Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej, Copenhagen, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark; Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark.
JACC Cardiovasc Imaging. 2017 Aug;10(8):858-866. doi: 10.1016/j.jcmg.2017.05.010.
This study sought to determine the incidence and progression of coronary artery calcification (CAC) in asymptomatic middle-aged subjects and to evaluate the value of a broad panel of biomarkers in the prediction of CAC growth.
CAC continues to be a major risk factor, but the value of biochemical markers in predicting CAC incidence and progression remains unresolved.
At baseline, 1,227 men and women underwent traditional risk assessment and a computed tomography (CT) scan to determine the CAC score. Biomarkers of calcium-phosphate metabolism (calcium, phosphate, vitamin D, parathyroid hormone, osteoprotegerin), lipid metabolism (triglyceride, high- and low-density lipoprotein, total cholesterol), inflammation (C-reactive protein, soluble urokinase-type plasminogen activator receptor), kidney function (creatinine, cystatin C, urate), and myocardial necrosis (cardiac troponin I) were analyzed. A second CT scan was scheduled after 5 years. General linear models were performed to examine the association between biomarkers and ΔCAC score, and additionally, sensitivity analyses were performed in terms of binary and ordinal logistic regressions.
A total of 1,006 participants underwent a CT scan after 5 years. Among the 562 participants with a baseline CAC score of 0, 189 (34%) had incident CAC, whereas 214 (48%) of the 444 participants with baseline CAC score >0 had significant progression (>15% annual increase in CAC score). In the multivariate models (n = 1,006), age, sex, hypertension, diabetes, dyslipidemia, and smoking were associated with ΔCAC, whereas the strongest predictor was baseline CAC score. Low-density lipoprotein and total cholesterol levels were independently associated with CAC incidence (n = 562; incidence rate ratio [IRR]: 1.47; 95% confidence interval [CI]: 1.05 to 2.05; and IRR: 1.34; 95% CI: 1.01 to 1.77, respectively), whereas phosphate level was associated with CAC progression (n = 444; IRR: 3.60; 95% CI: 1.42 to 9.11).
In this prospective study, a large part of participants had incident CAC or progression of prevalent CAC at 5 years of follow-up. Low-density lipoprotein and total cholesterol were associated with CAC incidence and phosphate with CAC progression, whereas 12 other biomarkers had little value.
本研究旨在确定无症状中年人群中冠状动脉钙化（CAC）的发生率和进展情况，并评估广泛的生物标志物在预测 CAC 生长中的价值。
CAC 仍然是一个主要的危险因素，但生化标志物在预测 CAC 发生率和进展方面的价值仍未得到解决。
在基线时，1227 名男性和女性接受了传统风险评估和计算机断层扫描（CT）扫描，以确定 CAC 评分。分析了钙磷代谢（钙、磷、维生素 D、甲状旁腺激素、骨保护素）、脂质代谢（甘油三酯、高低密度脂蛋白、总胆固醇）、炎症（C 反应蛋白、可溶性尿激酶型纤溶酶原激活物受体）、肾功能（肌酐、胱抑素 C、尿酸）和心肌坏死（肌钙蛋白 I）的生物标志物。在 5 年后安排了第二次 CT 扫描。进行了一般线性模型以检查生物标志物与ΔCAC 评分之间的关联，并且还进行了基于二元和有序逻辑回归的敏感性分析。
共有 1006 名参与者在 5 年后进行了 CT 扫描。在基线 CAC 评分为 0 的 562 名参与者中，有 189 名（34%）发生了 CAC，而在基线 CAC 评分>0 的 444 名参与者中，有 214 名（48%）出现了明显进展（CAC 评分每年增加>15%）。在多变量模型（n=1006）中，年龄、性别、高血压、糖尿病、血脂异常和吸烟与ΔCAC 相关，而最强的预测因素是基线 CAC 评分。低密度脂蛋白和总胆固醇水平与 CAC 发生率独立相关（n=562；发生率比[IRR]：1.47；95%置信区间[CI]：1.05 至 2.05；和 IRR：1.34；95%CI：1.01 至 1.77），而磷酸盐水平与 CAC 进展相关（n=444；IRR：3.60；95%CI：1.42 至 9.11）。
在这项前瞻性研究中，大部分参与者在 5 年随访期间发生 CAC 或 CAC 进展。低密度脂蛋白和总胆固醇与 CAC 发生率有关，而磷酸盐与 CAC 进展有关，而其他 12 个生物标志物则几乎没有价值。
