Division of Cardiology, Department of Internal Medicine (J.D.B., A.P.), UT Southwestern Medical Center, Dallas, TX.
Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.M.).
Circ Cardiovasc Imaging. 2019 Sep;12(9):e009226. doi: 10.1161/CIRCIMAGING.119.009226. Epub 2019 Sep 16.
Absence of cardiovascular risk factors (RF) in young adulthood is associated with a lower risk for cardiovascular disease. However, it is unclear if low RF burden in young adulthood decreases the quantitative burden and qualitative features of atherosclerosis.
Multi-contrast carotid magnetic resonance imaging was performed on 440 Chicago Healthy Aging Study participants in 2009 to 2011, whose RF (total cholesterol, blood pressure, diabetes mellitus, and smoking) were measured in 1967 to 1973. Participants were divided into 4 groups: low-risk (with total cholesterol <200 mg/dL and no treatment, blood pressure <120/80 mm Hg and no treatment, no smoking, and no diabetes mellitus), 0 high RF but some RF unfavorable (≥1 RF above low-risk threshold but below high-risk threshold), 1 high RF (total cholesterol ≥240 mg/dL or treated, blood pressure ≥140/90 or treated, diabetes mellitus, or smoking), and 2 or more high RF. Association of baseline RF status with carotid atherosclerosis (overall mean carotid wall thickness and lipid-rich necrotic core) at follow-up was assessed.
Among 424 participants with evaluable carotid magnetic resonance images, the mean age was 32 years at baseline and 73 years at follow-up; 67% were male, 86% white, and 36% were low-risk at baseline. Two or more high RF status was associated with higher carotid wall thickness (0.99±0.11 mm) and lipid-rich necrotic core prevalence (30%), as compared with low-risk group (0.94±0.09 mm and 17%, respectively). Each increment in baseline RF status was associated with higher carotid wall thickness (β-coefficient, 0.015; 95% CI, 0.004-0.026) and with higher lipid-rich necrotic core prevalence at older age (odds ratio, 1.26; 95% CI, 1.00-1.58) in models adjusted for baseline RF and demographics.
RF status in young adulthood is associated with the burden and quality of carotid atherosclerosis in older age suggesting that the decades-long protective effect of low-risk status might be mediated through a lower burden of quantitative and qualitative features of atherosclerotic plaque.
年轻人时期不存在心血管危险因素（RF）与心血管疾病风险降低相关。然而，目前尚不清楚年轻人时期低 RF 负担是否会降低动脉粥样硬化的定量负担和定性特征。
2009 年至 2011 年，对 440 名芝加哥健康老龄化研究参与者进行了多对比颈动脉磁共振成像检查，其 RF（总胆固醇、血压、糖尿病和吸烟）于 1967 年至 1973 年测量。参与者分为 4 组：低危组（总胆固醇<200mg/dL 且未治疗，血压<120/80mmHg 且未治疗，不吸烟且无糖尿病）、0 个高 RF 但有一些 RF 不利（≥1 个 RF 高于低危阈值但低于高危阈值）、1 个高 RF（总胆固醇≥240mg/dL 或治疗，血压≥140/90mmHg 或治疗，糖尿病或吸烟）和 2 个或更多高 RF。评估基线 RF 状态与随访时颈动脉粥样硬化（整体颈动脉壁厚度和富含脂质的坏死核心）之间的关系。
在 424 名可评估颈动脉磁共振成像的参与者中，基线时的平均年龄为 32 岁，随访时的平均年龄为 73 岁；67%为男性，86%为白人，36%为基线低危。与低危组相比，2 个或更多高 RF 状态与较高的颈动脉壁厚度（0.99±0.11mm）和富含脂质的坏死核心患病率（30%）相关。基线 RF 状态的每次增加与颈动脉壁厚度的增加相关（β 系数，0.015；95%CI，0.004-0.026），并且与调整基线 RF 和人口统计学数据后的较老年龄时较高的富含脂质的坏死核心患病率相关（优势比，1.26；95%CI，1.00-1.58）。
年轻人时期的 RF 状态与老年时颈动脉粥样硬化的负担和质量相关，表明低危状态的数十年保护作用可能通过降低动脉粥样硬化斑块的定量和定性特征的负担来介导。
