Hartley Adam, Rostamian Somayeh, Kaura Amit, Chrysostomou Paris, Welsh Paul, Ariti Cono, Sattar Naveed, Sever Peter, Khamis Ramzi
National Heart and Lung Institute, Imperial College London, UK.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
EBioMedicine. 2025 Jun 4;117:105786. doi: 10.1016/j.ebiom.2025.105786.
The prediction of future cardiovascular events in those with risk factors is important for the appropriate optimisation of preventative therapies for those at greatest risk. The value of high sensitivity C-reactive Protein (hsCRP) has been questioned in this regard. The objectives of this post-hoc analysis of a randomised controlled trial were to investigate the usefulness of baseline serum hsCRP for predicting very long-term cardiovascular events in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study.
The ASCOT Legacy Study reports events up to 20 years of follow-up of the UK participants in the Lipid Lowering Arm of the original ASCOT trial. We examined outcomes related to serum hsCRP levels measured using a commercial ELISA, in tertiles or continuously, adjusting for classical cardiovascular risk factors as well as treatment allocation within ASCOT. The primary outcome was non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD); whilst secondary outcomes were all-cause mortality, total coronary events and procedures, total cardiovascular events and stroke.
After excluding 3286 participants without hsCRP data, 5294 participants were included in the final cohort. The highest tertile of hsCRP was associated with the following outcomes compared to the lowest tertile: non-fatal myocardial infarction (MI) and fatal CHD (HR 1.32 [1.05-1.67]); total coronary events and procedures (HR 1.27 [1.09-1.47]); total cardiovascular events (HR 1.22 [1.08-1.37]); and all-cause mortality (HR 1.25 [1.10-1.42]). However, there was insufficient evidence regarding the association between hsCRP levels and stroke events. Addition of hsCRP in tertiles resulted in an improved net reclassification index for the prediction of non-fatal MI and fatal CHD at 20 years (9.68%, p < 0.0001).
Higher baseline serum hsCRP levels can independently predict cardiovascular events and all-cause mortality at long-term follow-up in stable patients with hypertension.
British Heart Foundation Clinical Research Fellowship (FS/17/16/32560), Wellcome Trust Clinical Research Fellowship (220572/Z/20/Z), and Sansour Fund at Imperial Healthcare Charity. The substudy of ASCOT Biomarker Programme was supported by Pfizer, New York, NY, USA. Infrastructure support was provided by the NIHR Imperial Biomedical Research Centre as well as the Imperial British Heart Foundation Research Excellence Award (4) (RE/24/130023).
对有风险因素者未来心血管事件进行预测，对于为风险最高者合理优化预防性治疗至关重要。在这方面，高敏C反应蛋白（hsCRP）的价值受到了质疑。这项对一项随机对照试验的事后分析的目的是，在盎格鲁-斯堪的纳维亚心脏结局试验（ASCOT）遗产研究中，调查基线血清hsCRP对预测高血压患者非常长期心血管事件的有用性。
ASCOT遗产研究报告了原ASCOT试验降脂组英国参与者长达20年的随访事件。我们研究了使用商业酶联免疫吸附测定法测量的血清hsCRP水平（按三分位数或连续变量）相关的结局，对经典心血管危险因素以及ASCOT内的治疗分配进行了调整。主要结局是非致命性心肌梗死（MI）和致命性冠心病（CHD）；次要结局是全因死亡率、总冠状动脉事件和手术、总心血管事件和中风。
在排除3286名无hsCRP数据的参与者后，最终队列纳入了5294名参与者。与最低三分位数相比，hsCRP最高三分位数与以下结局相关：非致命性心肌梗死（MI）和致命性CHD（风险比1.32 [1.05 - 1.67]）；总冠状动脉事件和手术（风险比1.27 [1.09 - 1.47]）；总心血管事件（风险比1.22 [1.08 - 1.37]）；以及全因死亡率（风险比1.25 [1.10 - 1.42]）。然而，关于hsCRP水平与中风事件之间的关联，证据不足。按三分位数加入hsCRP可改善20年时非致命性MI和致命性CHD预测的净重新分类指数（9.68%，p < 0.0001）。
在稳定的高血压患者长期随访中，较高的基线血清hsCRP水平可独立预测心血管事件和全因死亡率。
英国心脏基金会临床研究奖学金（FS/17/16/32560）、惠康信托临床研究奖学金（220572/Z/20/Z）以及帝国医疗保健慈善机构的桑索尔基金。ASCOT生物标志物项目的子研究由美国纽约辉瑞公司资助。基础设施支持由国家卫生研究院帝国生物医学研究中心以及帝国英国心脏基金会卓越研究奖（4）（RE/24/130023）提供。
