Combination of high-sensitivity C-reactive protein and homocysteine may predict an increased risk of coronary artery disease in Korean population

Background  The association of emerging biomarkers such as high-sensitivity C-reactive protein (hs-CRP), homocysteine and fibrinogen with the risk of coronary artery disease (CAD) is still uncertain in Asian population including Koreans and little is known about the combined effect of biomarkers on the risk of CAD.

Methods  A total of 10 650 subjects (6538 men and 4112 women) were enrolled in this study. A 10-year CAD risk was calculated using Framingham risk score modified by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and levels of circulating hs-CRP, homocysteine and fibrinogen were measured using validated assays.

Results  The 10-year CAD risk gradually augmented with increase in the circulating levels of hs-CRP, homocysteine and fibrinogen. For the highest quartile of hs-CRP, odds ratio (OR) of high-risk for CAD (10-year risk ≥20%) compared with the lowest quartile was 3.97 (95% CI: 2.51–6.29). For homocysteine and fibrinogen, ORs in the highest quartile compared to the lowest quartile were 5.10 (95% CI: 3.05–8.53, P <0.001) and 1.46 (95% CI: 0.69–3.11, P=0.325), respectively. OR of high-risk for CAD in both the highest quartile of hs-CRP and homocysteine was 9.05 (95% CI: 5.30–15.45) compared with the below median of hs-CRP and homocysteine.

Conclusions  The present study demonstrated that hs-CRP and homocysteine are well associated with the 10-year CAD risk estimated using NCEP ATP III in Koreans and combination of hs-CRP and homocysteine can have strong synergy in predicting the development of CAD.

     

Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women

Context  Current guidelines for cardiovascular risk detection are controversial with regard to the clinical utility of different lipid measures, non–high-density lipoprotein cholesterol (non–HDL-C), lipid ratios, apolipoproteins, and C-reactive protein (CRP). Objective  To directly compare the clinical utility of total cholesterol, low-density lipoprotein cholesterol (LDL-C), HDL-C, non–HDL-C, apolipoproteins A-I and B₁₀₀, high-sensitivity CRP, and the ratios of total cholesterol to HDL-C, LDL-C to HDL-C, apolipoprotein B₁₀₀ to apolipoprotein A-I, and apolipoprotein B₁₀₀ to HDL-C as predictors of future cardiovascular events in women. Design, Setting, and Participants  Prospective cohort study of 15 632 initially healthy US women aged 45 years or older (interquartile range, 48-59 years) who were enrolled between November 1992 and July 1995. All participants were followed up over a 10-year period for the occurrence of future cardiovascular events. Main Outcome Measure  Hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever major cardiovascular events (N = 464) according to baseline levels of each biomarker. Results  After adjustment for age, smoking status, blood pressure, diabetes, and body mass index, the HRs for future cardiovascular events for those in the extreme quintiles were 1.62 (95% CI, 1.17-2.25) for LDL-C, 1.75 (95% CI, 1.30-2.38) for apolipoprotein A-I, 2.08 (95% CI, 1.45-2.97) for total cholesterol, 2.32 (95% CI, 1.64-3.33) for HDL-C, 2.50 (95% CI, 1.68-3.72) for apolipoprotein B₁₀₀, 2.51 (95% CI, 1.69-3.72) for non–HDL-C, and 2.98 (95% CI, 1.90-4.67) for high-sensitivity CRP (P<.001 for trend across all quintiles). The HRs for the lipid ratios were 3.01 (95% CI, 2.01-4.50) for apolipoprotein B₁₀₀ to apolipoprotein A-I, 3.18 (95% CI, 2.12-4.75) for LDL-C to HDL-C, 3.56 (95% CI, 2.31-5.47) for apolipoprotein B₁₀₀ to HDL-C, and 3.81 (95% CI, 2.47-5.86) for the total cholesterol to HDL-C (P<.001 for trend across all quintiles). The correlation coefficients between high-sensitivity CRP and the lipid parameters ranged from –0.33 to 0.15, and the clinical cut points for CRP of less than 1, 1 to 3, and higher than 3 mg/L provided prognostic information on risk across increasing levels of each lipid measure and lipid ratio. Conclusions  Non–HDL-C and the ratio of total cholesterol to HDL-C were as good as or better than apolipoprotein fractions in the prediction of future cardiovascular events. After adjustment for age, blood pressure, smoking, diabetes, and obesity, high-sensitivity CRP added prognostic information beyond that conveyed by all lipid measures.      

Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial

CONTEXT: Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue. OBJECTIVE: To determine the effect of a program of changes in lifestyle designed to obtain a sustained reduction of body weight on markers of systemic vascular inflammation and insulin resistance. DESIGN AND SETTING: Randomized single-blind trial conducted from February 1999 to February 2002 at a university hospital in Italy. PATIENTS: One hundred twenty premenopausal obese women (body mass index > or =30) aged 20 to 46 years without diabetes, hypertension, or hyperlipidemia. INTERVENTIONS: The 60 women randomly assigned to the intervention group received detailed advice about how to achieve a reduction of weight of 10% or more through a low-energy Mediterranean-style diet and increased physical activity. The control group (n = 60) was given general information about healthy food choices and exercise. MAIN OUTCOME MEASURES: Lipid and glucose intake; blood pressure; homeostatic model assessment of insulin sensitivity; and circulating levels of interleukin 6 (IL-6), interleukin 18 (IL-18), C-reactive protein (CRP), and adiponectin. RESULTS: After 2 years, women in the intervention group consumed more foods rich in complex carbohydrates (9% corrected difference; P<.001), monounsaturated fat (2%; P =.009), and fiber (7 g/d; P<.001); had a lower ratio of omega-6 to omega-3 fatty acids (-5; P<.001); and had lower energy (-310 kcal/d; P<.001), saturated fat (-3.5%; P =.007), and cholesterol intake (-92 mg/d; P<.001) than controls. Body mass index decreased more in the intervention group than in controls (-4.2; P<.001), as did serum concentrations of IL-6 (-1.1 pg/mL; P =.009), IL-18 (-57 pg/mL; P =.02), and CRP (-1.6 mg/L; P =.008), while adiponectin levels increased significantly (2.2 microg/mL; P =.01). In multivariate analyses, changes in free fatty acids (P =.008), IL-6 (P =.02), and adiponectin (P =.007) levels were independently associated with changes in insulin sensitivity. CONCLUSION: In this study, a multidisciplinary program aimed to reduce body weight in obese women through lifestyle changes was associated with a reduction in markers of vascular inflammation and insulin resistance.     

C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus

CONTEXT: Inflammation is hypothesized to play a role in development of type 2 diabetes mellitus (DM); however, clinical data addressing this issue are limited. OBJECTIVE: To determine whether elevated levels of the inflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP) are associated with development of type 2 DM in healthy middle-aged women. DESIGN: Prospective, nested case-control study. SETTING: The Women's Health Study, an ongoing US primary prevention, randomized clinical trial initiated in 1992. PARTICIPANTS: From a nationwide cohort of 27 628 women free of diagnosed DM, cardiovascular disease, and cancer at baseline, 188 women who developed diagnosed DM over a 4-year follow-up period were defined as cases and matched by age and fasting status with 362 disease-free controls. MAIN OUTCOME MEASURES: Incidence of confirmed clinically diagnosed type 2 DM by baseline levels of IL-6 and CRP. RESULTS: Baseline levels of IL-6 (P<.001) and CRP (P<.001) were significantly higher among cases than among controls. The relative risks of future DM for women in the highest vs lowest quartile of these inflammatory markers were 7.5 for IL-6 (95% confidence interval [CI], 3.7-15.4) and 15.7 for CRP (95% CI, 6.5-37.9). Positive associations persisted after adjustment for body mass index, family history of diabetes, smoking, exercise, use of alcohol, and hormone replacement therapy; multivariate relative risks for the highest vs lowest quartiles were 2.3 for IL-6 (95% CI, 0.9-5.6; P for trend =.07) and 4.2 for CRP (95% CI, 1.5-12.0; P for trend =.001). Similar results were observed in analyses limited to women with a baseline hemoglobin A(1c) of 6.0% or less and after adjustment for fasting insulin level. CONCLUSIONS: Elevated levels of CRP and IL-6 predict the development of type 2 DM. These data support a possible role for inflammation in diabetogenesis.     

