C反応性タンパク質,冠動脈カルシウム,心血管疾患との関連:人口ベースのコホート研究MESAによるJUPITER集団への影響
Michael J Blaha1, Matthew J Budoff, Andrew P DeFilippis
1Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD 21287, USA. mblaha1@jhmi.edu
Lancet (London, England)
|August 23, 2011
まとめ
冠動脈カルシウム (CAC) スコアは,スタチン療法を受ける資格のある患者の心血管リスクを効果的に分層化します. CACは,治療から最も恩恵を受ける可能性が高い個人を特定し,リソースの割り当てを最適化します.
科学分野:
- 心臓病学 心臓病学
- 予防医学は,予防的な医療です.
- メディカルイマージング (医学イメージング)
背景:
- JUPITER試験では,LDLコレステロールが低いが,高感度C反応性タンパク質 (hsCRP) が上昇した選択された患者にスタチンの利点を示した.
- しかし,JUPITERの絶対的な心血管疾患の発生率は低いため,よりよいリスク分層化を必要とした.
- この研究では,冠動脈カルシウム (CAC) が同様の集団におけるリスク層分化について調査されました.
研究 の 目的:
- 冠動脈カルシウム (CAC) スコアが,JUPITER試験の基準を満たす個体において,心血管リスクをさらに分層化できるかどうかを判断する.
- CACとhsCRPのリスク予測能力を比較する.
- スタチン療法から最も恩恵を受ける患者のサブグループを特定する.
主な方法:
- JUPITERの入学基準を満たした多民族性動脈硬化症研究 (MESA) の950人の参加者を利用しました.
- リスクは,CACスコア (0,1-100,>100) に基づいて階層化されました.
- 冠動脈疾患 (CHD) と心血管疾患 (CVD) の発生率を比較し,治療に必要な5年数 (NNT) を計算した.
主要な成果:
- 参加者の47%がCACスコア0で,低発症率 (0.8/1000人年) を有していた.
- 全冠動脈イベントの74%は,CACスコア100以上 (20.2/1000人年) の参加者の25%で発生しました.
- CACの存在は,CHD (4.29) とCVD (2.57) の有意な危険比を示した; hsCRPは調整後のイベントと関連していなかった.
結論:
- 冠動脈カルシウム (CAC) は,スタチン療法を受ける資格のある患者の心血管リスクを効果的に分層化します.
- CACは,スタチンから最大または最小の絶対的な利益を得ると予想されるサブグループを特定することができます.
- 測定可能な動脈硬化症 (CAC) に基づく治療をターゲットにすることで,より適切なリソースの割り当てが可能になります.
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