在低弗莱明汉风险评分的受试者中，超声检测到的颈动脉粥样硬化发生率较高：这可能提示对亚临床动脉粥样硬化进行筛查。
High prevalence of ultrasound detected carotid atherosclerosis in subjects with low Framingham risk score: potential implications for screening for subclinical atherosclerosis.
机构信息
Cardiac Non Invasive Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
出版信息
J Am Soc Echocardiogr. 2010 Aug;23(8):809-15. doi: 10.1016/j.echo.2010.05.005. Epub 2010 May 31.
BACKGROUND
The cardiovascular (CV) risk assigned by the Framingham risk score (FRS) misses many subjects destined for CV events. Coronary artery calcification (CAC) as measured by computed tomography and carotid intima-media thickness (CIMT) and plaque assessment using B-mode ultrasound can identify subclinical atherosclerosis. The comparative relation of CAC and CIMT and carotid plaque after integration into the FRS is not established. The aim of this study was to develop a CV screening approach incorporating FRS, CAC, and CIMT.
METHODS
The prevalence of subclinical atherosclerosis, defined as CAC score > 0, CIMT > or = 75th percentile, or plaque > or = 1.5 mm, was determined in the groups with low, intermediate, and high FRS among 136 asymptomatic subjects. The CIMT and CAC values were used to determine "vascular age" and "coronary calcium" age, respectively, with established nomograms.
RESULTS
In the 103 low-risk (FRS < 10%) subjects, 41%, 50%, 59%, and 66% had CAC scores > 0, CIMT > or = 75th percentile, plaque > or = 1.5 mm, and CIMT > or = 75th percentile or plaque > or = 1.5 mm, respectively. In the 33 subjects with intermediate (n = 14) or high (n = 19) FRS, 70%, 81%, 87%, and 87% had CAC scores > 0, CIMT > or = 75th percentile, plaque > or = 1.5 mm, and CIMT > or = 75th percentile or plaque > or = 1.5 mm, respectively. Fifty-two percent of subjects with coronary calcium scores of zero had carotid plaque. Adjusted for FRS, body mass index was an independent predictor of abnormal CIMT in the low-FRS group, but not of abnormal CAC. Mean vascular CIMT age was significantly higher than coronary calcium age (61.6 + or - 11.4 vs 58.3 + or - 11.1 years, P = .001), and both were significantly higher than chronologic age (56.9 + or - 10.1 years) (P < .0001 and P < .04, respectively). CIMT upgraded or downgraded FRS by >5% in more cases than CAC (42% vs 17%).
CONCLUSION
In asymptomatic patients without CV disease, CIMT and plaque assessment are more likely to revise FRS than CAC. Body mass index predicts increased CIMT in low-FRS subjects. These findings may have broad implications for screening in low-FRS subjects.
背景
弗雷明汉风险评分（FRS）所评估的心血管（CV）风险会漏掉许多注定会发生 CV 事件的患者。通过计算机断层扫描测量的冠状动脉钙化（CAC）以及使用 B 型超声评估的颈动脉内膜中层厚度（CIMT）和斑块，可以识别亚临床动脉粥样硬化。将 CAC 和 CIMT 以及颈动脉斑块整合到 FRS 中的比较关系尚未确定。本研究旨在开发一种纳入 FRS、CAC 和 CIMT 的 CV 筛查方法。
方法
在 136 例无症状受试者中，根据 FRS 低、中、高分组，确定亚临床动脉粥样硬化的患病率，定义为 CAC 评分>0、CIMT≥第 75 百分位数或斑块≥1.5mm。使用既定的列线图确定 CIMT 和 CAC 值分别代表“血管年龄”和“冠状动脉钙年龄”。
结果
在 103 例低风险（FRS<10%）患者中，分别有 41%、50%、59%和 66%的患者 CAC 评分>0、CIMT≥第 75 百分位数、斑块≥1.5mm 和 CIMT≥第 75 百分位数或斑块≥1.5mm。在 33 例中危（n=14）或高危（n=19）FRS 患者中，分别有 70%、81%、87%和 87%的患者 CAC 评分>0、CIMT≥第 75 百分位数、斑块≥1.5mm 和 CIMT≥第 75 百分位数或斑块≥1.5mm。52%冠状动脉钙评分正常的患者存在颈动脉斑块。在低 FRS 组中，校正 FRS 后，体重指数是 CIMT 异常的独立预测因素，但不是 CAC 异常的独立预测因素。平均血管 CIMT 年龄明显高于冠状动脉钙年龄（61.6±11.4 岁比 58.3±11.1 岁，P=0.001），两者均明显高于实际年龄（56.9±10.1 岁）（P<0.0001 和 P<0.04）。CIMT 比 CAC 更能改变 FRS（42%比 17%）>5%。
结论
在无 CV 疾病的无症状患者中，CIMT 和斑块评估比 CAC 更有可能改变 FRS。体重指数预测低 FRS 患者的 CIMT 增加。这些发现可能对低 FRS 患者的筛查具有广泛意义。
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