Evaluation Of Hs-CRP Combined With Lp-PLA2 For Predicting Cardiovascular And Cerebrovascular Events And Verification Of Their Combined Methods

Objectives Inflammation not only reflects the severity of the subclinical stage of cardiovascular and cerebrovascular diseases,but also participates in various stages of atherosclerosis and plaque formation.Early studies have found that Hs-CRP is closely related to cardiovascular and cerebrovascular diseases,and clearly indicates that Hs-CRP can improve the Framingham cardiovascular and cerebrovascular disease scoring system.Lp-PLA2 has been approved by the US Food and Drug Administration(FDA)as one of the predictive markers for coronary heart disease and ischemic stroke.However,whether Hs-CRP and Lp-PLA2 predict cardiovascular and cerebrovascular events With a joint effect,there is no definitive conclusion.The purpose of this study was to evaluate the value of Hs-CRP in combination with Lp-PLA2 in predicting cardiovascular and cerebrovascular events,and to find a reasonable combination of Hs-CRP and Lp-PLA2 in predicting cardiovascular and cerebrovascular events and to verify the feasibility of the combination.Methods This study was designed as a prospective fixed cohort study.From 2010 to 2011,a survey site was established in the Kailuan community in Tangshan,with a history of more than 40 years and no stroke,no transient ischemic attack,no previous myocardial infarction,a history of acute coronary syndrome,no neurological deficit.The general situation(lifestyle,disease-related factors,etc.)of the individual subjects was obtained in the form of a questionnaire.The results of routine indicators such as height,weight,and vision were obtained from Kailuan General Hospital,and biochemical indicators were tested in professional laboratories.Follow-up was conducted by telephone on-site questionnaire and follow-up to December 31,2016.The number of strokes,myocardial infarction,and all-cause deaths and time of onset were collected.Through pre-period statistical analysis,the final definition of stroke,myocardial infarction and all-cause death is the final composite cardiovascular and cerebrovascular events.The COX proportional hazard model is used to determine the association between Hs-CRP and Lp-PLA2 and cardiovascular and cerebrovascular events.C statistic,NRI,IDI indicators are used to determine changes in incremental informations,and RCS curves are used to find Hs-CRP or Lp-PLA2 predicts the best node for cardiovascular and cerebrovascular events.Results A total of 1921 subjects participated in the seven-year follow-up and were included in the final analysis.During the follow-up period until December 31,2015,148 cardiovascular and cerebrovascular events were harvested.Baseline analysis found gender,age,hypertension,diabetes,taking antihypertensive drugs,taking hypoglycemic agents,serum TC,HDL,UA,Hs-CRP,and Lp-PLA2 between the affected population and those without cardiovascular and cerebrovascular events.There were statistical differences,P < 0.05.In the COX multivariate analysis,the first quintile was used as a reference.After correcting the potential confounding factors,the fourth HR(95% CI)of Hs-CRP was 1.75(1.06-2.89).The third and fourth quantile HR(95% CI)of Lp-PLA2 were 2.13(1.19-3.80)and 2.64(1.49-4.66),respectively.COX stepwise regression method was used to screen out the basic risk models of age,gender,hypertension,diabetes,hypoglycemic agents,SUA and TC.Based on this model,Hs-CRP and Lp-PLA2 were classified according to the quartile method.The combination of Hs-CRP and Lp-PLA2 provided greater incremental information(C=0.736;NRI=43.7,P=0.004;IDI=2.9,P<0.001).Using the COX proportional hazard model RCS curve,a reasonable node in the study population was able to improve the risk of cardiovascular and cerebrovascular events.The Hs-CRP level node is 1.60mg/L,and the Lp-PLA2 level node is 139.00ng/ml.According to these two nodes,Hs-CRP and Lp-PLA2 are combined into 551 people in the "Lp-CRP-" group,640 people in the "Lp-CRP+" group,326 people in the "Lp+ CRP-" group and the 404 people in the "Lp+ CRP+" group.Continued follow-up until December 31,2016,and collect new cardiovascular and cerebrovascular events.The COX proportional hazard regression model was used to verify the risk stratification ability of Lp-PLA2 and Hs-CRP combined to improve cardiovascular and cerebrovascular events.Using the “Lp-CRP-” group as a reference,after adjusting for potential confounders,Only the “Lp+ CRP+” group had a statistically significant risk(HR: 1.29;95% CI: 1.11-1.49).The COX model was tested and the confounding factors were adjusted.It was found that there was a linear trend between the risk of cardiovascular and cerebrovascular events and the different combinations of HsCRP and Lp-PLA2(P<0.01),which proves that the joint method is more reliable.Conclusions Both Hs-CRP and Lp-PLA2 are potential biomarkers for predicting cardiovascular and cerebrovascular events;Hs-CRP combined with Lp-PLA2 have complementary roles in predicting cardiovascular and cerebrovascular events.Figure 3;Table 10;Reference 93...