Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red - Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Department of Epidemiology, St. Louis University, St. Louis, Missouri.
Instituto Aragonés de Ciencias de Salud, IIS Aragón, Zaragoza, Spain.
J Am Coll Cardiol. 2016 Mar 22;67(11):1263-74. doi: 10.1016/j.jacc.2015.12.056.
Early subclinical atherosclerosis has been mainly researched in carotid arteries. The potential value of femoral arteries for improving the predictive capacity of traditional risk factors is an understudied area.
This study sought to evaluate the association of subclinical carotid and femoral plaques with risk factors and coronary artery calcium score (CACS) in middle-aged men.
Participants (n = 1,423) of the AWHS (Aragon Workers' Health Study), a study designed to assess cardiovascular risk and subclinical atherosclerosis in a cohort of middle-aged men (40 to 59 years of age), underwent carotid and femoral ultrasound plus noncontrast coronary computed tomography. Subclinical atherosclerosis was defined as the presence of any plaque in carotid or femoral arteries and/or CACS ≥1. Logistic regression models were used to estimate the prevalence of atherosclerosis adjusted for risk factors and age, to evaluate the association of atherosclerosis with risk factors, and to calculate areas under the receiver-operating characteristic curves for the presence of positive CACS.
Subclinical atherosclerosis was found in 72% of participants. Plaques were most common in femoral arteries (54%), followed by coronary calcification (38%) and carotid plaques (34%). Association of atherosclerosis with risk factors was stronger in femoral arteries than carotid or coronary arteries. The area under the receiver-operating characteristic curve for prediction of positive CACS increased from 0.665 when considering only risk factors (dyslipidemia, current smoking, hypertension, diabetes, and age) to 0.719 when adding femoral and carotid plaques (p < 0.001). In this model, the femoral odds ratio (2.58) exceeded the carotid odds ratio (1.80) for prediction of positive CACS.
Subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association with risk factors and positive CACS was stronger in femoral than carotid arteries. Screening for femoral plaques may be an appealing strategy for improving cardiovascular risk scales and predicting coronary disease.
早期亚临床动脉粥样硬化主要在颈动脉中进行研究。股动脉在提高传统危险因素预测能力方面的潜在价值是一个研究不足的领域。
本研究旨在评估中年男性亚临床颈动脉和股动脉斑块与危险因素和冠状动脉钙评分（CACS）的相关性。
AWHS（阿拉贡工人健康研究）的参与者（n=1423），该研究旨在评估中年男性（40 至 59 岁）队列的心血管风险和亚临床动脉粥样硬化，进行了颈动脉和股动脉超声检查以及非对比冠状动脉计算机断层扫描。亚临床动脉粥样硬化定义为颈动脉或股动脉存在任何斑块和/或 CACS≥1。使用逻辑回归模型调整危险因素和年龄后，估计动脉粥样硬化的患病率，评估动脉粥样硬化与危险因素的相关性，并计算存在阳性 CACS 的受试者工作特征曲线下面积。
72%的参与者存在亚临床动脉粥样硬化。斑块最常见于股动脉（54%），其次是冠状动脉钙化（38%）和颈动脉斑块（34%）。与颈动脉或冠状动脉相比，动脉粥样硬化与危险因素的相关性在股动脉中更强。仅考虑危险因素（血脂异常、当前吸烟、高血压、糖尿病和年龄）时，预测阳性 CACS 的受试者工作特征曲线下面积从 0.665 增加到增加到 0.719（p<0.001）。在该模型中，股动脉的比值比（2.58）超过了颈动脉的比值比（1.80），用于预测阳性 CACS。
在这个中年男性队列中，亚临床动脉粥样硬化的患病率很高。与危险因素和阳性 CACS 的相关性在股动脉中强于颈动脉。筛查股动脉斑块可能是改善心血管风险评分和预测冠心病的一种有吸引力的策略。
