Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA).
Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA).
复制标题
DOI：
10.1161/circulationaha.115.018524
复制
发表时间：
2016-03-01
期刊：
影响因子：
37.8
通讯作者：
Nasir K
中科院分区：
文献类型：
--
作者：
Blaha MJ;Cainzos-Achirica M;Greenland P;McEvoy JW;Blankstein R;Budoff MJ;Dardari Z;Sibley CT;Burke GL;Kronmal RA;Szklo M;Blumenthal RS;Nasir K
尽管阴性心血管疾病（CVD）风险标记具有改善医疗决策的潜力，但人们对它们的关注有限。我们使用诊断似然比（DLR）比较了13个阴性风险标记，该诊断似然比模拟了个体在附加测试结果后的风险变化。我们检查了来自多种族动脉粥样硬化研究的6814名参与者。冠状动脉钙(CAC) =0，颈动脉内膜-中膜厚度(CIMT) <25百分位，无颈动脉斑块，肱血流调节扩张>5%变化，踝肱指数(ABI) >0.9和<1.3，高敏c反应蛋白(hsCRP) < 2mg /L，同型半胱氨酸<10µmol/L, NTpro-BNP <100 pg/mL，无微量白蛋白尿，无冠心病（任何/过早）家族史，无代谢综合征，健康生活方式。硬性冠心病和所有心血管疾病在10年的随访中根据传统的心血管疾病危险因素对模型进行调整。在所有负风险指标中，CAC=0最强，所有冠心病的校正平均DLR （SD）为0.41 (0.12)，CVD的校正平均DLR （SD）为0.54(0.12)，其次是CIMT <25百分位（DLR分别为0.65[0.04]和0.75[0.04]）。HsCRP <2 mg/L和ABI正常的DLRs为0.80。在临床特征中，无冠心病家族史是最强的（dlr分别为0.76[0.07]和0.81[0.06]）。净重新分类改善（NRI）分析也得出了类似的结果，CAC=0导致最大、最准确的风险重新分类。动脉粥样硬化影像学检查的阴性结果，特别是CAC=0，导致CVD估计风险的最大下降。这些结果可能有助于指导关于鉴别不太可能从终生预防性药物治疗中获得净收益的个体的讨论。
Limited attention has been paid to negative cardiovascular disease (CVD) risk markers despite their potential to improve medical decision-making. We compared thirteen negative risk markers using diagnostic likelihood ratios (DLR), which model the change in risk for an individual after the result of an additional test. We examined 6,814 participants from the Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium (CAC) =0, carotid intima-media thickness (CIMT) <25th percentile, absence of carotid plaque, brachial flow-mediated dilation >5% change, ankle brachial index (ABI) >0.9 and <1.3, high sensitivity C-reactive protein (hsCRP) <2 mg/L, homocysteine <10 µmol/L, NTpro-BNP <100 pg/mL, no microalbuminuria, no family history of coronary heart disease (CHD) (any/premature), absence of metabolic syndrome, and healthy lifestyle were compared for all, hard CHD and all CVD events over 10-year follow-up. Models were adjusted for traditional CVD risk factors. Among all negative risk markers CAC=0 was the strongest, with adjusted mean DLR (SD) of 0.41 (0.12) for all CHD and 0.54 (0.12) for CVD, followed by CIMT <25th percentile (DLRs 0.65 [0.04] and 0.75 [0.04], respectively). HsCRP <2 mg/L and normal ABI had DLRs >0.80. Among clinical features, absence of any family history of CHD was the strongest (DLRs 0.76 [0.07] and 0.81 [0.06], respectively). Net Reclassification Improvement (NRI) analyses yielded similar findings, with CAC=0 resulting in the largest, most accurate downward risk reclassification. Negative results of atherosclerosis-imaging tests, particularly CAC=0, resulted in the greatest downward shift in estimated CVD risk. These results may help guide discussions regarding identification of individuals less likely to receive net benefit from lifelong preventive pharmacotherapy.