Department of Public Health and Clinical Medicine, and Heart Centre, Umea University, SE-901 87 Umea, Sweden.
Atherosclerosis. 2013 Apr;227(2):193-200. doi: 10.1016/j.atherosclerosis.2012.11.008. Epub 2012 Nov 23.
Although a relationship is commonly accepted between coronary and carotid arterial disease, suggesting that atherosclerosis is a systemic condition, the extent of this association and correspondence has not been fully elucidated. This review discusses recent research in this field and highlights areas for future study. The prevalence of severe carotid stenosis increases with prevalence of coronary stenosis, with the latter being found in a significant number of stroke patients, while those with carotid stenosis may be at higher risk of myocardial infarction than stroke. There also appear to be common risk factors (age, diabetes, hypertension, smoking and dyslipidemia), although the effects in both vascular systems may not be identical. Furthermore, while the degree of stenosis in the coronary artery has little ability to predict acute coronary syndrome, which is caused by local thrombosis from a ruptured or eroded plaque, severe carotid stenosis causing hypoperfusion is highly predictive of stroke, although this effect may be time-limited. This apparent difference in event mechanism in the two arteries is interesting as is the difference in the rate of development of collaterals. Overall, the evidence shows that a clear relationship exists between disease in the coronary and carotid arteries, since conventional risk factors and the extent of stenosis and/or previous events emanating from one artery have a strong bearing on the prevalence of events in the other artery. Nevertheless, the exact correspondence between the two arteries is unclear, with sometimes contradictory study results. More research is needed to identify the full extent of risk factors for severe stenosis and cardio- or cerebral vascular events, among which, inflammatory biomarkers such as hs-CRP and prior vascular events are likely to play a key role.
虽然冠状动脉疾病和颈动脉疾病之间存在普遍的关系，表明动脉粥样硬化是一种全身性疾病，但这种关联和对应关系尚未完全阐明。本文综述了该领域的最新研究，并强调了未来研究的领域。严重颈动脉狭窄的患病率随着冠状动脉狭窄的患病率增加而增加，后者在大量中风患者中发现，而颈动脉狭窄患者可能比中风患者更易发生心肌梗死。虽然可能存在共同的危险因素（年龄、糖尿病、高血压、吸烟和血脂异常），但这两种血管系统的影响可能并不相同。此外，虽然冠状动脉狭窄的程度几乎无法预测由破裂或侵蚀斑块引起的局部血栓形成的急性冠状动脉综合征，但严重颈动脉狭窄导致的低灌注对中风具有高度预测性，尽管这种影响可能是有限的。这种在两条动脉中的事件机制的明显差异很有趣，就像侧支循环发展的速度差异一样。总的来说，证据表明，冠状动脉和颈动脉疾病之间存在明显的关系，因为传统的危险因素以及源自一条动脉的狭窄程度和/或先前的事件对另一条动脉的事件发生率有很大的影响。然而，两条动脉之间的确切对应关系尚不清楚，有时研究结果相互矛盾。需要进一步的研究来确定严重狭窄和心血管或脑血管事件的危险因素的全部范围，其中，hs-CRP 等炎症生物标志物和先前的血管事件可能发挥关键作用。
