Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, 9452 Medical Center Dr. La Jolla, California, CA, USA.
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr. La Jolla, California, CA, USA.
Eur Heart J Cardiovasc Imaging. 2018 Dec 1;19(12):1343-1350. doi: 10.1093/ehjci/jey007.
Little is known regarding the risk of atherosclerotic cardiovascular disease (ASCVD) conferred by changes in the volume and density of ascending thoracic aorta calcium (ATAC) over time. We evaluated changes in ATAC volume and density scores and incident ASCVD events.
The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study of individuals without baseline clinical ASCVD. Ascending thoracic aorta calcium was measured from baseline and follow-up (mean interval 2.4 years) cardiac computed tomography (CT). Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) per standard deviation for events after the follow-up exam adjusted for ASCVD risk factors, baseline ATAC and coronary artery calcium (CAC) volume and density, and changes in CAC volume and density. Among 5887 participants, 296 (5.0%) had detectable ATAC at baseline, follow-up, or both exams. A total of 403 events occurred over 9.5 years. An increase in ATAC volume was associated with coronary heart disease (CHD) (HR 1.90, 95% CI 1.14-3.16), ASCVD (HR 1.93, 95% CI 1.26-2.94), and ischaemic stroke (HR 2.14, CI 1.21-3.78). An increase in ATAC density was inversely associated with CHD (HR 0.29, 95% CI 0.14-0.60) and ASCVD (HR 0.42, 95% CI 0.23-0.76), but not stroke (HR 0.61, CI 0.23-1.61).
Ascending thoracic aorta calcium is uncommon on serial cardiac CT. However, changes in ATAC volume and density are both associated with incident ASCVD events, but in opposite directions. Serial assessments in those with baseline ATAC may provide insight into an individual's trajectory of ASCVD risk.
关于随时间推移升主动脉钙（ATAC）体积和密度变化对动脉粥样硬化性心血管疾病（ASCVD）风险的影响，目前所知甚少。我们评估了 ATAC 体积和密度评分的变化与 ASCVD 事件的发生情况。
多民族动脉粥样硬化研究是一项无基线临床 ASCVD 的个体前瞻性队列研究。从基线和随访（平均间隔 2.4 年）心脏 CT 测量升主动脉钙。使用 Cox 比例风险回归估计每标准偏差的风险比（HR）和 95%置信区间（CI），以调整 ASCVD 危险因素、基线 ATAC 和冠状动脉钙（CAC）体积和密度以及 CAC 体积和密度变化后的随访检查后发生事件。在 5887 名参与者中，296 名（5.0%）在基线、随访或两次检查中均检测到 ATAC。9.5 年内共发生 403 例事件。ATAC 体积增加与冠心病（CHD）（HR 1.90，95%CI 1.14-3.16）、ASCVD（HR 1.93，95%CI 1.26-2.94）和缺血性卒中等（HR 2.14，CI 1.21-3.78）有关。ATAC 密度增加与 CHD（HR 0.29，95%CI 0.14-0.60）和 ASCVD（HR 0.42，95%CI 0.23-0.76）呈负相关，但与卒中无关（HR 0.61，CI 0.23-1.61）。
在连续心脏 CT 上，升主动脉钙并不常见。然而，ATAC 体积和密度的变化均与 ASCVD 事件的发生相关，但方向相反。在基线有 ATAC 的人群中进行连续评估，可能有助于深入了解个体 ASCVD 风险的轨迹。
