Gibson Ashleigh O, Blaha Michael J, Arnan Martinson K, Sacco Ralph L, Szklo Moyses, Herrington David M, Yeboah Joseph
Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JACC Cardiovasc Imaging. 2014 Nov;7(11):1108-15. doi: 10.1016/j.jcmg.2014.07.009. Epub 2014 Nov 10.
This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort.
The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear.
CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks.
During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p < 0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p < 0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE.
CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort.
本研究评估了无症状多民族队列中冠状动脉钙化（CAC）评分对脑血管事件（CVE）的预测价值。
CAC评分作为动脉粥样硬化负担的一种测量方法，已被证明可改善对冠心病事件的预测。然而，CAC对CVE的预测价值尚不清楚。
在动脉粥样硬化多民族研究（MESA）的参与者（N = 6779）基线检查时测量CAC，然后平均随访9.5±2.4年，以诊断新发CVE，新发CVE定义为所有中风或短暂性脑缺血发作。
在随访期间，发生了234例（3.5%）经判定的CVE。在Kaplan-Meier分析中，与无CAC相比，存在CAC与较低的无CVE事件生存率相关（对数秩卡方检验：59.8，p < 0.0001）。在调整年龄、性别、种族/民族、体重指数、收缩压和舒张压、总胆固醇、高密度脂蛋白胆固醇、吸烟状况、血压药物使用、他汀类药物使用和间歇性房颤后，对数转换后的CAC与CVE风险增加相关（风险比[HR]：1.13[95%置信区间（CI）：1.07至1.20]，p < 0.0001）。美国心脏病学会/美国心脏协会推荐的CAC临界值也是CVE和中风的独立预测因子（HR分别为：1.70[95%CI：1.24至2.35]，p = 0.001；HR为：1.59[95%CI：1.11至2.27]，p = 0.01）。当按性别或种族/民族进行分层分析时，CAC是CVE的独立预测因子，并且当添加到完整模型中时可改善对CVE的鉴别能力（c统计量：0.744对0.755）。CAC还提高了弗明汉姆中风风险评分对CVE的鉴别能力。
在最初无症状的多民族成年队列中，CAC是CVE的独立预测因子，并且可改善当前中风风险因素或弗明汉姆中风风险评分对新发CVE的鉴别能力。
