National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA.
J Am Coll Cardiol. 2010 Jun 1;55(22):2491-8. doi: 10.1016/j.jacc.2010.03.019.
To determine the association of long-term exposure to atherosclerosis risk factors with valvular calcification.
Traditional atherosclerosis risk factors have been associated with aortic and mitral valve calcium in cross-sectional studies, but long-term prospective data are lacking.
This was a prospective, community-based cohort study with 27-year follow-up (median follow-up 26.9 years; range 23.1 to 29.6 years). Participants from the Framingham Offspring Study (n = 1,323, enrolled between 1971 and 1975, mean age at enrollment 34 +/- 9 years; 52% women) underwent cardiac multidetector computed tomography assessment between 2002 and 2005. Associations between the long-term average of each cardiovascular risk factor and valve calcium were estimated using logistic regression.
Aortic valve calcium was present in 39% of participants and mitral valve calcium in 20%. In multivariable models, the odds ratio for aortic valve calcium associated with every SD increment in long-term mean total cholesterol was 1.74 (p < 0.0001); with every SD increment in high-density lipoprotein cholesterol, it was 0.77 (p = 0.002); and with every 9 cigarettes smoked per day, it was 1.23 (p = 0.002). Associations of similar magnitude were seen for mitral valve calcium. The mean of 3 serum C-reactive protein measurements was associated with mitral valve calcium (odds ratio: 1.29 per SD increment in C-reactive protein levels; p = 0.002). A higher Framingham risk score in early adulthood (40 years age or younger) was associated with increased prevalence and severity of aortic valve calcium measured 3 decades later.
Exposure to multiple atherosclerotic risk factors starting in early to mid-adulthood is associated with aortic and mitral valve calcium. Studies evaluating early risk factor modification to reduce the burden of valve disease are warranted.
确定长期暴露于动脉粥样硬化危险因素与瓣膜钙化的关系。
传统的动脉粥样硬化危险因素与横断面研究中的主动脉瓣和二尖瓣钙有关，但缺乏长期前瞻性数据。
这是一项前瞻性、基于社区的队列研究，随访时间为 27 年（中位随访时间为 26.9 年；范围为 23.1 至 29.6 年）。弗雷明汉后代研究（Framingham Offspring Study）的参与者（n=1323 人，1971 年至 1975 年之间招募，入组时平均年龄 34±9 岁；52%为女性）在 2002 年至 2005 年间接受了心脏多层计算机断层扫描评估。使用逻辑回归估计每种心血管危险因素的长期平均水平与瓣膜钙之间的关系。
39%的参与者存在主动脉瓣钙，20%的参与者存在二尖瓣钙。在多变量模型中，与长期平均总胆固醇每增加 1 个标准差相关的主动脉瓣钙的比值比为 1.74（p<0.0001）；与高密度脂蛋白胆固醇每增加 1 个标准差相关的比值比为 0.77（p=0.002）；与每天吸烟 9 支相关的比值比为 1.23（p=0.002）。类似程度的关联也见于二尖瓣钙。3 次血清 C 反应蛋白测量的平均值与二尖瓣钙有关（比值比：C 反应蛋白水平每增加 1 个标准差增加 1.29；p=0.002）。成年早期（40 岁或以下）较高的弗雷明汉风险评分与 30 年后测量的主动脉瓣钙的患病率和严重程度增加有关。
成年早期至中期暴露于多种动脉粥样硬化危险因素与主动脉瓣和二尖瓣钙有关。有必要进行评估早期危险因素修正以减少瓣膜疾病负担的研究。
