颈动脉壁内中膜厚度与心血管事件。
Carotid-wall intima-media thickness and cardiovascular events.
机构信息
Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA.
出版信息
N Engl J Med. 2011 Jul 21;365(3):213-21. doi: 10.1056/NEJMoa1012592.
BACKGROUND
Intima-media thickness of the walls of the common carotid artery and internal carotid artery may add to the Framingham risk score for predicting cardiovascular events.
METHODS
We measured the mean intima-media thickness of the common carotid artery and the maximum intima-media thickness of the internal carotid artery in 2965 members of the Framingham Offspring Study cohort. Cardiovascular-disease outcomes were evaluated for an average follow-up of 7.2 years. Multivariable Cox proportional-hazards models were generated for intima-media thickness and risk factors. We evaluated the reclassification of cardiovascular disease on the basis of the 8-year Framingham risk score category (low, intermediate, or high) after adding intima-media thickness values.
RESULTS
A total of 296 participants had a cardiovascular event. The risk factors of the Framingham risk score predicted these events, with a C statistic of 0.748 (95% confidence interval [CI], 0.719 to 0.776). The adjusted hazard ratio for cardiovascular disease with a 1-SD increase in the mean intima-media thickness of the common carotid artery was 1.13 (95% CI, 1.02 to 1.24), with a nonsignificant change in the C statistic of 0.003 (95% CI, 0.000 to 0.007); the corresponding hazard ratio for the maximum intima-media thickness of the internal carotid artery was 1.21 (95% CI, 1.13 to 1.29), with a modest increase in the C statistic of 0.009 (95% CI, 0.003 to 0.016). The net reclassification index increased significantly after addition of intima-media thickness of the internal carotid artery (7.6%, P<0.001) but not intima-media thickness of the common carotid artery (0.0%, P=0.99). With the presence of plaque, defined as intima-media thickness of the internal carotid artery of more than 1.5 mm, the net reclassification index was 7.3% (P=0.01), with an increase in the C statistic of 0.014 (95% CI, 0.003 to 0.025).
CONCLUSIONS
The maximum internal and mean common carotid-artery intima-media thicknesses both predict cardiovascular outcomes, but only the maximum intima-media thickness of (and presence of plaque in) the internal carotid artery significantly (albeit modestly) improves the classification of risk of cardiovascular disease in the Framingham Offspring Study cohort. (Funded by the National Heart, Lung, and Blood Institute.).
背景
颈总动脉和颈内动脉的壁内中膜厚度可能会增加弗拉明翰风险评分，以预测心血管事件。
方法
我们测量了弗拉明翰后代研究队列 2965 名成员的颈总动脉平均内中膜厚度和颈内动脉最大内中膜厚度。平均随访 7.2 年后评估心血管疾病结局。为内中膜厚度和危险因素生成多变量 Cox 比例风险模型。我们根据 8 年弗拉明翰风险评分类别（低、中或高），评估添加内中膜厚度值后的心血管疾病重新分类。
结果
共有 296 名参与者发生心血管事件。弗拉明翰风险评分的危险因素预测了这些事件，C 统计量为 0.748（95%置信区间[CI]，0.719 至 0.776）。颈总动脉内中膜厚度每增加 1-SD，心血管疾病的调整后危险比为 1.13（95%CI，1.02 至 1.24），C 统计量的变化无统计学意义（0.003，95%CI，0.000 至 0.007）；颈内动脉最大内中膜厚度的相应危险比为 1.21（95%CI，1.13 至 1.29），C 统计量略有增加（0.009，95%CI，0.003 至 0.016）。添加颈内动脉内中膜厚度后，净重新分类指数显著增加（7.6%，P<0.001），但添加颈总动脉内中膜厚度后无显著增加（0.0%，P=0.99）。存在斑块时（定义为颈内动脉内中膜厚度>1.5mm），净重新分类指数为 7.3%（P=0.01），C 统计量增加 0.014（95%CI，0.003 至 0.025）。
结论
颈内动脉最大和颈总动脉平均内中膜厚度均可预测心血管结局，但只有颈内动脉最大内中膜厚度（和存在斑块）适度显著提高了弗拉明翰后代研究队列的心血管疾病风险分类。（由美国国家心肺血液研究所资助）。
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