Bild Diane E, Detrano Robert, Peterson Do, Guerci Alan, Liu Kiang, Shahar Eyal, Ouyang Pamela, Jackson Sharon, Saad Mohammed F
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md, USA.
Circulation. 2005 Mar 15;111(10):1313-20. doi: 10.1161/01.CIR.0000157730.94423.4B.
There is substantial evidence that coronary calcification, a marker for the presence and quantity of coronary atherosclerosis, is higher in US whites than blacks; however, there have been no large population-based studies comparing coronary calcification among US ethnic groups.
Using computed tomography, we measured coronary calcification in 6814 white, black, Hispanic, and Chinese men and women aged 45 to 84 years with no clinical cardiovascular disease who participated in the Multi-Ethnic Study of Atherosclerosis (MESA). The prevalence of coronary calcification (Agatston score >0) in these 4 ethnic groups was 70.4%, 52.1%, 56.5%, and 59.2%, respectively, in men (P<0.001) and 44.6%, 36.5%, 34.9%, and 41.9%, respectively, (P<0.001) in women. After adjustment for age, education, lipids, body mass index, smoking, diabetes, hypertension, treatment for hypercholesterolemia, gender, and scanning center, compared with whites, the relative risks for having coronary calcification were 0.78 (95% CI 0.74 to 0.82) in blacks, 0.85 (95% CI 0.79 to 0.91) in Hispanics, and 0.92 (95% CI 0.85 to 0.99) in Chinese. After similar adjustments, the amount of coronary calcification among those with an Agatston score >0 was greatest among whites, followed by Chinese (77% that of whites; 95% CI 62% to 96%), Hispanics (74%; 95% CI 61% to 90%), and blacks (69%; 95% CI 59% to 80%).
We observed ethnic differences in the presence and quantity of coronary calcification that were not explained by coronary risk factors. Identification of the mechanism underlying these differences would further our understanding of the pathophysiology of coronary calcification and its clinical significance. Data on the predictive value of coronary calcium in different ethnic groups are needed.
有大量证据表明，冠状动脉钙化作为冠状动脉粥样硬化存在和数量的一个标志物，在美国白人中比黑人更高；然而，尚无基于大样本人群的研究比较美国不同种族群体之间的冠状动脉钙化情况。
我们利用计算机断层扫描技术，对参加动脉粥样硬化多民族研究（MESA）的6814名年龄在45至84岁、无临床心血管疾病的白人、黑人、西班牙裔和华裔男性及女性进行了冠状动脉钙化测量。这4个种族群体中男性冠状动脉钙化（阿加斯顿积分>0）的患病率分别为70.4%、52.1%、56.5%和59.2%（P<0.001），女性分别为44.6%、36.5%、34.9%和41.9%（P<0.001）。在对年龄、教育程度、血脂、体重指数、吸烟、糖尿病、高血压、高胆固醇血症治疗、性别和扫描中心进行校正后，与白人相比，黑人发生冠状动脉钙化的相对风险为0.78（95%可信区间0.74至0.82），西班牙裔为0.85（95%可信区间0.79至0.91），华裔为0.92（95%可信区间0.85至0.99）。经过类似校正后，阿加斯顿积分>0者的冠状动脉钙化量在白人中最大，其次是华裔（为白人的77%；95%可信区间62%至96%）、西班牙裔（74%；95%可信区间61%至90%）和黑人（69%；95%可信区间59%至80%）。
我们观察到冠状动脉钙化的存在和数量存在种族差异，这些差异无法用冠状动脉危险因素来解释。确定这些差异背后的机制将有助于我们进一步理解冠状动脉钙化的病理生理学及其临床意义。需要不同种族群体中冠状动脉钙化预测价值的数据。
