The National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study), Framingham, MA.
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
J Am Heart Assoc. 2018 Jun 16;7(12):e008057. doi: 10.1161/JAHA.117.008057.
We sought to determine whether increased aortic arch width (AAW) adds to standard Framingham risk factors and coronary artery calcium (CAC) for prediction of incident adverse cardiovascular disease (CVD) events in community-dwelling adults.
A total of 3026 Framingham Heart Study Offspring and Third Generation cohort participants underwent noncontrast multidetector computed tomography from 2002 to 2005 to quantify CAC. We measured AAW as the distance between the centroids of the ascending and descending thoracic aorta, at the level of main pulmonary artery bifurcation or the right pulmonary artery. We determined sex, age group, and body size specific cut points for high (≥90th percentile) AAW from a healthy referent group (N=1471) and dichotomized AAW as high or not high across all study participants. Clinical covariates were obtained at Offspring cycle 7 (1998-2001) or Third Generation cycle 1 (2002-2005) examinations. The primary CVD outcome was a composite of myocardial infarction, coronary insufficiency, cerebrovascular accident, first hospitalization for heart failure, or CVD death. Cox proportional hazards models were used to estimate hazard ratio of high AAW on time-to-incident CVD after adjustment for Framingham risk factors and CAC. Net reclassification improvement was used to assess the effect of adding AAW to the baseline Framingham risk factor+CAC model. A total of 2826 participants (aged 51±11 years, 48% women) had complete covariates and were free of CVD at multidetector computed tomography. Over a median 8.9 years of follow-up, there were 135 incident CVD events. High AAW was independently predictive of CVD events (hazard ratio, 1.55; =0.032) and appropriately reclassified participants at risk: net reclassification improvement, 0.31 (95% confidence interval, 0.15-0.48).
AAW augments traditional CVD risk factors and CAC for prediction of incident adverse CVD events among community-dwelling adults.
我们旨在确定主动脉弓宽度（AAW）的增加是否会增加标准弗雷明汉风险因素和冠状动脉钙（CAC），以预测社区居住的成年人中发生不良心血管疾病（CVD）事件。
总共 3026 名弗雷明汉心脏研究后代和第三代队列参与者在 2002 年至 2005 年期间接受了非对比多层计算机断层扫描，以量化 CAC。我们测量了在主肺动脉分叉处或右肺动脉处的升主动脉和降主动脉的质心之间的距离，以确定 AAW。我们从健康对照组（N=1471）中确定了性别、年龄组和体型特定的高（≥90 百分位）AAW 切点，并在所有研究参与者中对 AAW 进行了高或不高的二分法划分。临床协变量是在后代周期 7（1998-2001 年）或第三代周期 1（2002-2005 年）检查中获得的。主要 CVD 结局是心肌梗死、冠状动脉功能不全、脑卒中风、首次心力衰竭住院或 CVD 死亡的综合指标。Cox 比例风险模型用于估计在调整弗雷明汉风险因素和 CAC 后，高 AAW 对 CVD 发病时间的风险比。净重新分类改善用于评估在基线弗雷明汉风险因素+CAC 模型中添加 AAW 的效果。共有 2826 名参与者（年龄 51±11 岁，48%为女性）完成了协变量，并且在多层计算机断层扫描时没有 CVD。在中位数为 8.9 年的随访期间，发生了 135 例 CVD 事件。高 AAW 与 CVD 事件独立相关（风险比，1.55；P=0.032），并适当重新分类了高危患者：净重新分类改善，0.31（95%置信区间，0.15-0.48）。
AAW 增加了传统的 CVD 风险因素和 CAC，可用于预测社区居住的成年人中发生不良 CVD 事件的风险。
