黑人成年人 C 反应蛋白轨迹与心力衰竭事件：杰克逊心脏研究。
Trajectory of C-Reactive Protein and Incident Heart Failure in Black Adults: The Jackson Heart Study.
机构信息
Department of Medicine (A.H., R.K.K., A.C., J.B., M.E.H.), University of Mississippi Medical Center, Jackson.
Department of Data Science (W.K.Y.), University of Mississippi Medical Center, Jackson.
出版信息
Circ Heart Fail. 2024 Aug;17(8):e011199. doi: 10.1161/CIRCHEARTFAILURE.123.011199. Epub 2024 Aug 9.
BACKGROUND
Increased hsCRP (high-sensitivity C-reactive protein), a marker of inflammation, is associated with incident cardiovascular events. We aim to determine whether the baseline or trajectory of hsCRP levels over time predicts incident heart failure (HF) hospitalization.
METHODS
JHS (Jackson Heart Study) participants' (n=3920 Black adults) hsCRP levels were measured over 3 visits (from 2000 to 2013). We assessed the association of hsCRP at baseline (visit 1) with incident HF hospitalization using Cox proportional hazards models. Furthermore, we assessed the association of the trajectory of hsCRP over repeated measurements (visits 1-3) with incident HF using joint models. Hazard ratios are reflective of an increase in hsCRP by 1 SD on a log2 scale. We also assessed the association of change in hsCRP between visit 1 and visit 3 with Cox proportional hazards models by grouping patients by low (<2 mg/L) and high (≥2 mg/L) hsCRP levels. The 4 groups were low-to-low (referent), low-to-high, high-to-low, and high-to-high.
RESULTS
Mean baseline age of participants was 54±13 years, and 63.8% were women. Over a median follow-up of 12 years, 308 (7.9%) participants were hospitalized with incident HF. Baseline hsCRP was not associated with incident HF (adjusted hazard ratio, 1.08 [95% CI, 0.96-1.22]). However, increasing hsCRP levels over repeated measures were associated with a higher risk of incident HF overall (adjusted hazard ratio, 1.22 [95% CI, 1.03-1.44]) and HF with preserved ejection fraction (adjusted hazard ratio, 1.30 [95% CI, 1.02-1.65]) but not HF with reduced ejection fraction (>0.05). Furthermore, changes in hsCRP from low-to-high and high-to-low levels were associated with incident HF (<0.05).
CONCLUSIONS
While baseline hsCRP was not associated with incident HF, an increasing trajectory of hsCRP over time was associated with increased risk for incident HF (particularly HF with preserved ejection fraction). Temporal change in hsCRP may be an important marker of risk for incident HF with preserved ejection fraction in Black adults.
背景
高敏 C 反应蛋白（hsCRP）升高是炎症的标志物，与心血管事件的发生有关。我们旨在确定 hsCRP 水平的基线或随时间变化的轨迹是否可以预测心力衰竭（HF）住院事件的发生。
方法
JHS（杰克逊心脏研究）参与者（n=3920 名黑人成年人）的 hsCRP 水平在 3 次就诊时（2000 年至 2013 年）进行了测量。我们使用 Cox 比例风险模型评估 hsCRP 基线（第 1 次就诊）与 HF 住院事件的相关性。此外，我们使用联合模型评估了 hsCRP 重复测量（就诊 1-3）轨迹与 HF 事件的相关性。风险比反映了 log2 标度上 hsCRP 增加 1 个标准差。我们还通过将患者按 hsCRP 低值（<2mg/L）和高值（≥2mg/L）分组，使用 Cox 比例风险模型评估了 hsCRP 从第 1 次就诊到第 3 次就诊之间的变化与 HF 事件的相关性。4 组分别为低值到低值（参照组）、低值到高值、高值到低值和高值到高值。
结果
参与者的平均基线年龄为 54±13 岁，63.8%为女性。在中位随访 12 年期间，有 308 名（7.9%）参与者因 HF 住院。hsCRP 基线水平与 HF 住院事件无关（调整后的危险比，1.08[95%CI，0.96-1.22]）。然而，重复测量中 hsCRP 水平的升高与 HF 住院事件的整体风险增加相关（调整后的危险比，1.22[95%CI，1.03-1.44]），与射血分数保留性 HF 相关（调整后的危险比，1.30[95%CI，1.02-1.65]），但与射血分数降低性 HF 无关（>0.05）。此外，hsCRP 从低值到高值和从高值到低值的变化与 HF 住院事件相关（<0.05）。
结论
虽然 hsCRP 基线水平与 HF 住院事件无关，但随时间推移 hsCRP 轨迹的升高与 HF 住院事件风险增加相关（尤其是射血分数保留性 HF）。hsCRP 的时间变化可能是黑人成年人射血分数保留性 HF 发生风险的一个重要标志物。
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