Predictors of Coronary Artery Calcium and Long-Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults.
Predictors of Coronary Artery Calcium and Long-Term Risks of Death, Myocardial Infarction, and Stroke in Young Adults.
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DOI：
10.1161/jaha.121.022513
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发表时间：
2021-11-16
影响因子：
5.4
通讯作者：
Villines TC
中科院分区：
文献类型：
--
作者：
Javaid A;Mitchell JD;Villines TC
冠状动脉钙（CAC）在中老年成人心血管疾病风险分层中得到了很好的验证;然而，2019年美国心脏病学会/美国心脏协会指南指出，需要更多关于CAC在低风险年轻人中的表现的数据。我们在1997年至2009年期间对13397例年龄在30至49岁之间、无已知心血管疾病或恶性肿瘤的患者进行了CAC测量。使用考克斯比例风险模型评估心肌梗死（MI）、卒中、主要心血管不良事件（MACE; MI、卒中或心血管死亡）和全因死亡率的结局，控制基线风险因素（包括卒中和MACE的房颤）和死亡或非心源性死亡的竞争风险（如适用）。该队列（74%男性，平均年龄44岁，76%有≤1个心血管疾病风险因素）的任何CAC患病率为20.6%。年龄、男性、白色人种和心血管疾病危险因素是CAC的独立预测因素。在平均11年的随访中，MI和MACE的CAC >0的相对调整子风险比分别为2.9和1.6。CAC >100与MI（调整后的亚危险比，5.2）、MACE（调整后的亚危险比，3.1）、卒中（调整后的亚危险比，1.7）和全因死亡率（危险比，2.1）的风险显著增加相关。通过似然比检验，CAC显著提高了MACE、MI和全因死亡率风险因素的预后准确性（P<0.05）。CAC在低风险年轻人的大样本中普遍存在。有任何CAC的患者MACE和MI的长期风险显著更高，而重度CAC增加了所有结局（包括死亡）的风险。CAC可能对选定的年轻人的临床决策有用。
Coronary artery calcium (CAC) is well‐validated for cardiovascular disease risk stratification in middle to older–aged adults; however, the 2019 American College of Cardiology/American Heart Association guidelines state that more data are needed regarding the performance of CAC in low‐risk younger adults. We measured CAC in 13 397 patients aged 30 to 49 years without known cardiovascular disease or malignancy between 1997 and 2009. Outcomes of myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE; MI, stroke, or cardiovascular death), and all‐cause mortality were assessed using Cox proportional hazard models, controlling for baseline risk factors (including atrial fibrillation for stroke and MACE) and the competing risk of death or noncardiac death as appropriate. The cohort (74% men, mean age 44 years, and 76% with ≤1 cardiovascular disease risk factor) had a 20.6% prevalence of any CAC. CAC was independently predicted by age, male sex, White race, and cardiovascular disease risk factors. Over a mean of 11 years of follow‐up, the relative adjusted subhazard ratio of CAC >0 was 2.9 for MI and 1.6 for MACE. CAC >100 was associated with significantly increased hazards of MI (adjusted subhazard ratio, 5.2), MACE (adjusted subhazard ratio, 3.1), stroke (adjusted subhazard ratio, 1.7), and all‐cause mortality (hazard ratio, 2.1). CAC significantly improved the prognostic accuracy of risk factors for MACE, MI, and all‐cause mortality by the likelihood ratio test (P<0.05). CAC was prevalent in a large sample of low‐risk young adults. Those with any CAC had significantly higher long‐term hazards of MACE and MI, while severe CAC increased hazards for all outcomes including death. CAC may have utility for clinical decision‐making among select young adults.