Kelkar Anita A, Schultz William M, Khosa Faisal, Schulman-Marcus Joshua, O'Hartaigh Briain W J, Gransar Heidi, Blaha Michael J, Knapper Joseph T, Berman Daniel S, Quyyumi Arshed, Budoff Matthew J, Callister Tracy Q, Min James K, Shaw Leslee J
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.A.K., W.M.S., F.K., J.T.K., A.Q., L.J.S.); Departments of Medicine (J.S.-M.) and Radiology (B.W.J.O'H., J.K.M.), Weill Cornell Medical College, New York, NY; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA (H.G., D.S.B.); Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J. Blaha); Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA (M.J. Budoff); and Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.).
Circ Cardiovasc Imaging. 2016 Apr;9(4):e003742. doi: 10.1161/CIRCIMAGING.115.003742.
Cardiovascular screening of women using traditional risk factors has been challenging, with results often classifying a majority of women as lower risk than men. The aim of this report was to determine the long-term prognosis of asymptomatic women and men classified at low-intermediate risk undergoing screening with coronary artery calcium (CAC) scoring.
A total of 2363 asymptomatic women and men with traditional risk factors aggregating into a low-intermediate Framingham risk score (6%-9.9%; 10-year predicted risk) underwent CAC scanning. Individuals were followed up for a median of 14.6 years. We estimated all-cause mortality using Cox proportional hazards models; hazard ratios with 95% confidence intervals were calculated. The area under the curve from a receiver operating characteristics curve analysis was calculated. There were 1072 women who were older (55.6 years) when compared with the 1291 men (46.7 years; P<0.0001), resulting in a greater prevalence and extent of CAC; 18.8% of women and 15.1% of men had a CAC score ≥100 (P=0.029). This older group of women had a 1.44-fold higher 15-year adjusted mortality hazard when compared with men (P=0.022). For women, the 15-year mortality ranged from 5.0% for those with a CAC score of 0 to 23.5% for those with a CAC score ≥400 (P<0.001). For men, the 15-year mortality ranged from 3.5% for those with a CAC score of 0 to 18.0% for those with a CAC score ≥400 (P<0.001). Women with CAC scores >10 had a higher mortality risk when compared with men.
Our findings extend previous work that CAC effectively identifies high-risk women with a low-intermediate risk factor burden. These data require validation in external cohorts but lend credence to the use of CAC in women to improve risk detection algorithms that are currently based on traditional risk factors.
利用传统风险因素对女性进行心血管筛查具有挑战性，结果往往将大多数女性归类为风险低于男性。本报告的目的是确定接受冠状动脉钙化（CAC）评分筛查的低-中度风险无症状女性和男性的长期预后。
共有2363名有传统风险因素且汇总为低-中度弗雷明汉风险评分（6%-9.9%；10年预测风险）的无症状女性和男性接受了CAC扫描。对个体进行了中位数为14.6年的随访。我们使用Cox比例风险模型估计全因死亡率；计算了95%置信区间的风险比。计算了受试者工作特征曲线分析的曲线下面积。与1291名男性（46.7岁；P<0.0001）相比，有1072名女性年龄更大（55.6岁），导致CAC的患病率和程度更高；18.8%的女性和15.1%的男性CAC评分≥100（P=0.029）。与男性相比，这一年龄较大的女性群体15年调整后死亡风险高1.44倍（P=0.022）。对于女性，15年死亡率从CAC评分为0的5.0%到CAC评分≥400的23.5%不等（P<0.001）。对于男性，15年死亡率从CAC评分为0的3.5%到CAC评分≥400的18.0%不等（P<0.001）。CAC评分>10的女性与男性相比死亡风险更高。
我们的研究结果扩展了之前的工作，即CAC有效地识别了风险因素负担低-中度的高危女性。这些数据需要在外部队列中进行验证，但支持在女性中使用CAC来改进目前基于传统风险因素的风险检测算法。
