Cardiovascular imaging for assessing cardiovascular risk in asymptomatic men versus women: the multi-ethnic study of atherosclerosis (MESA).
Cardiovascular imaging for assessing cardiovascular risk in asymptomatic men versus women: the multi-ethnic study of atherosclerosis (MESA).
复制标题
DOI：
10.1161/circimaging.110.959403
复制
发表时间：
2011-01
期刊：
影响因子：
--
通讯作者：
Bluemke DA
中科院分区：
文献类型：
--
作者：
Jain A;McClelland RL;Polak JF;Shea S;Burke GL;Bild DE;Watson KE;Budoff MJ;Liu K;Post WS;Folsom AR;Lima JA;Bluemke DA
冠状动脉钙（CAC）、颈动脉内膜中层厚度以及左心室（LV）质量和几何形状有可能描述临床无症状个体的心血管疾病（CVD）风险。该研究的目的是比较这些心血管影像测量的总体和性别特异性预测 CVD 的能力。研究样本由 4965 名多种族动脉粥样硬化研究参与者组成（48% 为男性；平均年龄为 62±10 岁）。他们在基线时没有 CVD，并接受中位随访 5.8 年。共有 297 起 CVD 事件，其中 187 起冠心病 (CHD) 事件、65 起中风和 91 起心力衰竭 (HF) 事件。 CAC 与 CHD（风险比 [HR]，2.3/1 SD；95% CI，1.9 至 2.8）和所有 CVD 事件（HR，1.7；95% CI，1.5 至 1.9）密切相关。与卒中最密切相关的是左室质量（HR，1.3；95% CI，1.1至1.7）和左室质量/体积比（HR，1.3；95% CI，1.1至1.6）。左心室质量与心力衰竭的相关性最强（HR，1.8；95% CI，1.6 至 2.1）。对于任何 CVD 结果，影像学测量与性别和种族没有显着的相互作用。与单独的传统危险因素相比，通过添加CAC、LV质量和CAC，对未来CHD、HF和所有CVD的总体风险预测（C统计）显着改善（均P<0.05）。没有证据表明影像学测量结果与不同性别的 CVD 事件相关。 CAC 与 CHD 和 CVD 的相关性最强；左心室质量和左心室同心重塑最能预测中风； LV 质量最能预测 HF。
Coronary artery calcium (CAC), carotid intima-media thickness, and left ventricular (LV) mass and geometry offer the potential to characterize incident cardiovascular disease (CVD) risk in clinically asymptomatic individuals. The objective of the study was to compare these cardiovascular imaging measures for their overall and sex-specific ability to predict CVD. The study sample consisted of 4965 Multi-Ethnic Study of Atherosclerosis participants (48% men; mean age, 62±10 years). They were free of CVD at baseline and were followed for a median of 5.8 years. There were 297 CVD events, including 187 coronary heart disease (CHD) events, 65 strokes, and 91 heart failure (HF) events. CAC was most strongly associated with CHD (hazard ratio [HR], 2.3 per 1 SD; 95% CI, 1.9 to 2.8) and all CVD events (HR, 1.7; 95% CI, 1.5 to 1.9). Most strongly associated with stroke were LV mass (HR, 1.3; 95% CI, 1.1 to 1.7) and LV mass/volume ratio (HR, 1.3; 95% CI, 1.1 to 1.6). LV mass showed the strongest association with HF (HR, 1.8; 95% CI, 1.6 to 2.1). There were no significant interactions for imaging measures with sex and ethnicity for any CVD outcome. Compared with traditional risk factors alone, overall risk prediction (C statistic) for future CHD, HF, and all CVD was significantly improved by adding CAC, LV mass, and CAC, respectively (all P<0.05). There was no evidence that imaging measures differed in association with incident CVD by sex. CAC was most strongly associated with CHD and CVD; LV mass and LV concentric remodeling best predicted stroke; and LV mass best predicted HF.