Aortic Calcification Onset and Progression: Association With the Development of Coronary Atherosclerosis.
Aortic Calcification Onset and Progression: Association With the Development of Coronary Atherosclerosis.
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DOI：
10.1161/jaha.116.005093
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发表时间：
2017-03-30
影响因子：
5.4
通讯作者：
Mahabadi AA
中科院分区：
文献类型：
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作者：
Kälsch H;Lehmann N;Moebus S;Hoffmann B;Stang A;Jöckel KH;Erbel R;Mahabadi AA
胸主动脉钙化(TAC)和冠状动脉钙化(CAC)是亚临床动脉粥样硬化的标志，与发生的主要心血管事件有关。我们调查了TAC发生和进展的主要决定因素，以及TAC和CAC发生和进展之间的关系。在一项基于人群的队列研究中，3270名参与者(年龄45-74岁，53.1%的女性)在基线和平均5.1±0.3年的随访后接受了心脏计算机断层扫描，以量化胸主动脉(ATAC)和降主动脉(DTAC)和CAC的钙化。采用多变量相对风险回归分析研究心血管危险因素与事件TAC、基线TAC与事件CAC、基线CAC与事件TAC的关系。在基线TAC为0的1243名参与者中，517名(41.6%)在5年后发生了TAC。TAC下降的发生率(34.5%)高于上升的TAC(23.3%)。5年后发生TAC与年龄(相对危险度1.26[95%可信区间1.21~1.33]，每5年)、血压(相对危险度1.06[95%可信区间1.03~1.10]，每10毫米汞柱)、低密度脂蛋白胆固醇(相对危险度1.08[95%可信区间1.04~1.12]，每20毫克/分升)、吸烟(相对危险度1.28[95%可信区间1.07~1.53])有关。在基线时没有CAC的1185名参与者中，有基线TAC时发生CAC的风险为28.3%，而没有基线TAC的参与者发生CAC的风险为22.2%(超额风险6.1%[95%可信区间1.2-11.0%])。发生CAC的超额危险点估计值在TAC上升组较高(10.8%[95%CI 4.8~16.7%])，而TAC下降组较低(1.8%[95%CI−3.2%~6.7%])。目前基线CAC发生TAC上行和下行的超额风险分别为16.4%(95%可信区间12.7~20.0%)和15.6%(95%可信区间10.8~20.4%)。TAC和CAC具有相似的事件钙化的主要决定因素。患有TAC的患者，特别是TAC升高的患者，发生CAC的风险更高。
Thoracic aortic calcification (TAC) and coronary artery calcification (CAC) are markers of subclinical atherosclerosis and are associated with incident major cardiovascular events. We investigated major determinants for incidence and progression of TAC and the association between TAC and CAC incidence and progression. In a population‐based cohort study, 3270 participants (aged 45–74 years, 53.1% women) received cardiac computed tomography at baseline and after a mean follow‐up of 5.1±0.3 years for quantification of calcification of the ascending (ATAC) and descending thoracic aorta (DTAC) and CAC. Multivariable relative risk regression analysis was used to investigate associations of cardiovascular risk factors with incident TAC, of baseline TAC with incident CAC, and of baseline CAC with incident TAC. Of 1243 participants with baseline TAC of 0, 517 (41.6%) revealed incident TAC after 5 years. Incidence of descending TAC was higher (34.5%) than ascending TAC (23.3%). Incident TAC after 5 years was associated with age (relative risk 1.26 [95% CI 1.21–1.33], per 5 years), blood pressure (relative risk 1.06 [95% CI 1.03–1.10], per 10 mm Hg), low‐density lipoprotein cholesterol (relative risk 1.08 [95% CI 1.04–1.12], per 20 mg/dL), and smoking (relative risk 1.28 [95% CI 1.07–1.53]). Among the 1185 participants without CAC at baseline, the risk of developing CAC was 28.3% when baseline TAC was present compared with 22.2% among those without baseline TAC (excess risk 6.1% [95% CI 1.2–11.0%]). The point estimate of excess risk for incident CAC was higher for ascending TAC (10.8% [95% CI 4.8–16.7%]) and low for descending TAC (1.8% [95% CI −3.2% to 6.7%]). Excess risk for developing ascending and descending TAC with present baseline CAC was 16.4% (95% CI 12.7–20.0%) and 15.6% (95% CI 10.8–20.4%), respectively. TAC and CAC share similar major determinants for incident calcification. Participants with TAC, especially ascending TAC, are at elevated risk for development of CAC.