Junyent Mireia, Zambón Daniel, Gilabert Rosa, Núñez Isabel, Cofán Montserrat, Ros Emilio
Unitat de Lípids, Servei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.
Atherosclerosis. 2008 Feb;196(2):803-9. doi: 10.1016/j.atherosclerosis.2007.01.019. Epub 2007 Feb 21.
To assess how ultrasound measurements of carotid intima-media thickness (CIMT) and plaque burden compare with the Framingham Risk Score (FRS) in a clinical setting.
In a cross-sectional study, we determined CIMT and plaque in 409 asymptomatic, non-diabetic hyperlipidemic subjects (242 men, age 49+/-11 years) who were assessed for risk factors and classified into FRS categories: 10-year risk < or =5% (n=191), 6-20% (n=176), and >20% (n=42). Percentiles of CIMT and plaque height and regression equations of CIMT against age obtained in 250 controls subjects were used to define atherosclerosis and estimate vascular age, respectively. There was a wide dispersion of CIMT for each FRS category. CIMT values were discordant in 242 (59%) subjects, 80% of them showing more atherosclerosis than predicted. Smoking and the metabolic syndrome explained part of the discrepancies in the intermediate-risk group. Triglycerides, homocysteine, and lipoprotein(a) did not predict atherosclerotic burden. Mean vascular age was 14.5 years older than chronological age.
Carotid atherosclerosis findings readjust FRS categories in many asymptomatic subjects. Both carotid atherosclerotic burden and vascular age may be used to refine CHD risk and tailor preventive treatment beyond the FRS.
在临床环境中评估颈动脉内膜中层厚度（CIMT）和斑块负荷的超声测量结果与弗雷明汉风险评分（FRS）相比如何。
在一项横断面研究中，我们测定了409名无症状、非糖尿病高脂血症受试者（242名男性，年龄49±11岁）的CIMT和斑块情况，这些受试者接受了风险因素评估并被分类为FRS类别：10年风险≤5%（n = 191）、6 - 20%（n = 176）和>20%（n = 42）。在250名对照受试者中获得的CIMT和斑块高度百分位数以及CIMT与年龄的回归方程分别用于定义动脉粥样硬化和估计血管年龄。每个FRS类别中CIMT的离散度都很大。242名（59%）受试者的CIMT值不一致，其中80%显示出比预测更多的动脉粥样硬化。吸烟和代谢综合征解释了中风险组中部分差异。甘油三酯、同型半胱氨酸和脂蛋白(a)不能预测动脉粥样硬化负担。平均血管年龄比实际年龄大14.5岁。
颈动脉粥样硬化的发现使许多无症状受试者的FRS类别得到重新调整。颈动脉粥样硬化负担和血管年龄均可用于完善冠心病风险评估，并在FRS之外调整预防性治疗方案。
