From the Johns Hopkins GeneSTAR Research Program, Department of Medicine (B.G.K., L.C.B., D.V., L.R.Y., R.Q., T.F.M., D.M.B.) and Department of Radiology (S.L.Z., E.K.F.), The Johns Hopkins Medical Institutions, Baltimore, MD; and the Biomedical Imaging Research Institute, Department of Biomedical Sciences (D.D.) and Departments of Imaging and Medicine (D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA.
Circ Cardiovasc Imaging. 2014 May;7(3):446-53. doi: 10.1161/CIRCIMAGING.113.000980. Epub 2014 Feb 27.
Although age and sex distributions of calcified coronary plaque have been well described in the general population, noncalcified plaque (NCP) distributions remain unknown. This is important because NCP is a putative precursor for clinical coronary artery disease and could serve as a sentinel for aggressive primary prevention, especially in high-risk populations. We examined the distributions of NCP and calcified coronary plaque in healthy 30- to 74-year-old individuals from families with early onset coronary artery disease.
Participants in the GeneSTAR family study (N=805), mean age 51.1±10.8 years, 56% women, were screened for coronary artery disease risk factors and coronary plaque using dual-source computed tomographic angiography. Plaque volumes (mm(3)) were quantified using a validated automated method. The prevalence of coronary plaque was 57.8% in men and 35.8% in women (P<0.0001). NCP volume increased with age (P<0.001) and was higher in men than women (P<0.001). Although NCP, as a percentage of total plaque, was inversely related to age (P<0.01), NCP accounted for most of the total plaque volume at all ages, especially in men and women <55 years (>70% and >80%, respectively). Higher Framingham risk was associated with the number of affected vessels (P<0.01), but 44% of men and 20.8% of women considered intermediate risk had left main and 3-vessel disease involvement.
The majority of coronary plaque was noncalcified, particularly in younger individuals. These findings support the importance of assessing family history and suggest that early primary prevention interventions may be warranted at younger ages in families with early onset coronary artery disease.
虽然在普通人群中已经很好地描述了钙化性冠状动脉斑块的年龄和性别分布，但非钙化斑块（NCP）的分布仍然未知。这一点很重要，因为 NCP 是临床冠状动脉疾病的潜在前驱物，可以作为积极的一级预防的指标，特别是在高危人群中。我们研究了具有早发性冠状动脉疾病家族史的 30 至 74 岁健康个体中 NCP 和钙化性冠状动脉斑块的分布情况。
GeneSTAR 家族研究的参与者（N=805），平均年龄 51.1±10.8 岁，56%为女性，通过双源 CT 血管造影术筛查冠状动脉疾病危险因素和冠状动脉斑块。使用经过验证的自动方法量化斑块体积（mm³）。男性的冠状动脉斑块患病率为 57.8%，女性为 35.8%（P<0.0001）。NCP 体积随年龄增加而增加（P<0.001），且男性高于女性（P<0.001）。尽管 NCP 作为总斑块的百分比与年龄呈负相关（P<0.01），但 NCP 占总斑块体积的大部分，尤其是在<55 岁的男性和女性中（分别为>70%和>80%）。Framingham 风险评分越高与受影响血管的数量呈正相关（P<0.01），但 44%的男性和 20.8%的女性被认为是中等风险，却有左主干和 3 支血管疾病。
大多数冠状动脉斑块是非钙化的，尤其是在年轻个体中。这些发现支持评估家族史的重要性，并表明在具有早发性冠状动脉疾病家族史的年轻个体中，可能需要进行早期一级预防干预。
