Sağlıklı Bir Popülasyonda 10 Yıllık Kardiyovasküler Risk, Serum Lipid İndeksleri veYüksek Duyarlı CRP

Amaç: Aterosklerotik kardiyovasküler hastalık (ASKH) açısından yüksek risk altındaki bireylerin belirlenmesi oldukça önemlidir ve bu amaçla birçok risk hesaplama aracı ve parametresi kullanılmaktadır. Bu çalışmada, sağlıklı bir popülasyonda ACC/AHA tarafından geliştirilen kardiyovasküler risk hesaplama aracı ile serum lipid indeksleri ve yüksek duyarlıklı C-reaktif protein (hs-CRP) arasındaki ilişkiyi araştırmayı amaçladık. Yöntemler: Çalışmamız, hastane veri tabanı kullanılarak, 40-79 yaş arası ve yeterli veriye sahip bireyler üzerinde geriye dönük olarak yapıldı. Herhangi bir kronik hastalığı ve aktif enfeksiyonu olan hastalar çalışma dışı bırakıldı. Bireyler, düşük (<%5) ve sınırda-yüksek (>%5) tahmini 10 yıllık ASKH riski olarak gruplandırılarak analiz edildi. Bulgular: Çalışmaya ortanca yaşı 46 ve %37,5'i kadın olan 184 kişi dahil edildi. Çalışma popülasyonunda ortanca 10 yıllık tahmini ASKH riski %3'tü (1.3/5.98). Düşük risk grubu, sınırda-yüksek risk grubuna kıyasla önemli ölçüde daha düşük aterojenik plazma indeksi (AIP), Castelli I risk indeksi (CR-I) ve Castelli II risk indeksine (CR-II) sahipti (tümü için p <0,001). Ancak CRP gruplar arasında farklı değildi (p: 0.683). 10 yıllık ASKH riski, AIP (R:0.380; p<0.001), CR-I (R:0.467; p<0.001) ve CR-II (R:0.482; p<0.001) ile istatistiksel olarak anlamlı şekilde korele idi, ancak hs-CRP ile korelasyon saptanmadı (R:0.065; p:0.381). Sonuç: ACC/AHA'nın risk hesaplama aracı ile hs-CRP arasında korelasyon olmaması, hs-CRP'nin bu bireylerde yüksek risk göstergesi olarak kullanılamayacağını veya bu aracın bazı yüksek riskli hastaları tespit etmede yetersiz olduğunu düşündürmektedir.

Anahtar Kelimeler:

C-Reaktif Protein, Kardiyovasküler Risk Skoru, Dislipidemiler

10-Year Cardiovascular Risk, Serum Lipid Indices and High Sensitivity CRP in a Healthy Population

Objective: It is very important to identify individuals at high risk of atherosclerotic cardiovascular diseases (ASCVD) and for this purpose, many risk calculation tools and parameters are used. In this study, we aimed to investigate the correlation between the ACC/AHA cardiovascular risk and serum lipid indices and high sensitivity C-reactive protein (hs-CRP) in a healthy population. Methods: Our study was conducted retrospectively on individuals aged between 40 and 79 years and with sufficient data, using the hospital database. Patients with a history of any chronic disease and active infection were excluded. Individuals were analyzed by grouping them into low (<5%) and borderline to high (>5%) estimated 10-year risk of ASCVD. Results: 184 individuals with a median age of 46 and 37.5% women were included in the study. The median 10-year estimated risk of ASCVD in the study population was 3% (1.3/5.98). The low-risk group had a significantly lower atherogenic index of plasma (AIP), Castelli I risk index (CR-I), and Castelli II risk index (CR-II) compared to the borderline to high-risk group (p <0.001 for all). However, CRP was not different between groups (p: 0.683). The 10-year risk of ASCVD was statistically significantly correlated with AIP (R:0.380; p<0.001), CR-I (R:0.467; p<0.001), and CR-II (R:0.482; p<0.001), but no correlation was detected with hs-CRP (R:0.065; p:0.381). Conclusion: The lack of correlation between ACC/AHA's risk calculation tool and hs-CRPsuggests that hs-CRP cannot be used as a high-risk indicator in these individuals or that this tool is insufficient to detect some high-risk patients.

