Nicholls Stephen J, Tuzcu E Murat, Crowe Tim, Sipahi Ilke, Schoenhagen Paul, Kapadia Samir, Hazen Stanley L, Wun Chuan-Chuan, Norton Michele, Ntanios Fady, Nissen Steven E
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Am Coll Cardiol. 2006 May 16;47(10):1967-75. doi: 10.1016/j.jacc.2005.12.058. Epub 2006 Apr 24.
The goal of this study was to determine the relationship between established cardiovascular risk factors and the extent of coronary atherosclerotic plaque.
Few data exist correlating cardiovascular risk factors with volumetric measurements of coronary atheroma burden in patients with coronary artery disease.
Clinical characteristics, quantitative coronary angiography, and intravascular ultrasound (IVUS) were evaluated in subjects enrolled in a study comparing atorvastatin and pravastatin. Plaque areas were measured at 1-mm intervals to compute atheroma volume. The percent of cross sections with an abnormal intimal thickness (>0.5 mm) was determined. Data on cardiovascular risk factors were collected.
In 654 subjects, atheroma volume averaged 174.5 mm3 and percent atheroma volume 38.9%. Atherosclerosis was present in 81.2% of 25,897 cross sections. In univariate analysis, there was a strong association between diabetes, male gender, and a history of either prior revascularization or stroke with percent atheroma volume. Hypertension or prior myocardial infarction was also predictive of more severe disease. Low-density lipoprotein and C-reactive protein were not significant predictors of greater disease burden. In multivariate analysis, diabetes, male gender, and a history of a prior interventional procedure remained strong predictors of increased atheroma volume. History of stroke, non-Caucasian race, and smoking status remained significant. Although multiple measures of IVUS disease burden were worse in subjects with diabetes, angiographic stenosis severity was not different.
Male gender, diabetes, and a history of prior revascularization are strong independent predictors of atherosclerotic burden in coronary disease patients. Many risk factors did not predict angiographic disease severity, suggesting different mechanisms drive stenosis development and atheroma accumulation.
本研究的目的是确定已确定的心血管危险因素与冠状动脉粥样硬化斑块程度之间的关系。
关于冠心病患者心血管危险因素与冠状动脉粥样硬化负荷体积测量之间相关性的数据很少。
对参加比较阿托伐他汀和普伐他汀的研究的受试者进行临床特征、定量冠状动脉造影和血管内超声（IVUS）评估。以1毫米间隔测量斑块面积以计算粥样瘤体积。确定内膜厚度异常（>0.5毫米）的横截面百分比。收集心血管危险因素数据。
在654名受试者中，粥样瘤体积平均为174.5立方毫米，粥样瘤体积百分比为38.9%。在25897个横截面中，81.2%存在动脉粥样硬化。在单变量分析中，糖尿病、男性以及既往血运重建或中风史与粥样瘤体积百分比之间存在密切关联。高血压或既往心肌梗死也预示疾病更严重。低密度脂蛋白和C反应蛋白不是疾病负担加重的显著预测因素。在多变量分析中，糖尿病、男性和既往介入治疗史仍然是粥样瘤体积增加的有力预测因素。中风史、非白种人种族和吸烟状况仍然具有显著性。尽管糖尿病患者的IVUS疾病负担的多项测量结果更差，但血管造影狭窄严重程度并无差异。
男性、糖尿病和既往血运重建史是冠心病患者动脉粥样硬化负担的强大独立预测因素。许多危险因素并不能预测血管造影疾病严重程度，这表明不同机制驱动狭窄发展和粥样瘤积聚。
