C-反应蛋白,冠状动脉和心血管事件之间的关联:MESA对JUPITER人口的影响,这是一个基于人口的队列研究
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
概括
冠状动脉 (CAC) 评分有效地分层心血管风险在符合标准治疗的患者. CAC识别了最有可能从治疗中受益的个体,优化了资源配置.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 医疗成像医学成像
背景情况:
- 朱皮特试验表明,在一些患有低LDL胆固醇但高灵敏性C反应蛋白 (hsCRP) 升高的患者中,他类药物具有益处.
- 然而,JUPITER的绝对心血管事件率很低,需要更好的风险分层.
- 这项研究研究了冠状动脉 (CAC) 对类似人群的风险分层的研究.
研究的目的:
- 为了确定冠状动脉 (CAC) 评分是否可以进一步分层心血管风险在满足JUPITER试验标准的个体.
- 为了比较CAC与hsCRP的风险预测能力.
- 为了确定患者子组谁最能从他类药物治疗中受益.
主要方法:
- 利用了来自动脉样硬化多民族研究 (MESA) 的950名参与者,他们符合JUPITER入学标准.
- 风险根据CAC分数 (0,1-100,>100) 进行了分层.
- 与冠状动脉疾病 (CHD) 和心血管疾病 (CVD) 发病率进行比较,并计算出5年内需要治疗的数量 (NNT).
主要成果:
- 47%的参与者CAC得分为0,心脏病发病率低 (0.8/1000人年).
- 74%的冠状动脉事件发生在25%的参与者中,CAC分数>100 (20.2/1000人年).
- CAC存在显示了CHD (4.29) 和CVD (2.57) 的显著危险比率;在调整后hsCRP与事件无关.
结论:
- 冠状动脉 (CAC) 有效地分层心血管风险在符合标准治疗的患者.
- CAC可以确定预计从他类药物中获得最大或最小的绝对益处的子组.
- 基于可测量的动脉样硬化 (CAC) 的向治疗允许更适当的资源配置.
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