EFFECTS OF SIMVASTAIN COMBINED WITH OMEGA-3 FATTY ACIDS ON HIGH SENSITIVE C-REACTIVE PROTEIN,LIPIDEMIA,AND FIBRINOLYSIS IN PATIENTS WITH MIXED DYSLIPIDEMIA

Objective To evaluate the effects of simvastatin combined with omega-3 fatty acids on high sensitive C-reactive protein (HsCRP), lipidemia, and fibrinolysis in coronary heart disease (CHD) and CHD risk equivalent patients with mixed dyslipidemia.Methods A randomized, double-blind placebo controlled and parallel group trial was conducted. Patients with CHD and CHD risk equivalents with mixed dyslipidemia were treated with 10 or 20 mg simvastatin for 6-12 weeks. Following with the treatment of patients whose low-density lipoprotein cholesterol (LDL-ch) reaching goal level (＜ 100 mg/dL) or close to the goal (＜ 130 mg/dL), while triglyceride (TG) ≥ 200 mg/dL and ＜ 500 mg/dL, was combined with omega-3fatty acids (3 g/d) or a placebo for 2 months. The effects of the treatment on HsCRP, total cholesterol (TC), LDL-ch, highdensity lipoprotein cholesterol (HDL-ch), TG, lipoprotein (a) [LP (a)], apolipoprotein Al (apoAl), apolipoprotein B (apoB),plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (tPA) were investigated. Forty patients finished the study with each group consisting of twenty patients.Results (1) There were significant reductions of HsCRP, TG, TC, and TC/HDL-ch, which decreased by 2.16 ± 2.77mg/L (38.5%), 94.0± 65.4 mg/dL (31.1%), 13.3 ± 22.3 mg/dL (6.3%), 0.78 ± 1.60 respectively in the omega-3 fatty acids group (P ＜ 0.01, ＜ 0.001, ＜ 0.05, ＜ 0.05) compared to the baseline. HsCRP and triglyceride reduction were more significant in omega-3 fatty acids group compared to the placebo group (P= 0.021 and 0.011 respectively). (2) In the omega-3 fatty acids group, the values and percentage of TG reduction had a significantly positive relation with HsCRP reduction (r = 0.51and 0.45, P=0.021 and 0.047 respectively).Conclusion In CHD and CHD risk equivalent patients with mixed dyslipidemia, dyslipidemia's therapeutic effect using simvastatin and omega-3 fatty acids may result from not only the combination of lipid adjustment, but also enhancement of their own nonlipid influences.     

Low-density lipoprotein cholesterol and the risk of dementia with stroke.

CONTEXT: Next to Alzheimer disease, vascular dementia is the second most common form of dementia in the elderly, yet few specific risk factors have been identified. OBJECTIVE: To investigate the relationship of plasma lipids and lipoproteins to dementia with stroke. DESIGN AND SETTING: Prospective longitudinal community-based study over a 7-year period (1991-1998). PARTICIPANTS: A total of 1111 nondemented participants (mean [SD] age, 75.0 [5.9] years) were followed up for an average of 2.1 years (range, 1-7.8 years). MAIN OUTCOME MEASURE: Incident dementia with stroke according to standardized criteria, by baseline levels of total plasma cholesterol and triglycerides, low-density lipoprotein (LDL) cholesterol, LDL levels corrected for lipoprotein(a), high-density lipoprotein cholesterol, lipoprotein(a), and apolipoprotein E genotype. RESULTS: Two hundred eighty-six (25.7%) of the 1111 subjects developed dementia during follow-up; 61 (21.3%) were classified as having dementia with stroke and 225 (78.7%) as having probable Alzheimer disease. Levels of LDL cholesterol were significantly associated with an increased risk of dementia with stroke. Compared with the lowest quartile, the highest quartile of LDL cholesterol was associated with an approximately 3-fold increase in risk of dementia with stroke, adjusting for vascular risk factors and demographic variables (relative risk [RR], 3.1; 95% confidence interval [CI], 1.5-6.1). Levels of LDL corrected for lipoprotein(a) were an even stronger predictor of dementia with stroke in the adjusted multivariate analysis. Compared with the lowest quartile, the RR of dementia with stroke for the highest quartile of lipoprotein(a)-corrected LDL cholesterol was 4.1 (95% CI, 1.8-9.6) after adjusting for vascular factors and demographic variables. Lipid or lipoprotein levels were not associated with the development of Alzheimer disease in our cohort. CONCLUSIONS: Elevated levels of LDL cholesterol were associated with the risk of dementia with stroke in elderly patients. Further study is needed to determine whether treatment of elevated LDL cholesterol levels will reduce the risk of dementia with stroke.     

