Loria Catherine M, Liu Kiang, Lewis Cora E, Hulley Stephen B, Sidney Stephen, Schreiner Pamela J, Williams O Dale, Bild Diane E, Detrano Robert
Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7936, USA.
J Am Coll Cardiol. 2007 May 22;49(20):2013-20. doi: 10.1016/j.jacc.2007.03.009. Epub 2007 May 4.
We sought to determine whether early adult levels of cardiovascular risk factors predict subsequent coronary artery calcium (CAC) better than concurrent or average 15-year levels and independent of a 15-year change in levels.
Few studies have used multiple measures over the course of time to predict subclinical atherosclerosis.
African American and white adults, ages 18 to 30 years, in 4 U.S. cities were enrolled in the prospective CARDIA (Coronary Artery Risk Development in Young Adults) study from 1985 to 1986. Risk factors were measured at years 0, 2, 5, 7, 10, and 15, and CAC was assessed at year 15 (n = 3,043).
Overall, 9.6% adults had any CAC, with a greater prevalence among men than women (15.0% vs. 5.1%), white than African American men (17.6% vs. 11.3%), and ages 40 to 45 years than 33 to 39 years (13.3% vs. 5.5%). Baseline levels predicted CAC presence (C = 0.79) equally as well as average 15-year levels (C = 0.79; p = 0.8262) and better than concurrent levels (C = 0.77; p = 0.019), despite a 15-year change in risk factor levels. Multivariate-adjusted odds ratios of having CAC by ages 33 to 45 years were 1.5 (95% confidence interval [CI] 1.3 to 1.7) per 10 cigarettes, 1.5 (95% CI 1.3 to 1.8) per 30 mg/dl low-density lipoprotein cholesterol, 1.3 (95% CI 1.1 to 1.5) per 10 mm Hg systolic blood pressure, and 1.2 (95% CI 1.1 to 1.4) per 15 mg/dl glucose at baseline. Young adults with above optimal risk factor levels at baseline were 2 to 3 times as likely to have CAC.
Early adult levels of modifiable risk factors, albeit low, were equally or more informative about odds of CAC in middle age than subsequent levels. Earlier risk assessment and efforts to achieve and maintain optimal risk factor levels may be needed.
我们试图确定成年早期的心血管危险因素水平相较于同时期或15年平均水平，在预测后续冠状动脉钙化（CAC）方面是否更具优势，且不受15年水平变化的影响。
很少有研究在一段时间内使用多种测量方法来预测亚临床动脉粥样硬化。
1985年至1986年，来自美国4个城市的18至30岁非裔美国人和白人成年人参加了前瞻性CARDIA（年轻成年人冠状动脉风险发展）研究。在第0、2、5、7、10和15年测量危险因素，并在第15年评估CAC（n = 3,043）。
总体而言，9.6%的成年人有任何冠状动脉钙化，男性患病率高于女性（15.0%对5.1%），白人男性高于非裔美国男性（17.6%对11.3%），40至45岁年龄段高于33至39岁年龄段（13.3%对5.5%）。尽管危险因素水平有15年的变化，但基线水平预测冠状动脉钙化存在的能力（C = 0.79）与15年平均水平相当（C = 0.79；p = 0.8262），且优于同时期水平（C = 0.77；p = 0.019）。33至45岁有冠状动脉钙化的多变量调整优势比为每10支香烟1.5（95%置信区间[CI] 1.3至1.7），每30mg/dl低密度脂蛋白胆固醇1.5（95% CI 1.3至1.8），每10mmHg收缩压1.3（95% CI 1.1至1.5），基线时每15mg/dl血糖1.2（95% CI 1.1至1.4）。基线时危险因素水平高于最佳水平的年轻成年人患冠状动脉钙化的可能性是其他人的2至3倍。
成年早期可改变的危险因素水平虽低，但在预测中年时冠状动脉钙化的几率方面，与后续水平相比同样或更具参考价值。可能需要更早进行风险评估，并努力达到和维持最佳危险因素水平。
