炎症和CHD的流行病学：hs-CRP的证据PPT课件.ppt

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1、EpidemiologyofInflammatoryMarkersandCHD:EvidenceforHigh-SensitivityC-ReactiveProteinPaulM.Ridker,MD,MPHBeyondCholesterol:PredictingCardiovascularRiskInthe21stCenturyCardiovascularRiskLipidsHTNDiabetesBehavioralHemostaticThromboticInflammatoryGeneticTotalCholesterolDistribution:CHDvsNon-CHDP

2、opulationCastelliWP.Atherosclerosis.1996;124(suppl):S1-S9.1996ReprintedwithpermissionfromElsevierScience.35%ofCHDOccursinPeoplewithTC<200mg/dL150200TotalCholesterol(mg/dL)250300NoCHDCHDFraminghamHeartStudy—26-YearFollow-upInflammationandAtherosclerosisInflammationmaydetermineplaquestability-Un

3、stableplaqueshaveincreasedleukocyticinfiltrates-Tcells,macrophagespredominaterupturesites-CytokinesandmetalloproteinasesinfluencebothstabilityanddegradationofthefibrouscapLipidloweringmayreduceplaqueinflammation-Decreasedmacrophagenumber-Decreasedexpressionofcollagenolyticenzymes(MMP-1)-Increa

4、sedinterstitialcollagen-DecreasedexpressionofE-selectin-ReducedcalciumdepositionLibbyP.Circulation1995;91:2844-2850.RossR.NEnglJMed1999;340:115-126.Isthereclinicalevidencethatinflammatorymarkerspredictfuturecoronaryeventsandprovideadditionalpredictiveinformationbeyondtraditionalriskfactors?hs-

5、CRPandRiskofFutureMIinApparentlyHealthyMenRidkerPMetal.NEnglJMed1997;336:973-979.1<0.055RelativeRiskofMIP=0.03Quartileofhs-CRP(range,mg/dL)20.056–0.11430.115–0.2104>0.211P<0.001P<0.001PTrend<0.001hs-CRPandRiskofFutureMI:AnalysisStratifiedbySmokingStatusRidkerPMetal.NEnglJMed1997;336:973-979.1Re

6、lativeRiskofFutureMIQuartileofCRP234AllPatientsNonsmokershs-CRPandRiskofFutureMI:AnalysisStratifiedbyYearofFollow-upRidkerPMetal.NEnglJMed1997;336:973-979.1997MassachusettsMedicalSociety.Allrightsreserved.0–2RelativeRisk(perQuartile)YearsofStudyFollow-up2–44–66+hs-CRPandRiskofFutureStrokeinAp

7、parentlyHealthyMenRidkerPMetal.NEnglJMed1997;336:973-979.1<0.055RelativeRiskofIschemicStrokeQuartileofhs-CRP(range,mg/dL)20.056–0.11430.115–0.2104>0.211P=0.02P=0.02PTrend<0.03hs-CRPandRiskofDevelopingPVDinApparentlyHealthyMenRidke