Newman Anne B, Naydeck Barbara L, Sutton-Tyrrell Kim, Edmundowicz Daniel, O'Leary Daniel, Kronmal Richard, Burke Gregory L, Kuller Lewis H
Division of Geriatric Medicine, University of Pittsburgh, Pa 15213, USA.
Arterioscler Thromb Vasc Biol. 2002 Oct 1;22(10):1674-9. doi: 10.1161/01.atv.0000033540.89672.24.
In the Cardiovascular Health Study, subclinical cardiovascular disease (CVD) predicted CVD events in older adults. The extent to which this measure or its components reflect calcified coronary disease is unknown.
Coronary artery calcium (CAC) was assessed with electron beam tomography in 414 participants without clinical CVD and examined using cut points (CAC> or =400 and CAC> or =800) and the log(CAC); 274 had subclinical CVD by ankle-arm index, ECG, or carotid ultrasound. Cut points for subclinical disease as previously defined in the Cardiovascular Health Study were examined as well as continuous measures to produce receiver operating characteristic curve curves. A low ankle-arm index was highly specific for a high CAC score. The internal carotid artery intima-media thickness was most strongly correlated with CAC (r=0.30) and was significantly related to both CAC cut points and to the log(CAC) score independently of all other measures.
In these community-dwelling older adults without clinical CVD, internal carotid artery intima-media thickness was most closely related to CAC. However, 17.5% of those with a CAC> or =400 would be missed in the ascertainment of subclinical atherosclerosis using the previously published composite of subclinical atherosclerosis. Prospective follow-up will determine whether the CAC score improves prediction of CVD events over other noninvasive measures.
在心血管健康研究中，亚临床心血管疾病（CVD）可预测老年人的CVD事件。该指标或其组成部分反映钙化性冠状动脉疾病的程度尚不清楚。
采用电子束断层扫描对414例无临床CVD的参与者进行冠状动脉钙化（CAC）评估，并使用切点（CAC≥400和CAC≥800）和log（CAC）进行分析；274例通过踝臂指数、心电图或颈动脉超声诊断为亚临床CVD。研究了心血管健康研究中先前定义的亚临床疾病切点以及生成受试者工作特征曲线的连续测量指标。低踝臂指数对高CAC评分具有高度特异性。颈内动脉内膜中层厚度与CAC相关性最强（r=0.30），且独立于所有其他指标，与CAC切点和log（CAC）评分均显著相关。
在这些无临床CVD的社区居住老年人中，颈内动脉内膜中层厚度与CAC关系最为密切。然而，如果使用先前发表的亚临床动脉粥样硬化综合指标来确定亚临床动脉粥样硬化，那么CAC≥400的人群中有17.5%会被漏诊。前瞻性随访将确定CAC评分是否比其他非侵入性指标能更好地预测CVD事件。
