Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JACC Cardiovasc Imaging. 2015 Dec;8(12):1393-1400. doi: 10.1016/j.jcmg.2015.06.019. Epub 2015 Nov 11.
This study sought to determine the predictors of healthy arterial aging.
Long-term nondevelopment of coronary artery calcification (persistent CAC = 0) is a marker of healthy arterial aging. The predictors of this phenotype are not known.
We analyzed 1,850 participants from MESA (Multi-Ethnic Study of Atherosclerosis) with baseline CAC = 0 who underwent a follow-up CAC scan at visit 5 (median 9.6 years after baseline). We examined the proportion with persistent CAC = 0 and calculated multivariable relative risks and area under the receiver operating characteristic curve for prediction of this healthy arterial aging phenotype.
We found that 55% of participants (n = 1,000) had persistent CAC = 0, and these individuals were significantly more likely to be younger, female, and have fewer traditional risk factors (RF). Participants with an ASCVD (Atherosclerotic Cardiovascular Disease Risk Score) risk score <2.5% were 53% more likely to have healthy arterial aging than were participants with an ASCVD score ≥7.5%. There was no significant association between the Healthy Lifestyle variables (body mass index, physical activity, Mediterranean diet, and never smoking) and persistent CAC = 0. The area under the receiver operating characteristic curve incorporating age, sex, and ethnicity was 0.65, indicating fair to poor discrimination. No single traditional RF or combination of other risk factors increased the area under the receiver operating characteristic curve by more than 0.05.
Whereas participants free of traditional cardiovascular disease RF were significantly more likely to have persistent CAC = 0, there was no single RF or specific low-risk RF phenotype that markedly improved the discrimination of persistent CAC = 0 over demographic variables. Therefore, we conclude that healthy arterial aging may be predominantly influenced by the long-term maintenance of a low cardiovascular disease risk profile or yet to be determined genetic factors rather than the absence of any specific RF cluster identified in late adulthood.
本研究旨在确定健康动脉老化的预测因素。
冠状动脉钙化（持续 CAC = 0）的长期不发展是健康动脉老化的标志。这种表型的预测因素尚不清楚。
我们分析了 MESA（动脉粥样硬化多民族研究）中的 1850 名基线 CAC = 0 的参与者，他们在第 5 次就诊时（基线后中位数 9.6 年）进行了随访 CAC 扫描。我们检查了持续 CAC = 0 的比例，并计算了用于预测这种健康动脉老化表型的多变量相对风险和接收者操作特征曲线下的面积。
我们发现，55%的参与者（n = 1000）有持续的 CAC = 0，这些人更年轻、女性，传统风险因素（RF）更少。ASCVD（动脉粥样硬化性心血管疾病风险评分）风险评分<2.5%的参与者发生健康动脉老化的可能性比 ASCVD 评分≥7.5%的参与者高 53%。健康生活方式变量（体重指数、身体活动、地中海饮食和从不吸烟）与持续 CAC = 0 之间没有显著关联。纳入年龄、性别和种族的接收者操作特征曲线下面积为 0.65，表明为中等到较差的区分度。没有单一的传统 RF 或其他危险因素组合可以将接收者操作特征曲线下面积提高 0.05 以上。
虽然没有传统心血管疾病 RF 的参与者更有可能持续 CAC = 0，但没有单一的 RF 或特定的低风险 RF 表型可以显著提高持续 CAC = 0 的区分度，而不是在成年后期确定的任何特定 RF 簇。因此，我们得出结论，健康动脉老化可能主要受到长期保持低心血管疾病风险谱或尚未确定的遗传因素的影响，而不是在成年后期确定的任何特定 RF 簇的影响。
