Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA.
J Am Soc Echocardiogr. 2010 Aug;23(8):802-8. doi: 10.1016/j.echo.2010.06.003. Epub 2010 Jun 29.
Worldwide, cardiovascular (CV) disease remains the most common cause of morbidity and mortality. Although effective in predicting CV risk in select populations, the Framingham risk score (FRS) fails to identify many young individuals who experience premature CV events. Accordingly, the aim of this study was to determine the prevalence of high-risk carotid intima-media thickness (CIMT) or plaque, a marker of atherosclerosis and predictor of CV events, in young asymptomatic individuals with low and intermediate FRS (<2% annualized event rate) using the carotid ultrasound protocol recommended by the American Society of Echocardiography and the Society of Vascular Medicine.
Individuals aged < or = 65 years not taking statins and without diabetes mellitus or histories of coronary artery disease underwent CIMT and plaque examination for primary prevention. Clinical variables including lipid values, family history of premature coronary artery disease, and FRS and subsequent pharmacotherapy recommendations were retrospectively collected for statistical analysis.
Of 441 subjects (mean age, 49.7 + or - 7.9 years), 184 (42%; 95% confidence interval, 37.3%-46.5%) had high-risk carotid ultrasound findings (CIMT > or = 75th percentile adjusted for age, gender, and race or presence of plaque). Of those with the lowest FRS of < or =5% (n = 336) (mean age, 48.0 + or - 7.6 years; mean FRS, 2.5 + or - 1.5%), 127 (38%; 95% confidence interval, 32.6%-43.0%) had high-risk carotid ultrasound findings. For individuals with FRS < or = 5% and high-risk carotid ultrasound findings (n = 127; mean age, 47.3 + or - 8.1 years; mean FRS, 2.5 + or - 1.5%), lipid-lowering therapy was recommended by their treating physicians in 77 (61%).
Thirty-eight percent of asymptomatic young to middle-aged individuals with FRS < or = 5% have abnormal carotid ultrasound findings associated with increased risk for CV events. Pharmacologic therapy for CV prevention was recommended in the majority of these individuals. The lack of radiation exposure, relatively low cost, and ability to detect early-stage atherosclerosis suggest that carotid ultrasound for CIMT and plaque detection should continue to be explored as a primary tool for CV risk stratification in young to middle-aged adults with low FRS.
在全球范围内，心血管疾病仍然是发病率和死亡率最高的疾病。尽管弗雷明汉风险评分（Framingham risk score，FRS）在某些特定人群中有效预测心血管风险，但它无法识别许多发生过早心血管事件的年轻人。因此，本研究旨在使用美国超声心动图学会和血管医学学会推荐的颈动脉超声方案，确定低至中度 FRS（<2%年化事件率）的年轻无症状个体中，高风险颈动脉内膜中层厚度（carotid intima-media thickness，CIMT）或斑块的发生率，CIMT 或斑块是动脉粥样硬化的标志物，也是心血管事件的预测因子。
年龄<或=65 岁、未服用他汀类药物且无糖尿病或冠心病病史的个体进行 CIMT 和斑块检查，以进行一级预防。回顾性收集临床变量，包括血脂值、早发冠心病家族史、FRS 以及随后的药物治疗建议，用于统计分析。
在 441 名受试者中（平均年龄 49.7+/-7.9 岁），184 名（42%；95%置信区间，37.3%-46.5%）具有高风险颈动脉超声检查结果（CIMT>或=75 百分位值，按年龄、性别和种族调整或存在斑块）。在 FRS<或=5%（n=336）（平均年龄 48.0+/-7.6 岁；平均 FRS 2.5+/-1.5%）的最低 FRS 中，有 127 名（38%；95%置信区间，32.6%-43.0%）具有高风险颈动脉超声检查结果。对于 FRS<或=5%且颈动脉超声检查结果高风险的 127 名个体（平均年龄 47.3+/-8.1 岁；平均 FRS 2.5+/-1.5%），其治疗医生建议进行降脂治疗的有 77 名（61%）。
在 FRS<或=5%的无症状年轻至中年个体中，有 38%存在与心血管事件风险增加相关的异常颈动脉超声检查结果。在这些个体中，大多数人建议进行心血管预防药物治疗。由于没有辐射暴露、相对较低的成本以及早期检测动脉粥样硬化的能力，颈动脉超声检查用于 CIMT 和斑块检测应继续作为低 FRS 的年轻至中年成年人心血管风险分层的主要工具进行探索。
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