Hoffmann Udo, Massaro Joseph M, D'Agostino Ralph B, Kathiresan Sekar, Fox Caroline S, O'Donnell Christopher J
Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Department of Mathematics, Boston University, Boston, MA The Framingham Heart Study of the National Heart, Lung and Blood Institute (NHLBI) and Boston University, Framingham, MA.
J Am Heart Assoc. 2016 Feb 22;5(2):e003144. doi: 10.1161/JAHA.115.003144.
We determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all-cause mortality independent of Framingham risk factors in the community-based Framingham Heart Study.
Coronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C-statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all-cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all-cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78-0.82; net reclassification index 32%, 95% CI 11-53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5-10%) 10-year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%).
CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community-dwelling persons and accurately reclassifies two-thirds of the intermediate-risk population.
在基于社区的弗明汉心脏研究中，我们确定血管和瓣膜钙化是否能独立于弗明汉危险因素预测主要冠心病、心血管疾病（CVD）及全因死亡率。
通过心脏计算机断层扫描测量无CVD参与者的冠状动脉钙化（CAC）、胸主动脉和腹主动脉钙化以及二尖瓣或主动脉瓣钙化。对参与者进行了中位时间为8年的随访。采用多变量Cox比例风险模型确定CAC、胸主动脉和腹主动脉钙化以及二尖瓣和主动脉瓣钙化与终点事件的关联。通过C统计量和净重新分类指数测试危险因素之外判别能力的改善情况。在这个包含3486名参与者（平均年龄50±10岁；51%为女性）的队列中，CAC与主要冠心病关联最为紧密，其次是主要CVD和全因死亡率，且独立于弗明汉危险因素。在非冠状动脉钙化中，二尖瓣钙化与主要CVD和全因死亡率相关，独立于弗明汉危险因素和CAC。对于冠心病，CAC显著提高了危险因素之外的判别价值（曲线下面积0.78 - 0.82；净重新分类指数32%，95%CI 11 - 53），但对CVD未提高。基于弗明汉危险因素，CAC准确地将261名10年冠心病风险处于中等水平（5 - 10%）的患者中的85%重新分类为低风险（n = 172；未观察到事件）或高风险（n = 53；观察到的事件发生率8%）。
对于无症状的社区居民，CAC提高了对主要冠心病和CVD的判别能力及风险重新分类能力，且能准确地对三分之二的中等风险人群进行重新分类。
