Mortensen Martin Bødtker, Dzaye Omar, Bødtker Henrik, Steffensen Flemming Hald, Bøtker Hans Erik, Jensen Jesper Møller, Rønnow Sand Niels Peter, Maeng Michael, Warnakula Olesen Kevin Kris, Sørensen Henrik Toft, Kanstrup Helle, Blankstein Ron, Blaha Michael J, Nørgaard Bjarne Linde
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JACC Cardiovasc Imaging. 2021 Dec;14(12):2387-2396. doi: 10.1016/j.jcmg.2021.05.003. Epub 2021 Jun 16.
The aim of this study was to examine prevalence, predictors, and impact of coronary artery calcium (CAC) across different risk factor burdens on the prevalence of obstructive coronary artery disease (CAD) and future coronary heart disease (CHD) risk in young patients.
The interplay of risk factors and CAC for predicting CHD in young patients aged ≤45 years is not clear.
The study included 3,691 symptomatic patients (18-45 years of age) from the WDHR (Western Denmark Heart Registry) undergoing coronary computed tomographic angiography. CHD events were myocardial infarction and late revascularization.
During a median of 4.1 years of follow-up, 57 first-time CHD events occurred. In total, 3,180 patients (86.1%) had CAC = 0 and 511 patients (13.9%) had CAC >0. Presence of CAC increased with number of risk factors (odds ratio: 4.5 [95% CI: 2.7-7.3] in patients with >3 vs 0 risk factors). The prevalence of obstructive CAD at baseline and the rate of future CHD events increased in a stepwise manner with both higher CAC and number of risk factors. The CHD event rate was lowest at 0.5 (95% CI: 0.1-3.6) per 1,000 person-years in patients with 0 risk factors and CAC = 0. Among patients with >3 risk factors, the event rate was 3.1 (95% CI: 1.0-9.7) in patients with CAC = 0 compared with 36.3 (95% CI: 17.3-76.1) in patients with CAC >10.
In young patients, there is a strong interplay between CAC and risk factors for predicting the presence of obstructive CAD and for future CHD risk. In the presence of risk factors, even a low CAC score is a high-risk marker. These results demonstrate the importance of assessing risk factors and CAC simultaneously when assessing risk in young patients.
本研究旨在探讨不同危险因素负担下冠状动脉钙化（CAC）的患病率、预测因素及其对年轻患者阻塞性冠状动脉疾病（CAD）患病率和未来冠心病（CHD）风险的影响。
在年龄≤45岁的年轻患者中，危险因素与CAC在预测CHD方面的相互作用尚不清楚。
本研究纳入了3691例来自丹麦西部心脏登记处（WDHR）的有症状患者（18 - 45岁），他们接受了冠状动脉计算机断层扫描血管造影。CHD事件包括心肌梗死和晚期血运重建。
在中位4.1年的随访期间，发生了57例首次CHD事件。总共有3180例患者（86.1%）CAC = 0，511例患者（13.9%）CAC>0。CAC的存在随着危险因素数量的增加而增加（>3个危险因素的患者与0个危险因素的患者相比，比值比：4.5 [95%CI：2.7 - 7.3]）。基线时阻塞性CAD的患病率以及未来CHD事件发生率均随着CAC和危险因素数量的增加而逐步上升。在0个危险因素且CAC = 0的患者中，CHD事件发生率最低，为每1000人年0.5（95%CI：0.1 - 3.6）。在>3个危险因素的患者中，CAC = 0的患者事件发生率为3.1（95%CI：1.0 - 9.7），而CAC>10的患者为36.3（95%CI：17.3 - 76.1）。
在年轻患者中，CAC与危险因素之间在预测阻塞性CAD的存在和未来CHD风险方面存在强烈的相互作用。在存在危险因素的情况下，即使CAC评分较低也是一个高风险标志物。这些结果表明，在评估年轻患者的风险时，同时评估危险因素和CAC非常重要。
