Statins 사용에 따른 High Sensitivity C-Reactive Protein의 혈중 농도 변화
Change of Serum hsCRP Concentration after Statin Therapy in Dyslipidemic Patients
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연구배경 스타틴계 약물 치료는 hsCRP와 같은 염증 지표를 유의하게 감소시킨다고 보고되고 있다. 우리나라에서는 스타틴계 약물 사 용 기간과 혈중 hsCRP의 농도의 변화에 대한 장기간 연구가 미흡하다. 이에 본 연구에서는 장기간의 스타틴계 약물 치료에 따른 hsCRP 변화를 알아보고자 하였다. 방 법 2002년 5월부터 2005년 5월까지 한 대학병원 가정의학과를 방문하여 고지혈증으로 진단된 환자를 대상으로 후향적 의무기록 지 검토를 하였다. hsCRP 농도에 영향을 미칠 수 있는 경우를 배제하고, 최종 156명의 연구 대상자들 중 식이 처방, 운동 요 법 및 스타틴계 약물 치료를 한 군(스타틴 치료군)이 69명이었고 식이 처방과 운동 요법만 시행한 군(대조군)이 87명이었다. 대상자들은 고지혈증 진단 당시와 평균 40일 후, 180일 후, 360일 후의 3번의 추적 방문을 통해 hsCRP 농도와 총 콜레스테 롤 농도를 측정하였다. 고지혈증 진단 당시의 hsCRP 및 총 콜레스테롤 농도와 각 추적 방문 시 hsCRP 및 총 콜레스테롤 농 도의 변화량을 분석하였고, hsCRP 농도 변화와 총 콜레스테롤 농도 변화와의 상관관계를 알아보았다. 두 비교군 사이의 각 시기별 hsCRP와 총 콜레스테롤 변화량의 차이를 비교하였다. 결 과 스타틴 치료군에서 기저 loghsCRP 평균값은 평균 -1.115±0.509 mg/dL이었고 두 번째 추적방문(평균 180일 후)과 세 번째 추 적방문(평균 360일 후)의 loghsCRP 평균값은 각각 -1.337±0.318 mg/dL, -1.359±0.383 mg/dL 로써 기저 loghsCRP 평균값에 비하여 유의하게 감소하였다(p<0.05). 이러한 loghsCRP의 감소와 총 콜레스테롤 농도의 감소는 유의한 상관관계가 없었다. 대조군에서는 각 시기별 loghsCRP 평균값의 차이가 없었다. 하지만 각 시기별 loghsCRP 평균값은 스타틴 치료군과 대조군 에서 유의한 차이를 보이지 않았다. 결 론 장기간의 스타틴 약물치료는 총 콜레스테롤 감소와 무관하게 hsCRP 농도를 감소시켜, 심혈관 질환의 발생 감소에 역할을 할 수 있음을 시사한다.
Abstract
Background Statins lowers the hsCRP, a marker of inflammation. There are few study of change in plasma concentration of hsCRP after statin therapy in Korea. The purpose of this study is to determine the change in plasma hsCRP concentration after statin therapy. Methods We studied 156 patients who were visited a department of family medicine at a university hospital and diagnosed with dyslipidemia between May 2002 and May 2005. We reviewed chart retrospectively. The statin group is participated of 69 patients who were treated with diet/exercise and statin. The control group is 87 patients who were treated with only diet/exercise. The hsCRP and total cholesterol concentration was measured in serum on each visit that days 0, 40, 180, 360. We analyzed correlation between change of hsCRP concentration and change of total cholesterol. we analyzed difference of change of hsCRP and total cholesterol at each visit in two groups. Results In statin group, mean baseline loghsCRP was -1.115±0.509mg/dL. The differences loghsCRP between baseline and second(after 180 days) and third visit(after 360 days) were respectively -1.337±0.318mg/dL and -1.359±0.383mg/dL(P<0.05). Correlation between reduction of hsCRP concentration and reduction of total cholesterol was not significantly. In control group, there were no significant differences in means of loghsCRP at the each visit. Conclusions Longtime statin therapy lowered serum hsCRP concentration without correlated reduction of total cholesterol then can play the role of reduction of cardiovascular disease.
