Predictive Value of Coronary Artery Calcium Score Categories for Coronary Events Versus Strokes: Impact of Sex and Race MESA and DHS
Predictive Value of Coronary Artery Calcium Score Categories for Coronary Events Versus Strokes: Impact of Sex and Race MESA and DHS
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DOI：
10.1161/circimaging.119.010153
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发表时间：
2020-08-01
影响因子：
7.5
通讯作者：
Joshi, Parag H.
中科院分区：
文献类型：
--
作者：
Mehta, Anurag;Pandey, Ambarish;Joshi, Parag H.
背景资料：冠状动脉钙（CAC）预测动脉粥样硬化性心血管疾病（ASCVD）事件，包括冠心病（CHD）和中风，是一级预防的决策辅助。CAC分类对CHD和卒中的预测价值以及无症状人群的性别和种族组尚不清楚。研究方法：梅萨（多种族动脉粥样硬化研究）和DHS（达拉斯心脏研究）的白色、黑人和西班牙裔受试者在入组时接受CAC测量，并对ASCVD事件进行随访。评估了CAC评分类别0、1 - 99和≥ 100的10年CHD与卒中的发病率比。采用多变量校正的考克斯模型评价CAC与CHD和卒中事件的相关性，并检验CAC与性别/种族的多重相互作用。结果如下：在7042名参与者中（平均年龄57岁，54%为女性，36%为黑人，23%为西班牙裔，49% CAC=0，19% CAC >= 100），在12.3年的随访中观察到574起ASCVD事件（333例CHD和241例卒中）。在CAC分类中，男性、女性、白人、黑人和西班牙裔的10年CHD-卒中发病率比显著增加（所有P = 100），与所有组的ASCVD和CHD风险独立相关，与整个队列和黑人的卒中风险独立相关。未观察到基于性别或人种的CAC对ASCVD、CHD和卒中事件的相互作用。将CAC添加到传统的危险因素模型中改善了CHD的风险区分和重新分类，但对卒中事件没有改善。结论：在2个基于人群的无症状个体队列中，10年CHD与卒中的发病率比在性别和种族组中随着CAC评分类别的增加而升高，CAC始终是CHD比卒中更好的预测因子。在不同性别和种族人群中，高CAC负荷与ASCVD风险相关。
Background: Coronary artery calcium (CAC) predicts atherosclerotic cardiovascular disease (ASCVD) events, inclusive of coronary heart disease (CHD) and stroke, and is a decision-making aid for primary prevention. The predictive value of CAC categories for CHD and stroke separately and across sex and race groups of an asymptomatic population is unclear. Methods: White, Black, and Hispanic participants of MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) underwent CAC measurement at enrollment and were followed for incident ASCVD events. Ten-year CHD-to-stroke incidence ratios across CAC score categories 0, 1 to 99, and >= 100 were assessed. Associations of CAC with incident CHD and stroke events were evaluated using multivariable-adjusted Cox models and multiplicative interactions of CAC with sex/race were tested. Results: Among 7042 participants (mean age, 57 years, 54% women, 36% Black, 23% Hispanic, 49% CAC=0, 19% CAC >= 100), 574 incident ASCVD events (333 CHD and 241 stroke) were observed over 12.3-year follow-up. Ten-year CHD-to-stroke incidence ratio increased significantly across CAC categories in men, women, Whites, Blacks, and Hispanics (allP= 100) was independently associated with ASCVD and CHD risk in all groups and with stroke risk in the overall cohort and Blacks. No sex- or race-based CAC interactions for ASCVD, CHD, and stroke events were observed. Adding CAC to a traditional risk factor model improved risk discrimination and reclassification for CHD but not for stroke events. Conclusions: In 2 population-based cohorts of asymptomatic individuals, 10-year CHD-to-stroke incidence ratio was higher with increasing CAC score categories across sex and race groups, and CAC was consistently a better predictor of CHD than stroke. High CAC burden comparably associated with ASCVD risk across sex and race groups.