Coronary Artery Calcium and Carotid Artery Intima Media Thickness and Plaque: Clinical Use in Need of Clarification.
Coronary Artery Calcium and Carotid Artery Intima Media Thickness and Plaque: Clinical Use in Need of Clarification.
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DOI：
10.5551/jat.rv16005
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发表时间：
2017-03-01
影响因子：
4.4
通讯作者：
Miura K
中科院分区：
文献类型：
--
作者：
Zaid M;Fujiyoshi A;Kadota A;Abbott RD;Miura K
动脉粥样硬化开始于生命早期，在临床发病前有很长的潜伏期。因此，亚临床动脉粥样硬化的测量可能对动脉粥样硬化性心血管疾病（ASCVD）的研究和临床实践具有重要意义。在这篇综述中，我们重点关注冠状动脉钙（CAC）和颈动脉内膜-中膜厚度（cIMT）和斑块，因为许多基于人群的研究已经调查了这些测量方法，因为它们具有无创性和易于给药的特点。迄今为止，绝大多数研究都是在美国和欧洲国家进行的，其中CAC和cIMT/斑块都被证明与ASCVD的未来风险相关，独立于传统的风险因素。此外，当将这些措施添加到全球风险预测模型（如Framingham风险评分）中时，这些措施可以改进风险预测。然而，没有临床试验评估CAC或cIMT/斑块筛查是否会改善临床结果和医疗费用。有趣的是，不同地区和种族群体中相似的CAC或cIMT/斑块水平实际上可能与ASCVD绝对风险水平显著不同相关。因此，亚临床动脉粥样硬化的测量是否能改善非美国/欧洲人群的风险预测仍有待确定。尽管在研究中，CAC和cIMT/斑块是ASCVD的有希望的替代品，但我们得出结论，由于许多变数仍有待澄清，它们在临床实践中的应用，特别是作为无症状成人一级预防的筛查工具，尚不成熟。
Atherosclerosis begins in early life and has a long latent period prior to onset of clinical disease. Measures of subclinical atherosclerosis, therefore, may have important implications for research and clinical practice of atherosclerotic cardiovascular disease (ASCVD). In this review, we focus on coronary artery calcium (CAC) and carotid artery intima-media thickness (cIMT) and plaque as many population-based studies have investigated these measures due to their non-invasive features and ease of administration. To date, a vast majority of studies have been conducted in the US and European countries, in which both CAC and cIMT/plaque have been shown to be associated with future risk of ASCVD, independent of conventional risk factors. Furthermore, these measures improve risk prediction when added to a global risk prediction model, such as the Framingham risk score. However, no clinical trial has assessed whether screening with CAC or cIMT/plaque will lead to improved clinical outcomes and healthcare costs. Interestingly, similar levels of CAC or cIMT/plaque among various regions and ethnic groups may in fact be associated with significantly different levels of absolute risk of ASCVD. Therefore, it remains to be determined whether measures of subclinical atherosclerosis improve risk prediction in non-US/European populations. Although CAC and cIMT/plaque are promising surrogates of ASCVD in research, we conclude that their use in clinical practice, especially as screening tools for primary prevention in asymptomatic adults, is premature due to many vagaries that remain to be clarified.