Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
JACC Cardiovasc Imaging. 2017 Aug;10(8):845-854. doi: 10.1016/j.jcmg.2017.04.018.
This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification.
In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events.
A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events.
During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction.
The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification.
本研究旨在确定冠状动脉钙（CAC）体积或 CAC 密度之间、与年龄、性别、种族、新的动脉粥样硬化性心血管疾病（ASCVD）风险评分、糖尿病状态以及通过估计肾小球滤过率的肾功能之间的相互作用的可能性，并使用不同的 CAC 评分，确定在风险预测和重新分类方面，相较于 ASCVD 风险评分的改善。
在 MESA（动脉粥样硬化多民族研究）中，CAC 体积与心血管疾病（CVD）事件呈正相关，而 CAC 密度与 CVD 事件呈负相关。
共有 3398 名基线时无临床 CVD 但存在 CAC 阳性的 MESA 参与者，随访其发生 CVD 事件。
在中位 11.0 年的随访期间，共发生 390 例 CVD 事件，其中 264 例为冠心病（CHD）。每增加一个 CAC 体积的 SD（1.62），CHD 的风险增加 73%（p<0.001），CVD 的风险增加 61%（p<0.001）。相反，CAC 密度每增加一个 SD（0.69），则 CHD 的风险降低 28%（p<0.001），CVD 的风险降低 25%（p<0.001）。在 CAC 体积的各个水平，CAC 密度与风险呈负相关（即，不存在交互作用）。在多变量 Cox 模型中，CAC 体积与年龄和 ASCVD 风险评分之间存在显著的交互作用，而 CAC 密度与 ASCVD 风险评分之间存在显著的交互作用，用于 CVD。危险比在风险较低的组中更强。接受者操作特征曲线下面积和净重新分类指数分析显示，CAC 体积比 Agatston 更能预测 CHD 和 CVD 事件，并且 CAC 密度与 CAC 体积相结合可以进一步显著改善预测。
CAC 密度与冠心病和 CVD 事件的负相关在其他 CVD 风险因素的各个分层中都是稳健的。与 ASCVD 风险评分相加后，CAC 体积和密度对 CHD 和 CVD 事件的预测最强，正确分类的程度最高。
