Valenti Valentina, Ó Hartaigh Bríain, Heo Ran, Schulman-Marcus Joshua, Cho Iksung, Kalra Dan K, Truong Quynh A, Giambrone Ashley E, Gransar Heidi, Callister Tracy Q, Shaw Leslee J, Lin Fay Y, Chang Hyuk-Jae, Sciarretta Sebastiano, Min James K
Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, United States.
Division of Cardiology, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, United States.
Int J Cardiol. 2015;187:534-40. doi: 10.1016/j.ijcard.2015.03.060. Epub 2015 Mar 5.
To examine the performance of coronary artery calcification (CAC) for stratifying long-term risk of death in asymptomatic hypertensive patients.
8905 consecutive asymptomatic individuals without cardiovascular disease or diabetes who underwent CAC testing (mean age 53.3 ± 10.5, 59.3% male) were followed for a mean of 14 years and categorized on the background of hypertension as well as age above or below 60 years (in accordance with the 2014 Guidelines from the Joint National Committee 8). The prevalence and severity of CAC were higher for those with hypertension versus without hypertension (P<0.001), and the extent increased proportionally with advancing age (P<0.001). Following adjustment, the presence of CAC in hypertensive with respect to normotensive, was associated with worse prognosis for individuals above the age of 60 years (HR 7.74 [95% CI: 5.15-11.63] vs. HR 4.83 [95% CI: 3.18-7.33]) than individuals below the age of 60 (HR 3.18 [95% CI: 2.42-4.19] vs. HR 2.14 [95% CI: 1.61-2.85]), respectively. A zero CAC score in hypertensive over the age of 60 years was associated with a lower but persisting risk of mortality for (HR 2.48 [95% CI: 1.50-4.08]) that was attenuated non-significant for those below the age of 60 years (P=0.09). In a "low risk" hypertensive population, the presence any CAC was associated with an almost five-fold (HR 4.68 [95% CI: 2.22-9.87]) increased risk of death.
The presence and extent of CAC effectively may help the clinicians to further discriminate the long-term risk of mortality among asymptomatic hypertensive individuals, beyond conventional cardiovascular risk and current guidelines.
研究冠状动脉钙化（CAC）在无症状高血压患者长期死亡风险分层中的表现。
对8905例连续的无心血管疾病或糖尿病且接受CAC检测的无症状个体（平均年龄53.3±10.5岁，男性占59.3%）进行了平均14年的随访，并根据高血压情况以及年龄是否高于或低于60岁（按照美国国家联合委员会8于2014年发布的指南）进行分类。与无高血压者相比，高血压患者的CAC患病率和严重程度更高（P<0.001），且随着年龄增长程度呈比例增加（P<0.001）。调整后，60岁及以上的高血压患者中，与血压正常者相比，存在CAC与预后较差相关（风险比[HR] 7.74 [95%置信区间：5.15 - 11.63] 对比HR 4.83 [95%置信区间：3.18 - 7.33]），而60岁以下的患者中该关联为（HR 3.18 [95%置信区间：2.42 - 4.19] 对比HR 2.14 [95%置信区间：1.61 - 2.85]）。60岁及以上高血压患者CAC评分为零与较低但持续的死亡风险相关（HR 2.48 [95%置信区间：1.50 - 4.08]），而60岁以下患者中该关联减弱且无统计学意义（P = 0.09）。在“低风险”高血压人群中，存在任何CAC与死亡风险增加近五倍（HR 4.68 [95%置信区间：2.22 - 9.87]）相关。
CAC的存在和程度可能有效地帮助临床医生在传统心血管风险和现行指南之外，进一步区分无症状高血压个体的长期死亡风险。
