Mamudu Hadii M, Jones Antwan, Paul Timir, Subedi Pooja, Wang Liang, Alamian Arsham, Alamin Ali E, Blackwell Gerald, Budoff Matthew
Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee.
Department of Sociology, George Washington University, Washington, DC.
Am J Med Sci. 2018 Feb;355(2):140-148. doi: 10.1016/j.amjms.2017.08.011. Epub 2017 Aug 31.
This study aimed to examine the association between subclinical atherosclerosis (ascertained as coronary artery calcium [CAC]) in asymptomatic individuals in the Central Appalachian region of the United States and individual- and geographic-level factors.
Data were obtained from participants in CAC screening between 2012 and 2016. CAC score was assessed as CAC = 0 (no plaque), 1 ≤ CAC ≤ 99 (mild plaque), 100 ≤ CAC ≤ 399 (moderate plaque) and CAC ≥ 400 (severe plaque). Additionally, data on demographics (age, sex and race), medical conditions, lifestyle factors and family history of coronary artery disease were obtained. Further, zip codes of place of residence for participants were used to generate geographic-level data. Descriptive statistics were used to estimate the prevalence of CAC, and multinomial logistic regression models were used to delineate significant factors.
Of 1,512 participants, 57.6% had CAC > 0. The prevalence of mild, moderate and severe plaques was 31.6%, 16.3% and 9.7%, respectively. Demographics (age and sex), medical conditions, lifestyle factors and family history of coronary artery disease were associated with increased risk for subclinical atherosclerosis. Further, the proportion of minority residents significantly increased the risk for severe plaque (relative risk ratio = 1.06, P = 0.04) and the proportion of residents on government assistance significantly decreased the risk for mild plaque (relative risk ratio = 0.93, P = 0.03).
The results imply that the proportion of minority residents in a geographic area is associated with increased relative risk for subclinical atherosclerosis, while the proportion of residents on government assistance decreased such risk. However, future geographic or neighborhood-level studies with a larger sample size are needed to delineate further the consistency of these results in the Central Appalachian population.
本研究旨在探讨美国中阿巴拉契亚地区无症状个体的亚临床动脉粥样硬化（通过冠状动脉钙化[CAC]确定）与个体层面及地理层面因素之间的关联。
数据来源于2012年至2016年间进行CAC筛查的参与者。CAC评分被评估为：CAC = 0（无斑块），1≤CAC≤99（轻度斑块），100≤CAC≤399（中度斑块）以及CAC≥400（重度斑块）。此外，还获取了有关人口统计学信息（年龄、性别和种族）、医疗状况、生活方式因素以及冠状动脉疾病家族史的数据。此外，参与者居住地址的邮政编码被用于生成地理层面的数据。描述性统计用于估计CAC的患病率，多项逻辑回归模型用于确定显著因素。
在1512名参与者中，57.6%的人CAC>0。轻度、中度和重度斑块的患病率分别为31.6%、16.3%和9.7%。人口统计学信息（年龄和性别）、医疗状况、生活方式因素以及冠状动脉疾病家族史与亚临床动脉粥样硬化风险增加相关。此外，少数族裔居民的比例显著增加了重度斑块的风险（相对风险比 = 1.06，P = 0.04），而接受政府援助的居民比例显著降低了轻度斑块的风险（相对风险比 = 0.93，P = 0.03）。
结果表明，地理区域内少数族裔居民的比例与亚临床动脉粥样硬化的相对风险增加相关，而接受政府援助的居民比例则降低了这种风险。然而，未来需要进行更大样本量的地理或社区层面研究，以进一步明确这些结果在中阿巴拉契亚人群中的一致性。
