Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population
Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population
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DOI：
10.1093/eurheartj/ehx120
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发表时间：
2017-06-14
影响因子：
39.3
通讯作者：
Mahabadi, Amir A.
中科院分区：
文献类型：
--
作者：
Geisel, Marie Henrike;Bauer, Marcus;Mahabadi, Amir A.
目的：在一级预防队列中，根据危险因素特征，比较冠状动脉钙化（CAC）、颈动脉内膜中层厚度（CIMT）和踝肱指数（ABI）的预测价值，以确定三种标志物中哪一种在哪一个危险组中最能提高心血管（CV）风险区分。在基于人群的海因茨Nixdorf Recall研究中，3108例无流行CV疾病的受试者（平均年龄59.2 ± 7.7岁，47.1%为男性）中进行了ABI。在10.3 +/- 2.8年的随访期内，采用考克斯比例回归法评估了与总队列中发生的重大CV事件（冠状动脉事件、卒中、CV死亡; n = 223）的相关性，并按Fragrance风险评分（FRS）组分层。用Harrell’s C.所有三种标志物均与CV事件相关（风险比[95%置信区间（CI）]：CAC：log（CAC+1）每增加1个单位，CAC：1.31（1.23-1.39）vs. CIMT：1.27（1.13-1.43）每1 SD vs. ABI：1.30（1.14-1.49）每1 SD，在FRS调整模型中）。考虑到重新分类，CAC导致总队列中最高的重新分类，同时观察到CIMT和ABI的净重新分类显著改善[NRI（95%CI）：CAC：0.55（0.42-0.69）; CIMT：0.32（0.19-0.45）; ABI：0.19（0.10-0.28）]结论冠状动脉钙化与CIMT和ABI相比，可提供最好的危险区分度，尤其是在中危组，而CIMT可能是低风险组的另一种安慰措施。
Aims To compare the predictive value of coronary artery calcification (CAC), carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) in a primary prevention cohort depending on risk factor profile to determine which of the three markers improves cardiovascular (CV) risk discrimination best in which risk groupMethods and results We quantified CAC, CIMT, and ABI in 3108 subjects (mean age 59.2 +/- 7.7, 47.1% male) without prevalent CV diseases from the population-based Heinz Nixdorf Recall study. Associations with incident major CV events (coronary event, stroke, CV death; n = 223) were assessed during a follow-up period of 10.3 +/- 2.8 years with Cox proportional regressions in the total cohort and stratified by Framingham risk score (FRS) groups. Discrimination ability was evaluated with Harrell's C. All three markers were associated with CV events (hazard ratio [95% confidence interval (CI)]: CAC: 1.31 (1.23-1.39) per 1-unit increase in log(CAC+1) vs. CIMT: 1.27 (1.13-1.43) per 1 SD vs. ABI: 1.30 (1.14-1.49) per 1 SD, in FRS adjusted models). Considering reclassification, CAC lead to highest reclassification in the total cohort, while also for CIMT and ABI significant improvement in net-reclassification was observed [NRI (95% CI): CAC: 0.55 (0.42-0.69); CIMT: 0.32 (0.19-0.45); ABI: 0.19 (0.10-0.28)]Conclusion Coronary artery calcification provides the best discrimination of risk compared with CIMT and ABI, particularly in the intermediate risk group, whereas CIMT may be an alternative measure for reassurance in the low risk group.