Dipartimento di Scienze Farmacologiche e Biomolecolari, Milan, Italy.
J Am Coll Cardiol. 2012 Oct 16;60(16):1489-99. doi: 10.1016/j.jacc.2012.06.034. Epub 2012 Sep 19.
The goal of this study was to compare the performance of several measures of carotid intima-media thickness (C-IMT) as predictors of cardiovascular events (CVEs), and to investigate whether they add to the predictive accuracy of Framingham risk factors (FRFs).
Various markers of subclinical atherosclerosis have been identified as predictors of CVEs, but the most powerful variable is still under debate.
A cohort study was carried out in 5 European countries. A total of 3,703 subjects (median age 64.4 years; 48% men) were followed-up for a median of 36.2 months, and 215 suffered a first CVE (incidence: 19.9/1,000 person-years).
All measures of C-IMT and the interadventitia common carotid artery diameter (ICCAD) were associated with the risk of CVEs, after adjustment for FRFs and therapies (all p < 0.005). The average of 8 maximal IMT measurements (IMT(mean-max)), alone or combined with ICCAD, classified events and non-events better than the common carotid mean IMT (net reclassification improvement [NRI]: +11.6% and +19.9%, respectively; both p < 0.01). Compared with classification based on FRFs alone, the NRI resulting from the combination of FRFs+ICCAD+IMT(mean-max) was +12.1% (p < 0.01). The presence of at least 1 plaque (maximum IMT >1.5 mm) performed significantly worse than composite IMTs that incorporated plaques (p < 0.001). Adjusted Kaplan-Meier curves showed that individuals with a FRS = 22.6% (cohort average), and both IMT(mean-max) and ICCAD above the median, had a 6.5% risk to develop a CVE over 3 years versus a 3.4% risk for those with the same FRS, and both IMT(mean-max) and ICCAD below the median.
A risk stratification strategy based on C-IMT and ICCAD as an adjunct to FRFs is a rational approach to prevention of cardiovascular disease.
本研究旨在比较几种颈动脉内膜中层厚度（C-IMT）测量指标作为心血管事件（CVE）预测因子的性能，并探讨它们是否能提高弗雷明汉风险因素（FRFs）的预测准确性。
已经确定了多种亚临床动脉粥样硬化标志物作为 CVE 的预测因子，但最有力的变量仍存在争议。
在 5 个欧洲国家进行了一项队列研究。共有 3703 名受试者（中位年龄 64.4 岁；48%为男性）接受了中位 36.2 个月的随访，215 名受试者发生了首次 CVE（发生率：19.9/1000 人年）。
在调整 FRFs 和治疗后，所有 C-IMT 测量指标和颈总动脉内中膜厚度（ICCAD）均与 CVE 风险相关（均 P<0.005）。8 个最大 IMT 测量值的平均值（IMT（mean-max）），单独或与 ICCAD 联合使用，比颈总动脉平均 IMT（net reclassification improvement [NRI]：分别为+11.6%和+19.9%；均 P<0.01）更好地对事件和非事件进行分类。与仅基于 FRFs 的分类相比，FRFs+ICCAD+IMT（mean-max）组合的 NRI 为+12.1%（P<0.01）。至少存在 1 个斑块（最大 IMT>1.5mm）的患者比包含斑块的复合 IMTs 表现更差（P<0.001）。调整后的 Kaplan-Meier 曲线显示，在队列平均Framingham 风险评分（FRS）为 22.6%的个体中，IMT（mean-max）和 ICCAD 均高于中位数的个体，在 3 年内发生 CVE 的风险为 6.5%，而 FRS 相同但 IMT（mean-max）和 ICCAD 均低于中位数的个体的风险为 3.4%。
基于 C-IMT 和 ICCAD 的风险分层策略作为 FRFs 的补充，是预防心血管疾病的合理方法。
