Erqou S, Kip K E, Mulukutla S R, Aiyer A N, Reis S E
Department of Medicine, Weill Cornell Medical College, 525 E 68th Street, Box 130, New York, NY, 10065, USA,
Neth Heart J. 2015 Jan;23(1):44-51. doi: 10.1007/s12471-014-0610-4.
Identification of racial differences in the burden and correlates of carotid intima media thickness (CIMT) and coronary artery calcium (CAC) may provide the basis for the development of race-specific cardiovascular disease (CVD) risk prediction algorithms.
In the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, CIMT was measured by carotid ultrasonography in 792 individuals (35 % Black). CIMT >1 mm was considered significant. CAC was quantified by electron beam computed tomography in 776 individuals (46 % Black). CAC was considered significant if the Agatston score was >100. Cross-sectional associations between race, CIMT and CAC were assessed using logistic regression models.
Blacks had greater CIMT (mean difference 0.033 mm, 95 % CI 0.005-0.06 mm; p = 0.02) and 1.5-fold (95 % CI 1.0-2.3) higher odds of having significant CIMT than Whites. Blacks had less CAC than Whites (mean Agatston score difference 66, [11-122]; p = 0.02) and 50 % lower odds of a significant CAC score compared with Whites (0.5 [0.3-0.7]). These associations were virtually unchanged after adjustment for CVD risk factors. Of the novel CVD risk markers assessed, small-dense low-density lipoprotein was independently associated with increased odds of significant CIMT, with the association being similar among Blacks and Whites (odds ratio [95 % CI]: 1.7 [1.2-2.5] and 1.4 [1.0-1.8] per 1-SD higher level, respectively). Interleukin-6 was significantly associated with CAC among Blacks (1.4 [1.0-2.0]).
Black race is independently associated with greater CIMT but less CAC than White race. CVD risk stratification strategies that incorporate these measures of subclinical atherosclerosis should consider race-specific algorithms.
识别颈动脉内膜中层厚度（CIMT）和冠状动脉钙化（CAC）负担及相关因素的种族差异，可为开发针对特定种族的心血管疾病（CVD）风险预测算法提供依据。
在聚焦风险评估的心脏策略（Heart SCORE）研究中，通过颈动脉超声对792名个体（35%为黑人）进行CIMT测量。CIMT>1mm被视为有意义。通过电子束计算机断层扫描对776名个体（46%为黑人）进行CAC定量。如果阿加斯顿评分>100，则认为CAC有意义。使用逻辑回归模型评估种族、CIMT和CAC之间的横断面关联。
黑人的CIMT更大（平均差异0.033mm，95%可信区间0.005 - 0.06mm；p = 0.02），且CIMT有意义的几率比白人高1.5倍（95%可信区间1.0 - 2.3）。黑人的CAC比白人少（平均阿加斯顿评分差异66，[11 - 122]；p = 0.02），且CAC评分有意义的几率比白人低50%（0.5 [0.3 - 0.7]）。在调整心血管疾病风险因素后，这些关联几乎没有变化。在所评估的新型心血管疾病风险标志物中，小而密低密度脂蛋白与CIMT有意义的几率增加独立相关，黑人和白人中的关联相似（优势比[95%可信区间]：每升高1个标准差分别为1.7 [1.2 - 2.5]和1.4 [1.0 - 1.8]）。白细胞介素-6在黑人中与CAC显著相关（1.4 [1.0 - 2.0]）。
与白人相比，黑人种族独立地与更大的CIMT相关，但与更少的CAC相关。纳入这些亚临床动脉粥样硬化指标的心血管疾病风险分层策略应考虑针对特定种族的算法。