贵州省汉族、苗族及布依族人群载脂蛋白M基因多态性与血脂的相关性

目的:探讨载脂蛋白M(apo M)基因启动子区多态性在贵州省汉族、苗族及布依族人群之间的差异,并分析单核苷酸多态性对apo M水平及血脂水平的影响.方法:奥林巴斯AU5400全自动生化分析仪测定血清甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C),应用聚合酶链反应-限...     

老年高血压病患者血胰岛素水平与糖、脂代谢异常的关系

目的　探讨老年高血压病患者高胰岛素血症与血糖、血清脂质水平之间的关系。方法　对 78例老年高血压病患者(观察组 )及 60例老年对照组 ,进行了血清甘油三酯 (TG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL -C)、低密度脂蛋白胆固醇(LDL -C)、载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)、脂蛋白 (a) [Lpo (a) ]、空腹血糖 (FPG)及胰岛素 (INS)的测定。 结果　观察组血清TG、LDL -C、Lpo(a)、INS、FPG含量明显高于对照组 ;观察组血清HDL -C、ApoAI水平和胰岛素敏感性指数 (ISI)明显低于对照组。结论　老年高血压病患者胰岛素、血脂和血糖代谢异常的共存是该病发生、发展的危险因素 ,也是心、脑血管疾病的危险因素 ,故在降压治疗的同时 ,应考虑纠正其胰岛素、糖及脂代谢的异常。     

丹参对LDL受体及apoA－Ⅰ mRNA水平的影响

研究了丹参对高脂喂饲大鼠的血清脂质水平、肝低来度脂蛋白（ＬＤＬ）受体ｍＲＮＡ和载脂蛋白（ａｐｏ）Ａ－ＩｍＲＮＡ水平的影响，以及对培养的人成纤维细胞上述两种ｍＲＮＡ水平的影响。发现丹参能升高鼠肝及人成纤维细胞ＬＤＬ受体ｍＲＮＡ水平，但降血清总胆固醇及ＬＤＬ胆固醇作用不明显。提示ＬＤＬ受体可能存在翻译或翻译后水平的调节。丹参对鼠肝及人成纤维细胞ａｐｏＡ－１ｍＲＮＡ水平未见有影响。     

评估肥胖相关指标对非酒精性脂肪肝的筛查价值

  目的  探讨筛查中老年人非酒精性脂肪肝(NAFLD)的最佳肥胖相关指标。  方法  本项横断面研究筛选了2019年1—3月在陕西省人民医院健康管理中心参加体检的40岁及以上受试者1 281人,进行病史采集、体格检查及实验室检查,所有受试者均接受腹部B超检查。应用logistic回归分析研究各肥胖指标与NAFLD患病风险的相关性,采用ROC曲线评估肥胖指标对NAFLD患病风险的筛查价值。  结果  在1 281例受试者中,335例诊断为NAFLD,NAFLD的患病率为26.15%。NAFLD组的血压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、转氨酶、空腹血糖、空腹胰岛素、稳态模型估计的胰岛素抵抗指数、糖化血红蛋白、腰围、腰臀比、BMI、脂质蓄积指数(LAP)均明显升高,高密度脂蛋白胆固醇降低。Logistic回归分析显示,在校正了相关混杂因素后,腰围、腰臀比、BMI、LAP均与NAFLD的患病风险相关。其中LAP与NAFLD的相关性最强,与处于LAP第一分位的受试者相比,处于LAP第四分位的受试者NAFLD的患病风险显著增加(OR=18.055,95% CI: 7.683~42.427,P < 0.001)。4个肥胖相关指标的AUC均>0.7,表明4个肥胖相关指标均对NAFLD有较高的筛查价值。不论男性还是女性,LAP对NAFLD的筛查价值均最高,男性AUC为85.34(95% CI: 81.78~88.90),女性AUC为80.22(95% CI: 76.95~83.48)。  结论  LAP与NAFLD的患病风险密切相关,可能是筛查中老年人NAFLD的有效工具。      

