日本城市普通人群中主要冠状动脉危险因素聚集与颈动脉粥样硬化加速之间存在强烈且显著的关系：吹田研究。

Strong and significant relationships between aggregation of major coronary risk factors and the acceleration of carotid atherosclerosis in the general population of a Japanese city: the Suita Study.

作者信息

Mannami T, Baba S, Ogata J

机构信息

Department of Preventive Cardiology, National Cardiovascular Center, Fujishirodai, Suita, Osaka, Japan.

出版信息

Arch Intern Med. 2000;160(15):2297-303. doi: 10.1001/archinte.160.15.2297.

DOI:10.1001/archinte.160.15.2297

PMID:10927726

Abstract

BACKGROUND

Carotid arterial intimal-medial thickness (IMT) measured by high-resolution B-mode ultrasonography has come to be used as a noninvasive surrogate end point to measure progression of atherosclerosis. However, there are no detailed data on the relationship between aggregation of coronary risk factors and carotid atherogenesis.

METHODS

Cross-sectional assessment of the relationship between carotid atherosclerosis detected by high-resolution ultrasonography and integration of major coronary risk factors by age and sex. Subjects aged 30 to 86 years were randomly selected from Suita, located in Osaka, the second largest urban area of Japan, including 1896 men and 2102 women. Carotid atherosclerosis was evaluated by using our atherosclerotic indexes of IMT, plaque number, plaque score, and percentage of stenosis of the carotid artery assessed using ultrasonography by sex and age group classified by number of major coronary risk factors (ie, hypertension [diastolic blood pressure > or =90 mm Hg and/or systolic blood pressure > or 140 mm Hg or receiving medication], smoking [current smoker], and hypercholesterolemia [serum total cholesterol level > or =5.68 mmol/L [220 mg/dL] or receiving medication]).

RESULTS

The mean carotid atherosclerotic index value, especially the mean IMT value, of the subjects with 1 major coronary risk factor was on average 0.028 mm (3.2%) higher for men and 0.025 mm (2.9%) higher for women than that of the subjects without major coronary risk factors; for subjects with 2 risk factors, 0.054 mm (6.3%) higher for men and 0.053 mm (6.2%) higher for women; and for high-risk subjects with 3 major risk factors, 0.135 mm (15.8%) higher for men and 0.137 mm (15.4%) higher for women. The percentage of the subjects with severe stenosis of at least 50% increased stepwise with increases in the number of coronary risk factors and showed a significant difference (P<.05) between men and women, ie, 2.4% vs 0. 6% (P =.01) among the subjects with no risk factors; 6.7% vs 1.5% (P<.001), subjects with 1 risk factor; 10.7% vs 2.7% (P<.001), subjects with 2 risk factors; and 18.6% vs 5.0% (P =.01), high-risk subjects.

CONCLUSIONS

Aggregation of established major coronary risk factors strongly influenced carotid atherogenesis in both sexes. There were significant differences between sexes in the acceleration or progression of carotid atherosclerosis.

摘要

背景

通过高分辨率B型超声测量的颈动脉内膜中层厚度（IMT）已被用作评估动脉粥样硬化进展的非侵入性替代终点。然而，关于冠状动脉危险因素聚集与颈动脉粥样硬化发生之间的关系，目前尚无详细数据。

方法

通过高分辨率超声检测颈动脉粥样硬化，并按年龄和性别对主要冠状动脉危险因素进行综合分析，进行横断面评估。研究对象为年龄在30至86岁之间的人群，从日本第二大城市大阪的吹田市随机选取，其中男性1896名，女性2102名。使用我们的动脉粥样硬化指标（IMT、斑块数量、斑块评分以及通过超声评估的颈动脉狭窄百分比），按主要冠状动脉危险因素数量（即高血压[舒张压≥90 mmHg和/或收缩压≥140 mmHg或正在接受药物治疗]、吸烟[当前吸烟者]和高胆固醇血症[血清总胆固醇水平≥5.68 mmol/L（220 mg/dL）或正在接受药物治疗]）对性别和年龄组进行分类，评估颈动脉粥样硬化情况。

结果

有1个主要冠状动脉危险因素的受试者，其平均颈动脉粥样硬化指标值，尤其是平均IMT值，男性比无主要冠状动脉危险因素的受试者平均高0.028 mm（3.2%），女性高0.025 mm（2.9%）；有2个危险因素的受试者，男性高0.054 mm（6.3%），女性高0.053 mm（6.2%）；有3个主要危险因素的高危受试者，男性高0.135 mm（15.8%），女性高0.137 mm（15.4%）。至少50%严重狭窄的受试者百分比随着冠状动脉危险因素数量的增加而逐步上升，且男女之间存在显著差异（P<0.05），即无危险因素的受试者中分别为2.4%和0.6%（P = 0.01）；有1个危险因素的受试者中分别为6.7%和1.5%（P<0.001）；有2个危险因素的受试者中分别为10.7%和2.7%（P<0.001）；高危受试者中分别为18.6%和5.0%（P = 0.01）。