高敏心肌肌钙蛋白T的时间变化模式及决定因素：社区动脉粥样硬化风险队列研究
Patterns and determinants of temporal change in high-sensitivity cardiac troponin-T: The Atherosclerosis Risk in Communities Cohort Study.
作者信息
McEvoy John W, Lazo Mariana, Chen Yuan, Shen Lu, Nambi Vijay, Hoogeveen Ron C, Ballantyne Christie M, Blumenthal Roger S, Coresh Josef, Selvin Elizabeth
机构信息
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
出版信息
Int J Cardiol. 2015;187:651-7. doi: 10.1016/j.ijcard.2015.03.436. Epub 2015 Apr 1.
BACKGROUND
Patterns and determinants of temporal change in highly-sensitivity troponin-T (hs-cTNT), a novel measure of subclinical myocardial injury, among asymptomatic persons have not been well characterized.
METHODS
We studied 8571 ARIC Study participants, free of cardiovascular disease, who had hs-cTNT measured at two time-points, 6 years apart (1990-1992 and 1996-1998). We examined the association of baseline 10-year atherosclerotic cardiovascular (ASCVD) risk-group (<5%, 5-7.4%, ≥ 7.5%) and individual cardiac risk-factors with change across hs-cTNT categories using Poisson and Multinomial Logistic regression and with mean continuous hs-cTNT change using linear regression.
RESULTS
Mean age was 57 years and 43% were male. Mean (SD) 6-year hs-cTNT change was higher across increasing ASCVD risk-groups; +1.2 (6.1) ng/L [<5%], +2.1 (5.4) ng/L [5-7.4%], and +2.8 (8.8) ng/L [≥ 7.5%]. Major baseline determinants of temporal hs-cTNT increases were: age, male gender, hypertension, diabetes, and obesity. In addition, the relative risk (RR) of incident elevated hs-cTNT (≥ 14 ng/L) was 1.46 (95% CI 1.1-2.0) for persons with sustained hypertension compared to those who remained normotensive. Results for sustained obesity (RR 1.65 [1.19-2.29]) and hyperglycemia (RR 1.76 [1.16-2.67]) were similar. These associations were generally stronger after accounting for survival bias. However, smoking, LDL-cholesterol and triglycerides were not associated with hs-cTNT change. HDL-cholesterol was associated with declining hs-cTNT.
CONCLUSIONS
Persons in higher ASCVD risk-groups were more likely to have increases in hs-cTNT over 6 years of follow-up. The modifiable risk-factors primarily driving this association were diabetes, hypertension, and obesity; particularly when they were persistently elevated over follow-up. Future studies are needed to determine whether modifying these risk factors can prevent progression of subclinical myocardial injury.
背景
超敏肌钙蛋白T（hs-cTNT）作为亚临床心肌损伤的一种新指标，在无症状人群中的时间变化模式和决定因素尚未得到充分描述。
方法
我们研究了8571名参加动脉粥样硬化多民族研究（ARIC研究）的参与者，这些人无心血管疾病，在两个时间点（相隔6年，即1990 - 1992年和1996 - 1998年）测量了hs-cTNT。我们使用泊松回归和多项逻辑回归分析了基线10年动脉粥样硬化性心血管疾病（ASCVD）风险组（<5%、5 - 7.4%、≥7.5%）和个体心脏危险因素与hs-cTNT类别变化之间的关联，并使用线性回归分析了与hs-cTNT平均连续变化之间的关联。
结果
平均年龄为57岁，43%为男性。随着ASCVD风险组的增加，hs-cTNT的平均（标准差）6年变化更大；<5%风险组为 +1.2（6.1）ng/L，5 - 7.4%风险组为 +2.1（5.4）ng/L，≥7.5%风险组为 +2.8（8.8）ng/L。hs-cTNT随时间增加的主要基线决定因素为：年龄、男性、高血压、糖尿病和肥胖。此外，与血压保持正常的人相比，持续高血压患者hs-cTNT升高（≥14 ng/L）的相对风险（RR）为1.46（95%置信区间1.1 - 2.0）。持续肥胖（RR 1.65 [1.19 - 2.29]）和高血糖（RR 1.76 [1.16 - 2.67]）的结果相似。在考虑生存偏倚后，这些关联通常更强。然而，吸烟、低密度脂蛋白胆固醇和甘油三酯与hs-cTNT变化无关。高密度脂蛋白胆固醇与hs-cTNT下降有关。
结论
在6年的随访中，ASCVD风险较高组的人更有可能出现hs-cTNT升高。导致这种关联的主要可改变危险因素是糖尿病、高血压和肥胖；尤其是在随访期间持续升高时。未来需要进行研究以确定改变这些危险因素是否可以预防亚临床心肌损伤的进展。
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