Aortic Valve Calcium Independently Predicts Coronary and Cardiovascular Events in a Primary Prevention Population
Aortic Valve Calcium Independently Predicts Coronary and Cardiovascular Events in a Primary Prevention Population
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DOI：
10.1016/j.jcmg.2011.12.023
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发表时间：
2012-06-01
影响因子：
14
通讯作者：
O'Brien, Kevin D.
中科院分区：
文献类型：
--
作者：
Owens, David S.;Budoff, Matthew J.;O'Brien, Kevin D.
本研究旨在测试主动脉瓣钙化（AVC）是否与一级预防人群中的冠状动脉和心血管事件独立相关。背景主动脉硬化与老年人心血管发病率和死亡率增加相关，但这种相关性的机制仍存在争议。此外，它是未知的，这种关联是否延伸到年轻的individuals.METHODS我们进行了一项前瞻性分析的6,685名参与者在梅萨（多种族研究动脉粥样硬化）。所有受试者，年龄45 - 84岁，基线时无临床心血管疾病，均接受了AVC和冠状动脉钙评分的计算机断层扫描。心血管事件的主要、预先规定的联合终点包括心肌梗死、致死性和非致死性卒中、心脏骤停复苏和心血管死亡，而冠状动脉事件的次要联合终点不包括卒中。采用考克斯比例风险回归法对AVC和临床事件之间的关系进行评估，并对人口统计学、心血管危险因素、炎症生物标志物和亚临床冠状动脉粥样硬化进行增量调整。（四分位间距：5.6 - 5.9岁），调整人口统计学和心血管风险因素，AVC受试者（n = 894，13.4%）与无AVC的患者相比，心血管（风险比[HR]：1.50; 95%置信区间[CI]：1.10 - 2.03）和冠状动脉（HR：1.72; 95% CI：1.19 - 2.49）事件的风险更高。炎症生物标志物的调整并没有改变这些关联，但冠状动脉钙的调整大大降低了心血管（HR：1.32; 95% CI：0.98至1.78）和冠状动脉（HR：1.41; 95% CI：0.98至2.02）事件的风险。即使在完全校正后，AVC仍然可以预测心血管死亡率（HR：2.51; 95%CI：1.22至5.21）。结论：在这个梅萨队列中，无临床心血管疾病，AVC预测心血管和冠状动脉事件风险独立于传统的危险因素和炎症生物标志物，可能是由于AVC和亚临床动脉粥样硬化之间的强相关性。除冠状动脉粥样硬化风险外，AVC与心血管死亡率的相关性值得进一步研究。（动脉粥样硬化的多种族研究[梅萨]; NCT 00005487）（J Am科尔Cardiol Img 2012; 5：619 - 25）（C）美国心脏病学会基金会2012年
OBJECTIVES This study sought to test whether aortic valve calcium (AVC) is independently associated with coronary and cardiovascular events in a primary-prevention population.BACKGROUND Aortic sclerosis is associated with increased cardiovascular morbidity and mortality among the elderly, but the mechanisms underlying this association remain controversial. Also, it is unknown whether this association extends to younger individuals.METHODS We performed a prospective analysis of 6,685 participants in MESA (Multi-Ethnic Study of Atherosclerosis). All subjects, ages 45 to 84 years and free of clinical cardiovascular disease at baseline, underwent computed tomography for AVC and coronary artery calcium scoring. The primary, pre-specified combined endpoint of cardiovascular events included myocardial infarctions, fatal and nonfatal strokes, resuscitated cardiac arrest, and cardiovascular death, whereas a secondary combined endpoint of coronary events excluded strokes. The association between AVC and clinical events was assessed using Cox proportional hazards regression with incremental adjustments for demographics, cardiovascular risk factors, inflammatory biomarkers, and subclinical coronary atherosclerosis.RESULTS Over a median follow-up of 5.8 years (interquartile range: 5.6 to 5.9 years), adjusting for demographics and cardiovascular risk factors, subjects with AVC (n = 894, 13.4%) had higher risks of cardiovascular (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.10 to 2.03) and coronary (HR: 1.72; 95% CI: 1.19 to 2.49) events compared with those without AVC. Adjustments for inflammatory biomarkers did not alter these associations, but adjustment for coronary artery calcium substantially attenuated both cardiovascular (HR: 1.32; 95% CI: 0.98 to 1.78) and coronary (HR: 1.41; 95% CI: 0.98 to 2.02) event risk. AVC remained predictive of cardiovascular mortality even after full adjustment (HR: 2.51; 95% CI: 1.22 to 5.21).CONCLUSIONS In this MESA cohort, free of clinical cardiovascular disease, AVC predicts cardiovascular and coronary event risk independent of traditional risk factors and inflammatory biomarkers, likely due to the strong correlation between AVC and subclinical atherosclerosis. The association of AVC with excess cardiovascular mortality beyond coronary atherosclerosis risk merits further investigation. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487) (J Am Coll Cardiol Img 2012; 5: 619 -25) (C) 2012 by the American College of Cardiology Foundation