外周动脉疾病与冠状动脉粥样硬化进展。

Peripheral arterial disease and progression of coronary atherosclerosis.

机构信息

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.

出版信息

J Am Coll Cardiol. 2011 Mar 8;57(10):1220-5. doi: 10.1016/j.jacc.2010.10.034.

DOI:10.1016/j.jacc.2010.10.034

PMID:21371639

Abstract

OBJECTIVES

The purpose of this analysis was to characterize the progression of coronary atherosclerosis in patients with concomitant peripheral arterial disease (PAD).

BACKGROUND

Peripheral arterial disease is associated with adverse cardiovascular outcomes. The impact of concomitant PAD on coronary atherosclerosis progression in patients with coronary artery disease has not been well established.

METHODS

The burden and progression of coronary atherosclerosis was investigated in 3,479 patients with coronary artery disease with (n = 216) and without (n = 3,263) concomitant PAD who participated in 7 clinical trials that employed serial intravascular ultrasound imaging.

RESULTS

Patients with PAD had a greater percent atheroma volume (40.4 ± 9.2% vs. 38.5 ± 9.1%, p = 0.002) and percentage of images containing calcium (35.1 ± 26.2% vs. 29.6 ± 24.2%, p = 0.002), in association with smaller lumen volume (275.7 ± 101.6 mm(3) vs. 301.4 ± 110.3 mm(3), p < 0.001) and vessel wall volume (467.7 ± 166.8 mm(3) vs. 492.9 ± 169.8 mm(3), p = 0.01). On serial evaluation, patients with PAD demonstrated greater progression of percent atheroma volume (+0.58 ± 0.38 vs. +0.23 ± 0.3%, p = 0.009) and total atheroma volume (-0.17 ± 2.69 mm(3) vs. -2.05 ± 2.15 mm(3), p = 0.03) and experienced more cardiovascular events (26.3% vs. 19.8%, p = 0.03). In patients with PAD and without PAD, respectively, achieving levels of low-density lipoprotein cholesterol <70 mg/dl was associated with less progression of percent atheroma volume (+0.16 ± 0.27% vs. +0.76 ± 0.20%, p = 0.04; and +0.05 ± 0.14% vs. +0.29 ± 0.13%, p < 0.001) and total atheroma volume (-3.0 ± 1.9 mm(3) vs. +1.0 ± 1.4 mm(3), p = 0.04; and -3.3 ± 1.1 mm(3) vs. -1.6 ± 1.0 mm(3), p < 0.001).

CONCLUSIONS

Patients with concomitant PAD harbor more extensive and calcified coronary atherosclerosis, constrictive arterial remodeling, and greater disease progression. These changes are likely to contribute to adverse cardiovascular outcomes. The benefit for all patients achieving low levels of low-density lipoprotein cholesterol supports the need for intensive lipid lowering in patients with PAD.

摘要

目的

本分析旨在描述同时患有外周动脉疾病（PAD）的冠心病患者冠状动脉粥样硬化的进展情况。

背景

PAD 与不良心血管结局相关。同时患有 PAD 对冠心病患者冠状动脉粥样硬化进展的影响尚未得到很好的证实。

方法

在 7 项临床研究中，共有 3479 例患有冠心病的患者参与了这项研究，这些患者中（n=216）有同时患有 PAD 的患者，（n=3263）无同时患有 PAD 的患者。这些患者均接受了连续的血管内超声成像检查。

结果

与无 PAD 的患者相比，同时患有 PAD 的患者有更大的动脉粥样斑块体积百分比（40.4±9.2% vs. 38.5±9.1%，p=0.002）和更多的钙化图像比例（35.1±26.2% vs. 29.6±24.2%，p=0.002），同时伴有更小的管腔体积（275.7±101.6 mm³ vs. 301.4±110.3 mm³，p<0.001）和血管壁体积（467.7±166.8 mm³ vs. 492.9±169.8 mm³，p=0.01）。在连续评估中，同时患有 PAD 的患者的动脉粥样斑块体积百分比的进展更大（+0.58±0.38% vs. +0.23±0.3%，p=0.009），总动脉粥样斑块体积的进展更大（-0.17±2.69 mm³ vs. -2.05±2.15 mm³，p=0.03），并且经历了更多的心血管事件（26.3% vs. 19.8%，p=0.03）。在同时患有 PAD 和无 PAD 的患者中，分别将低密度脂蛋白胆固醇水平降至<70 mg/dl 与动脉粥样斑块体积百分比的进展减少相关（+0.16±0.27% vs. +0.76±0.20%，p=0.04；+0.05±0.14% vs. +0.29±0.13%，p<0.001），总动脉粥样斑块体积的进展减少（-3.0±1.9 mm³ vs. +1.0±1.4 mm³，p=0.04；-3.3±1.1 mm³ vs. -1.6±1.0 mm³，p<0.001）。