Impact of Intima-Media Thickness Progression in the Common Carotid Arteries on the Risk of Incident Cardiovascular Disease in the Suita Study.
Impact of Intima-Media Thickness Progression in the Common Carotid Arteries on the Risk of Incident Cardiovascular Disease in the Suita Study.
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DOI：
10.1161/jaha.117.007720
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发表时间：
2018-06-01
影响因子：
5.4
通讯作者：
Miyamoto Y
中科院分区：
文献类型：
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作者：
Kokubo Y;Watanabe M;Higashiyama A;Nakao YM;Nakamura F;Miyamoto Y
目前还没有关于血管内膜-中层厚度(IMT)进展与心血管疾病(CVD)发病关系的前瞻性研究。我们研究了4724名参与者(平均年龄：59.7±11.9岁；基线没有心血管疾病)，他们在1994年4月至2001年8月期间接受了颈动脉超声测量整个颈动脉区域(即，整个扫描的颈总动脉[CCA]、颈动脉球部、颈内动脉和颈外动脉区域)两侧的IMT。从1994年4月至2005年3月，2722名参与者每两年进行一次颈动脉超声随访，新发现193个颈总动脉斑块(颈总动脉和颈总动脉最大内膜厚度为1.1 mm)。我们对CVD事件进行了跟踪调查，直到2013年12月。使用COX比例风险回归模型进行统计分析，使用C统计量进行评估，并进行净重分类改进。在59-909人年的随访中，我们观察到221例中风和154例冠心病事件。颈总动脉斑块和颈动脉全区最大IMT<1.7 mm是CVD的危险因素。根据C统计量和当前风险预测模型的重新分类改进，CCA斑块显示出CVD的风险增加。在增加新的事件CCA斑块后，在23-702人年的随访中，发生了69次中风和43次冠心病事件。发生CCA斑块的调整危险比在心血管疾病中为1.95(95%可信区间，1.14-3.30)，在卒中中为2.01(95%可信区间，1.01-3.99)。颈总动脉最大内中膜厚度对计算传统危险因素所用的突发心血管事件的预测力有显著的贡献，但作用不大。这项研究首次证明了事件CCA斑块的新进展是心血管疾病的危险因素。
No prospective study of the relationship between intima–media thickness (IMT) progression and incident cardiovascular disease (CVD) has been performed. We studied 4724 participants (mean age: 59.7±11.9 years; without CVD at the baseline) who had carotid ultrasonographic measurement of IMT on both sides of the entire carotid artery area (ie, the entire scanned common carotid artery [CCA], carotid artery bulb, internal carotid artery, and external carotid artery areas for both sides) between April 1994 and August 2001. Carotid ultrasonographic follow‐up was performed every 2 years between April 1994 and March 2005 in 2722 of these participants, newly revealing 193 CCA plaques (maximum IMT in the CCA >1.1 mm). We followed up for incident CVD until December 2013. Statistical analyses were performed using a Cox proportional hazards regression model, evaluated using C statistics, and net reclassification improvement. During the 59 909 person‐years of follow‐up, we observed 221 strokes and 154 coronary heart disease events. CCA plaque and maximum IMT in the whole carotid artery area >1.7 mm were risk factors for CVD. CCA plaque presented an increased risk of CVD based on C statistics and the reclassification improvement of the current risk prediction model. After adding the new incident CCA plaques, during the 23 702 person‐years of follow‐up, 69 strokes and 43 coronary heart disease events occurred. The adjusted hazard ratios for incident CCA plaque were 1.95 (95% confidence interval, 1.14–3.30) in CVD and 2.01 (95% confidence interval, 1.01–3.99) in stroke. Maximum IMT in the CCA contributed significantly but modestly to the predictive power of incident CVD used in calculating traditional risk factors. This study provides the first demonstration that new progression of incident CCA plaque is a CVD risk.