Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
University of California Irvine School of Medicine, Irvine, California.
JACC Cardiovasc Imaging. 2021 Jan;14(1):219-229. doi: 10.1016/j.jcmg.2020.06.047. Epub 2020 Oct 28.
The purpose of this study was to identify predictors of healthy arterial aging (long-term coronary artery calcification [CAC] of 0) among individuals with metabolic syndrome (MetS) or type 2 diabetes (T2D), which may improve primary prevention strategies.
Individuals with MetS or T2D have a heterogeneously increased risk of atherosclerotic cardiovascular disease and not all have a high-intermediate risk.
We included 574 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with MetS or T2D who had CAC=0 at baseline and a repeat CAC scan 10 years later. Multivariable logistic regression assessed the association of traditional and novel atherosclerotic cardiovascular disease risk factors and the MetS severity score (based on the 5 MetS criteria) with healthy arterial aging.
The mean age of participants was 58.9 years, 67% were women, 422 participants had MetS, and 152 had T2D. The proportion with long-term CAC=0 was similar for MetS (42%) and T2D (44%). A younger age was the only individual low/normal traditional risk factor associated with an increased likelihood of long-term CAC=0 (odds ratio [OR]: 1.50; 95% confidence interval [CI]: 1.22 to 1.85 per 10-years younger). The strongest associations of nontraditional risk factors were observed for an absence of thoracic calcification (OR: 2.42; 95% CI: 1.24 to 4.72), absence of carotid plaque (OR: 1.81; 95% CI: 1.25 to 2.61), and among persons with a high sensitivity troponin <3 ng/ml (OR: 1.55; 95% CI: 1.01 to 2.38). In addition, persons with the lowest quartile MetS severity score had a substantially higher odds of healthy long-term CAC=0 (OR: 2.71; 95% CI: 1.27 to 5.76).
More than 40% of adults with MetS or T2D and baseline CAC=0 had long-term absence of CAC, which was most strongly associated with an absence of extracoronary atherosclerosis and a low MetS score. An optimal overall cardiovascular profile appears to be more important than an ideal value of any individual risk factor to maintain healthy arterial aging.
本研究旨在确定代谢综合征（MetS）或 2 型糖尿病（T2D）患者中健康动脉老化（长期冠状动脉钙化 [CAC] 为 0）的预测因素，这可能有助于改进一级预防策略。
MetS 或 T2D 患者的动脉粥样硬化性心血管疾病风险存在异质性增加，并非所有人都具有中高危风险。
我们纳入了基线 CAC=0 且 10 年后重复 CAC 扫描的 MESA（多民族动脉粥样硬化研究）中的 574 名 MetS 或 T2D 患者。多变量逻辑回归评估了传统和新型动脉粥样硬化心血管疾病风险因素以及 MetS 严重程度评分（基于 5 项 MetS 标准）与健康动脉老化的关联。
参与者的平均年龄为 58.9 岁，67%为女性，422 名参与者患有 MetS，152 名患有 T2D。MetS（42%）和 T2D（44%）的长期 CAC=0 比例相似。年龄较轻是唯一与长期 CAC=0 发生几率增加相关的低/正常传统危险因素（优势比 [OR]：每年轻 10 岁增加 1.50；95%置信区间 [CI]：1.22 至 1.85）。非传统危险因素的最强关联见于无胸主动脉钙化（OR：2.42；95%CI：1.24 至 4.72）、无颈动脉斑块（OR：1.81；95%CI：1.25 至 2.61）和高敏肌钙蛋白 <3ng/ml 的人群（OR：1.55；95%CI：1.01 至 2.38）。此外，MetS 严重程度评分最低四分位数的患者发生健康长期 CAC=0 的几率显著更高（OR：2.71；95%CI：1.27 至 5.76）。
超过 40%的 MetS 或 T2D 且基线 CAC=0 的成年人长期不存在 CAC，这与无冠状动脉外动脉粥样硬化和低 MetS 评分的关联最强。维持健康动脉老化似乎需要的是一个优化的整体心血管特征，而不仅仅是任何单一风险因素的理想值。
