Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.M., L.S.S.).
Department of Biostatistics and Data Science (J.R.), Wake Forest University School of Medicine, Winston-Salem, NC.
Circ Cardiovasc Imaging. 2021 Apr;14(4):e011701. doi: 10.1161/CIRCIMAGING.120.011701. Epub 2021 Apr 8.
Absence of coronary artery calcium (CAC) identifies asymptomatic individuals at low cardiovascular disease risk. Carotid artery plaque is a marker of increased risk, but its association with cardiovascular risk and incident CAC in people without CAC is unclear.
Multi-Ethnic Study of Atherosclerosis participants with CAC score of 0 at enrollment who also underwent carotid plaque measurement using B-mode ultrasonography were prospectively followed for incident coronary heart disease, stroke, and cardiovascular disease events, and CAC (score >0 on up to 3 serial computed tomography scans). The association of carotid plaque presence and plaque score (Ln[score+1]) at baseline with cardiovascular events and incident CAC was evaluated with Cox proportional hazards regression models adjusted for demographics, risk factors, and statin use.
Among these 2673 participants (58 years, 64% women, 34% White, 30% Black, 24% Hispanic, and 12% Chinese), carotid plaque at baseline was observed in 973 (36%) and the median plaque score (range, 1-12) among those with plaque was 1. A total of 79 coronary heart disease, 80 stroke, and 151 cardiovascular disease events were observed during 16.1 years of follow-up. Carotid plaque presence and plaque score were independently associated with coronary heart disease risk (HRs, 1.66 [95% CI, 1.04-2.66]; and 1.48 [95% CI, 1.01-2.17], respectively) but not with stroke and cardiovascular disease risk. A total of 973 (36.4%) participants developed CAC over the evaluation period (median 9.3 years). Carotid plaque presence and plaque score were independently associated with incident CAC (HRs, 1.34 [95% CI, 1.18-1.54]; and 1.37 [95% CI, 1.21-1.54]), respectively.
The presence and extent of carotid plaque are associated with long-term coronary heart disease risk and incident CAC among middle-aged asymptomatic individuals with an initial CAC score of 0.
冠状动脉钙（CAC）的缺失可识别出心血管疾病风险较低的无症状个体。颈动脉斑块是风险增加的标志物，但在没有 CAC 的人群中，其与心血管风险和 CAC 事件的相关性尚不清楚。
多民族动脉粥样硬化研究（Multi-Ethnic Study of Atherosclerosis）的参与者在入组时 CAC 评分为 0，并且还接受了颈动脉斑块 B 型超声测量。这些参与者前瞻性随访了冠心病、卒中和心血管疾病事件以及 CAC（在多达 3 次连续 CT 扫描中评分>0）的发生情况。使用 Cox 比例风险回归模型评估了基线时颈动脉斑块的存在和斑块评分（Ln[评分+1]）与心血管事件和 CAC 事件的相关性，模型调整了人口统计学、危险因素和他汀类药物的使用情况。
在这 2673 名参与者（58 岁，64%为女性，34%为白人，30%为黑人，24%为西班牙裔，12%为华裔）中，基线时存在颈动脉斑块的有 973 名（36%），有斑块的参与者的中位数斑块评分（范围为 1-12）为 1。在 16.1 年的随访期间，共发生了 79 例冠心病、80 例卒中和 151 例心血管疾病事件。颈动脉斑块的存在和斑块评分与冠心病风险独立相关（风险比分别为 1.66[95%CI，1.04-2.66]和 1.48[95%CI，1.01-2.17]），但与卒中和心血管疾病风险无关。在评估期间，共有 973 名（36.4%）参与者发生了 CAC（中位数为 9.3 年）。颈动脉斑块的存在和斑块评分与 CAC 事件的发生独立相关（风险比分别为 1.34[95%CI，1.18-1.54]和 1.37[95%CI，1.21-1.54]）。
在初始 CAC 评分为 0 的中年无症状个体中，颈动脉斑块的存在和程度与长期冠心病风险和 CAC 事件的发生相关。