참고문헌 (37)
- Murray DJ, "Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study", Lancet, 349, pp.1436~1442 (1997)
- American Heart Association, "Heart Disease and Stroke Statistics-2004 Update" (2003), American Heart Association
- Goran K, "Inflammation, Atherosclerosis, an Coronary Artery Disease", N Engl J Med, 352(16), pp.1685~1695 (2005)
- Ross R, "Atherosclerosis: an inflammatory disease", N Engl J Med, 14(340)통권 : 2, pp.115~126 (1999)
- Libby P, "Molecular bases of the acute coronary syndromes", Circulation, 1(91)통권 : 11, pp.2844~2850 (1995)
- Maseri A, "Inflammation, atherosclerosis, and ischemic events: exploring the hidden side of the moon", N Engl J Med, 3(336)통권 : 14, pp.1014~1016 (1997)
- Ridker PM, "C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women", N Engl J Med, 342(12), pp.836~843 (2000)
- Yilmazer M, "Hormone replacement therapy, C-reactive protein, and fibrinogen in healthy postmenopausal women", Maturitas, 46(4), pp.245~253 (2003)
- Crisby M, "Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization", Circulation, 103, pp.926~933 (2001)
- Sposito AC, "Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit", Arterioscler Thromb Vasc Biol, 22, pp.1524~1534 (2002)
- David J, "Statins as Potent Antiinflammatory Drugs", Circulation, 106, pp.2041~2042 (2002)
- Cipollone F, "Association between enhanced soluble CD40L and prothrombotic state in hypercholesterolemia: effects of statin therapy", circulation, 106, pp.399~402 (2002)
- Ridker PM, "Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events", N Engl J Med, 344(26), pp.1959~1965 (2001)
- Ridker PM, "Rapid reduction in C-reactive protein with cerivastatin among 785 patients with primary hypercholesterolemia", Circulation, 103, pp.1191~1193 (2001)
- Plenge JK, "Simvastatin lowers C-reactive protein within 14 days; an effect independent of low-density lipoprotein cholesterol reduction", Circulation, 106, pp.1447~1452 (2002)
- "Detection, Evaluation and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel III)" (2002), NIH Publication
- Gabay C, "Acute-phase proteins and other systemic responses to inflammation", N Engl J Med, 340(6), pp.448~454 (1999)
- Person TA, "Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association", Circulation, 107(3), pp.499~511 (2003)
- 김영주, "급성관상동맥 증후군(ACS) 환자에서 유산소운동과 스타틴 약물이 혈중지질과 hsCRP에 미치는 영향", 체육과학연구, 16(4), pp.71~80 (2005), 국민체육진흥공단 체육과학연구원
- 박태성, "성인을 대상으로 한 High Sensitivity C-Reactive Protein의 참고치 분포와 심혈관 위험인자들과의 상관성에 관한 연구", 대한진단검사의학회지(제43차 학술대회 초록집), 23(1)통권 : 23, pp.S181~S181 (2003)
- Vikas Khurana, "Statins reduce the risk of lung cancer in humans: a large case-control study of US veterans", Chest, 13, pp.1282~1288 (2007)
- Merten M, "Cholesterol sulfate: a new adhesive molecule for platelets", Circulation, 103, pp.2032~2034 (2001)
- Lacoste L, "Hyperlipidemia and coronary disease: correction of the increased thrombogenic potential with cholesterol reduction", Circulation, 92, pp.3172~3177 (1995)
- Dupuis J, "Cholesterol reduction rapidly improves endothelial function after acute coronary syndromes", Circulation, 99, pp.3227~3233 (1999)
- Strandberg TE, "Effect of statins on C-reactive protein in patients with coronary artery disease", Lancet, 353, pp.118~119 (1999)
- Koenig W, "C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992", Circulation, 99, pp.237~242 (1999)
- Ridker PM, "Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men", N Engl J Med, 336(14), pp.973~979 (1997)
- Danesh J, "Appleby P, et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analysis", BMJ, 321, pp.199~204 (2000)
- Gotto AM Jr, "Effect of lovastatin on cardiovascular resource utilization and costs in the Air Force", Texas Coronary Atherosclerosis Prevention Study(AFCAPS, Am J Cardiol, pp.2000, 86[DOI]
- Mendall MA, "C-reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study", BMJ, 312, pp.1061~1065 (1996)
- Albert MA, "Plasma concentration of c-reactive protein and the calculated framingham coronary heart disease risk score", Circulation, 108, pp.161~165 (2003)
- Ridker PM, "Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease", Circulation, 97, pp.425~428 (1998)
- Ridker PM, "Stamfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis. Acomparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screenig as prediction of peripheral arterial disease", JAMA, 285, pp.2481~2485 (2001)
- Paul M Ridker, "C-Reactive Protein Levels and Outcomes after Statin Therapy", N Engl J Med, 352(1), pp.20~28 (2005)
- Fortmann SP, "CDC; AHA.CDC", AHA Workshop on Markers of inflammation and Cardiovascular Disease. Application to clinical and public health practice: report from the population science discussion group, 2004, pp.110(25), 554~559