冠状动脉钙化进展与高血压成年人的长期心血管事件相关。
Progression of coronary artery calcification is associated with long-term cardiovascular events in hypertensive adults.
机构信息
aGrace Ballas Research Unit of the Cardiac Rehabilitation Institute bDepartment of Internal Medicine D and Hypertension Unit cDepartment of Epidemiology and Preventive Medicine dDepartment of Diagnostic Imaging eThe Chaim Sheba Medical Center, Tel-Hashomer fSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
出版信息
J Hypertens. 2013 Sep;31(9):1886-92. doi: 10.1097/HJH.0b013e328362b9f8.
OBJECTIVES
Coronary artery calcification (CAC) is an independent predictor of cardiovascular (CV) events in hypertensive adults. However, the additive value of serial CAC measurements for risk stratification is unclear. The aim of the present study was to find whether CAC progression predicts long-term CV events in hypertensive patients.
METHODS
The study group included 210 patients (mean age 64 ± 5.6 years, 54% men), a subgroup of 544 participants in the calcification side arm of the INSIGHT (International Nifedipine Study Intervention as Goal for Hypertension Therapy). All were free of symptoms or known CV disease, had at least two CT scans 1 year apart, and had available long-term follow-up. Progression of CAC was defined as the absolute change in CAC score between maximal score during follow-up and baseline score. The endpoint was the first CV event after the last CT scan. Three categories of CAC progression were defined. Zero progression was defined as 'nonprogressors', and progression below and above the median of maximal progression were defined as 'slow progressors' and 'rapid progressors', respectively.
RESULTS
During 15 years of follow-up (mean 11.4 ± 4.4), 83 patients experienced a first CV event. The rate of events was higher in rapid (29/59, 49%), and slow (36/78 46%) than in nonprogressors (18/73 25%); (P=0.005). Compared with nonprogressors, the adjusted hazard ratio for CV events was 1.91 [95% confidence interval (95% CI); 1.05-3.47] in the slow, and 2.13 (95% CI; 1.12-4.03) in the rapid progressors.
CONCLUSION
In hypertensive patients, progression of CAC is associated with long-term CV events.
目的
冠状动脉钙化（CAC）是高血压成年人心血管（CV）事件的独立预测因子。然而，连续 CAC 测量对风险分层的附加价值尚不清楚。本研究旨在探讨 CAC 进展是否可预测高血压患者的长期 CV 事件。
方法
研究组纳入 210 例患者（平均年龄 64 ± 5.6 岁，54%为男性），其中包括 INSIGHT（硝苯地平国际研究干预作为高血压治疗目标）钙化侧臂的 544 名参与者的一个亚组。所有患者均无 CV 症状或已知 CV 疾病，至少有两次 CT 扫描，且随访时间至少 1 年。CAC 进展定义为随访期间最大 CAC 评分与基线评分之间的绝对变化。终点为最后一次 CT 扫描后首次 CV 事件。将 CAC 进展分为三个类别。无进展定义为“非进展者”，进展低于和高于最大进展中位数定义为“进展缓慢者”和“进展迅速者”。
结果
在 15 年的随访期间（平均 11.4 ± 4.4 年），83 例患者发生首次 CV 事件。快速（29/59，49%）和缓慢（36/78，46%）进展者的事件发生率高于非进展者（18/73，25%）；（P=0.005）。与非进展者相比，缓慢进展者和快速进展者的 CV 事件调整风险比分别为 1.91（95%置信区间[95%CI]；1.05-3.47）和 2.13（95%CI；1.12-4.03）。
结论
在高血压患者中，CAC 的进展与长期 CV 事件相关。
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