Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Eur Heart J. 2011 Aug;32(16):2050-8. doi: 10.1093/eurheartj/ehr125. Epub 2011 May 23.
Since atherosclerosis is a systemic process, risk prediction would benefit from targeting multiple components of cardiovascular disease simultaneously. To this end, it is useful to examine the predictive value of non-invasive measures of atherosclerosis in various vascular beds for both coronary heart disease (CHD) and cerebrovascular disease.
Between September 2003 and February 2006, 2153 asymptomatic participants (69.6±6.6 years) from the Rotterdam Study underwent a multi-detector computed tomography scan. During a median follow-up of 3.5 years, 58 CHD events (myocardial infarction and CHD death) and 52 cerebrovascular events (TIA and stroke) occurred. Participants were classified into low (<5%), intermediate (5-10%), and high (>10%) 5-year risk categories based on a refitted Framingham risk model. The model was extended by coronary, aortic arch, or carotid calcium and reclassification percentages were calculated. For the outcome CHD, the C-statistic improved from 0.693 for the Framingham refitted model to 0.743, 0.740, and 0.749 by addition of coronary, aortic arch, and carotid calcium, respectively. Reclassification was most substantial in the intermediate risk group where addition of coronary calcium reclassified 56% of persons [net reclassification improvement (NRI): 15%; P<0.01)]. Adding aortic arch calcium led to a reclassification of 32% of persons (NRI: 8%; P=0.01) and adding carotid calcium reclassified 51% (NRI: 9%; P=0.02). In contrast, calcification in any of the three vascular beds did not improve cerebrovascular risk prediction.
Coronary, aortic arch, and carotid artery calcification significantly improved risk prediction of CHD but not of cerebrovascular events.
由于动脉粥样硬化是一个全身性的过程，因此从多个心血管疾病的组成部分同时进行风险预测将获益。为此，检查各种血管床的动脉粥样硬化的非侵入性测量对冠心病（CHD）和脑血管疾病的预测价值是有用的。
2003 年 9 月至 2006 年 2 月，来自鹿特丹研究的 2153 名无症状参与者（69.6±6.6 岁）接受了多探测器计算机断层扫描。在中位数为 3.5 年的随访期间，发生了 58 例 CHD 事件（心肌梗死和 CHD 死亡）和 52 例脑血管事件（TIA 和中风）。根据重新拟合的 Framingham 风险模型，参与者被分为低（<5%）、中（5-10%）和高（>10%）5 年风险类别。通过添加冠状动脉、主动脉弓或颈动脉钙，扩展了该模型，并计算了重新分类的百分比。对于 CHD 结局，C 统计量从 Framingham 重新拟合模型的 0.693 提高到 0.743、0.740 和 0.749，分别通过添加冠状动脉、主动脉弓和颈动脉钙。重新分类在中危组最为显著，其中添加冠状动脉钙重新分类了 56%的人[净重新分类改善（NRI）：15%；P<0.01)]。添加主动脉弓钙导致 32%的人重新分类（NRI：8%；P=0.01），添加颈动脉钙导致 51%的人重新分类（NRI：9%；P=0.02）。相比之下，在这三个血管床中的任何一个部位的钙化都不能改善脑血管风险预测。
冠状动脉、主动脉弓和颈动脉钙化显著提高了 CHD 的风险预测，但不能提高脑血管事件的风险预测。
