Kim Joonseok, Budoff Matthew J, Nasir Khurram, Wong Nathan D, Yeboah Joseph, Al-Mallah Mouaz H, Shea Steve, Dardari Zeina A, Blumenthal Roger S, Blaha Michael J, Cainzos-Achirica Miguel
Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45257, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Division of Cardiology, Los Angeles Biomedical Research Center at Harbor-UCLA, Division of Cardiology, Torrance, CA 90502, USA.
Atherosclerosis. 2017 Feb;257:1-8. doi: 10.1016/j.atherosclerosis.2016.12.012. Epub 2016 Dec 10.
TAC is associated with incident CVD and all-cause mortality. Nevertheless, the independent 10-year prognostic value of TAC in individuals with CAC = 0 beyond traditional risk factors is not well established.
3415 MESA participants with baseline CAC = 0 were followed for CHD, CVD events and all-cause mortality. TAC was measured in the ascending and descending aorta in all participants and quantified using Agatston's score. Multivariable Cox proportional hazards regression models were used to study the associations between TAC and incident CHD, CVD events and all-cause mortality. Likelihood ratio tests were used to compare prediction models including traditional risk factors plus TAC versus risk factors alone.
406 participants (11.9%) had TAC>0 at baseline. Over a median follow-up of 11.3 years, unadjusted event rates per 1000 person-years were higher in TAC>0 than in TAC = 0 participants: CHD 2.18 vs. 2.03; CVD 6.85 vs. 3.42; all-cause mortality 12.84 vs. 4.96. However, in multivariable Cox regression analyses adjusting for CVD risk factors, neither TAC>0, TAC>100 nor log(TAC+1) were independently associated with any of the study outcomes, nor improved their prediction compared to traditional risk factors alone (p value of likelihood ratio tests >0.05).
In a multi-ethnic, modern US population of asymptomatic individuals with CAC = 0 at baseline, the prevalence of TAC>0 was low, and TAC did not improve 10-year estimation of prognosis beyond traditional risk factors. In the presence of CAC = 0, measurement of TAC is unlikely to provide sufficient additional prognostic information to further improve risk assessment.
冠脉钙化积分（TAC）与心血管疾病（CVD）的发生及全因死亡率相关。然而，在无冠脉钙化（CAC）的个体中，TAC超过传统危险因素的独立10年预后价值尚未明确。
对3415名基线CAC为0的多民族动脉粥样硬化社区研究（MESA）参与者进行冠心病（CHD）、CVD事件及全因死亡率随访。所有参与者均测量升主动脉和降主动脉的TAC，并采用阿加斯顿积分法进行量化。采用多变量Cox比例风险回归模型研究TAC与CHD、CVD事件及全因死亡率之间的关联。采用似然比检验比较包含传统危险因素加TAC的预测模型与仅包含危险因素的预测模型。
406名参与者（11.9%）基线时TAC>0。在中位随访11.3年期间，每1000人年未调整的事件发生率在TAC>0的参与者中高于TAC = 0的参与者：CHD分别为2.18和2.03；CVD分别为6.85和3.42；全因死亡率分别为12.84和4.96。然而，在调整CVD危险因素的多变量Cox回归分析中，TAC>0、TAC>100或log(TAC + 1)均与任何研究结局无独立关联，与仅使用传统危险因素相比，也未改善其预测能力（似然比检验p值>0.05）。
在基线CAC = 0的多民族、现代美国无症状个体人群中，TAC>0的患病率较低，且TAC并未改善传统危险因素以外的10年预后估计。在CAC = 0的情况下，测量TAC不太可能提供足够的额外预后信息以进一步改善风险评估。
