The Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA.
Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil.
Atherosclerosis. 2020 Sep;309:8-15. doi: 10.1016/j.atherosclerosis.2020.07.003. Epub 2020 Jul 29.
There are limited data on serial coronary artery calcium (CAC) assessments outside North American and European populations. We sought to investigate risk factors for CAC incidence and progression in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
We included individuals with no prior cardiovascular disease and two CAC measurements in ELSA-Brasil. Incident CAC was defined as a baseline CAC of 0 followed by CAC >0 on the second study. CAC progression was defined according to multiple published criteria. We performed logistic and linear regression to identify risk factors for CAC incidence and progression. We also examined risk factor effect modification by baseline CAC (0 vs. >0).
A total of 2707 individuals were included (57% women, age 48.6 ± 7.7 years). Participants self-identified as white (55%), brown (24%), black (16%), Asian (4%) and Indigenous (1%). The mean period between CAC assessments was 5.1 ± 0.9 years. CAC incidence occurred in 282 (13.3%) of 2127 individuals with baseline CAC of 0. CAC progression occurred in 319 (55%) of 580 participants with baseline CAC >0. Risk factors for CAC incidence included older age, male sex, white race, hypertension, diabetes, higher BMI, smoking, lower HDL-C, higher LDL-C and triglycerides, and metabolic syndrome. Older age and elevated LDL-C were associated with CAC incidence, but not progression. Risk factors consistently associated with CAC progression were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome. On interaction testing, these four risk factors were more strongly associated with CAC progression as compared to CAC incidence.
CAC incidence was associated with multiple traditional risk factors, whereas the only risk factors associated with progression of CAC were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome.
北美的欧洲人群以外的关于连续冠状动脉钙（CAC）评估的数据有限。我们旨在研究巴西纵向成人健康研究（ELSA-Brasil）中 CAC 发病和进展的危险因素。
我们纳入了无心血管疾病病史且在 ELSA-Brasil 中有两次 CAC 测量值的个体。CAC 发病定义为基线 CAC 为 0，随后第二次研究中 CAC>0。根据多个已发表的标准，定义 CAC 进展。我们进行了逻辑和线性回归分析，以确定 CAC 发病和进展的危险因素。我们还检查了基线 CAC（0 与>0）对危险因素作用修饰的影响。
共纳入 2707 名个体（57%为女性，年龄 48.6±7.7 岁）。参与者自认为是白人（55%）、棕色（24%）、黑色（16%）、亚洲人（4%）和原住民（1%）。两次 CAC 评估之间的平均间隔为 5.1±0.9 年。在基线 CAC 为 0 的 2127 名个体中，有 282 名（13.3%）发生 CAC 发病。在基线 CAC>0 的 580 名参与者中，有 319 名（55%）发生 CAC 进展。CAC 发病的危险因素包括年龄较大、男性、白种人、高血压、糖尿病、更高的 BMI、吸烟、较低的 HDL-C、较高的 LDL-C 和甘油三酯，以及代谢综合征。年龄较大和 LDL-C 升高与 CAC 发病相关，但与 CAC 进展无关。与 CAC 进展始终相关的危险因素是高血压、糖尿病、高甘油三酯血症和代谢综合征。在交互测试中，这四个危险因素与 CAC 进展的相关性强于 CAC 发病。
CAC 发病与多种传统危险因素有关，而与 CAC 进展相关的唯一危险因素是高血压、糖尿病、高甘油三酯血症和代谢综合征。
