Kuller Lewis H, Matthews Karen A, Edmundowicz Daniel, Chang Yuefang
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, United States.
Atherosclerosis. 2008 Oct;200(2):278-85. doi: 10.1016/j.atherosclerosis.2007.12.057. Epub 2008 Mar 4.
Recent studies have shown that individuals with 0 coronary artery calcium (CAC) scores have very low risk of coronary heart disease. In the Healthy Women Study, we evaluated development of new CAC among postmenopausal women (n=272) over a 6-year period, age 62 at the 1st and 68 at the 3rd electron beam tomography (EBT) examination. At the 1st EBT, 155 of 272 (57%) women had 0 CAC. By the 3rd, 56 (36%) of these women had developed new CAC, including 38 with >or=5 Agatston units. There was practically no regression from having CAC at the 1st EBT to no CAC at the 3rd EBT. The risk of developing new CAC over 6 years among women with 0 CAC on their 1st EBT was strongly and significantly related to presence of both aortic calcium and carotid plaque at the time of 1st EBT. Baseline premenopausal risk factors, age 47, apolipoprotein B, body mass index (BMI) and triglycerides, were significant predictors of incident CAC as were the changes in BMI and low density lipoprotein cholesterol between premenopause and the 1st post exam, age 53. Risk factors measured premenopause and change in risk factors from premenopause to the 1st post exam and the extent of subclinical disease in other vascular beds are primary determinants of the risk of developing incident CAC in women over a 6-year period.
近期研究表明，冠状动脉钙化（CAC）评分为0的个体患冠心病的风险非常低。在健康女性研究中，我们评估了绝经后女性（n = 272）在6年期间新出现的CAC情况，第一次电子束断层扫描（EBT）检查时年龄为62岁，第三次检查时为68岁。在第一次EBT检查时，272名女性中有155名（57%）的CAC评分为0。到第三次检查时，这些女性中有56名（36%）出现了新的CAC，其中38名的阿加斯顿单位≥5。实际上，从第一次EBT检查时有CAC到第三次检查时无CAC的情况几乎没有逆转。第一次EBT检查时CAC评分为0的女性在6年内出现新的CAC的风险与第一次EBT检查时主动脉钙化和颈动脉斑块的存在密切相关且具有显著相关性。绝经前的基线风险因素，如47岁时的载脂蛋白B、体重指数（BMI）和甘油三酯，以及绝经前和第一次检查后（53岁）之间BMI和低密度脂蛋白胆固醇的变化，都是新发CAC的显著预测因素。绝经前测量的风险因素、绝经前到第一次检查后风险因素的变化以及其他血管床亚临床疾病的程度是女性在6年期间发生新发CAC风险的主要决定因素。
