Kitagawa Kazuo, Hougaku Hidetaka, Yamagami Hiroshi, Hashimoto Hiroyuki, Itoh Taiji, Shimizu Yoshiomi, Takahashi Daisuke, Murata Shinji, Seike Yujiro, Kondo Kimito, Hoshi Taku, Furukado Shigetaka, Abe Yuko, Yagita Yoshiki, Sakaguchi Manabu, Tagaya Masafumi, Etani Hideki, Fukunaga Ryuzo, Nagai Yoji, Matsumoto Masayasu, Hori Masatsugu
Stroke Division, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Cerebrovasc Dis. 2007;24(1):35-42. doi: 10.1159/000103114. Epub 2007 May 22.
There is epidemiological evidence that increased carotid intima-media thickness (IMT) is a predictor of cardiovascular disease (CVD) events. However, the significance of carotid IMT in high-risk patients in whom risk factors are managed clinically has not been adequately investigated. The purpose of this study was to determine the usefulness of carotid IMT measurement in such patients.
The study comprised 900 outpatients with cardiovascular risk factors or established atherosclerosis. Carotid IMT was calculated as the mean bilateral IMT of the common carotid artery, bifurcation, and internal carotid artery. Baseline vascular risk factors, medications, and history of CVD were recorded at the time of enrollment. The incidence of CVD events was determined prospectively.
During a mean follow-up period of 2.6 years, there were 64 CVD events. The relative risk (RR) of a CVD event increased with increased IMT. Association between CVD events and carotid IMT was significant after adjustment for risk factors and history of CVD, showing an increased risk per IMT tertile from the middle tertile (RR, 2.5; 95% confidence interval [CI]: 1.0-6.3) to the highest (RR, 3.6; 95% CI: 1.4-9.0). When patients with a history of CVD were excluded (n = 574), the predictive value of IMT was significant even after adjustment for risk factors (hazard ratio per 1 SD IMT increase was 1.57 [95% CI: 1.11-2.20]).
Carotid IMT is an independent predictor of vascular events in high-risk patients in whom risk factors are managed clinically.
有流行病学证据表明，颈动脉内膜中层厚度（IMT）增加是心血管疾病（CVD）事件的一个预测指标。然而，对于临床上已对危险因素进行管理的高危患者，颈动脉IMT的意义尚未得到充分研究。本研究的目的是确定在这类患者中测量颈动脉IMT的实用性。
本研究纳入了900例有心血管危险因素或已确诊动脉粥样硬化的门诊患者。颈动脉IMT计算为双侧颈总动脉、分叉处和颈内动脉的平均IMT。在入组时记录基线血管危险因素、用药情况和CVD病史。前瞻性地确定CVD事件的发生率。
在平均2.6年的随访期内，发生了64例CVD事件。CVD事件的相对风险（RR）随IMT增加而升高。在对危险因素和CVD病史进行调整后，CVD事件与颈动脉IMT之间的关联具有显著性，显示从中间三分位数到最高三分位数，每增加一个IMT三分位数风险增加（RR，2.5；95%置信区间[CI]：1.0 - 6.3）至（RR，3.6；95% CI：1.4 - 9.0）。当排除有CVD病史的患者（n = 574）时，即使在对危险因素进行调整后，IMT的预测价值仍具有显著性（IMT每增加1个标准差的风险比为1.57 [95% CI：1.11 - 2.20]）。
对于临床上已对危险因素进行管理的高危患者，颈动脉IMT是血管事件的独立预测指标。
