Department of Medicine, Walter Reed Army Medical Center, Washington, DC, USA.
Am J Cardiol. 2010 Jul 1;106(1):47-50. doi: 10.1016/j.amjcard.2010.02.009. Epub 2010 May 18.
The Prospective Army Coronary Calcium Project is evaluating the predictive value of coronary artery calcium (CAC) in unselected, healthy, lower-risk, 40- to 50-year-old men. Although this study has found that coronary calcium is predictive of future coronary heart disease (CHD), criteria are needed to narrow the screening population to those in whom CAC measurement is most efficient (vs unselected screening of low-risk men). In 1,634 unselected volunteer men (mean age 42 years, mean 10-year CHD Framingham risk score [FRS] 4.6%, CAC prevalence 22.4%), we evaluated the independent relation between CAC and incident CHD over 5.6 years including hard events (hospitalized unstable angina, myocardial infarction, and CHD death) and coronary revascularization. The cohort was analyzed in tertiles of FRS for the relation between CAC and CHD outcomes. FRS tertile cutpoints were 0% to 3% (n = 547), >3% to 5% (n = 547), and >5% (n = 540) 10-year CHD risk. Over a mean follow-up of 5.6 +/- 1.5 years (range 1.0 to 8.3), there were 22 total CHD events, including 14 hard events and 8 revascularizations. Most events occurred in the highest FRS tertile (n = 14) versus the middle (n = 6) and lowest (n = 2) risk tertiles (p = 0.005). CAC and CHD events increased across FRS tertiles. Only in the highest FRS tertile was there a significant relation between CAC and CHD outcomes (hazard ratio 9.3). In conclusion, CAC screening could be of benefit in refining risk assessment of low-risk men, but only when the FRS exceeds approximately 5%.
前瞻性陆军冠状动脉钙项目正在评估冠状动脉钙（CAC）在未经选择的健康低危 40 至 50 岁男性中的预测价值。尽管这项研究发现冠状动脉钙可预测未来的冠心病（CHD），但需要确定标准来缩小筛查人群，以便 CAC 测量在最有效（相对于低危男性的未选择筛查）的人群中进行。在 1634 名未经选择的志愿者男性中（平均年龄 42 岁，平均 10 年冠心病 Framingham 风险评分[FRS]为 4.6%，CAC 患病率为 22.4%），我们评估了 CAC 与 5.6 年期间发生 CHD 的独立关系，包括严重事件（不稳定型心绞痛、心肌梗死和 CHD 死亡住院和冠状动脉血运重建）。该队列根据 CAC 与 CHD 结局的关系按 FRS 三分位数进行分析。FRS 三分位数切点为 0%至 3%（n = 547）、>3%至 5%（n = 547）和>5%（n = 540）10 年 CHD 风险。在平均 5.6 +/- 1.5 年（范围 1.0 至 8.3）的随访中，共发生 22 例总 CHD 事件，包括 14 例严重事件和 8 例血运重建。大多数事件发生在最高 FRS 三分位数（n = 14），而在中间（n = 6）和最低（n = 2）风险三分位数（p = 0.005）。CAC 和 CHD 事件随 FRS 三分位数增加而增加。仅在最高 FRS 三分位数中，CAC 与 CHD 结局之间存在显著关系（危险比 9.3）。总之，CAC 筛查可能有助于改善低危男性的风险评估，但仅当 FRS 超过约 5%时。
