Wyman Rachael A, Fraizer Michael C, Keevil Jon G, Busse Kjersten L, Aeschlimann Susan E, Korcarz Claudia E, Stein James H
Section of Cardiovascular Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA.
Am Heart J. 2005 Nov;150(5):1081-5. doi: 10.1016/j.ahj.2005.01.010.
There is great need for a simple, noninvasive tool that can be used in an office setting to screen for subclinical atherosclerosis. In patients referred for cardiovascular (CV) risk assessment, we evaluated the ability of ultrasound screening for carotid plaque to identify patients with advanced subclinical atherosclerosis.
Consecutive asymptomatic patients without vascular disease referred by their physician for measurement of the ankle-brachial pressure index and carotid intima-media thickness (CIMT) were included. Carotid intima-media thickness was measured using the standardized ultrasound protocol from the Atherosclerosis Risk in Communities (ARIC) study. Advanced atherosclerosis was defined as CIMT > or = 75th percentile for age, sex, and race in ARIC.
The mean age of the 327 subjects was 55.4 years (SD 7.7 years). The 10-year Framingham CV risk was 5.1% (4.8%). In a multiple logistic regression model that included Framingham CV risk, ankle-brachial pressure index, and use of lipid-lowering medications, plaque presence significantly predicted advanced atherosclerosis (odds ratio 3.08, 95% CI 1.91-4.96, P < .001). In stepwise regression models that included age, body mass index, current tobacco use, family history of premature CV disease, fasting glucose, sex, systolic blood pressure, total/high-density lipoprotein cholesterol ratio, and use of antihypertensive and lipid-lowering medications, plaque presence independently predicted advanced atherosclerosis (P < .001).
Ultrasound detection of carotid plaque helped identify asymptomatic patients with advanced subclinical atherosclerosis. Screening for carotid plaque is easier than determination of CIMT and may help detect asymptomatic patients at increased CV risk.
非常需要一种简单的、非侵入性的工具，可在门诊环境中用于筛查亚临床动脉粥样硬化。在因心血管（CV）风险评估而转诊的患者中，我们评估了超声筛查颈动脉斑块以识别患有晚期亚临床动脉粥样硬化患者的能力。
纳入由医生转诊来测量踝臂压力指数和颈动脉内膜中层厚度（CIMT）的连续无症状且无血管疾病的患者。使用社区动脉粥样硬化风险（ARIC）研究的标准化超声方案测量颈动脉内膜中层厚度。晚期动脉粥样硬化定义为在ARIC研究中，根据年龄、性别和种族，CIMT大于或等于第75百分位数。
327名受试者的平均年龄为55.4岁（标准差7.7岁）。10年弗明汉心血管风险为5.1%（4.8%）。在一个多因素逻辑回归模型中，该模型纳入了弗明汉心血管风险、踝臂压力指数和降脂药物的使用情况，斑块的存在显著预测了晚期动脉粥样硬化（优势比3.08，95%可信区间1.91 - 4.96，P <.001）。在逐步回归模型中，该模型纳入了年龄、体重指数、当前吸烟情况、早发性心血管疾病家族史、空腹血糖、性别、收缩压、总胆固醇/高密度脂蛋白胆固醇比值以及抗高血压和降脂药物的使用情况，斑块的存在独立预测了晚期动脉粥样硬化（P <.001）。
超声检测颈动脉斑块有助于识别患有晚期亚临床动脉粥样硬化的无症状患者。筛查颈动脉斑块比测定CIMT更容易，并且可能有助于检测出心血管风险增加的无症状患者。
