Carotid Intima-Media Thickness and the Risk of Sudden Cardiac Death: The ARIC Study and the CHS.
Carotid Intima-Media Thickness and the Risk of Sudden Cardiac Death: The ARIC Study and the CHS.
复制标题
DOI：
10.1161/jaha.120.016981
复制
发表时间：
2020-10-20
影响因子：
5.4
通讯作者：
Mosley TH
中科院分区：
文献类型：
--
作者：
Suzuki T;Wang W;Wilsdon A;Butler KR;Adabag S;Griswold ME;Nambi V;Rosamond W;Sotoodehnia N;Mosley TH
在大多数情况下，心源性猝死（SCD）与严重冠心病有关。颈动脉内膜中层厚度 (C-IMT) 作为亚临床动脉粥样硬化的已知替代标志物，是否与普通人群发生 SCD 的风险相关仍不清楚。本研究的目的是调查 C-IMT 与 SCD 风险之间的关联。我们总共检查了 20,862 名参与者：15,307 名 ARIC（社区动脉粥样硬化风险）研究参与者和 5555 名 CHS（心血管健康研究）参与者。在基线时通过超声测量 C-IMT 和颈总动脉内膜中层厚度。由训练有素的读者来判断斑块的存在。在 ARIC 研究中，平均随访时间为 23.5 年，其中 569 名参与者患有 SCD（每 1000 人年 1.81 例）。在调整传统危险因素和时变调整因素后，平均 C-IMT 和颈总动脉内膜中层厚度与 SCD 风险相关：第四四分位数与第一四分位数的 95% CI 的风险比 (HR) 分别为 1.64 (1.15-2.63) 和 1.49 (1.05-2.11)。在 CHS 中，13.1 年内有 302 名参与者患上 SCD（每 1000 人年 4.64 例）。调整后最大 C-IMT 与 SCD 风险相关：第四四分位数与第一四分位数的 HR (95% CI) 为 1.75 (1.22–2.51)。斑块的存在与 SCD 风险增加 35% 相关：ARIC 研究中的 HR (95% CI) 为 1.37 (1.13–1.67)，CHS 中的 HR (95% CI) 为 1.32 (1.04–1.68)。在 2 个混血社区队列中，C-IMT 与 SCD 风险相关。 C-IMT 可用作 SCD 风险的标志，并有可能启动早期治疗干预措施以减轻风险。
Sudden cardiac death (SCD) is associated with severe coronary heart disease in the great majority of cases. Whether carotid intima‐media thickness (C‐IMT), a known surrogate marker of subclinical atherosclerosis, is associated with risk of SCD in a general population remains unknown. The objective of this study was to investigate the association between C‐IMT and risk of SCD. We examined a total of 20 862 participants: 15 307 participants of the ARIC (Atherosclerosis Risk in Communities) study and 5555 participants of the CHS (Cardiovascular Health Study). C‐IMT and common carotid artery intima‐media thickness was measured at baseline by ultrasound. Presence of plaque was judged by trained readers. Over a median of 23.5 years of follow‐up, 569 participants had SCD (1.81 cases per 1000 person‐years) in the ARIC study. Mean C‐IMT and common carotid artery intima‐media thickness were associated with risk of SCD after adjustment for traditional risk factors and time‐varying adjustors: hazard ratios (HRs) with 95% CIs for fourth versus first quartile were 1.64 (1.15–2.63) and 1.49 (1.05–2.11), respectively. In CHS, 302 participants developed SCD (4.64 cases per 1000 person‐years) over 13.1 years. Maximum C‐IMT was associated with risk of SCD after adjustment: HR (95% CI) for fourth versus first quartile was 1.75 (1.22–2.51). Presence of plaque was associated with 35% increased risk of SCD: HR (95% CI) of 1.37 (1.13–1.67) in the ARIC study and 1.32 (1.04–1.68) in CHS. C‐IMT was associated with risk of SCD in 2 biracial community‐based cohorts. C‐IMT may be used as a marker of SCD risk and potentially to initiate early therapeutic interventions to mitigate the risk.