Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany.
Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Clin Res Cardiol. 2020 Mar;109(3):315-323. doi: 10.1007/s00392-019-01511-0. Epub 2019 Jul 19.
Inflammation drives atherosclerosis and its complications. Anti-inflammatory therapy with interleukin 1 beta (IL-1β) antibody reduces cardiovascular events in patients with elevated high-sensitive C-reactive protein (hsCRP). This study aims to identify the share of patients with coronary heart disease (CHD) and residual inflammation who may benefit from anti-inflammatory therapy.
hsCRP and low-density lipoprotein (LDL) levels were determined in 2741 all-comers admitted to the cardiological ward of our tertiary referral hospital between June 2016 and June 2018. Patients without CHD, with acute coronary syndrome, chronic or recurrent systemic infection, use of immunosuppressant or anti-inflammatory agents, chronic inflammatory diseases, chemotherapy, terminal organ failure, traumatic injury and pregnancy were excluded.
856 patients with stable CHD were included. 42.7% of those had elevated hsCRP ≥ 2 mg/l. Within the group of patients with LDL-cholesterol < 70 mg/dl, 30.9% shared increased hsCRP indicating residual inflammation. After multivariate adjusted backward selection elevated Lipoprotein (a) (OR 1.61, p = 0.048), elevated proBNP (OR 2.57, p < 0.0001), smoking (OR 1.70, p = 0.022), and obesity (OR 2.28, p = 0.007) were associated with elevated hsCRP. In contrast, the use of ezetimibe was associated with normal hsCRP (OR 0.51, p = 0.014). In the subgroup of patients with on-target LDL-cholesterol < 70 mg/dl, backward selection identified elevated proBNP (OR 3.49, p = 0.007) as independent predictor of elevated hsCRP in patients with LDL-cholesterol < 70 mg/dl.
One-third of all-comers patients with CHD showed increased levels of hsCRP despite a LDL-cholesterol < 70 mg/dl potentially qualifying for an anti-inflammatory therapy. Elevated proBNP is an independent risk factor for hsCRP elevation.
炎症会导致动脉粥样硬化及其并发症。使用白细胞介素 1β（IL-1β）抗体的抗炎疗法可降低高敏 C 反应蛋白（hsCRP）升高的患者发生心血管事件的风险。本研究旨在确定那些可能受益于抗炎治疗的冠心病（CHD）和存在残余炎症的患者比例。
2016 年 6 月至 2018 年 6 月期间，我们对入住三级转诊医院心内科病房的所有患者（共 2741 例）进行 hsCRP 和低密度脂蛋白（LDL）检测。排除无 CHD、急性冠状动脉综合征、慢性或复发性全身感染、使用免疫抑制剂或抗炎药物、慢性炎症性疾病、化疗、终末器官衰竭、创伤性损伤和妊娠的患者。
共纳入 856 例稳定型 CHD 患者。其中 42.7%hsCRP 升高（≥2mg/L）。在 LDL-胆固醇＜70mg/dl 的患者中，30.9%hsCRP 升高提示存在残余炎症。多变量向后选择调整后，脂蛋白（a）升高（OR 1.61，p=0.048）、proBNP 升高（OR 2.57，p＜0.0001）、吸烟（OR 1.70，p=0.022）和肥胖（OR 2.28，p=0.007）与 hsCRP 升高相关。相反，使用依折麦布与 hsCRP 正常相关（OR 0.51，p=0.014）。在 LDL-胆固醇＜70mg/dl 的患者亚组中，向后选择确定 proBNP 升高（OR 3.49，p=0.007）为 LDL-胆固醇＜70mg/dl 患者 hsCRP 升高的独立预测因子。
尽管 LDL-胆固醇＜70mg/dl 可能适合抗炎治疗，但三分之一的 CHD 患者即使 LDL-胆固醇＜70mg/dl 仍存在 hsCRP 水平升高，提示存在残余炎症。升高的 proBNP 是 hsCRP 升高的独立危险因素。
