From the National Heart, Lung and Blood Institute's Intramural Research Program, Framingham Heart Study, MA (S.-J.H., C.S.F., C.J.O.); Population Sciences Branch, Division of Intramural Research (S.-J.H.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (Y.P.F.), NHLBI, NIH, Bethesda, MD; World Health Organization Department for Management of Non-Communicable Diseases, Disability, Violence and Injury Prevention (NVI), Geneva, Switzerland (O.O.); Department of Mathematics and Statistics (J.M.M.) and Section of Biomedical Genetics, School of Medicine (X.Z.), Boston University, MA; Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.S.F.); and Cardiology Section, Boston Veteran's Administration Healthcare, MA (C.J.O.).
Circ Cardiovasc Imaging. 2018 Jan;11(1):e006209. doi: 10.1161/CIRCIMAGING.117.006209.
Ideal cardiovascular health (CVH) is associated with a lower risk of cardiovascular disease and freedom from coronary artery calcium (CAC). Prospective data on the association between maintenance of optimal CVH and the progression of subclinical coronary atherosclerosis are limited. We assessed the influence of unfavorable versus favorable CVH on the incidence of CAC progression.
The study population consisted of 1119 FHS (Framingham Heart Study) participants who attended the serial FHS MDCT I and MDCT II study (Multi-Detector Computed Tomography) and had a zero Agatston CAC score at baseline. CVH status was defined using 6 CVH metrics from the American Heart Association definition. CAC progression was defined by an increase in Agatston CAC score to ≥3.4. Generalized estimating equations were applied to identify significant associations of CAC progression with both the baseline measurement of CVH and the longitudinal maintenance of CVH. After follow-up (mean, 6.1 years), we observed CAC progression in 191 participants (17.1%). Participants with unfavorable CVH at baseline had a greater risk of CAC progression (odds ratio, 2.43; 95% confidence interval, 1.40-4.23; =0.0017). In addition, each unit decrease in ideal CVH metric was associated with an increase in CAC progression (odds ratio, 1.15; 95% confidence interval, 0.99-1.34; =0.067), after adjustment for baseline ideal CVH metrics.
Significant associations between an unfavorable CVH profile and CAC progression support public health measures that seek to prevent cardiovascular disease by promoting favorable CVH profiles in persons free of clinical and subclinical cardiovascular disease.
理想的心血管健康（CVH）与心血管疾病风险降低和无冠状动脉钙（CAC）有关。关于维持最佳 CVH 与亚临床冠状动脉粥样硬化进展之间的关系的前瞻性数据有限。我们评估了不利的 CVH 与有利的 CVH 对 CAC 进展发生率的影响。
研究人群包括 1119 名参加了系列 FHS MDCT I 和 MDCT II 研究（多探测器计算机断层扫描）且基线时 CAC 评分零的 FHS（弗雷明汉心脏研究）参与者。CVH 状态使用美国心脏协会定义的 6 个 CVH 指标来定义。CAC 进展定义为 Agatston CAC 评分增加到≥3.4。广义估计方程用于确定 CAC 进展与 CVH 的基线测量和 CVH 的纵向维持之间的显著关联。随访（平均 6.1 年）后，我们观察到 191 名参与者（17.1%）的 CAC 进展。基线时 CVH 不良的参与者 CAC 进展的风险更高（优势比，2.43；95%置信区间，1.40-4.23；=0.0017）。此外，在调整基线理想 CVH 指标后，每个理想 CVH 指标单位的下降与 CAC 进展增加相关（优势比，1.15；95%置信区间，0.99-1.34；=0.067）。
不利的 CVH 特征与 CAC 进展之间存在显著关联，支持通过在无临床和亚临床心血管疾病的人群中促进有利的 CVH 特征来预防心血管疾病的公共卫生措施。
