The relationship of baseline high-sensitivity C-reactive protein with incident cardiovascular events and all-cause mortality over 20 years.

IF 9.7 1区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

EBioMedicine Pub Date : 2025-06-04 DOI:10.1016/j.ebiom.2025.105786

Adam Hartley, Somayeh Rostamian, Amit Kaura, Paris Chrysostomou, Paul Welsh, Cono Ariti, Naveed Sattar, Peter Sever, Ramzi Khamis

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Findings: 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).

Interpretation: Higher baseline serum hsCRP levels can independently predict cardiovascular events and all-cause mortality at long-term follow-up in stable patients with hypertension.

Funding: 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).

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基线高敏c反应蛋白与20年心血管事件和全因死亡率的关系

背景：预测那些有危险因素的人未来的心血管事件对于那些风险最大的人适当优化预防治疗是重要的。在这方面，高灵敏度c反应蛋白（hsCRP）的价值一直受到质疑。这项随机对照试验的事后分析的目的是调查基线血清hsCRP在盎格鲁-斯堪的纳维亚心脏结局试验（ASCOT）遗留研究中预测高血压患者非常长期心血管事件的有效性。方法：ASCOT遗留研究报告了英国参与者在最初ASCOT试验降脂组长达20年的随访事件。我们检查了使用商用ELISA测量的血清hsCRP水平的相关结果，在三分位数或连续测量，调整了经典心血管危险因素以及ASCOT内的治疗分配。主要结局为非致死性心肌梗死（MI）和致死性冠心病（CHD）；次要结局是全因死亡率、总冠状动脉事件和手术、总心血管事件和卒中。结果：在排除3286名没有hsCRP数据的参与者后，5294名参与者被纳入最终队列。与最低分位数相比，hsCRP的最高分位数与以下结果相关：非致死性心肌梗死（MI）和致死性冠心病（HR 1.32 [1.05-1.67]）；总冠状动脉事件和手术（HR 1.27 [1.09-1.47]）；总心血管事件（HR 1.22 [1.08-1.37]）；全因死亡率（HR 1.25[1.10-1.42]）。然而，没有足够的证据表明hsCRP水平与卒中事件之间存在关联。在试验组中加入hsCRP可提高预测20年非致死性心肌梗死和致死性冠心病的净重分类指数（9.68%,p < 0.0001）。结论：在稳定型高血压患者的长期随访中，较高的基线血清hsCRP水平可以独立预测心血管事件和全因死亡率。资助：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Sansour基金。ASCOT生物标志物项目的子研究得到了美国纽约辉瑞公司的支持。基础设施支持由NIHR帝国生物医学研究中心和帝国英国心脏基金会卓越研究奖(4)（RE/24/130023）提供。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

EBioMedicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology

CiteScore

17.70

自引率

0.90%

发文量

579

审稿时长

5 weeks

期刊介绍： eBioMedicine is a comprehensive biomedical research journal that covers a wide range of studies that are relevant to human health. Our focus is on original research that explores the fundamental factors influencing human health and disease, including the discovery of new therapeutic targets and treatments, the identification of biomarkers and diagnostic tools, and the investigation and modification of disease pathways and mechanisms. We welcome studies from any biomedical discipline that contribute to our understanding of disease and aim to improve human health.