Serum lipoproteins and apolipoproteins in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction

Serum total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and apolipoprotein B were evaluated as potential indicators of the risk of coronary artery disease in young (less than 46 years) normocholesterolaemic, non-diabetic men who had previously sustained a myocardial infarction (n = 50) and in healthy age and sex matched controls (n = 122) with a similar socioeconomic background. Significant differences were observed between patients and controls in the mean concentrations of serum total cholesterol, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and apolipoprotein B, as well as in the ratios of total cholesterol to high density lipoprotein cholesterol and apolipoprotein A-I to apolipoprotein B. No significant difference was demonstrated in the concentration of apolipoprotein A-I between the two groups. Stepwise discriminant analysis indicated that apolipoprotein B was the best discriminant between patients and controls. The percentage of exact classification was 74% in patients and 66% in controls. When the patients were compared to a subset of controls (n = 50) matched for age and total cholesterol, significant differences were demonstrated only in the mean concentrations of apolipoprotein B. Discriminant analysis confirmed that the best single discriminating variable was apolipoprotein B. The results therefore indicate that in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction, apolipoprotein B is superior to other lipid parameters studied, as a marker for coronary artery disease.     

中国汉族青年低脂高糖膳食6天后的血清高密度脂蛋白、胆固醇水平

目的探讨低脂高糖膳食对中国汉族青年血脂及载脂蛋白的影响。方法我室招募健康在校大学生自愿者56名[(22.89±1.80)岁],于7d平衡膳食后给予低脂高糖膳食6d,分别在第1d、8d、14d清晨收集受试者人类学指标并抽取空腹静脉血,测定血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血糖(GLU)、胰岛素(Insulin)、载脂蛋白A-Ⅰ(ApoA-Ⅰ)、载脂蛋白B-100(ApoB-100)浓度。结果经过6d低脂高糖膳食以后,健康男性青年血清HDL-C升高,而体质量(Weight)、体重指数(BMI)、TC及LDL-C降低;健康女性青年血清TG、胰岛素升高而TC及LDL-C降低。根据BMI分别将男女受试者分为高、中、低BMI3组分析发现,尽管某些变化不具有显著性,高、中、低BMI3组都出现TC及LDL-C降低;男性低BMI和高BMI组出现血清HDT-C及ApoA-Ⅰ显著升高,其它各组膳食前后变化差异无统计学意义。血清TG升高只在女性低BMI和中BMI组中出现。结论不同性别、BMI的健康青年低脂高糖膳食后的血脂及载脂蛋白改变不相同,但均没有发现HDL-C显著降低。     

Lipids, Lipoproteins and Apolipoproteins Abnormalities inPatients undergoing Dialysis

Patientswithchronicrenalfailureoftenhavehypertriglyceridemiaanddecreasedhigh-densitylipoproteincholesterol(HDL-C)concentrations[l'2].Whilecardiovasculardiseaseisamajorcauseofhighmorbidityandmortalityamongthesepatients['].Somestudiessuggestedthatabnormallipoproteinmetabolismwasoneofthecauses.InChina,fewreportswereavailableonlipids,lipoproteins,especiallyapolipoproteinsmetabolisminpatientsundergoingdialysis.Thepurposeofthisstudyistoobservethelipids,lipoproteinsandapolipoproteins(Apo)levelsinp…     

