Pogosova N V, Yufereva Y M, Kachanova N P, Metelskaya V A, Koltunov I Y, Voronina V P, Mazaev A P, Arutyunov A A, Vygodin V A
FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation.
State Budgetary Institution City Polyclinic #180 of the Moscow City Health Department.
Kardiologiia. 2019 Jul 23;59(11S):53-62. doi: 10.18087/cardio.n471.
The search for optimal approaches to the diagnosis of subclinical atherosclerosis using a wide range of traditional and psychosocial risk factors (RFs), as well as clinical and instrumental diagnostic methods in patients (pts) with high or very high cardiovascular (CV) risk.
This cross-sectional study enrolled52 pts, aged 40 to 65 years with high or very high CV risk (5-9 and ≥10% by the Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT)angiography and calcium scoring. Traditional RFs (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound, arterial stiffness were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality.
All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. It was found that patients with subclinical atherosclerosis significantly more often have a very high (≥10%) CV risk (42.9% vs.16.3%, p<0.05), a long (≥5 years) history of arterial hypertension (47.6% vs. 12.9% , p<0.01) and longer duration of antihypertensive therapy (61.9% vs. 29.0%, p<0.05), higher heart rate in rest (87. ± 14 vs. 77 ± 10 beats/min, p<0.01), increased arterial stiffness according to aortic pulse wave velocity (85.7% vs. 61.3%, p<0.05) and high level of hs-CRP (100% vs. 90.3%, p<0.05).
Using in routine clinical practice of additional anamnestic (hypertension lasting ≥ 5 years and the intake of any antihypertensive drugs) and clinical-instrumental parameters (high heart rate in rest, hs CRP and arterial stiffness in pts with high and very high CV risk increases effectiveness of early detection of subclinical atherosclerosis.
探寻利用广泛的传统和心理社会风险因素以及临床和仪器诊断方法，对心血管（CV）风险高或极高的患者进行亚临床动脉粥样硬化诊断的最佳方法。
这项横断面研究纳入了52例年龄在40至65岁之间、CV风险高或极高的患者（分别根据系统性冠状动脉风险评估量表[SCORE]为5 - 9%和≥10%）。所有参与者均接受了心脏计算机断层扫描（CT）血管造影和钙化评分。对所有患者评估了传统风险因素（早发性心血管疾病家族史、吸烟、超重/肥胖和腹型肥胖、高血压、2型糖尿病、血脂参数（总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯）和血脂相关标志物（载脂蛋白A1、载脂蛋白B、ApoB/ApoA1比值）、炎症生物标志物（高敏C反应蛋白[hs CRP]、纤维蛋白原）、碳水化合物代谢指标（血糖）、踝臂指数、应激试验、超声检查的颈动脉斑块、动脉僵硬度）。使用医院焦虑抑郁量表和D型人格的DS - 14评估心理风险因素。
根据CT血管造影结果将所有患者分为2组：主要组（n = 21）的患者有任何非阻塞性病变或钙化评分>0，对照组（n = 31）的患者冠状动脉正常。两组在年龄或性别上无差异。发现亚临床动脉粥样硬化患者CV风险极高（≥10%）的情况显著更常见（42.9%对16.3%，p<0.05），有较长（≥5年）的动脉高血压病史（47.6%对12.9%，p<0.01）以及较长的抗高血压治疗时间（61.9%对29.0%，p<0.05），静息时心率较高（87. ± 14对77 ± 10次/分钟，p<0.01），根据主动脉脉搏波速度测量的动脉僵硬度增加（85.7%对61.3%，p<0.05）以及hs - CRP水平较高（100%对90.3%，p<0.05）。
在常规临床实践中使用额外的病史信息（持续≥5年的高血压和服用任何抗高血压药物）以及临床 - 仪器参数（高CV风险和极高CV风险患者静息时的高心率、hs CRP和动脉僵硬度）可提高亚临床动脉粥样硬化早期检测的有效性。
