Coronary Artery Calcium Progression: An Important Clinical Measurement? A Review of Published Reports
Coronary Artery Calcium Progression: An Important Clinical Measurement? A Review of Published Reports
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DOI：
10.1016/j.jacc.2010.06.038
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发表时间：
2010-11-09
影响因子：
24
通讯作者：
Jones, Steven R.
中科院分区：
文献类型：
--
作者：
McEvoy, John W.;Blaha, Michael J.;Jones, Steven R.
基线冠状动脉钙化（CAC）可准确识别冠状动脉粥样硬化，并可能改善未来心脏事件的预测。CAC评分的系列评估已被提议用于监测动脉粥样硬化进展和评估旨在降低心脏风险的药物治疗的有效性。然而，CAC评分随时间推移的进展是否进一步改善了风险预测尚不清楚。在没有任何关于CAC进展定义以及如何最好地量化CAC进展的正式指南的情况下，进行了几项将药物治疗与CAC进展相关的试验。我们对已发表的CAC进展报告进行了全面审查。CAC进展增加与许多已知的心脏风险因素相关。我们发现CAC进展与动脉粥样硬化恶化相关，并可能有助于预测未来的心脏事件。这些发现支持了通过治疗干预减缓CAC进展可能提供预后益处的观点。然而，尽管早期的数据很有希望，但在迄今为止的任何随机对照试验中，除了事后亚组分析外，这些干预措施（最明显的是他汀类药物治疗）尚未显示出减缓CAC的进展。因此，目前在临床实践中不推荐常规定量CAC进展。首先，需要制定如何定义和评估CAC进展的标准。此外，还需要进一步研究分析其他心脏治疗对CAC进展和心脏结局的影响。（J Am科尔心脏病学杂志2010;56：1613-22）（C）美国心脏病学会基金会2010年
Baseline coronary artery calcification (CAC) accurately identifies coronary atherosclerosis and might improve prediction of future cardiac events. Serial assessment of CAC scores has been proposed for monitoring atherosclerosis progression and for assessing the effectiveness of medical therapies aimed at reducing cardiac risk. However, whether knowledge of progression of CAC scores over time further improves risk prediction is unclear. Several trials relating medical therapies to CAC progression have been performed without any formal guidelines on the definition of CAC progression and how it is best quantified. We conducted a comprehensive review of published reports on CAC progression. Increased CAC progression is associated with many known cardiac risk factors. We found that CAC progression correlates with worsening atherosclerosis and may facilitate prediction of future cardiac events. These findings support the notion that slowing CAC progression with therapeutic interventions might provide prognostic benefit. However, despite promising early data, such interventions (most notably with statin therapy) have not been shown to slow the progression of CAC in any randomized controlled trial to date, outside of post hoc subgroup analyses. Thus, routine quantification of CAC progression cannot currently be recommended in clinical practice. First, standards of how CAC progression should be defined and assessed need to be developed. In addition, there remains a need for further studies analyzing the effect of other cardiac therapies on CAC progression and cardiac outcomes. (J Am Coll Cardiol 2010;56:1613-22) (C) 2010 by the American College of Cardiology Foundation