Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA)
Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA)
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DOI：
10.1093/eurheartj/ehy217
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发表时间：
2018-07-01
影响因子：
39.3
通讯作者：
Wong, Nathan D.
中科院分区：
文献类型：
--
作者：
Budoff, Matthew J.;Young, Rebekah;Wong, Nathan D.
目的 虽然冠状动脉钙 (CAC) 已被广泛验证用于预测临床事件，但大多数 CAC 结果研究评估的是冠心病 (CHD)，而不是动脉粥样硬化性心血管疾病 (ASCVD) 事件（包括中风）。此外，几乎所有 CAC 研究都是短期或中期随访，因此在广泛临床使用之前，有必要进行跨多种族队列的长期随访研究。我们试图使用基于人群的 MESA 队列对 ASCVD 事件进行超过 10 年的随访来评估 CAC 的贡献，以及 CAC 与事件的关联是否因性别、种族/民族或年龄类别而异。 方法和结果 我们利用了 MESA，这是一项前瞻性多种族队列研究，共有 6814 名参与者（51% 为女性），年龄为 45-84 岁，基线时没有临床 CVD。我们使用 MESA 评估了 CAC 与事件 ASCVD 之间的关系Cox回归模型根据年龄、种族/民族、性别、教育、收入、吸烟状况、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、糖尿病、降脂药物、收缩压、抗高血压药物、有意体育锻炼和体重指数进行调整。分析中仅使用每个人的第一个事件。总体而言，在中位 11.1 年的时间里，在整个研究人群中观察到了 500 起 ASCVD (7.4%) 事件。严重 ASCVD 包括 217 例心肌梗死、188 例中风（非短暂性脑缺血发作）、13 例心脏骤停复苏和 82 例 CHD 死亡。 CAC = 0 Agatston 单位的患者的事件发生率范围为 1.3% 至 5.6%，而对于 CAC > 300 的患者，不同年龄、性别和种族亚组的 10 年事件发生率范围为 13.1% 至 25.6%。在 10 年的随访中，无论人口亚群如何，所有 CAC>100 的参与者估计都有 >7.5% 的风险。无论年龄、性别或种族/民族，十年 ASCVD 事件发生率在 CAC 类别中稳步上升。在所有其他风险因素保持不变的情况下，CAC 每增加一倍，我们估计 ASCVD 风险就会相对增加 14%。这种关联不会因年龄、性别、种族/民族或基线降脂使用而显着改变。 结论 冠状动脉钙与 10 年发生 ASCVD 的风险呈分级方式密切相关，就像 CHD 一样，与标准风险因素无关，并且与年龄、性别和种族相似。虽然 CAC = 0 的患者的 10 年事件发生率几乎完全低于 5%，但 CAC >= 100 的患者的 10 年事件发生率始终高于 7.5%，这为考虑预防性治疗提供了这些潜在有价值的切点。冠状动脉钙可以强烈预测风险，对所有种族、年龄组和男女都有相同程度的影响，这使其成为预测 ASCVD 风险最有用的标志物之一。
Aims While coronary artery calcium (CAC) has been extensively validated for predicting clinical events, most outcome studies of CAC have evaluated coronary heart disease (CHD) rather than atherosclerotic cardiovascular disease (ASCVD) events (including stroke). Also, virtually all CAC studies are of short- or intermediate-term follow-up, so studies across multi-ethnic cohorts with long-term follow-up are warranted prior to widespread clinical use. We sought to evaluate the contribution of CAC using the population-based MESA cohort with over 10years of follow-up for ASCVD events, and whether the association of CAC with events varied by sex, race/ethnicity, or age category.Methods and results We utilized MESA, a prospective multi-ethnic cohort study of 6814 participants (51% women), aged 45-84years, free of clinical CVD at baseline We evaluated the relationship between CAC and incident ASCVD using Cox regression models adjusted for age, race/ethnicity, sex, education, income, cigarette smoking status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes, lipid-lowering medication, systolic blood pressure, antihypertensive medication, intentional physical exercise, and body mass index. Only the first event for each individual was used in the analysis. Overall, 500 incident ASCVD (7.4%) events were observed in the total study population over a median of 11.1 years. Hard ASCVD included 217 myocardial infarction, 188 strokes (not transient ischaemic attack), 13 resuscitated cardiac arrest, and 82 CHD deaths. Event rates in those with CAC = 0 Agatston units ranged from 1.3% to 5.6%, while for those with CAC > 300, the 10-year event rates ranged from 13.1% to 25.6% across different age, gender, and racial subgroups. At 10years of follow-up, all participants with CAC>100 were estimated to have >7.5% risk regardless of demographic subset. Ten-year ASCVD event rates increased steadily across CAC categories regardless of age, sex, or race/ethnicity. For each doubling of CAC, we estimated a 14% relative increment in ASCVD risk, holding all other risk factors constant. This association was not significantly modified by age, sex, race/ethnicity, or baseline lipid-lowering use.Conclusions Coronary artery calcium is associated strongly and in a graded fashion with 10-year risk of incident ASCVD as it is for CHD, independent of standard risk factors, and similarly by age, gender, and ethnicity. While 10-year event rates in those with CAC = 0 were almost exclusively below 5%, those with CAC >= 100 were consistently above 7.5%, making these potentially valuable cutpoints for the consideration of preventive therapies. Coronary artery calcium strongly predicts risk with the same magnitude of effect in all races, age groups, and both sexes, which makes it among the most useful markers for predicting ASCVD risk.