Department of Medicine, University of Washington, Seattle, Washington 98195-6422, USA.
JACC Cardiovasc Imaging. 2012 Jun;5(6):619-25. doi: 10.1016/j.jcmg.2011.12.023.
This study sought to test whether aortic valve calcium (AVC) is independently associated with coronary and cardiovascular events in a primary-prevention population.
Aortic sclerosis is associated with increased cardiovascular morbidity and mortality among the elderly, but the mechanisms underlying this association remain controversial. Also, it is unknown whether this association extends to younger individuals.
We performed a prospective analysis of 6,685 participants in MESA (Multi-Ethnic Study of Atherosclerosis). All subjects, ages 45 to 84 years and free of clinical cardiovascular disease at baseline, underwent computed tomography for AVC and coronary artery calcium scoring. The primary, pre-specified combined endpoint of cardiovascular events included myocardial infarctions, fatal and nonfatal strokes, resuscitated cardiac arrest, and cardiovascular death, whereas a secondary combined endpoint of coronary events excluded strokes. The association between AVC and clinical events was assessed using Cox proportional hazards regression with incremental adjustments for demographics, cardiovascular risk factors, inflammatory biomarkers, and subclinical coronary atherosclerosis.
Over a median follow-up of 5.8 years (interquartile range: 5.6 to 5.9 years), adjusting for demographics and cardiovascular risk factors, subjects with AVC (n = 894, 13.4%) had higher risks of cardiovascular (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.10 to 2.03) and coronary (HR: 1.72; 95% CI: 1.19 to 2.49) events compared with those without AVC. Adjustments for inflammatory biomarkers did not alter these associations, but adjustment for coronary artery calcium substantially attenuated both cardiovascular (HR: 1.32; 95% CI: 0.98 to 1.78) and coronary (HR: 1.41; 95% CI: 0.98 to 2.02) event risk. AVC remained predictive of cardiovascular mortality even after full adjustment (HR: 2.51; 95% CI: 1.22 to 5.21).
In this MESA cohort, free of clinical cardiovascular disease, AVC predicts cardiovascular and coronary event risk independent of traditional risk factors and inflammatory biomarkers, likely due to the strong correlation between AVC and subclinical atherosclerosis. The association of AVC with excess cardiovascular mortality beyond coronary atherosclerosis risk merits further investigation. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487).
本研究旨在检验主动脉瓣钙化（AVC）是否与初级预防人群的冠状动脉和心血管事件独立相关。
老年人的主动脉硬化与心血管发病率和死亡率的增加有关，但这种关联的机制仍存在争议。此外，尚不清楚这种关联是否会扩展到年轻个体。
我们对 MESA（动脉粥样硬化多民族研究）中的 6685 名参与者进行了前瞻性分析。所有受试者年龄在 45 至 84 岁之间，基线时无临床心血管疾病，均接受了计算机断层扫描以进行 AVC 和冠状动脉钙评分。心血管事件的主要、预先指定的复合终点包括心肌梗死、致命和非致命性中风、复苏性心脏骤停和心血管死亡，而冠状动脉事件的次要复合终点排除了中风。使用 Cox 比例风险回归评估 AVC 与临床事件之间的关联，逐步调整人口统计学、心血管危险因素、炎症生物标志物和亚临床冠状动脉粥样硬化。
在中位数为 5.8 年（四分位距：5.6 至 5.9 年）的随访期间，在调整人口统计学和心血管危险因素后，患有 AVC（n=894，13.4%）的受试者发生心血管（风险比[HR]：1.50；95%置信区间[CI]：1.10 至 2.03）和冠状动脉（HR：1.72；95%CI：1.19 至 2.49）事件的风险均高于无 AVC 的受试者。炎症生物标志物的调整并未改变这些关联，但冠状动脉钙的调整大大减弱了心血管（HR：1.32；95%CI：0.98 至 1.78）和冠状动脉（HR：1.41；95%CI：0.98 至 2.02）事件风险。即使进行了充分调整，AVC 仍然可以预测心血管死亡率（HR：2.51；95%CI：1.22 至 5.21）。
在本 MESA 队列中，无临床心血管疾病，AVC 预测心血管和冠状动脉事件风险独立于传统危险因素和炎症生物标志物，可能是因为 AVC 与亚临床动脉粥样硬化之间存在很强的相关性。AVC 与冠状动脉粥样硬化风险以外的心血管死亡率增加之间的关联值得进一步研究。（动脉粥样硬化多民族研究[MESA]；NCT00005487）。
