Ridker P M, Rifai N, Pfeffer M A, Sacks F M, Moye L A, Goldman S, Flaker G C, Braunwald E
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02115, USA.
Circulation. 1998 Sep 1;98(9):839-44. doi: 10.1161/01.cir.98.9.839.
We studied whether inflammation after myocardial infarction (MI) is a risk factor for recurrent coronary events and whether randomized treatment with pravastatin reduces that risk.
A nested case-control design was used to compare C-reactive protein (CRP) and serum amyloid A (SAA) levels in prerandomization blood samples from 391 participants in the Cholesterol and Recurrent Events (CARE) trial who subsequently developed recurrent nonfatal MI or a fatal coronary event (cases) and from an equal number of age- and sex-matched participants who remained free of these events during follow-up (control subjects). Overall, CRP and SAA were higher among cases than control subjects (for CRP P=0.05; for SAA P=0.006) such that those with levels in the highest quintile had a relative risk (RR) of recurrent events 75% higher than those with levels in the lowest quintile (for CRP RR= 1.77, P=0.02; for SAA RR= 1.74, P=0.02). The study group with the highest risk was that with consistent evidence of inflammation (elevation of both CRP and SAA) who were randomly assigned to placebo (RR=2.81, P=0.007); this risk estimate was greater than the product of the individual risks associated with inflammation or placebo assignment alone. In stratified analyses, the association between inflammation and risk was significant among those randomized to placebo (RR=2.11, P=0.048) but was attenuated and nonsignificant among those randomized to pravastatin (RR=1.29, P=0.5).
Evidence of inflammation after MI is associated with increased risk of recurrent coronary events. Therapy with pravastatin may decrease this risk, an observation consistent with a nonlipid effect of this agent.
我们研究了心肌梗死（MI）后的炎症是否为复发性冠状动脉事件的危险因素，以及普伐他汀随机治疗是否能降低该风险。
采用巢式病例对照设计，比较了胆固醇与复发性事件（CARE）试验中391名参与者随机分组前血样中的C反应蛋白（CRP）和血清淀粉样蛋白A（SAA）水平。这些参与者随后发生了复发性非致命性MI或致命性冠状动脉事件（病例组），并与相同数量的年龄和性别匹配的参与者进行比较，这些参与者在随访期间未发生这些事件（对照组）。总体而言，病例组的CRP和SAA水平高于对照组（CRP P = 0.05；SAA P = 0.006），因此处于最高五分位数水平的参与者复发性事件的相对风险（RR）比处于最低五分位数水平的参与者高75%（CRP的RR = 1.77，P = 0.02；SAA的RR = 1.74，P = 0.02）。风险最高的研究组是那些有持续炎症证据（CRP和SAA均升高）且被随机分配到安慰剂组的患者（RR = 2.81，P = 0.007）；该风险估计值大于单独与炎症或安慰剂分配相关的个体风险的乘积。在分层分析中，炎症与风险之间的关联在随机分配到安慰剂组的患者中具有显著性（RR = 2.11，P = 0.048），但在随机分配到普伐他汀组的患者中减弱且无显著性（RR = 1.29，P = 0.5）。
MI后炎症证据与复发性冠状动脉事件风险增加相关。普伐他汀治疗可能降低该风险，这一观察结果与该药物的非脂质效应一致。
