Folsom Aaron R, Kronmal Richard A, Detrano Robert C, O'Leary Daniel H, Bild Diane E, Bluemke David A, Budoff Matthew J, Liu Kiang, Shea Steven, Szklo Moyses, Tracy Russell P, Watson Karol E, Burke Gregory L
Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Ste 300, Minneapolis, MN 55454-1015, USA.
Arch Intern Med. 2008 Jun 23;168(12):1333-9. doi: 10.1001/archinte.168.12.1333.
Coronary artery calcium (CAC) and carotid intima-media thickness (IMT) are noninvasive measures of atherosclerosis that consensus panels have recommended as possible additions to risk factor assessment for predicting the probability of cardiovascular disease (CVD) occurrence. Our objective was to assess whether maximum carotid IMT or CAC (Agatston score) is the better predictor of incident CVD.
A prospective cohort study of subjects aged 45 to 84 years in 4 ethnic groups, who were initially free of CVD (n = 6698) was performed, with standardized carotid IMT and CAC measures at baseline, in 6 field centers of the Multi-Ethnic Study of Atherosclerosis (MESA). The main outcome measure was the risk of incident CVD events (coronary heart disease, stroke, and fatal CVD) over a maximum of 5.3 years of follow-up.
There were 222 CVD events during follow-up. Coronary artery calcium was associated more strongly than carotid IMT with the risk of incident CVD. After adjustment for each other (CAC score and IMT) and age, race, and sex [corrected], the hazard ratio of CVD increased 2.1-fold (95% confidence interval [CI], 1.8-2.5) for each 1-standard deviation (SD) increment of log-transformed CAC score, vs 1.3-fold (95% CI, 1.1-1.4) for each 1-SD increment of the maximum IMT. For coronary heart disease, the hazard ratios per 1-SD increment increased 2.5-fold (95% CI, 2.1-3.1) for CAC score and 1.2-fold (95% CI, 1.0-1.4) for IMT. A receiver operating characteristic curve analysis also suggested that CAC score was a better predictor of incident CVD than was IMT, with areas under the curve of 0.81 vs 0.78, respectively.
Although whether and how to clinically use bioimaging tests of subclinical atherosclerosis remains a topic of debate, this study found that CAC score is a better predictor of subsequent CVD events than carotid IMT.
冠状动脉钙化（CAC）和颈动脉内膜中层厚度（IMT）是动脉粥样硬化的无创检测指标，共识小组建议将其作为预测心血管疾病（CVD）发生概率的风险因素评估的可能补充指标。我们的目的是评估最大颈动脉IMT或CAC（阿加斯顿评分）是否是新发CVD的更好预测指标。
对4个种族的45至84岁受试者进行了一项前瞻性队列研究，这些受试者最初无CVD（n = 6698），在动脉粥样硬化多民族研究（MESA）的6个现场中心进行了基线时标准化的颈动脉IMT和CAC测量。主要结局指标是在最长5.3年的随访期间新发CVD事件（冠心病、中风和致命性CVD）的风险。
随访期间发生了222例CVD事件。冠状动脉钙化与新发CVD风险的相关性比颈动脉IMT更强。在相互调整（CAC评分和IMT）以及年龄、种族和性别[校正后]后, 对数转换后的CAC评分每增加1个标准差（SD），CVD的风险比增加2.1倍（95%置信区间[CI]，1.8 - 2.5），而最大IMT每增加1个SD，风险比增加1.3倍（95%CI，1.1 - 1.4）。对于冠心病，CAC评分每增加1个SD，风险比增加2.5倍（95%CI，2.1 - 3.1），IMT每增加1个SD，风险比增加1.2倍（95%CI，1.0 - 1.4）。受试者工作特征曲线分析还表明，CAC评分是比IMT更好的新发CVD预测指标，曲线下面积分别为0.81和0.78。
尽管亚临床动脉粥样硬化的生物成像检查是否以及如何在临床上应用仍是一个有争议的话题，但本研究发现，CAC评分比颈动脉IMT是更好的后续CVD事件预测指标。