Low-density lipoprotein size, pravastatin treatment, and coronary events

CONTEXT: Small low-density lipoprotein (LDL) particle size has been hypothesized to be a risk factor for coronary heart disease (CHD). Animal models link large LDL to atherosclerosis. However, the strong association between small LDL and other risk factors, particularly triglyceride levels, impedes determining whether LDL size independently predicts CHD in humans. OBJECTIVE: To examine whether LDL size is an independent predictor of recurrent coronary events in patients with known CHD, as opposed to a marker for other lipid abnormalities. DESIGN AND SETTING: Prospective, nested case-control study in the Cholesterol and Recurrent Events (CARE) trial, a randomized placebo-controlled trial of pravastatin conducted in 1989-1996. PARTICIPANTS: Survivors of myocardial infarction with typical LDL concentrations (416 cases and 421 controls). MAIN OUTCOME MEASURE: Subsequent myocardial infarction or coronary death during the 5-year follow-up, analyzed by quintile of LDL particle size and by treatment group. RESULTS: Overall, the mean LDL size was identical in cases and controls (25.6 nm). In patients in the placebo group, large LDL predicted coronary events in models adjusted only for age (relative risk [RR], 1.79; 95% confidence interval [CI], 1.01-3.17) and for age and lipid and nonlipid risk factors (RR, 4.00; 95% CI, 1.81-8.82), comparing those in the highest (mean, 26.6 nm) and lowest (mean, 24.5 nm) quintiles of LDL size. This increased risk was not present in those taking pravastatin (age-adjusted analysis: RR, 0.98; 95% CI, 0.47-2.04; P =.046 for interaction for a difference in the effect of LDL size on coronary events between the placebo and treatment groups; multivariable analysis: RR, 1.33; 95% CI, 0.52-3.38; P =.11 for interaction). CONCLUSIONS: Large LDL size was an independent predictor of coronary events in a typical population with myocardial infarction, but the adverse effect was not present among patients who were treated with pravastatin. Identifying patients on the basis of LDL size may not be useful clinically, since effective treatment for elevated LDL cholesterol concentrations also effectively treats risk associated with large LDL.     

C反应蛋白水平与代谢综合征及其组分患病风险的研究

目的探讨C反应蛋白（CRP）水平的变化与代谢综合征（MS）及其相关组分的患病风险。方法取自1998～2001年上海华阳、曹杨社区代谢综合征及其相关疾病的流行病学基线调查资料,5502例（男2379例,女3123例）20岁以上人群,具有完整的体脂参数、血压、血脂、胰岛素及CRP的资料者纳入本次分析。代谢综合征及其相关组分的诊断标准采用1999年WHO代谢综合征的工作定义。超敏C反应蛋白测定采用速率散射比浊法。结果（1）该社区人群中代谢综合征及其各组分的患病率分别为高血糖21．63％（糖尿病9．21％,糖调节异常12．41％）,高血压32．95％,高甘油三酯（TG）／低高密度脂蛋白胆固醇（HDL—C）血症46．04％,中心性肥胖40．68％,代谢综合征13．98％。（2）CRP水平均随年龄增加而升高（趋势分析P〈0．01）。（3）1—2项代谢异常亚组及MS亚组的CRP水平显著增高于无代谢异常亚组（P〈0．01）,MS亚组的CRP水平显著高于1～2项代谢异常亚组明显增加（P〈0．01）。代谢综合征的发生随CRP水平的升高而递增（趋势分析P〈0．001）。（4）把男、女人群的CRP值分或4分位数,以ms各组分及ms为应变量,CRP各分布位点为自变量进行Logistic回归分析。与CRP处于下114位点人群比较,CRP位于上114位点者各代谢异常风险增加的幅度为：男性高血糖3．8倍、高血压2．8倍、高TG 1．3倍、低HDL—C 1．5倍、中心性肥胖5．5倍及MS10．0倍,女性高血糖7．7倍、高血压6．1倍、高TG 3．6倍、低HDL—C1．1倍、中心性肥胖2．2倍及MS8．6倍。结论（1）CRP水平与增龄有关,年龄越大,CRP水平越高;（2）同一个体所聚集的代谢异常的数目越多,CRP水平越高;（3）代谢综合征的发生频率随CRP水平升高而递增;男性CRP水平大于2．11mg/L及女性CRP水平大于2．22mg/L者,出现高血糖、血脂紊乱、高血压、中心性肥胖及代谢综合征的风险显著增加。     

Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults.

