| BackgroundThere were few reports on the effects of inflammatory biomarkers and theirinteraction with blood pressure and blood lipids on the prognosis of acute myocardialinfarction (AMI) patients.PurposeTo explore the effects of C-reactive protein (CRP) levels or white blood cell (WBC)count and their interaction with blood pressure and blood lipids at admission on theprognosis of AMI patients at discharge among patients with the first AMI, and provideclinical epidemiology evidence for prognosis assessment and the effective controlling ofrisk factors among AMI patients.MethodsA total of849AMI patients consecutively hospitalized in the Second AffiliatedHospital of Soochow University from January of1998to October of2010were selectedas study subjects. Trained and qualified investigators collected data on the informationof demographic characteristics, lifestyle, admission blood pressure, clinical laboratorytests, medical history and study outcome(severe heart failure at discharge, NYHA≥Ⅲdegree or death in-hospital) for all subjects from medical records by usingquestionnaires. Statistic analysis was conducted by using SPSS16.0software.Comparisons of baseline characteristics at admission between the patients with andwithout study outcome were conducted. The associations between CRP level, WBCcount and the blood pressure or blood lipid, and the study outcome were analyzed byusing logistic regression model, and calculated the relative effects of variouscombinations by exposure factors. Logistic regression model also used to estimatemultiplicative interaction by bringing the product terms into the model, the additive interaction was evaluated by the interaction calculation sheet which made by Andersson,et al. We also analyzed the association between clustering number of risk factors andstudy outcome among AMI patients.Results1. Among849AMI patients,648were male and201were female, the proportionof male(76.3%) was higher than that of female(23.7%), p<0.05. There were157(18.5%)patients with study outcome during hospitalization or at discharge,139patients weredied and18patients had severe heart failure(NYHA≥Ⅲ degree).2. After adjustment for age, gender, smoking, stroke history, compared to thosewith normal systolic blood pressure(SBP), the OR of study outcome was9.844for AMIpatients with low SBP at admission, and compared to those with normal diastolic bloodpressure(DBP), the OR of study outcome was5.144for AMI patients with low DBP atadmission, all p<0.05. Risk of study outcome increased with SBP or DBP decreasing,p<0.05.3. After adjustment for age, gender, smoking, stroke history, compared to thosewithout high total cholesterol(TC), high triglyceride(TG) and high low-densitylipoprotein cholesterol(LDL-C) at admission, ORs of study outcome were2.847,1.915,3.024in patients with high TC, high TG, and high LDL-C, respectively, all p<0.05.However, the association between low high-density lipoprotein cholesterol(HDL-C) atadmission and the study outcome was not reach the statistical significance.4. After adjustment for age, gender, smoking, stroke history, compared to thosewith the lowest CRP level or WBC count at admission, ORs of study outcome were1.896and3.494in patients with the highest CRP level and WBC count, respectively, allp<0.05. Risk of study outcome increased with CRP level and WBC count increasing,p<0.05.5. After adjustment for age, gender, smoking, stroke history, compared to thosewithout co-existences of high CRP level with low SBP, low DBP or low HDL-C, theORs of study outcome were9.563,8.259,3.549for patients with both high CRP andlow SBP, both high CRP and low DBP, both high CRP and low HDL-C, respectively,p<0.05. Compared to those without co-existences of the high WBC count with low SBP,low DBP, high TC, high TG, low HDL-C or high LDL-C, ORs of study outcome were16.603,8.910,6.523,5.662,4.288,5.060for patients with both high WBC count and low SBP, both high WBC count and low DBP, both high WBC count and high TC, bothhigh WBC count and high TG, both high WBC count and low HDL-C, both high WBCcount and high LDL-C, respectively, p<0.05. Compared to patients with alone high CRPlevel, high WBC count, low SBP, low DBP, high TC, high TG, low HDL-C or highLDL-C separately, the risk of study outcome were higher among those withco-existences of high CRP or high WBC count with low SBP, low DBP, high TC, highTG, low HDL-C or high LDL-C(p<0.05).6. In the analysis of multiplicative interaction, after adjustment for age, gender,smoking, stroke history, all the ORs of the study outcome associated with interactions ofhigh CRP or high WBC count with low SBP, low DBP, high TC, high TG, low HDL-C,high LDL-C were not reach statistical significance(p>0.05).7. In the analysis of additive interaction, after adjustment for age, gender, smoking,stroke history, all the indexes of the study outcome associated with interactions of highCRP with low SBP, low DBP, high TC, high TG, low HDL-C, high LDL-C were notreach statistical significance(p>0.05).8. After adjustment for age, gender, smoking, stroke history, a significant additiveinteraction between high WBC count and low HDL-C on study outcome was foundamong patients with AMI. Compared to patients without co-existences of high WBCcount with low HDL-C, the RERI(the relative excess risk due to interaction) of studyoutcome associated with additive interaction of high WBC count with low HDL-C was2.293, and53.5%of AMI patients with study outcome attributed to this additiveinteraction. All indexes which reflected the additive interaction among AMI patientswith co-existences of high WBC count with low SBP, low DBP, high TC, high TG, highLDL-C were not reach statistical significance(p>0.05).9. After adjustment for age, gender, smoking, stroke history, compared to thosewithout risk factors(including high CRP level, high WBC count, low SBP, low DBP,high TC, high TG, low HDL-C, high LDL-C), the ORs of study outcome were1.540(p>0.05),2.601(p<0.05),6.356(p<0.05),20.392(p<0.05) among AMI patients withthe number of risk factors were1,2,3or≥4, respectively. The risk of study outcomeincreased with the increase of clustering number of risk factors, p value for trendtest<0.05. Conclusions1. The AMI patients with high CRP level or high WBC count at admission couldsignificantly increase the risk of in-hospital death or NYHA≥Ⅲ degree at discharge.The low SBP, low DBP, high TC, high TG, high LDL-C at admission were the riskfactors of in-hospital death or NYHA≥Ⅲ degree at discharge for AMI patients.2. A significant additive interaction between high WBC count and low HDL-C atadmission on study outcome was found among patients with AMI. The risk ofin-hospital death or NYHA≥Ⅲ degree at discharge increased significantly among AMIpatients co-existences of high WBC count with low HDL-C.3. Although multiplicative interaction and additive interactions of high CRP orhigh WBC count with low SBP, low DBP, high TC, high TG, high LDL-C, and highCRP with low HDL-C at admission were not reach statistical significance, the resultsstill suggest that their synergistic effects on study outcome exist.4. Clustering of risk factors including high CRP, high WBC count, low SBP, lowDBP, high TC, high TG, low HDL-C and high LDL-C at admission could increase therisk of in-hospital death or NYHA≥Ⅲ degree at discharge among AMI patients. |
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