從JUPITER研究談當前hsCRP在心血管疾病初級預防的應用

Update on C-reactive Protein for the Primary Prevention of Cardiovascular Disease-The Impact of JUPITER Study

陳朝欽(Chao-Chin Chen) ； 雷孟桓(Meng-Huan Lei)

《內科學誌》 20卷5期 (2009/10) Pp. 385-395

https://doi.org/10.6314/JIMT.2009.20(5).01

摘要

動脈硬化是心血管疾病的主要原因，同時已被認定爲發炎性疾病。此顯示一些發炎標記（如C－反應蛋白）可作爲疾病進展與臨床事件的預估因子。許多前瞻性研究認爲高敏感度C－反應蛋白(hs-CRP)是健康人未來心血管疾病風險的獨立預測因子，雖然其因果關係尚未確立。此外在無冠心病的人hs-CRP也可增加佛萊明罕風險計分的預估能力，所以hs-CRP有助於心血管疾病初級預防的總體風險評估。同時一些statin研究發現hs-CRP和冠心病風險間的關連，產生以statin治療hs-CRP升高病人可改善預後的假說，即使LDL-C正常。在此推論架構下的JUPITER研究提供部分的答案，LDL正常而hsCRP升高的人，給予高效能statin確實能夠改善其預後。此具指標性的研究可能改變目前一般民眾初級預防的策略，然而statin所能及的治療範疇必須取決於其絕對治療效益與長期安全性的評估，並與成本效益分析取得平衡點。

關鍵字

動脈硬化 ； 心血管疾病 ； 高敏感度C-反應蛋白 ； JUPITER研究 ； 低密度脂蛋白膽固醇 ； 史塔丁

並列摘要

Atherosclerosis, the principal cause of cardiovascular disease, has been identified as an inflammatory disease. This suggests that some markers of inflammation (e.g., C-reactive protein) may serve as predictors of disease progression or clinical events. Several prospective studies have demonstrated that high-sensitivity C-reactive protein (hs-CRP) is an independent predictor of future risk for cardiovascular events among healthy individuals, although a causal relation has not yet been established. In addition, hs-CRP also adds prognostic information to the calculated Framingham Risk Score in individuals without overt coronary disease. Thus, hs-CRP is a potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Furthermore, a number of statin trials have linked CRP levels with coronary risk, leading to the hypothesis that treatment initiated on the basis of CRP elevations can improve patient outcomes, even when hypercholesterolemia is not present. The JUPITER trial provided partial answers for these questions by finding that a highly potent statin lowered the risk of cardiovascular events in patients with ”normal” LDL-C but elevated levels of hs-CRP. This land-mark study could potentially alter our current primary prevention in the general population, but requires critical analysis. The orbit of statin therapy depends on the balance between the benefits of treatment (absolute risk reductions) as well as its long-term safety and cost.

並列關鍵字

Atherosclerosis ； Cardiovascular disease ； High-sensitivity C-reactive protein ； JUPITER study ； Low density lipoprotein-cholesterol ； Statin