Harvard-Thorndike Laboratory and Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Vasc Med. 2011 Aug;16(4):253-9. doi: 10.1177/1358863X11408640. Epub 2011 Jun 27.
We aimed to determine the relationships between resting left ventricular (LV) wall motion abnormalities (WMAs), aortic plaque, and peripheral artery disease (PAD) in a community cohort. A total of 1726 Framingham Heart Study Offspring Cohort participants (806 males, 65 ± 9 years) underwent cardiovascular magnetic resonance with quantification of aortic plaque volume and assessment of regional left ventricular systolic function. Claudication, lower extremity revascularization, and ankle-brachial index (ABI) were recorded at the most contemporaneous examination visit. WMAs were associated with greater aortic plaque burden, decreased ABI, and claudication in age- and sex-adjusted analyses (all p < 0.001), which were not significant after adjustment for cardiovascular risk factors. In age- and sex-adjusted analyses, both the presence (p < 0.001) and volume of aortic plaque were associated with decreased ABI (p < 0.001). After multivariable adjustment, an ABI ≤ 0.9 or prior revascularization was associated with a threefold odds of aortic plaque (p = 0.0083). Plaque volume significantly increased with decreasing ABI in multivariable-adjusted analyses (p < 0.0001). In this free-living population, associations of WMAs with aortic plaque burden and clinical measures of PAD were attenuated after adjustment for coronary heart disease risk factors. Aortic plaque volume and ABI remained strongly negatively correlated after multivariable adjustment. Our findings suggest that the association between coronary heart disease and non-coronary atherosclerosis is explained by cardiovascular risk factors. Aortic atherosclerosis and PAD remain strongly associated after multivariable adjustment, suggesting shared mechanisms beyond those captured by traditional risk factors.
我们旨在确定静息左心室（LV）壁运动异常（WMA）、主动脉斑块和外周动脉疾病（PAD）之间的关系，研究对象为一个社区队列中的 1726 名弗雷明汉心脏研究后代队列参与者（806 名男性，65±9 岁），他们接受了心血管磁共振检查，以量化主动脉斑块体积并评估局部左心室收缩功能。在最近一次检查时记录跛行、下肢血运重建和踝肱指数（ABI）。在年龄和性别调整分析中，WMA 与更大的主动脉斑块负担、ABI 降低和跛行相关（所有 p<0.001），但在调整心血管危险因素后则不显著。在年龄和性别调整分析中，主动脉斑块的存在（p<0.001）和体积与 ABI 降低（p<0.001）相关。多变量调整后，ABI≤0.9 或先前血运重建与主动脉斑块的三倍比值比相关（p=0.0083）。在多变量调整后，斑块体积在 ABI 降低的情况下显著增加（p<0.0001）。在这个自由生活的人群中，WMA 与主动脉斑块负担和 PAD 的临床测量之间的关联在调整冠心病危险因素后减弱。在多变量调整后，主动脉斑块体积和 ABI 仍然呈强烈负相关。我们的研究结果表明，冠心病和非冠状动脉粥样硬化之间的关联可以通过心血管危险因素来解释。在多变量调整后，主动脉粥样硬化和 PAD 仍然存在强烈的相关性，表明除了传统危险因素所捕获的机制之外，还有共同的机制。
