Departments of Radiology.
Epidemiology.
J Thorac Imaging. 2021 May 1;36(3):174-180. doi: 10.1097/RTI.0000000000000566.
To assess the presence of coronary artery calcium (CAC) and its association with cardiovascular risk factors and Systematic COronary Risk Evaluation (SCORE) risk in a middle-aged Dutch population.
Classic cardiovascular risk factors and CAC were analyzed in 4083 participants aged 45 to 60 years (57.9% women) from the population-based ImaLife study. CAC scores were quantified on noncontrast cardiac CT scans. Age-specific and sex-specific distribution of CAC categories (0, 1 to 99, 100 to 299, ≥300) and percentiles were determined. SCORE risk categories (<1%, ≥1% to 5%, and ≥5%) were compared with CAC distribution. Population attributable fractions (PAFs) of classic risk factors for CAC were estimated.
CAC was present in 54.5% male and 26.5% female participants. The percentage of individuals with CAC increased with increasing age. Mean SCORE was 2.0% in men and 0.7% in women. In SCORE <1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE ≥5%, 26.9% had no CAC. Only 0.1% of women had SCORE ≥5%. PAF of classic risk factors for CAC was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% confidence interval, 4.2%-11.8%; in women 13.1%, 95% confidence interval, 7.9%-18.2%) followed by hypercholesterolemia and obesity.
In this middle-aged cohort, more than half of the men and a quarter of the women had CAC. One out of 4 men at high risk (SCORE ≥5%) could be placed into a lower risk category owing to absence of CAC. Thus, adding CAC scoring to SCORE could have considerable effect on cardiovascular risk classification. Elimination of exposure to classic risk factors could reduce limited proportion of CAC in a middle-aged population.
评估中年荷兰人群中冠状动脉钙（CAC）的存在及其与心血管危险因素和系统性冠状动脉风险评估（SCORE）风险的关系。
在基于人群的 ImaLife 研究中，对 4083 名年龄在 45 至 60 岁（57.9%为女性）的参与者进行了经典心血管危险因素和 CAC 分析。在非对比性心脏 CT 扫描上量化 CAC 评分。确定 CAC 分类（0、1 至 99、100 至 299、≥300）和百分位数的年龄和性别特异性分布。比较 SCORE 风险类别（<1%、≥1%至 5%和≥5%）与 CAC 分布。估计 CAC 的经典危险因素的人群归因分数（PAFs）。
54.5%的男性和 26.5%的女性参与者存在 CAC。随着年龄的增加，存在 CAC 的个体百分比增加。男性的平均 SCORE 为 2.0%，女性为 0.7%。在 SCORE <1%的男性和女性中，32.7%和 17.1%有 CAC。在 SCORE≥5%的男性中，26.9%没有 CAC。只有 0.1%的女性 SCORE≥5%。CAC 的经典危险因素的 PAF 在男性中为 18.5%，在女性中为 31.4%。高血压的 PAF 最高（男性 8.0%，95%置信区间，4.2%-11.8%；女性 13.1%，95%置信区间，7.9%-18.2%），其次是高胆固醇血症和肥胖。
在这个中年队列中，超过一半的男性和四分之一的女性存在 CAC。由于 CAC 不存在，高危（SCORE≥5%）的 1/4 男性可以归入较低的风险类别。因此，将 CAC 评分添加到 SCORE 中可能会对心血管风险分类产生重大影响。消除经典危险因素的暴露可以减少中年人群中 CAC 的有限比例。
