Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD.
Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland OH.
J Am Heart Assoc. 2020 Feb 4;9(3):e013600. doi: 10.1161/JAHA.119.013600. Epub 2020 Jan 30.
Background Inflammation is an independent causal risk factor for atherosclerotic cardiovascular diseases (ASCVDs). However, whether hsCRP (high-sensitivity C-reactive protein) is prognostic across various levels of atherogenic lipid measures such as low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B and total cholesterol/high-density lipoprotein cholesterol in primary prevention is unknown. Methods and Results We studied 9748 ARIC (Atherosclerosis Risk in Communities) study participants who were free of ASCVD at baseline (visit 4, 1996-1998) and had measurements of lipids, apolipoprotein B, and hsCRP. We used multivariable adjusted Cox models to estimate the risk of incident ASCVD events associated with hsCRP levels (less than/greater than or equal to median) in individuals where triple lipid measures combined (low-density lipoprotein cholesterol + non-high-density lipoprotein cholesterol + apolipoprotein B) or quadruple measures combined [triple + total cholesterol/high-density lipoprotein cholesterol] were less than versus greater than or equal to median cut points. Mean age of participants was 62.6±5.6 years; 59% women, 22% black. There were 1574 ASCVD events over median (interquartile range) follow-up of 18.4 (12.8-19.5) years, and discordance between hsCRP and lipid measures was prevalent in 50% of the population. hsCRP greater than or equal to median (2.4 mg/L), compared with less than median, was associated with an increased risk of ASCVD in individuals with less than median levels of the triple (adjusted hazard ratio, 1.33; 95% CI, 1.09-1.60) and quadruple (adjusted hazard ratio,1.47; 95% CI, 1.18-1.85) lipid measures. Such increased risk was consistent among individuals with low (<7.5%) or high (≥7.5%) estimated risk by the pooled cohort equation. There were no interactions by sex, diabetes mellitus, or statin use. Conclusions Our findings suggest that inflammation is independently associated with ASCVD regardless of atherogenic lipid levels and pooled cohort equation risk score in individuals without known ASCVD.
炎症是动脉粥样硬化性心血管疾病（ASCVD）的独立因果风险因素。然而，在初级预防中，hsCRP（高敏 C 反应蛋白）是否与各种致动脉粥样脂质指标（如低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇、载脂蛋白 B 和总胆固醇/高密度脂蛋白胆固醇）的水平相关，目前尚不清楚。
我们研究了 9748 名 ARIC（社区动脉粥样硬化风险）研究参与者，他们在基线时（第 4 次访视，1996-1998 年）无 ASCVD 病史，且有血脂、载脂蛋白 B 和 hsCRP 的测量值。我们使用多变量调整的 Cox 模型来估计与 hsCRP 水平（<中位数/≥中位数）相关的 ASCVD 事件风险，这些参与者的三重脂质指标（低密度脂蛋白胆固醇+非高密度脂蛋白胆固醇+载脂蛋白 B）或四重指标[三重+总胆固醇/高密度脂蛋白胆固醇]的组合均<中位数与≥中位数切点。参与者的平均年龄为 62.6±5.6 岁；59%为女性，22%为黑人。在中位（四分位距）随访 18.4（12.8-19.5）年期间，共发生 1574 例 ASCVD 事件，人群中 50%存在 hsCRP 与脂质指标之间的不一致。与 hsCRP<中位数相比，hsCRP≥中位数（2.4mg/L）与三重脂质指标<中位数（调整后的危险比，1.33；95%可信区间，1.09-1.60）和四重脂质指标<中位数（调整后的危险比，1.47；95%可信区间，1.18-1.85）的个体 ASCVD 风险增加相关。这种风险增加在 pooled cohort equation 估计的低（<7.5%）或高（≥7.5%）风险个体中是一致的。性别、糖尿病或他汀类药物使用均无交互作用。
在无已知 ASCVD 的个体中，无论致动脉粥样脂质水平和 pooled cohort equation 风险评分如何，炎症与 ASCVD 独立相关。
