional risk reduction of any investigated outcome, but with the significant increase of all-cause mortality (HR 1.37, 1.07-1.74).
In this high-risk population, we found that low hs-CRP (<2 mg/L) appeared to be associated with reduced risk of incident stroke, incident CHD, and CHD death, whereas low LDL-C (<70 mg/dL) was not associated with protective effects. Thus, our results support other data with respect to the importance of inflammatory processes in the pathogenesis of CVD.
最近的研究结果表明，在低密度脂蛋白胆固醇（LDL-C）得到最佳控制的个体中，炎症对心血管疾病（CVD）风险的重要贡献。我们在一个自由生活的美国人群中探索了 LDL-C、高敏 C 反应蛋白（hs-CRP）与临床结局之间的关系。
我们使用了 REasons for Geographical And Racial Differences in Stroke（REGARDS）的数据，并选择了Framingham 冠状动脉风险评分≥10%或动脉粥样硬化性心血管疾病（ASCVD）风险≥7.5%的“高风险”个体，以探索 LDL-C[<70mg/dL（1.8mmol/L）与≥70mg/dL（1.8mmol/L）]；hs-CRP<2 与≥2mg/L 与临床结局[全因死亡率、冠心病（CHD）事件和卒中事件]之间的关系。为了评估 LDL-C 和 hs-CRP 类别与每种结局之间的关联，我们使用一系列增量 Cox 比例风险模型对完整病例进行了分析。为了处理缺失观察值，使用最调整的模型使用链式方程的多重插补（MICE）来查询数据。在这项分析中，纳入了 6136 名 REGARDS 高危参与者。在 MICE 分析中，LDL-C 较高（≥70mg/dL）且 hs-CRP 较低（<2mg/L）的参与者发生卒中的风险较低[风险比（HR）0.69，0.47-0.997]、冠心病（HR 0.71，0.53-0.95）和冠心病死亡（HR 0.70，0.50-0.99）比处于相同 LDL-C 类别的 hs-CRP 较高（≥2mg/L）的参与者低。在 hs-CRP 较高（≥2mg/dL）的参与者中，LDL-C 较低[<70mg/dL（1.8mmol/L）]与任何研究结局的风险降低无关，但与全因死亡率的显著增加相关（HR 1.37，1.07-1.74）。
在这个高危人群中，我们发现低 hs-CRP（<2mg/L）似乎与卒中、冠心病和冠心病死亡风险降低相关，而低 LDL-C（<70mg/dL）与保护作用无关。因此，我们的结果支持其他关于炎症过程在 CVD 发病机制中的重要性的数据。
