Tattersall Matthew C, Gassett Amanda, Korcarz Claudia E, Gepner Adam D, Kaufman Joel D, Liu Kiang J, Astor Brad C, Sheppard Lianne, Kronmal Richard A, Stein James H
From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle.
Stroke. 2014 Nov;45(11):3257-62. doi: 10.1161/STROKEAHA.114.005669. Epub 2014 Sep 11.
Carotid artery intima-media thickness (IMT) and plaque are noninvasive markers of subclinical arterial injury that predict incident cardiovascular disease. We evaluated predictors of longitudinal changes in IMT and new plaque during a decade in a longitudinal multiethnic cohort.
Carotid IMT and plaque were evaluated in Multi-Ethnic Study of Atherosclerosis (MESA) participants at exams 1 and 5, a mean (standard deviation) of 9.4 (0.5) years later. Far wall carotid IMT was measured in both common and internal carotid arteries. A plaque score was calculated from all carotid segments. Mixed-effects longitudinal and multivariate regression models evaluated associations of baseline risk factors and time-updated medication use with IMT progression and plaque formation.
The 3441 MESA participants were aged 60.3 (9.4) years (53% women; 26% blacks, 22% Hispanic, 13% Chinese); 1620 (47%) had carotid plaque. Mean common carotid artery IMT progression was 11.8 (12.8) μm/year, and 1923 (56%) subjects developed new plaque. IMT progressed more slowly in Chinese (β=-2.89; P=0.001) and Hispanic participants (β=-1.81; P=0.02), and with higher baseline high-density lipoprotein cholesterol (per 5 mg/dL; β=-0.22; P=0.03), antihypertensive use (β=-2.06; P=0.0004), and time on antihypertensive medications (years; β=-0.29; P<0.0001). Traditional risk factors were associated with new plaque formation, with strong associations for cigarette use (odds ratio, 2.31; P<0.0001) and protection by black ethnicity (odds ratio, 0.68; P<0.0001).
In a large, multiethnic cohort with a decade of follow-up, ethnicity was a strong, independent predictor of carotid IMT and plaque progression. Antihypertensive medication use was associated with less subclinical disease progression.
颈动脉内膜中层厚度（IMT）和斑块是亚临床动脉损伤的无创性标志物，可预测心血管疾病的发生。我们在一个纵向多民族队列中评估了十年间IMT和新斑块纵向变化的预测因素。
在动脉粥样硬化多民族研究（MESA）参与者的第1次和第5次检查中评估颈动脉IMT和斑块，两次检查间隔时间平均（标准差）为9.4（0.5）年。测量颈总动脉和颈内动脉远壁的IMT。计算所有颈动脉节段的斑块评分。混合效应纵向和多变量回归模型评估基线危险因素和随时间更新的药物使用与IMT进展和斑块形成的关联。
3441名MESA参与者年龄为60.3（9.4）岁（53%为女性；26%为黑人，22%为西班牙裔，13%为华裔）；1620名（47%）有颈动脉斑块。颈总动脉IMT平均进展为11.8（12.8）μm/年，1923名（56%）受试者出现新斑块。华裔（β=-2.89；P=0.001）和西班牙裔参与者（β=-1.81；P=0.02）的IMT进展较慢，且基线高密度脂蛋白胆固醇水平较高（每5mg/dL；β=-0.22；P=0.03）、使用抗高血压药物（β=-2.06；P=0.0004）以及服用抗高血压药物的时间（年；β=-0.29；P<0.0001）与IMT进展较慢相关。传统危险因素与新斑块形成有关，吸烟的关联性很强（比值比，2.31；P<0.0001），黑人种族具有保护作用（比值比，0.68；P<0.0001）。
在一个进行了十年随访的大型多民族队列中，种族是颈动脉IMT和斑块进展的强大独立预测因素。使用抗高血压药物与亚临床疾病进展较慢有关。
