Division of Cardiovascular Diseases, Department of Internal Medicine, University of Arizona College of Medicine, Maricopa Medical Center, Phoenix, Arizona.
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, Arizona.
J Am Soc Echocardiogr. 2015 Oct;28(10):1232-9. doi: 10.1016/j.echo.2015.06.015. Epub 2015 Aug 1.
Traditional risk assessment tools classify the majority of middle-aged women at low risk despite cardiovascular (CV) disease's affecting >50% of women and remaining the leading cause of death. Ultrasound-determined carotid intima-media thickness (CIMT) and/or computed tomographic coronary artery calcium score (CACS) quantify subclinical atherosclerosis and add incremental prognostic value. The aim of this study was to assess the utility of CIMT and CACS to detect subclinical atherosclerosis in younger women.
Asymptomatic women aged 50 to 65 years with at least one CV risk factor and low Framingham risk scores were identified prospectively at primary care and cardiology clinics. Mean intimal thickness, plaque on CIMT, and Agatston calcium score for CACS were obtained.
Of 86 women (mean age, 58 ± 4.6 years; mean Framingham risk score, 1.9 ± 1.2; mean low-density lipoprotein cholesterol level, 138.9 ± 37.0 mg/dL), 53 (62%) had high-risk CIMT (51% plaque, 11% CIMT > 75th percentile). In contrast, three women (3.5%) had CACS > 100, all of whom had plaque by CIMT. Of the 58 women with CACS of 0, 32 (55%) had high-risk CIMT (48% plaque, 7% CIMT > 75th percentile).
In patients referred by their physicians for assessment of CV risk, CIMT in asymptomatic middle-aged women with at least one CV risk factor and low risk by the Framingham risk score identified a large number with advanced subclinical atherosclerosis despite low CACS. Our results suggest that CIMT may be a more sensitive method for CV risk assessment than CACS or traditional risk tools in this population. Further studies are needed to determine if earlier detection would be of clinical benefit.
尽管心血管疾病影响超过 50%的女性，仍是导致死亡的主要原因，但传统的风险评估工具仍将大多数中年女性归类为低危人群。超声检测颈动脉内膜中层厚度（CIMT）和/或计算机断层扫描冠状动脉钙评分（CACS）可量化亚临床动脉粥样硬化，并增加额外的预后价值。本研究旨在评估 CIMT 和 CACS 检测年轻女性亚临床动脉粥样硬化的效用。
前瞻性地在初级保健和心脏病学诊所确定年龄在 50 至 65 岁之间、至少有一个心血管危险因素和低弗雷明汉风险评分的无症状女性。获得平均内膜厚度、CIMT 上的斑块和 CACS 的 Agatston 钙评分。
在 86 名女性（平均年龄 58 ± 4.6 岁；平均弗雷明汉风险评分 1.9 ± 1.2；平均低密度脂蛋白胆固醇水平 138.9 ± 37.0 mg/dL）中，53 名（62%）CIMT 高风险（51%斑块，11% CIMT > 第 75 百分位）。相比之下，有 3 名女性（3.5%）的 CACS > 100，她们均有 CIMT 上的斑块。在 CACS 为 0 的 58 名女性中，有 32 名（55%）CIMT 高风险（48%斑块，7% CIMT > 第 75 百分位）。
在医生建议评估心血管风险的患者中，在至少有一个心血管危险因素和弗雷明汉风险评分低危的无症状中年女性中，CIMT 识别出大量亚临床动脉粥样硬化程度较高的患者，尽管 CACS 较低。我们的结果表明，在该人群中，CIMT 可能是比 CACS 或传统风险工具更敏感的心血管风险评估方法。需要进一步的研究来确定早期检测是否具有临床益处。
