Measuring hsCRP—An Important Part of a Comprehensive Risk Profile or a Clinically Redundant Practice 英文参考文献.docVIP

Essay MeasuringhsCRP—AnImportantPartofa ComprehensiveRiskProfileoraClinicallyRedundant Practice? JamesP.McCormack1*,G.MichaelAllan2 1FacultyofPharmaceuticalSciences,UniversityofBritishColumbia,Vancouver,BritishColumbia,Canada,2FacultyofMedicine,UniversityofAlberta,Edmonton,Alberta, Canada With the publication of the JUPITER trial[1]thereisnowconsiderableinterest in measuring high-sensitivity C-reactive protein (hsCRP). While treatment with beenestimatedthat‘‘inordertoreducethe intra-individual variation sufficiently, each subject is likely to require blood samples collectedonatleast10occasions’’[9]. mentinriskstratificationorreclassification …issmallandinconsistent’’[12]. HowDoesMeasuringhsCRP AffectAbsoluteRiskEstimates ofCVDinIndividuals? rosuvastatin decreased the chance of clinically important events in the JUPI- TER trial, does this necessarily justify treatment based on hsCRP measure- ments? Here, we discuss issues surround- inghsCRPmeasurementsinpatients. DoesMeasuringhsCRPAdd ValuetoAlreadyEstablished RiskFactorsWhenItComesto AssessingCHDor The Reynolds Risk Score [13] is an online calculator that incorporates hsCRP measurement with other risk factor infor- mation (age, sex, systolic blood pressure [SBP], smoking history, total cholesterol, high-densitylipoprotein[HDL]cholesterol, andfamilyhistory)tocomputetherisk(%) ofheartattack,stroke,orothermajorheart diseasein the next 10 years.Weused two patients, one male and one female with a ‘‘moderate’’ hsCRP level (2mg/l), and adjusted other factors so that they would have an overall absolute risk estimate of 15%—inthemiddleofthe‘‘intermediate’’ risk category. We then changed hsCRP to 0.5, 5, or 10mg/l to see what would happentotheircalculatedrisk(Table1). Absoluteriskestimateschangedbyjust 62% (male) and 63%–4% (female). It is important to appreciate that the magni- tude of these risk estimate changes are equal to or less than the confidence interval (CI) on the original risk estimate. Andersonetal.notedfo