CONTEXT: Dietary composition may affect insulin secretion, and high insulin levels, in turn, may increase the risk for cardiovascular disease (CVD). OBJECTIVE: To examine the role of fiber consumption and its association with insulin levels, weight gain, and other CVD risk factors compared with other major dietary components. DESIGN AND SETTING: The Coronary Artery Risk Development in Young Adults (CARDIA) Study, a multicenter population-based cohort study of the change in CVD risk factors over 10 years (1985-1986 to 1995-1996) in Birmingham, Ala; Chicago, III; Minneapolis, Minn; and Oakland, Calif. PARTICIPANTS: A total of 2909 healthy black and white adults, 18 to 30 years of age at enrollment. MAIN OUTCOME MEASURES: Body weight, insulin levels, and other CVD risk factors at year 10, adjusted for baseline values. RESULTS: After adjustment for potential confounding factors, dietary fiber showed linear associations from lowest to highest quintiles of intake with the following: body weight (whites: 174.8-166.7 lb [78.3-75.0 kg], P<.001; blacks: 185.6-177.6 lb [83.5-79.9 kg], P = .001), waist-to-hip ratio (whites: 0.813-0.801, P = .004; blacks: 0.809-0.799, P = .05), fasting insulin adjusted for body mass index (whites: 77.8-72.2 pmol/L [11.2-10.4 microU/mL], P = .007; blacks: 92.4-82.6 pmol/L [13.3-11.9 microU/mL], P = .01) and 2-hour postglucose insulin adjusted for body mass index (whites: 261.1-234.7 pmol/L [37.6-33.8 microU/mL], P = .03; blacks: 370.2-259.7 pmol/L [53.3-37.4 microU/mL], P<.001). Fiber was also associated with blood pressure and levels of triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fibrinogen; these associations were substantially attenuated by adjustment for fasting insulin level. In comparison with fiber, intake of fat, carbohydrate, and protein had inconsistent or weak associations with all CVD risk factors. CONCLUSIONS: Fiber consumption predicted insulin levels, weight gain, and other CVD risk factors more strongly than did total or saturated fat consumption. High-fiber diets may protect against obesity and CVD by lowering insulin levels.     

肥胖儿童血浆胆固醇酯转运蛋白与血脂相关性

目的探讨单纯性肥胖儿童血浆胆固醇酯转运蛋白（CETP）与血脂的相关性及其与动脉粥样硬化(AS)的关系。方法用本室建立的酶联免疫测定法（ELISA）检测49例单纯性肥胖儿童血浆CETP水平。结果肥胖儿童与健康儿童相比,其血浆胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B（apoB）的浓度均显著升高（P<0.05）,存在较明显的脂质代谢紊乱;高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A1（apoA1）水平与健康儿童差异不显著（P>0.05）;CETP水平显著高于正常儿童（P<0.05）,且与LDL-C、apoB、TC/HDL-C、LDL-C/HDL-C、apoB/apoA1显著相关,而与HDL-C、apoA1则不相关。结论肥胖儿童存在脂蛋白代谢紊乱,且可能与其CETP水平增高有密切关系;过量脂肪摄入和缺乏体育锻炼也是其CETP水平增高的重要因素。     

无创性肢体远隔缺血后处理对脑卒中患者血清指标影响的临床研究

目的 探讨远隔缺血后适应（RIPostC）对缺血性脑卒中（CVA）患者血清指标的影响,并探讨其 临床意义。方法 选择就诊于该院的缺血性CVA 患者200 例,将其随机分为实验组和对照组,每组各100 例。 实验组采用远隔缺血后适应疗法12 个月,对照组不进行特殊处理。实验前后分别采集两组静脉血,对其血清 同型半胱氨酸（Hcy）、血脂水平[ 高密度脂蛋白（HDL）和总胆固醇（TC）]、血小板聚集率（PAR）及缺 血修饰白蛋白（IMA）水平进行检测。结果 治疗前两组血清生化指标水平比较无差异（P >0.05）,均表现为 血清Hcy、TC、PAR 及IMA 水平较正常值升高,HDL 较正常值下降。治疗后两组血清Hcy、TC、PAR 及 IMA 水平比较,差异有统计学意义（P <0.05）,且较治疗前下降,HDL 较治疗前升高,治疗前后比较,差异有 统计学意义（P <0.05）,且实验组较对照组改善程度,差异有统计学意义（P <0.05）。结论 远隔缺血后适应 疗法能有效降低缺血性CVA 患者病情的危险程度,对其预后有较好的促进作用。     