Keywords:

C-reactive protein, Cardiovascular Risk Score, Dyslipidemias,

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Visseren FLJ, Mach F, Smulders YM,Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337.
Lloyd-Jones DM, Braun LT, Ndumele CE, Smith Jr SC, Sperling LS, Virani SS, et al. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2019;73(24):3153-3167.
Thomas MR, Lip GYH. Novel Risk Markers and Risk Assessments for Cardiovascular Disease. Circ Res. 2017;120(1):133-149.
Bhardwaj S, Bhattacharjee J, Bhatnagar MK, Tyagi S. Atherogenic Index of Plasma, Castelli Risk Index and Atherogenic Coefficient-New Parameters in Assessing Cardiovascular Risk. Int J Pharm Biol Sci. 2013;3(3):359-364.
Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American college of cardiology/American heart association task force on practice guidelines. Circulation. 2014;129(25 SUPPL. 2).
Windgassen EB, Funtowicz L, Lunsford TN, Harris LA, Mulvagh SL. C-reactive protein and high-sensitivity C-reactive protein: An update for clinicians. Postgrad Med. 2011;123(1):114-119.
Tajfard M, Tavakoly Sany SB, Avan A, Latiff LA, Rahimi HR, Moohebati M, et al. Relationship between serum high sensitivity C-reactive protein with angiographic severity of coronary artery disease and traditional cardiovascular risk factors. J Cell Physiol. 2019;234(7):10289-10299.
Yang X, Zhang D, Zhao Y, Liu D, Li Q, Guo C, et al. Association between serum level of C-reactive protein and risk of cardiovascular events based on cohort studies. J Hum Hypertens. 2021;35(12):1149-1158.
Kelishadi R, Sharifi M, Khosravi A, Adeli K. Relationship between C-reactive protein and atherosclerotic risk factors and oxidative stress markers among young persons 10-18 years old. Clin Chem. 2007;53(3):456-464.
ASCVD Risk Estimator +. Accessed August 30, 2021. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
Edwards MK, Blaha MJ, Loprinzi PD. Atherogenic Index of Plasma and Triglyceride/High-Density Lipoprotein Cholesterol Ratio Predict Mortality Risk Better Than Individual Cholesterol Risk Factors, Among an Older Adult Population. Mayo Clin Proc. 2017;92(4):680-681.
Arnold N, Lechner K, Waldeyer C, Shapiro MD, Koenig W. Inflammation and Cardiovascular Disease: The Future. Eur Cardiol Rev. 2021;16:1-8.
Anand SS, Razak F, Yi Q, et al. C-reactive protein as a screening test for cardiovascular risk in a multiethnic population. Arterioscler Thromb Vasc Biol. 2004;24(8):1509-1515.
Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: The Reynolds Risk Score. J Am Med Assoc. 2007;297(6):611-619.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):e177-e232.
Juonala M, Viikari JSA, Rönnemaa T, Taittonen L, Marniemi J, Raitakari OT. Childhood C-reactive protein in predicting CRP and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. Arterioscler Thromb Vasc Biol. 2006;26(8):1883-1888.
Mora S, Glynn RJ, Hsia J, MacFadyen JG, Genest J, Ridker PM. Statins for the Primary Prevention of Cardiovascular Events in Women With Elevated High-Sensitivity C-Reactive Protein or Dyslipidemia. Circulation. 2010;121(9):1069-1077.
Heart Protection Study Collaborative Group. C-reactive protein concentration and the vascular benefits of statin therapy: an analysis of 20 536 patients in the Heart Protection Study. Lancet. 2011;377(9764):469-476.
Koenig W. High-sensitivity C-reactive protein and atherosclerotic disease: From improved risk prediction to risk-guided therapy. Int J Cardiol. 2013;168(6):5126-5134.
Shah T, Casas JP, Cooper JA, Tzoulaki I, Sofat R, McCormackV, et al. Critical appraisal of CRP measurement for the prediction of coronary heart disease events: New data and systematic review of 31 prospective cohorts. Int J Epidemiol. 2009;38(1):217-231.