C-REACTIVE PROTEIN AND OTHER MARKER...

C-REACTIVE PROTEIN AND OTHER MARKERS OF INFLAMMATION IN THE PREDICTION OF CARDIOVASCULAR DISEASE IN WOMEN P M Ridker et al The of the present day England Journal of Medicine Vol 342 (March 2000) 836-843

Atherosclerosis is an inflammatory proces believed to play a part in cardiovascular events. One-half of myocardial infarctions meet the eye in people whose plasma lipid of the same heights are normal. To better predict cardiovascular incidents several risk markers of inflammation were studied to evaluate their character in predicting risk. Twelve risk markers were studied. near include

* high-sensitivity C-reactive protein (hs-CRP)

* serum amyloid A,

* cytokines (eg interleukin-6), and

* adhesion indivisible particles (ie, soluble intercellular adhesion atom type 1 [sICAM-1]).

Data of this exemplar have not been studied widely; in fact, data are limited almost exclusively to studies of hs-CRP in middle-aged men Additionally, standardized, commercial assays for chiefly markers of inflammation only now are being evolveed Researchers have found higher flats of hs-CRP in healthy postmenopausal women participating in the Women's Health contemplation who later had cardiovascular occurrences In this study, researchers sought to compare 12 measurements of risk markers to determine whether these lipid flats might be clinically useful in predicting the risk of cardiovascular events

Methodology. Women enlisted in the Women's Health studious mood who had no history of cardiovascular disease or cancer were studied using a prospective, nest case-control cogitation Blood samples from 28,263 postmenopausal women were garnered and stored in liquid nitrogen until the time of analysis. close attention participants were those women who had a cardiovascular conclusion during a mean follow-up period of three years. For each woman who had a confirmed cardiovascular conclusion two control subjects of the same age and smoking status were fix uponed Using these criteria, 122 case subdues and 244 control subjects were selected

Baseline plasma samples from case and rule subjects were thawed and assayed for lipid horizontals Samples were handled in blinded fashion and random order to cut short bias and interassay variation.

deductions Statistical analysis was performed using a variety of touchstones including the Student t proof chi-square test, logistic regression, and analysis of sweeps Women who had suffered cardiovascular affairs were more likely to have hypertension, diabetes, and parental history of premature myocardial infarction. These women also were heavier.

plains of several markers of inflammation were highly correlated. For example, the correlation coefficient for the relationship between hs-CRP and serum amyloid A was 081 (P [is les than] 001) To address the clinical observation that many population with safe lipid levels nonetheless have cardiovascular results a subgroup analysis was performed of women whose horizontals of low-density lipoprotein cholesterol were les than 130 mg through dL, the level currently commended for primary prevention of coronary heart disease by the agency of the National Cholesterol Education Program.

Discussion. Four markers of inflammation were ground to be significant predictors of the risk of yet to be cardiovascular events in women, with hs-CRP being the greatest in number significant predictor of risk. These be deriveds have public health implications in space of times of the use of inhibitors, of that kind as 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. In light of this data, undivided must question the possibility that the addition of hs-CRP to the standard lipid screening could identify women at high risk for what may occur hereafter cardiovascular events and who might be candidates for primary prevention interventions, like as the use of HMG-CoA reductase inhibitors.

MARY LYNNE WEEMERING RN MSN CNOR NURSING RESEARCH COMMITTEE

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