Lipid Clinic Heart Institute - InCor, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.
Atherosclerosis. 2010 Mar;209(1):131-5. doi: 10.1016/j.atherosclerosis.2009.08.025. Epub 2009 Aug 21.
The presence of coronary artery calcium (CAC) is an independent marker of increased risk of cardiovascular disease (CVD) events and mortality. However, the predictive value of thoracic aorta calcification (TAC), which can be additionally identified without further scanning during assessment of CAC, is unknown.
We followed a cohort of 8401 asymptomatic individuals (mean age: 53+/-10 years, 69% men) undergoing cardiac risk factor evaluation and TAC and CAC testing with electron beam computed tomography. Multivariable Cox proportional hazards models were developed to predict all-cause mortality based on the presence of TAC.
During a median follow-up period of 5 years, 124 (1.5%) deaths were observed. Overall survival was 96.9% and 98.9% for those with and without detectable TAC, respectively (p<0.0001). Compared to those with no TAC, the hazard ratio for mortality in the presence of TAC was 3.25 (95% CI: 2.28-4.65, p<0.0001) in unadjusted analysis. After adjusting for age, gender, hypertension, dyslipidemia, diabetes mellitus, smoking and family history of premature coronary artery disease, and presence of CAC the relationship remained robust (HR 1.61, 95% CI: 1.10-2.27, p=0.015). Likelihood ratio chi(2) statistics demonstrated that the addition of TAC contributed significantly in predicting mortality to traditional risk factors alone (chi(2)=13.62, p=0.002) as well as risk factors+CAC (chi(2)=5.84, p=0.02) models.
In conclusion, the presence of TAC was associated with all-cause mortality in our study; this relationship was independent of conventional CVD risk factors as well as the presence of CAC.
冠状动脉钙（CAC）的存在是心血管疾病（CVD）事件和死亡率增加的独立标志物。然而，在评估 CAC 期间无需进一步扫描即可额外识别的胸主动脉钙化（TAC）的预测价值尚不清楚。
我们对 8401 名无症状个体（平均年龄：53+/-10 岁，69%为男性）进行了心脏危险因素评估，并进行了 TAC 和 CAC 电子束计算机断层扫描检测。使用多变量 Cox 比例风险模型，根据 TAC 的存在情况预测全因死亡率。
在中位随访 5 年期间，观察到 124 例（1.5%）死亡。总生存率分别为 96.9%和 98.9%，对于有和无可检测到 TAC 的个体分别为（p<0.0001）。与无 TAC 个体相比，存在 TAC 时死亡率的风险比为 3.25（95%CI：2.28-4.65，p<0.0001），未经调整分析。在调整年龄、性别、高血压、血脂异常、糖尿病、吸烟和家族性早发性冠心病史以及 CAC 存在后，这种关系仍然很牢固（HR 1.61，95%CI：1.10-2.27，p=0.015）。似然比 χ2 检验表明，与仅传统危险因素（χ2=13.62，p=0.002）以及危险因素+CAC（χ2=5.84，p=0.02）模型相比，TAC 的存在显著有助于预测死亡率。
总之，在我们的研究中，TAC 的存在与全因死亡率相关；这种关系独立于传统的 CVD 危险因素以及 CAC 的存在。
