Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA.
Am J Cardiol. 2011 Mar 15;107(6):879-85. doi: 10.1016/j.amjcard.2010.10.072.
Even among asymptomatic persons at low risk (<10%) according to the Framingham risk score, high coronary artery calcium (CAC) scores signify a greater predicted risk of coronary heart disease events. We sought to determine the noninvasive factors (without radiation exposure) significantly associated with CAC in low-risk, asymptomatic persons. In a cross-sectional analysis, we studied 3,046 participants from the Multi-Ethnic Study of Atherosclerosis at a low 10-year predicted risk (Framingham risk score <10%) of coronary heart disease events. Multivariate logistic regression analysis was used to assess the association of novel markers with the presence of any CAC (CAC >0) and advanced CAC (CAC ≥ 300). A CAC level of >0 and of ≥ 300 was present in 30% and 3.5% of participants, respectively. Factor VIIIc, fibrinogen, and soluble intercellular adhesion molecule were each associated with the presence of CAC (p ≤ 0.02), and C-reactive protein, D-dimer, and the carotid intima-media thickness with advanced CAC (p ≤ 0.03). The base model combining the traditional risk factors had excellent discrimination for advanced CAC (C-statistic 0.808). The addition of the 2 best-fit models combining the biomarkers with or without carotid intima-media thickness improved the c-statistic to 0.822 and 0.820, respectively. All 3 models calibrated well but were similar in estimating the individual risk probabilities for advanced CAC (prevalence 9.97%, 10.63%, and 10.10% in the greatest quartiles of predicted probabilities vs 0.26%, 0.26%, and 0.26% in the lowest quartiles, respectively). In conclusion, in low-risk persons, the traditional risk factors alone predicted advanced CAC with high discrimination and calibration. The biomarker combinations with and without carotid intima-media thickness were also significantly associated with advanced CAC; however, the improvement in the prediction and estimation of the clinical risk were modest compared to the traditional risk factors alone.
即使根据弗雷明汉风险评分低风险（<10%）的无症状者，冠状动脉钙（CAC）评分高也意味着冠心病事件的预测风险更大。我们试图确定与低危无症状者 CAC 相关的非侵入性因素（无辐射暴露）。在一项横断面分析中，我们研究了来自动脉粥样硬化多民族研究的 3046 名低 10 年冠心病事件预测风险（弗雷明汉风险评分<10%）的参与者。多变量逻辑回归分析用于评估新型标志物与任何 CAC（CAC>0）和高级 CAC（CAC≥300）存在的相关性。30%和 3.5%的参与者分别存在 CAC>0 和 CAC≥300。因子 VIIIc、纤维蛋白原和可溶性细胞间黏附分子均与 CAC 存在相关（p≤0.02），C 反应蛋白、D-二聚体和颈动脉内膜中层厚度与高级 CAC 相关（p≤0.03）。结合传统危险因素的基础模型对高级 CAC 具有极好的判别能力（C 统计量 0.808）。结合生物标志物与或不结合颈动脉内膜中层厚度的 2 个最佳拟合模型的添加将 c 统计量分别提高到 0.822 和 0.820。所有 3 种模型校准良好，但在估计高级 CAC 的个体风险概率方面相似（最高四分位数预测概率分别为 9.97%、10.63%和 10.10%，最低四分位数为 0.26%、0.26%和 0.26%）。总之，在低危人群中，传统危险因素单独预测高级 CAC 的区分度和校准度均较高。结合或不结合颈动脉内膜中层厚度的生物标志物组合也与高级 CAC 显著相关；然而，与传统危险因素单独相比，预测和估计临床风险的改善是适度的。
