无症状巴西男性中亚临床冠状动脉粥样硬化与美国国家胆固醇教育计划指南的关系
Relationship of subclinical coronary atherosclerosis and National Cholesterol Education Panel guidelines in asymptomatic Brazilian men.
作者信息
Nasir Khurram, Santos Raul D, Roguin Ariel, Carvalho Jose A M, Meneghello Romeu, Blumenthal Roger S
机构信息
Ciccarone Preventive Cardiology Center, Blalock 524 C-Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street Baltimore, MD 21287, United States.
出版信息
Int J Cardiol. 2006 Mar 22;108(1):68-75. doi: 10.1016/j.ijcard.2005.04.008.
BACKGROUND AND OBJECTIVE
Coronary heart disease (CHD) is the leading cause of death worldwide including Brazil. Improved precision in detecting early coronary disease may aid in more targeted preventive therapy. The National Cholesterol Education Program (NCEP) provides guidelines for determining the aggressiveness of primary prevention strategies including lipid lowering based on Framingham risk equation. Identification of subclinical atherosclerosis and coronary plaque burden is a step towards identifying high-risk individuals. This investigation was designed to determine how the updated NCEP guidelines classify asymptomatic individuals with presence of any as well as advanced CACS (coronary artery calcium score), a powerful intermediary for CHD events, in asymptomatic Brazilian men.
METHODS AND RESULTS
Five hundred forty-six asymptomatic Brazilian men (mean age: 46+/-7 years) presented to a single electron beam tomography (EBT) facility in Sao Paulo. The study population was categorized into low risk (0-1 risk factors, n=166, 30%), intermediate risk (> or = 2 risk factors but < 10% risk of CHD over 10 years, n=150, 27%), moderately high risk (2 risk factors and 10-20% risk of hard CHD events in 10 years, n=147, 28%) and high-risk (> or = 2 risk factors and > 20% risk of hard CHD events in 10 years, n=83, 15%), respectively. In our study population, overall no CACS, mild CACS (1-99.9), moderate-severe CACS (> or = 100) were observed in 317 (58%), 160 (29%) and 69 (13%) men, respectively. Advanced calcification (CACS > or = 75th percentile for age) was present in 19% (n=104) men. Based on the LDL-C cutoffs recommended by the NCEP guidelines for initiation of lipid lowering, overall only 55% with CACS > or = 100 and 42% men with CACS > or = 75th percentile qualified for pharmacotherapy. As a result nearly half of individuals with CACS > or = 100 (45%) and CACS > or = 75th percentile (48%) missed eligibility for drug therapy.
CONCLUSION
Our findings reveal the potential limitation of NCEP guidelines in identifying asymptomatic Brazilian men with significant coronary atherosclerosis who are potential candidates for aggressive primary prevention. Assessment of CACS may provide incremental value to global risk assessment in high-risk Brazilian men.
背景与目的
冠心病（CHD）是包括巴西在内的全球主要死因。提高早期冠心病检测的精准度可能有助于采取更具针对性的预防治疗。美国国家胆固醇教育计划（NCEP）提供了基于弗雷明汉风险方程确定包括降脂在内的一级预防策略积极程度的指南。识别亚临床动脉粥样硬化和冠状动脉斑块负荷是识别高危个体的重要一步。本研究旨在确定更新后的NCEP指南如何对无症状的巴西男性中存在任何程度以及重度冠状动脉钙化积分（CACS）（冠心病事件的有力中介因素）的个体进行分类。
方法与结果
546名无症状的巴西男性（平均年龄：46±7岁）前往圣保罗的一家单电子束断层扫描（EBT）机构。研究人群分为低风险组（0 - 1个风险因素，n = 166，30%）、中度风险组（≥2个风险因素但10年内心血管疾病风险<10%，n = 150，27%）、中度高风险组（2个风险因素且10年内心血管疾病硬终点事件风险为10 - 20%，n = 147，28%）和高风险组（≥2个风险因素且10年内心血管疾病硬终点事件风险>20%，n = 83，15%）。在我们的研究人群中，分别有317名（58%）、160名（29%）和69名（13%）男性未检测到CACS、轻度CACS（1 - 99.9）、中度至重度CACS（≥100）。19%（n = 104）的男性存在重度钙化（CACS≥年龄的第75百分位数）。根据NCEP指南推荐的启动降脂治疗的低密度脂蛋白胆固醇切点，总体上只有55%的CACS≥100的男性和42%的CACS≥第75百分位数的男性符合药物治疗标准。结果，近一半CACS≥100（45%）和CACS≥第75百分位数（48%）的个体未达到药物治疗标准。
结论
我们的研究结果揭示了NCEP指南在识别无症状的巴西男性中具有显著冠状动脉粥样硬化且可能是积极一级预防候选者方面的潜在局限性。对CACS的评估可能为巴西高危男性的全球风险评估提供额外价值。
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