上海市社区≥65岁老年人超敏C反应蛋白与10年动脉粥样硬化性心血管病风险的相关性研究

Association between high-sensitivity C-reactive protein and 10-year risk of atherosclerotic cardiovascular disease among community-dwelling older adults aged 65 years and above in Shanghai

目的描述上海市社区≥65岁老年人10年动脉粥样硬化性心血管病(atherosclerotic cardiovascular disease,ASCVD)风险,分析超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平与10年ASCVD发病风险及相关预测因子的关联。方法基于2023年上海市松江区中山街道老年人体检数据库的相关资料,使用中国动脉粥样硬化性心血管病风险预测(prediction for atherosclerotic cardiovascular disease risk in China,China-PAR)模型评估该人群10年ASCVD风险,采用多因素logistic回归分析模型和限制性立方样条模型分析≥65岁老年人hs-CRP水平与10年ASCVD风险及其组分的关联。结果本研究共纳入3654名研究对象,年龄中位数为70.00(68.00,75.00)岁,血液中hs-CRP水平的中位数为1.05(0.43,2.23)mg/L,其中高、中、低水平分别为48.25%、35.14%和16.61%。研究对象10年ASCVD平均发病风险为10.39%,调整混杂因素后显示,hs-CRP中、高水平组10年ASCVD的高发病风险分别是低水平组的2.50倍(95%CI:1.78~3.52)和3.32倍(95%CI:2.02~5.47),进一步分析发现,老年人群hs-CRP水平与10年ASCVD发病风险之间存在非线性递增剂量-反应关系。高龄、高腰围、高总胆固醇、低高密度脂蛋白胆固醇、吸烟且服用降压药的老年人更可能有较高水平的hs-CRP(均P<0.05)。结论老年人hs-CRP水平与10年ASCVD风险呈正相关,应关注重点人群hs-CRP水平的早期筛查,以有效精准干预、降低ASCVD的发病风险。

Objective To evaluate the 10-year risk of atherosclerotic cardiovascular disease(ASCVD)in community-dwelling older adults aged≥65 years and to examine the association between high-sensitivity C-reactive protein(hs-CRP)levels and ASCVD risk,along with related predictive factors.Methods Using data from the 2023 physical examination database for older adults in Zhongshan Street,Songjiang District,Shanghai,the 10-year ASCVD risk was assessed using the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)model.The association between hs-CRP levels and the 10-year ASCVD risk and its components was analyzed using a multivariate logistic regression model and a restricted cubic spline model.Results A total of 3654 participants were enrolled,with a median age of 70.00(interquartile range:68.00-75.00)years.The median level of hs-CRP was 1.05(interquartile range:0.43-2.23)mg/L,with 48.25%,35.14%,and 16.61%of participants exhibiting high,medium,and low levels,respectively.The average 10-year ASCVD risk among the study population was 10.39%.After adjusting for confounding factors using multivariable logistic regression,the risk of high 10-year ASCVD was 2.50 times(95%CI:1.78-3.52)and 3.32 times(95%CI:2.02-5.47)higher in the medium and high hs-CRP groups,respectively,compared to the low group.Restricted cubic spline models demonstrated a non-linear dose-response relationship between hs-CRP levels and 10-year ASCVD risk among older adults.Older age,increasing waist circumference,elevated total cholesterol,lower levels of high density lipoprotein cholesterol,smoking,and the use of antihypertensive medications were associated with higher hs-CRP levels(all P<0.05).Conclusions Higher hs-CRP levels are significantly associated with increased 10-year ASCVD risk in older adults.Early screening of hs-CRP levels in high-risk populations may facilitate targeted interventions to reduce ASCVD risk.