在可检测到亚临床动脉粥样硬化的个体中，传统心血管代谢风险因素的变化与冠状动脉钙化的变化之间的关系：动脉粥样硬化的多民族研究。
Relationship of change in traditional cardiometabolic risk factors to change in coronary artery calcification among individuals with detectable subclinical atherosclerosis: the multi-ethnic study of atherosclerosis.
机构信息
Department of Psychology, University of Miami, United States.
Department of Psychology, University of Miami, United States.
出版信息
Int J Cardiol. 2014 Jun 1;174(1):51-6. doi: 10.1016/j.ijcard.2014.03.137. Epub 2014 Mar 21.
BACKGROUND/OBJECTIVES: Data describing relationships between change in risk factors and coronary artery calcification (CAC) are lacking and could inform optimal cardiovascular disease prevention and treatment strategies. This study aimed to examine how change in traditional cardiometabolic risk factors related to change in CAC among individuals with detectable subclinical atherosclerosis.
METHODS
Latent growth modeling was used to examine change in cardiometabolic risk factors (waist circumference, body mass index, systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, triglycerides, and glucose) related to change in CAC up to an average 4.9-year follow-up in a multi-ethnic cohort of 3398 asymptomatic individuals (57.8% men) who had detectable CAC (score>0) at baseline, adjusting for baseline risk factor levels and CAC values, age, gender, race/ethnicity, smoking, family history of CVD, income, and use of antihypertensive, lipid-lowering, and glucose-lowering medications.
RESULTS
Greater declines in blood pressure (systolic and diastolic) and low-density lipoprotein cholesterol at follow-up were each associated with greater CAC progression. The observed inverse associations were attributable to greater CAC progression in participants taking antihypertensive and lipid-lowering drugs who, as expected, had declines in blood pressure and lipid levels, respectively. These inverse associations did not emerge in participants not taking these medications.
CONCLUSIONS
Among individuals with subclinical atherosclerosis, the unexpected inverse associations observed between change in blood pressure and lipid levels with CAC progression emphasize the importance of considering medication use, and, when feasible, the severity and duration of disease, in exploring associations between risk factors and CAC change.
背景/目的：缺乏描述风险因素变化与冠状动脉钙化（CAC）之间关系的数据，这些数据可以为最佳心血管疾病预防和治疗策略提供信息。本研究旨在研究在有可检测的亚临床动脉粥样硬化的个体中，传统心血管代谢危险因素的变化与 CAC 变化之间的关系。
方法
采用潜在增长模型来研究心血管代谢危险因素（腰围、体重指数、收缩压和舒张压、高低密度脂蛋白胆固醇、甘油三酯和血糖）的变化与 CAC 的变化之间的关系，在一个多民族队列中对 3398 名无症状个体（57.8%为男性）进行了平均 4.9 年的随访，这些个体在基线时有可检测的 CAC（评分>0），调整了基线风险因素水平和 CAC 值、年龄、性别、种族/民族、吸烟、CVD 家族史、收入以及使用降压、降脂和降糖药物。
结果
随访时血压（收缩压和舒张压）和低密度脂蛋白胆固醇的下降幅度越大，CAC 的进展就越大。观察到的负相关归因于服用降压和降脂药物的参与者 CAC 进展更大，这些参与者的血压和血脂水平分别下降，这是意料之中的。在未服用这些药物的参与者中，没有出现这些负相关。
结论
在有亚临床动脉粥样硬化的个体中，血压和血脂水平与 CAC 进展之间观察到的意外负相关强调了考虑药物使用的重要性，并且在可行的情况下，还应考虑疾病的严重程度和持续时间，以探讨危险因素与 CAC 变化之间的关系。
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