Department of Internal Medicine, The Cardiovascular Research Unit, Glostrup University Hospital, Nordre Ringvej, Glostrup, Denmark.
Eur Heart J. 2010 Apr;31(7):883-91. doi: 10.1093/eurheartj/ehp546. Epub 2009 Dec 23.
It is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects.
In a population-based sample of 1968 subjects without cardiovascular disease or diabetes not receiving any cardiovascular, anti-diabetic, or lipid-lowering treatment, aged 41, 51, 61, or 71 years, we measured traditional cardiovascular risk factors, left ventricular (LV) mass index, atherosclerotic plaques in the carotid arteries, carotid/femoral pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR) and followed them for a median of 12.8 years. Eighty-one subjects died because of cardiovascular causes. Risk of cardiovascular death was independently of SCORE associated with LV hypertrophy [hazard ratio (HR) 2.2 (95% CI 1.2-4.0)], plaques [HR 2.5 (1.6-4.0)], UACR > or = 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE > or = 5% and 7.3 (3.2-16.1) for SCORE < 5%]. Restricting primary prevention to subjects with SCORE > or = 5% as well as subclinical organ damage, increased specificity of risk prediction from 75 to 81% (P < 0.002), but reduced sensitivity from 72 to 65% (P = 0.4). Broaden primary prevention from subjects with SCORE > or = 5% to include subjects with 1% < or = SCORE < 5% together with subclinical organ damage increased sensitivity from 72 to 89% (P = 0.006), but reduced specificity from 75 to 57% (P < 0.002) and positive predictive value from 11 to 8% (P = 0.07).
Subclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction.
目前尚不清楚亚临床血管损伤是否会显著增加健康人群中系统性冠状动脉风险评估（SCORE）的风险分层。
在一个基于人群的样本中，我们纳入了 1968 名无心血管疾病或糖尿病、未接受任何心血管、抗糖尿病或降脂治疗、年龄在 41、51、61 或 71 岁的受试者，测量了传统的心血管危险因素、左心室（LV）质量指数、颈动脉粥样硬化斑块、颈动脉/股动脉脉搏波速度（PWV）和尿白蛋白/肌酐比值（UACR），并随访中位数为 12.8 年。81 名受试者因心血管原因死亡。心血管死亡的风险与 SCORE 无关，但与 LV 肥大[危险比（HR）2.2（95%可信区间 1.2-4.0）]、斑块[HR 2.5（1.6-4.0）]、UACR>或=90 百分位[HR 3.3（1.8-5.9）]、PWV>12 m/s[HR 1.9（1.1-3.3），SCORE>或=5%和 7.3（3.2-16.1），SCORE<5%]相关。将一级预防限制在 SCORE>或=5%和亚临床器官损伤的患者中，可使风险预测的特异性从 75%提高到 81%（P<0.002），但敏感性从 72%降低到 65%（P=0.4）。将一级预防从 SCORE>或=5%的患者扩大到包括 SCORE 为 1%<或=SCORE<5%和亚临床器官损伤的患者，可使敏感性从 72%提高到 89%（P=0.006），但特异性从 75%降低到 57%（P<0.002）和阳性预测值从 11%降低到 8%（P=0.07）。
亚临床器官损伤独立于 SCORE 预测心血管死亡，两者结合可能改善风险预测。
