2019 年美国心脏病学会/美国心脏协会一级预防指南的意义，以及在美国南亚人群中冠状动脉钙评分的潜在价值：生活在美国的南亚人中动脉粥样硬化的介质（MASALA）研究。
Implications of the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines and potential value of the coronary artery calcium score among South Asians in the US: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.
机构信息
Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
出版信息
Atherosclerosis. 2021 Oct;334:48-56. doi: 10.1016/j.atherosclerosis.2021.08.030. Epub 2021 Aug 23.
BACKGROUND AND AIMS
South Asian (SA) ethnicity is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, the implications of considering SA ethnicity as a "risk-enhancing factor" per recent American College of Cardiology/American Heart Association guidelines are not fully understood.
METHODS
We used data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, a community-based cohort study of individuals of SA ancestry living in the US. The Pooled Cohort Equations were used to estimate 10-year ASCVD risk. Metabolic risk factors and coronary artery calcium (CAC) scores were assessed.
RESULTS
Among 1114 MASALA participants included (median age 56 years, 48% women), 28% were already using a statin at baseline, 25% had prevalent diabetes, and 59% qualified for 10-year ASCVD risk assessment for statin allocation purposes. The prevalence of low, borderline, intermediate, and high estimated ASCVD risk was 65%, 11%, 20% and 5%, respectively. Among participants at intermediate risk, 30% had CAC = 0 and 37% had CAC>100, while among participants at borderline risk, 54% had CAC = 0 and 13% had CAC>100. Systematic consideration of intermediate and, particularly, of borderline risk individuals as statin candidates would enrich the statin-consideration group with CAC = 0 participants up to 35%. Prediabetes and abdominal obesity were highly prevalent across all estimated risk strata, including among those with CAC = 0.
CONCLUSIONS
Our findings suggest that systematic consideration of borderline risk SAs as statin candidates might result in considerable overtreatment, and further risk assessment with CAC may help better personalize statin allocation in these individuals. Early, aggressive lifestyle interventions aimed at reducing the risk of incident diabetes should be strongly recommended in US SAs, particularly among those considered candidates for statin therapy for primary prevention. Longitudinal studies are needed to confirm the favorable prognosis of CAC = 0 in SAs.
背景与目的
南亚（SA）族群与动脉粥样硬化性心血管疾病（ASCVD）风险增加相关。然而，根据最近的美国心脏病学会/美国心脏协会指南，将 SA 族群视为“风险增强因素”的含义尚未完全被理解。
方法
我们使用了美国南亚裔动脉粥样硬化发病机制研究（MASALA）的社区为基础的队列研究数据，该研究纳入了居住在美国的南亚裔个体。使用 Pooled Cohort Equations 来估计 10 年 ASCVD 风险。评估了代谢危险因素和冠状动脉钙（CAC）评分。
结果
在纳入的 1114 名 MASALA 参与者中（中位年龄 56 岁，48%为女性），28%在基线时已经使用他汀类药物，25%患有糖尿病，59%符合他汀类药物分配目的的 10 年 ASCVD 风险评估标准。低、边缘、中等和高估计 ASCVD 风险的患病率分别为 65%、11%、20%和 5%。在中等风险的参与者中，30%的 CAC=0，37%的 CAC>100，而在边缘风险的参与者中，54%的 CAC=0，13%的 CAC>100。系统地考虑中等风险，特别是边缘风险的个体作为他汀类药物的候选者，可以将 CAC=0 的参与者纳入他汀类药物考虑组，增加至 35%。在所有估计的风险分层中，包括 CAC=0 的参与者中，糖尿病前期和腹部肥胖都非常普遍。
结论
我们的研究结果表明，系统地考虑边缘风险的 SA 族群作为他汀类药物的候选者可能会导致大量过度治疗，并且使用 CAC 进行进一步的风险评估可能有助于更好地个体化这些个体的他汀类药物分配。应强烈建议在美国的 SA 族群中进行早期、积极的生活方式干预，以降低发生糖尿病的风险，特别是那些被认为是他汀类药物一级预防候选者的人群。需要进行纵向研究来证实 CAC=0 在 SA 族群中的良好预后。
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