Medical Research Center Oulu, Oulu University Hospital, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.
Medical Research Center Oulu, Oulu University Hospital, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.
Atherosclerosis. 2021 Aug;330:36-42. doi: 10.1016/j.atherosclerosis.2021.06.925. Epub 2021 Jul 1.
Both carotid intima-media thickness (IMT) and arterial plaques have been shown to predict future CV events. Since there are no previous studies on the subject, our objective was to compare carotid IMT and the length of plaques in abdominal-pelvic main arteries in CV risk assessment in a prospective study setting with a follow-up of over 20 years.
A total of 1007 patients (50% men), aged 51 ± 6.0 years, participated in the current study. Carotid IMT and the summarized plaque length (SUM) from abdominal aorta to common femoral arteries were ultrasonographically assessed. Patients were followed-up a median (1st-3rd quartile) of 22.5 (17.5-23.2) years for CV events.
SUM significantly predicted CV events (HR per every 10 mm increase: 1.035, 95% CI: 1.027-1.044, p < 0.001). Those in the highest SUM tertile had over 3-fold risk for CV event (HR: 3.392, 95% CI: 2.427-4.741, p < 0.001) when compared to those in the lowest tertile. SUM significantly predicted CV events even after adjusting for age, sex, hypertension, diabetes, smoking (pack-years), LDL cholesterol and IMT. Adding SUM to the established model improved C-index (95% CI) from 0.706 (0.674-0.738) to 0.718 (0.688-0.747) as well as both discrimination (p < 0.001) and reclassification (p < 0.001) of the patients. In contrast, IMT predicted cardiovascular events only in univariate analysis and it did not improve discrimination or reclassification of the patients.
In light of our findings, SUM is a superior indicator and clinical tool for evaluating the overall CV risk compared to carotid IMT.
颈动脉内膜中层厚度（IMT）和动脉斑块均已被证实可预测未来心血管事件。由于目前尚无关于这一主题的研究，我们的目的是在一项前瞻性研究中比较颈动脉 IMT 和腹主动脉-股总动脉斑块长度在心血管风险评估中的作用，该研究的随访时间超过 20 年。
共纳入 1007 名（50%为男性）年龄 51 ± 6.0 岁的患者参与本研究。采用超声技术评估颈动脉 IMT 和腹主动脉至股总动脉的斑块总长度（SUM）。中位（1 四分位间距-3 四分位间距）随访 22.5（17.5-23.2）年以观察心血管事件。
SUM 显著预测心血管事件（每增加 10mm 的 HR：1.035，95%CI：1.027-1.044，p<0.001）。与最低 SUM 三分位数相比，最高 SUM 三分位数的患者发生心血管事件的风险增加了 3 倍以上（HR：3.392，95%CI：2.427-4.741，p<0.001）。即使在校正年龄、性别、高血压、糖尿病、吸烟（包年）、LDL 胆固醇和 IMT 后，SUM 仍显著预测心血管事件。与建立的模型相比，SUM 可使 C 指数（95%CI）从 0.706（0.674-0.738）提高至 0.718（0.688-0.747），并改善患者的区分度（p<0.001）和再分类能力（p<0.001）。相比之下，IMT 仅在单变量分析中预测心血管事件，且不能改善患者的区分度或再分类能力。
根据我们的发现，与颈动脉 IMT 相比，SUM 是评估整体心血管风险的更好指标和临床工具。
