Risk Factors for Long-Term Coronary Artery Calcium Progression in the Multi-Ethnic Study of Atherosclerosis.
Risk Factors for Long-Term Coronary Artery Calcium Progression in the Multi-Ethnic Study of Atherosclerosis.
复制标题
DOI：
10.1161/jaha.114.001726
复制
发表时间：
2015-08-06
影响因子：
5.4
通讯作者：
Kaufman JD
中科院分区：
文献类型：
--
作者：
Gassett AJ;Sheppard L;McClelland RL;Olives C;Kronmal R;Blaha MJ;Budoff M;Kaufman JD
冠状动脉钙化（CAC）是一种测量冠状动脉粥样硬化负荷的方法。CAC水平的升高与冠状动脉事件的增加密切相关。先前对心血管疾病危险因素和CAC进展的研究受限于随访时间短或限于疾病晚期患者。我们在一项前瞻性多民族队列研究中检查了心血管疾病危险因素和CAC进展。6810名无心血管疾病的成年人在10年内测量CAC 1至4次（平均2.5次扫描）。平均CAC进展为23.9 Agatston单位/年。混合效应模型的创新应用研究了心血管疾病危险因素与CAC进展之间的关系。该方法根据时变因素进行调整，在随访时间和每个参与者的观察次数方面具有灵活性，并允许同时控制与基线CAC和CAC进展相关的因素。模型包括年龄、性别、研究地点、扫描仪类型和种族。CAC进展与年龄（每10年14.2 Agatston单位/年[95% CI 13.0 ~ 15.5]）、男性（17.8 Agatston单位/年[95% CI 15.3 ~ 20.3]）、高血压（13.8 Agatston单位/年[95% CI 11.2 ~ 16.5]）、糖尿病（31.3 Agatston单位/年[95% CI 27.4 ~ 35.3]）和其他因素存在关联。通过一种新颖的分析方法，在10年的随访中分析了CAC的进展，结果表明CAC与心血管事件发生的危险因素有很强的关系。在此框架下分析的CAC纵向进展可用于评估新的心血管危险因素。
Coronary artery calcium (CAC) detected by noncontrast cardiac computed tomography scanning is a measure of coronary atherosclerosis burden. Increasing CAC levels have been strongly associated with increased coronary events. Prior studies of cardiovascular disease risk factors and CAC progression have been limited by short follow-up or restricted to patients with advanced disease. We examined cardiovascular disease risk factors and CAC progression in a prospective multiethnic cohort study. CAC was measured 1 to 4 times (mean 2.5 scans) over 10 years in 6810 adults without preexisting cardiovascular disease. Mean CAC progression was 23.9 Agatston units/year. An innovative application of mixed-effects models investigated associations between cardiovascular disease risk factors and CAC progression. This approach adjusted for time-varying factors, was flexible with respect to follow-up time and number of observations per participant, and allowed simultaneous control of factors associated with both baseline CAC and CAC progression. Models included age, sex, study site, scanner type, and race/ethnicity. Associations were observed between CAC progression and age (14.2 Agatston units/year per 10 years [95% CI 13.0 to 15.5]), male sex (17.8 Agatston units/year [95% CI 15.3 to 20.3]), hypertension (13.8 Agatston units/year [95% CI 11.2 to 16.5]), diabetes (31.3 Agatston units/year [95% CI 27.4 to 35.3]), and other factors. CAC progression analyzed over 10 years of follow-up, with a novel analytical approach, demonstrated strong relationships with risk factors for incident cardiovascular events. Longitudinal CAC progression analyzed in this framework can be used to evaluate novel cardiovascular risk factors.