高脂血症患者C—反应蛋白含量的变化及氟伐他汀对它的影响

OBJECTIVE: To observe the changes of C-reactive protein (CRP) level and its relationship with blood lipids, and the effects of fluvastatin on CRP and the lipids in patients with hyperlipidemia. METHODS: Serum levels of cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C) and lipoprotein(a)[Lp(a)] were measured by enzyme assay, and plasma CRP level by immunonephelometry before and after fluvastatin treatment (20 mg/d for 4 weeks) in patients with hyperlipidemia. RESULTS: CRP levels were above normal in 90.3% hyperlipidemia cases in spite of the various accompanying diseases. Fluvastatin treatment significantly reduced TC (-7.49%), TG (-14.32%), LDL (-13.88%), VLDL (-18.48%) and TC/HDL(-13.50%) levels (P<0.01), and also brought down Lp(a) concentration (-13.81%). CRP levels was very effectively reduced after the treatment (-15.92%, P<0.001). No association between basal CRP levels and basal lipids and Lp(a) concentrations was observed. Positive correlation of CRP, however, was observed after fluvastatin treatment with TC/HDL (r=0.62, P=0.041) and Lp(a) (r=0.320, P=0.011), while inverse relations were noted between CRP and HDL (r=-0.288, P=0.023). CONCLUSION: CRP levels increases markedly in patients with hyperlipidemia, a fact that is independent of the accompanying diseases. In addition to modulating blood lipid levels, fluvastatin also reduces CRP level, the latter possibly serving as an independent predictive factor for atherosclerotic cardiovascular diseases and also as an indicator for estimating the effectiveness of the treatment.     

Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE): a randomized trial and cohort study.

CONTEXT: Plasma levels of the inflammatory biomarker C-reactive protein (CRP) predict cardiovascular risk, and retrospective studies suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may lower CRP in a manner largely independent of low-density lipoprotein cholesterol (LDL-C). However, prospective trial data directly evaluating this anti-inflammatory effect of statins are not available. OBJECTIVE: To test the hypothesis that pravastatin has anti-inflammatory effects as evidenced by CRP reduction. DESIGN, SETTING, AND PARTICIPANTS: Community-based, prospective, randomized, double-blind trial including 1702 men and women with no prior history of cardiovascular disease (primary prevention cohort) and open-label study including 1182 patients with known cardiovascular disease (secondary prevention cohort) who provided at least baseline and 12-week blood samples. The study was conducted in US office-based practices from February to December 2000. INTERVENTIONS: Participants in the double-blind primary prevention trial were randomly assigned to receive 40 mg/d of pravastatin (n = 865) or placebo (n = 837) for 24 weeks. Participants in the secondary prevention cohort received 40 mg/d of open-label pravastatin for 24 weeks. MAIN OUTCOME MEASURE: Change in CRP levels from baseline to 24 weeks. RESULTS: In the primary prevention trial, compared with placebo, pravastatin reduced median CRP levels by 16.9% (P<.001) at 24 weeks, reflecting a decrease of 0.02 mg/dL in the pravastatin group while no change in CRP levels was observed in the placebo group. This effect was seen as early as 12 weeks (median reduction in CRP with pravastatin, 14.7%; P<.001) and was present among all prespecified subgroups according to sex, age, smoking status, body mass index, baseline lipid levels, presence of diabetes, and use of aspirin or hormone replacement therapy. No significant association was observed between baseline CRP and baseline LDL-C levels, end-of-study CRP and end-of-study LDL-C levels, or change in CRP and change in LDL-C levels over time. In linear regression analyses, the only significant predictors of change in CRP on a log scale were randomized pravastatin allocation and baseline CRP levels (P<.001 for both). Similar reductions in CRP levels were observed at 12 weeks (-14.3%) and 24 weeks (-13.1%) in the secondary prevention cohort treated with pravastatin (P<.005 for both). CONCLUSIONS: In this prospective trial, pravastatin reduced CRP levels at both 12 and 24 weeks in a largely LDL-C-independent manner. These data provide evidence that statins may have anti-inflammatory effects in addition to lipid-lowering effects.