Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the coronary artery risk development in young adults study and multi-ethnic study of atherosclerosis.
Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the coronary artery risk development in young adults study and multi-ethnic study of atherosclerosis.
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DOI：
10.1161/circulationaha.108.800235
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发表时间：
2009-01-27
期刊：
影响因子：
37.8
通讯作者：
Lloyd-Jones DM
中科院分区：
文献类型：
--
作者：
Berry JD;Liu K;Folsom AR;Lewis CE;Carr JJ;Polak JF;Shea S;Sidney S;O'Leary DH;Chan C;Lloyd-Jones DM
我们假设10年心血管疾病（CVD）风险低但终生心血管疾病风险高的个体比10年心血管疾病风险低但终生心血管疾病风险低的个体有更大的亚临床动脉粥样硬化负担。我们纳入了来自青年人冠状动脉风险发展（CARDIA）研究的2988名年龄≤50岁的受试者和来自动脉粥样硬化多种族研究（MESA）的1076名年龄≤50岁的受试者。对每位参与者的10年心血管疾病风险和终生心血管疾病风险进行估计，并将其分为三组：低10年(<10%)/低终生（<39%）风险、低10年(<10%)/高终生风险（≥39%）和高10年风险（≥10%）或诊断为糖尿病。比较亚临床动脉粥样硬化（冠状动脉钙[CAC]或颈动脉内膜-中膜厚度[IMT]）的基线水平和变化。在CARDIA低10年风险的参与者中（占所有参与者的91%），终生风险高的参与者与终生风险低的参与者相比，颈动脉内IMT（男性0.83 vs 0.80 mm；女性0.79 vs 0.75 mm）和颈动脉内IMT （0.85 vs 0.80 mm; 0.80 vs 0.76 mm）明显更高，CAC患病率更高（16.6 vs 9.8%; 7.1 vs 2.3%）， CAC进展发生率显著更高（22.3 vs 15.4%; 8.7 vs 5.3%）。在MESA中也观察到类似的结果。与10年和终生风险低的个体相比，10年和终生风险低的个体有更大的亚临床疾病负担和更大的动脉粥样硬化进展发生率，即使在更年轻的时候也是如此。
We hypothesized that individuals with low 10-year but high lifetime cardiovascular disease (CVD) risk would have a greater burden of subclinical atherosclerosis than those with low 10-year but low lifetime risk. We included 2988 individuals age ≤50 at exam year 15 from the Coronary Artery Risk Development in Young Adults (CARDIA) study and 1076 individuals age ≤50 at study entry from the Multi-Ethnic Study of Atherosclerosis (MESA). The 10-year risk and lifetime risk for CVD were estimated for each participant, permitting stratification into three groups: low 10-year (<10%)/low lifetime (<39%) risk, low 10-year (<10%)/high lifetime risk (≥39%), and high 10-year risk (≥10%) or diagnosed diabetes. Baseline levels and change in levels of subclinical atherosclerosis (coronary artery calcium [CAC] or carotid intima-media thickness [IMT]) were compared across risk strata. Among participants with low 10-year risk (91% of all participants) in CARDIA, those with a high lifetime risk compared to low lifetime risk had significantly greater common (0.83 vs 0.80 mm in men; 0.79 vs 0.75 mm in women) and internal (0.85 vs 0.80 mm; 0.80 vs 0.76 mm) carotid IMT, higher CAC prevalence (16.6 vs 9.8%; 7.1 vs 2.3%), and significantly greater incidence of CAC progression (22.3 vs 15.4%; 8.7 vs 5.3%). Similar results were observed in MESA. Individuals with low 10-year but high lifetime risk have a greater subclinical disease burden and greater incidence of atherosclerotic progression compared to individuals with low 10-year and low lifetime risk, even at younger ages.