The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis.
The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis.
复制标题
颈动脉牙菌斑和内膜媒体厚度对心血管疾病的价值：动脉粥样硬化的多种族研究。
DOI：
10.1161/jaha.113.000087
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发表时间：
2013-04-08
影响因子：
5.4
通讯作者：
O'Leary DH
中科院分区：
文献类型：
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作者：
Polak JF;Szklo M;Kronmal RA;Burke GL;Shea S;Zavodni AE;O'Leary DH
颈动脉斑块与冠状动脉粥样硬化病变有关。我们评估了颈动脉斑块的各种超声定义作为未来心血管疾病（CVD）和冠心病（CHD）事件的预测因子。我们研究了多种族动脉粥样硬化研究 (MESA) 的 6562 名成员（平均年龄 61.1 岁；52.6% 为女性）的危险因素和颈动脉超声测量基线。 ICA 病变主观定义为>0% 或≥25% 直径狭窄，采用连续内膜中层厚度 (IMT) 测量（最大 IMT 或 6 个图像的最大 IMT 的平均值）并使用 1.5 mm IMT 切点。多变量 Cox 比例风险模型用于估计 CVD、CHD 和中风事件的风险比。 Harrell 的 C 统计、净重分类改进和综合判别改进用于评估斑块指标的增量预测价值。在 7.8 年的平均随访中，当添加到弗雷明汉风险因素中时，所有斑块指标均显着预测 CVD 事件 (n=515)。除 1 项指标外，所有指标均改善了 CHD 的预测（通过 C 统计量、净重分类改进和综合辨别改进。最大 IMT 平均值的 NRI 最高（7.0%；P=0.0003），风险比为 1.43/mm；95% CI 1.26–1.63），其次是最大 IMT，NRI 为 6.8%，风险比为 1.27（95% CI） 1.18–1.38）。超声衍生的斑块指标独立预测我们队列中的心血管事件，并在添加到弗雷明汉风险因素中时改善冠心病事件的风险预测。
Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events. We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi‐Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima‐media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5‐mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C‐statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8‐year mean follow‐up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C‐statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P=0.0003) with risk ratio of 1.43/mm; 95% CI 1.26–1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18–1.38). Ultrasound‐derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.