Rivera Juan J, Nasir Khurram, Katz Ronit, Takasu Junichiro, Allison Matthew, Wong Nathan D, Barr R Graham, Carr Jeffrey J, Blumenthal Roger S, Budoff Matthew J
Division of Cardiology, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Am J Cardiol. 2009 Jun 1;103(11):1562-7. doi: 10.1016/j.amjcard.2009.02.004. Epub 2009 Apr 1.
Thoracic aortic calcium (TAC) has been associated with a higher prevalence of coronary arterial calcium (CAC). The purpose of this study was to assess the relations between TAC and incident CAC and CAC progression in a cohort from the Multi-Ethnic Study of Atherosclerosis (MESA). MESA is a prospective cohort study of 6,814 participants free of clinical cardiovascular disease at entry who underwent noncontrast cardiac computed tomographic scanning at baseline examination and at a 2-year follow-up assessment. The independent associations between TAC and incident CAC in those without CAC at baseline and between TAC and CAC progression in those with CAC at baseline were investigated. The final study population consisted of 5,755 subjects (84%; mean age 62 +/- 10 years, 48% men) who had follow-up CAC scores an average of 2.4 years later. Incident CAC was significantly higher in those with TAC compared with those without TAC at baseline (11 per 100 patient-years vs 6 per 100 patient-years). Similarly, TAC was associated with a higher CAC change (p <0.0001) in those with some CAC at baseline. In analysis adjusted for demographics and follow-up duration, TAC was associated with incident CAC (relative risk 1.72, p <0.0001) as well as with a greater CAC change (first quartile: relative risk 2.89, 95% confidence interval -3.16 to 8.95; fourth quartile: relative risk 24.21, 95% confidence interval 18.25 to 30.18). In conclusion, TAC is associated with the incidence and progression of CAC. The detection of TAC may improve risk stratification efforts. Future clinical outcomes studies are needed to support such an approach.
胸主动脉钙化（TAC）与冠状动脉钙化（CAC）的较高患病率相关。本研究的目的是在动脉粥样硬化多族裔研究（MESA）队列中评估TAC与新发CAC以及CAC进展之间的关系。MESA是一项前瞻性队列研究，纳入了6814名入组时无临床心血管疾病的参与者，他们在基线检查和2年随访评估时接受了非增强心脏计算机断层扫描。研究调查了基线时无CAC者中TAC与新发CAC之间以及基线时有CAC者中TAC与CAC进展之间的独立关联。最终研究人群包括5755名受试者（84%；平均年龄62±10岁，48%为男性），他们在平均2.4年后有随访的CAC评分。与基线时无TAC者相比，有TAC者的新发CAC显著更高（每100患者年11例 vs 每100患者年6例）。同样，在基线时有一些CAC的患者中，TAC与更高的CAC变化相关（p<0.0001）。在针对人口统计学和随访持续时间进行调整的分析中，TAC与新发CAC相关（相对风险1.72，p<0.0001），也与更大的CAC变化相关（第一四分位数：相对风险2.89，95%置信区间 -3.16至8.95；第四四分位数：相对风险24.21，95%置信区间18.25至30.18）。总之，TAC与CAC的发生和进展相关。TAC的检测可能会改善风险分层工作。需要未来的临床结局研究来支持这种方法。
