Wasserman Bruce A, Sharrett A Richey, Lai Shenghan, Gomes Antoinette S, Cushman Mary, Folsom Aaron R, Bild Diane E, Kronmal Richard A, Sinha Shantanu, Bluemke David A
The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Stroke. 2008 Feb;39(2):329-35. doi: 10.1161/STROKEAHA.107.498634. Epub 2008 Jan 3.
Atheroma vulnerability to rupture is increased in the presence of a large lipid core. Factors associated with a lipid core in the general population have not been studied.
The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of individuals free of clinical cardiovascular disease designed to include a high proportion of ethnic minorities. We selected MESA participants from the top 15th percentile of maximum carotid intima media thickness by ultrasound and acquired high-resolution black blood MRI images through their carotid plaque before and after the intravenous administration of gadodiamide (0.1 mmol/kg). Lumen and outer wall contours were defined using semiautomated analysis software. We analyzed only plaques with a maximum thickness >or=1.5 mm by MRI (n=214) and assessed cross-sectional risk factor associations with lipid core presence by multivariable logistic regression.
A lipid core was present in 151 (71%) of the plaques. After controlling for age, ethnicity, sex, maximum arterial wall thickness, hypertension, cigarette smoking, diabetes, and C-reactive protein, compared with participants in the lowest tertile of total plasma cholesterol, the ORs of having a lipid core for participants in the middle and highest tertiles were 2.76 (95% CI: 1.01 to 7.51) and 4.63 (95% CI: 1.56 to 13.75), respectively. None of the other risk factors was associated with lipid core.
In persons with thickened carotid walls, plasma total cholesterol, but not other established coronary heart disease risk factors, is strongly associated with lipid core presence by MRI. High total cholesterol may be associated with rupture proneness of atherosclerotic lesions in the general population.
存在大脂质核心时，动脉粥样硬化斑块破裂的易损性增加。尚未对一般人群中与脂质核心相关的因素进行研究。
动脉粥样硬化多民族研究（MESA）是一项针对无临床心血管疾病个体的多中心队列研究，旨在纳入高比例的少数族裔。我们通过超声从颈动脉内膜中层厚度最大值处于前15%的MESA参与者中进行选择，并在静脉注射钆双胺（0.1 mmol/kg）前后获取其颈动脉斑块的高分辨率黑血MRI图像。使用半自动分析软件定义管腔和外壁轮廓。我们仅分析MRI显示最大厚度≥1.5 mm的斑块（n = 214），并通过多变量逻辑回归评估与脂质核心存在相关的横断面危险因素。
151个（71%）斑块存在脂质核心。在控制年龄、种族、性别、最大动脉壁厚度、高血压、吸烟、糖尿病和C反应蛋白后，与总血浆胆固醇处于最低三分位数的参与者相比，总血浆胆固醇处于中间和最高三分位数的参与者存在脂质核心的比值比分别为2.76（95%CI：1.01至7.51）和4.63（95%CI：1.56至13.75）。其他危险因素均与脂质核心无关。
在颈动脉壁增厚的人群中，血浆总胆固醇而非其他已确定的冠心病危险因素与MRI显示的脂质核心存在密切相关。高总胆固醇可能与一般人群中动脉粥样硬化病变易于破裂有关。
