Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
JACC Cardiovasc Imaging. 2010 Jun;3(6):605-13. doi: 10.1016/j.jcmg.2010.03.005.
To examine whether individuals with low short-term risk of coronary heart disease but high lifetime predicted risk of cardiovascular disease (CVD) have greater prevalence of left ventricular (LV) hypertrophy and increased aortic wall thickness (AWT) than those with low short-term and low lifetime risk.
Lifetime risk prediction can be used for stratifying individuals younger than 50 years of age into 2 groups: low short-term/high lifetime and low short-term/low lifetime predicted risk of CVD. Individuals with low short-term/high lifetime risk have a greater burden of subclinical atherosclerosis as measured by coronary artery calcium and carotid intima-media thickness. However, >75% of individuals with low short-term/high lifetime risk do not have detectable coronary artery calcium, suggesting the presence of alternative subclinical abnormalities.
We stratified 1,804 Dallas Heart Study subjects between the ages of 30 and 50 years who had cardiac magnetic resonance into 3 groups: low short-term (<10% 10-year risk of coronary heart disease)/low lifetime predicted risk (<39% lifetime risk of CVD), low short-term (<10%)/high lifetime risk (> or =39%), and high short-term risk (> or =10%, prevalent diabetes, or previous stroke, or myocardial infarction). In those with low short-term risk, we compared measures of LV hypertrophy and AWT between those with low versus high lifetime risk.
Subjects with low short-term/high lifetime risk compared with those with low short-term/low lifetime risk had increased LV mass (men: 95 +/- 17 g/m(2) vs. 90 +/- 12 g/m(2) and women: 75 +/- 14 g/m(2) vs. 71 +/- 10 g/m(2), respectively; p < 0.001 for both). LV concentricity (mass/volume), wall thickness, and AWT were also significantly greater in those with high lifetime risk in this comparison (p < 0.001 for all), but LV end-diastolic volume was not (p > 0.3). These associations persisted among participants without detectable coronary artery calcium.
Among individuals 30 to 50 years of age with low short-term risk, a high lifetime predicted risk of CVD is associated with concentric LV hypertrophy and increased AWT.
探讨短期冠心病风险低但终生心血管疾病（CVD）预测风险高的个体是否比短期和终生风险均低的个体更容易出现左心室（LV）肥厚和主动脉壁增厚（AWT）。
终生风险预测可用于将 50 岁以下的个体分为两组：短期风险低/终生风险高和短期风险低/终生风险低。通过冠状动脉钙和颈动脉内膜中层厚度（CIMT）测量，短期风险低/终生风险高的个体亚临床动脉粥样硬化负担更重。然而，>75%的短期风险高/终生风险高的个体没有检测到冠状动脉钙，这表明存在其他亚临床异常。
我们将年龄在 30 至 50 岁之间的达拉斯心脏研究（Dallas Heart Study）受试者分为三组：短期风险低（<10%的 10 年冠心病风险）/终生预测风险低（<39%的 CVD 终生风险）、短期风险低（<10%）/终生风险高（≥39%）和高短期风险（≥10%，伴糖尿病、既往卒中和心肌梗死）。在短期风险低的人群中，我们比较了终生风险低与高的个体之间 LV 肥厚和 AWT 的差异。
与短期风险低/终生风险低的个体相比，短期风险高/终生风险高的个体的 LV 质量更大（男性：95±17 g/m2 vs. 90±12 g/m2，女性：75±14 g/m2 vs. 71±10 g/m2，均 p<0.001）。在这种比较中，高终生风险个体的 LV 心腔非对称性肥厚（质量/容积）、壁厚度和 AWT 也明显更高（均 p<0.001），但 LV 舒张末期容积没有（p>0.3）。在没有检测到冠状动脉钙的参与者中，这些关联仍然存在。
在短期风险低的 30 至 50 岁人群中，终生 CVD 预测风险高与 LV 向心性肥厚和 AWT 增加相关。
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