BACKGROUND High-sensitivity C-reactive protein (CRP), low-density lipoprotein (LDL) cholesterol, and lipoprotein(a) levels contribute to 5-year and 10-year predictions of cardiovascular risk and represent distinct pathways for pharmacologic intervention. More information about the usefulness of these biomarkers for predicting cardiovascular risk over longer periods of time in women is needed because early-life intervention represents an important risk-reduction method. METHODS We measured high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels at baseline in 27,939 initially healthy U.S. women who were subsequently followed for 30 years. The primary end point was a first major adverse cardiovascular event, which was a composite of myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes. We calculated the adjusted hazard ratios and 95% confidence intervals across quintiles of each biomarker, along with 30-year cumulative incidence curves adjusted for age and competing risks. RESULTS The mean age of the participants at baseline was 54.7 years. During the 30-year follow-up, 3662 first major cardiovascular events occurred. Quintiles of increasing baseline levels of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) all predicted 30-year risks. Covariable-adjusted hazard ratios for the primary end point in a comparison of the top with the bottom quintile were 1.70 (95% confidence interval [CI], 1.52 to 1.90) for high-sensitivity CRP, 1.36 (95% CI, 1.23 to 1.52) for LDL cholesterol, and 1.33 (95% CI, 1.21 to 1.47) for lipoprotein(a). Findings for coronary heart disease and stroke appeared to be consistent with those for the primary end point. Each biomarker showed independent contributions to overall risk. The greatest spread for risk was obtained in models that incorporated all three biomarkers. CONCLUSIONS A single combined measure of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels among initially healthy U.S. women was predictive of incident cardiovascular events during a 30-year period. These data support efforts to extend strategies for the primary prevention of atherosclerotic events beyond traditional 10-year estimates of risk. (Funded by the National Institutes of Health; Women's Health Study ClinicalTrials.gov number, NCT00000479.).

中文翻译：

---

女性炎症、胆固醇、脂蛋白 （a） 和 30 年心血管结果。


背景 高敏 C 反应蛋白 （CRP） 、低密度脂蛋白 （LDL） 胆固醇和脂蛋白 （a） 水平有助于 5 年和 10 年心血管风险的预测，并代表了药物干预的不同途径。需要更多关于这些生物标志物在预测女性较长时间心血管风险方面的有效性的信息，因为生命早期干预是一种重要的降低风险的方法。方法 我们测量了 27,939 名最初健康的美国女性在基线时的高敏 CRP、LDL 胆固醇和脂蛋白 （a） 水平，这些女性随后接受了 30 年的随访。主要终点是第一个主要不良心血管事件，这是心肌梗死、冠状动脉血运重建、中风或心血管原因死亡的复合事件。我们计算了每个生物标志物的调整后风险比和 95% 置信区间，以及根据年龄和竞争风险调整的 30 年累积发生率曲线。结果 参与者基线时的平均年龄为 54.7 岁。在 30 年的随访中，发生了 3662 例首次重大心血管事件。高敏 CRP、LDL 胆固醇和脂蛋白 （a） 基线水平升高的五分位数都预测了 30 年的风险。在顶部与底部五分位数的比较中，主要终点的协变量调整风险比为高敏 CRP 为 1.70 （95% 置信区间 [CI]，1.52 至 1.90），低密度脂蛋白胆固醇为 1.36 （95% CI，1.23 至 1.52），脂蛋白 （a） 为 1.33 （95% CI，1.21 至 1.47）。冠心病和卒中的发现似乎与主要终点一致。每个生物标志物都显示出对总体风险的独立贡献。 在包含所有三种生物标志物的模型中获得了最大的风险传播。结论 最初健康的美国女性的高敏 CRP 、 LDL 胆固醇和脂蛋白 （a） 水平的单一综合测量可预测 30 年期间发生的心血管事件。这些数据支持将动脉粥样硬化事件的一级预防策略扩展到传统的 10 年风险评估之外的努力。（由美国国立卫生研究院资助;女性健康研究 ClinicalTrials.gov 编号，NCT00000479.）。