Common carotid artery intima-media thickness progression as a predictor of stroke in multi-ethnic study of atherosclerosis.
Common carotid artery intima-media thickness progression as a predictor of stroke in multi-ethnic study of atherosclerosis.
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DOI：
10.1161/strokeaha.111.625186
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发表时间：
2011-11
期刊：
影响因子：
8.3
通讯作者：
D'Agostino RB
中科院分区：
文献类型：
--
作者：
Polak JF;Pencina MJ;O'Leary DH;D'Agostino RB
颈动脉内膜-中膜厚度（IMT）是与卒中事件相关的心血管疾病的标志物。我们研究IMT变化率是否与中风有关。我们研究了5028名多种族动脉粥样硬化研究（MESA）的参与者，他们包括白人、华人、西班牙裔和非裔美国人，无心血管疾病。在MESA IMT进展研究中，IMT变化率（mm/年）是右颈总动脉（CCA）远壁IMT （mm）的差异除以两次超声检查之间的间隔（中位间隔为32个月）。在无斑块区域测量CCA IMT。当测量IMT变化率时，确定心血管危险因素和基线IMT。多变量Cox比例风险模型生成了以心血管危险因素、种族和教育水平/收入为预测因子的危险风险比（HR）。在平均3.22年（中位3.0年）的随访期间，有42例首次中风。平均年龄64.2岁，男性占48%。在多变量模型中，年龄（HR: 1.05 /年）、收缩压（HR: 1.02 / mmHg）、较低的高密度脂蛋白胆固醇水平（HR: 0.96 / mg/dL）和IMT变化率（HR: 1.23 / 0.05 mm/年；95% C.L. 1.02, 1.48）与卒中事件显著相关。IMT变化率的上四分位数与下四分位数的总风险比为2.18 （95% C.L: 1.07, 4.46）。在基线时无流行心血管疾病和心房颤动的队列中，颈总动脉IMT进展与卒中事件相关。
Carotid artery intima-media thickness (IMT) is a marker of cardiovascular disease associated with incident stroke. We study whether IMT rate-of-change is associated with stroke. We studied 5028 participants of the Multi-Ethnic Study of Atherosclerosis (MESA) composed of whites, Chinese, Hispanic and African-Americans free of cardiovascular disease. In this MESA IMT progression study, IMT rate-of-change (mm/year) was the difference in right common carotid artery (CCA) far-wall IMT (mm) divided by the interval between two ultrasound examinations (median interval of 32 months). CCA IMT was measured in a region free of plaque. Cardiovascular risk factors and baseline IMT were determined when IMT rate-of-change was measured. Multivariable Cox proportional hazards models generated Hazard risk Ratios (HR) with cardiovascular risk factors, ethnicity and education level/income as predictors. There were 42 first time strokes seen during a mean follow-up of 3.22 years (median 3.0 years). Average age was 64.2 years, with 48% males. In multivariable models, age (HR: 1.05 per year), systolic blood pressure (HR 1.02 per mmHg), lower HDL cholesterol levels (HR: 0.96 per mg/dL) and IMT rate-of-change (HR 1.23 per 0.05 mm/year; 95% C.L. 1.02, 1.48) were significantly associated with incident stroke. The upper quartile of IMT rate-of-change had an HR of 2.18 (95% C.L.: 1.07, 4.46) compared to the lower three quartiles combined. Common carotid artery IMT progression is associated with incident stroke in this cohort free of prevalent cardiovascular disease and atrial fibrillation at baseline.