Methodological issues facing studies of atherosclerotic change.
Methodological issues facing studies of atherosclerotic change.
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发表时间：
1993-03
期刊：
影响因子：
37.8
通讯作者：
J. Probstfield;R. Byington;D. Egan;M. Espeland;S. Margitić;W. Riley;C. Furberg
中科院分区：
文献类型：
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作者：
J. Probstfield;R. Byington;D. Egan;M. Espeland;S. Margitić;W. Riley;C. Furberg
背景冠心病与冠状动脉病变之间的关系导致了对动脉粥样硬化改变的不同干预措施的研究。目前，对患者动脉粥样硬化病变程度最准确的评价是外周动脉b超，而不是冠状动脉造影。方法与结果在测量危险因素改变对动脉粥样硬化改变的影响时，选择合适的方法和终点来量化疾病并评估随后的变化是很重要的。测量必须有效、精确和可靠，并要求对终点及其变化有适当的先验定义。研究中一致的方法是至关重要的。多种测量和数据简化方法可以提高比较的效率，值得仔细考虑。由于站点的非可视化而导致的数据缺失使分析复杂化。识别动脉粥样硬化改变的协变量和可能的混杂干预需要监测生化、生理和/或临床变量，并从中进行推断。结论：为了加强b超在动脉粥样硬化自然史评估中的应用，必须解决四个方法学问题：利用颈动脉粥样硬化评估的复合和/或单独测量来评估主要终点，评估可能允许评估特定病变解剖和/或其破裂潜力的新方法，开发利用管腔直径血管造影测量和动脉壁超声评估相补充的方法。以及内膜内侧厚度增加与随后的临床事件之间的直接联系的具体证明。在超声研究中使用连续变量（内膜-内侧厚度）具有成本/效益优势；这种方法还在不断发展。
BACKGROUND The association between coronary heart disease and lesions of the coronary arteries has led to investigations of different interventions on atherosclerotic change. Currently, B-mode ultrasound of the peripheral arterial vessels, rather than arteriography of the coronary arteries, provides the most accurate evaluation of atherosclerotic disease extent in the patient. METHODS AND RESULTS When measuring the effect of risk factor modification on atherosclerotic change, it is important to select appropriate methods and end points for quantifying disease and evaluating subsequent change. Measurements must be valid, precise, and reliable and require appropriate a priori definitions of end points and their change. Consistent methodology within studies is crucial. Multiple measurements and data reduction methods can increase the efficiency of comparisons and merit careful consideration. Missing data arising from nonvisualization of sites complicate analyses. Identifying both covariates of atherosclerotic change and possible confounding interventions require monitoring biochemical, physiological, and/or clinical variables and making inferences from these. CONCLUSIONS To strengthen the rationale for use of B-mode ultrasonography in assessing the natural history of atherosclerosis, four methodological issues must be addressed: evaluation of primary end points using composite and/or individual measurements of atherosclerotic assessment from the carotid arteries, evaluation of new methodology that may allow assessment of the anatomy of specific lesions and/or their potential for rupture, development of methods making complementary use of both angiographic measurements of lumen diameter and ultrasound assessment of the arterial wall, and concrete demonstration of a direct link between increasing intimal-medial thickness and subsequent clinical events. The use of a continuous variable (intimal-medial thickness) in ultrasound studies offers cost/benefit advantages; this methodology continues to evolve.