Department of Internal Medicine F and the Rheumatology unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Am J Hypertens. 2018 Feb 9;31(3):313-320. doi: 10.1093/ajh/hpx181.
Coronary artery calcification (CAC) is associated with increased cardiovascular (CV) risk. Left ventricular hypertrophy (LVH) is an independent risk factor for CV events. Our aim was to estimate the relative CV risk of LVH in the presence of CAC.
We included asymptomatic hypertensive patients who were enrolled in the calcification arm of the INSIGHT (International Nifedipine Study Intervention as Goal for Hypertension Therapy). Patients had baseline echocardiography and computed tomography to assess CAC. The primary end-point was the first CV event.
Two hundred and fifty-two subjects (mean age 64.7 ± 5.5 years, 54% men) were followed for a mean of 13.3 ± 2.6 years. 72 patients (28.5%) had LVH and 159 patients (63%) had CAC. During follow up, 89 patients had a first CV event. The rate of CV events was higher in those with than in those without CAC (43.4% vs. 21.5%, P < 0.01) and in those with than in those without LVH (44% vs. 31.6%, P < 0.01). However, LVH had no effect on CV events in the absence of CAC, whereas LVH almost doubled the rate of CV events (61.4% vs. 36.5%, P < 0.01) in the presence of CAC. In comparison to patients without CAC and without LVH the hazard ratio for CV event in those with LVH was 1.46 (95% confidence interval [CI], 0.50-4.21) in those without CAC and 4.4 (95% CI, 2.02-9.56) in those with CAC.
LVH and CAC independently predict CV events in asymptomatic hypertensive patients. However, the risk of LVH is mainly observed in those with CAC.
冠状动脉钙化（CAC）与心血管（CV）风险增加相关。左心室肥厚（LVH）是 CV 事件的独立危险因素。我们的目的是评估 CAC 存在时 LVH 的相对 CV 风险。
我们纳入了无症状高血压患者，他们参加了 INSIGHT（硝苯地平国际研究干预高血压治疗目标）的钙化臂。患者基线行超声心动图和计算机断层扫描评估 CAC。主要终点是首次 CV 事件。
252 例患者（平均年龄 64.7 ± 5.5 岁，54%为男性）平均随访 13.3 ± 2.6 年。72 例（28.5%）有 LVH，159 例（63%）有 CAC。随访期间，89 例患者发生首次 CV 事件。有 CAC 患者的 CV 事件发生率高于无 CAC 患者（43.4% vs. 21.5%，P < 0.01）和有 LVH 患者（44% vs. 31.6%，P < 0.01）。然而，在无 CAC 的情况下，LVH 对 CV 事件没有影响，而在 CAC 存在的情况下，LVH 使 CV 事件的发生率几乎增加了一倍（61.4% vs. 36.5%，P < 0.01）。与无 CAC 和无 LVH 的患者相比，无 CAC 且有 LVH 的患者的 CV 事件发生风险比为 1.46（95%置信区间 [CI]，0.50-4.21），而有 CAC 且有 LVH 的患者为 4.4（95%CI，2.02-9.56）。
在无症状高血压患者中，LVH 和 CAC 独立预测 CV 事件。然而，LVH 的风险主要发生在有 CAC 的患者中。
