Division of Cardiovascular Medicine University of Virginia Health Charlottesville VA.
Cardiovascular Division Washington University in St. Louis St. Louis MO.
J Am Heart Assoc. 2021 Nov 16;10(22):e022513. doi: 10.1161/JAHA.121.022513. Epub 2021 Nov 6.
Background Coronary artery calcium (CAC) is well-validated for cardiovascular disease risk stratification in middle to older-aged adults; however, the 2019 American College of Cardiology/American Heart Association guidelines state that more data are needed regarding the performance of CAC in low-risk younger adults. Methods and Results We measured CAC in 13 397 patients aged 30 to 49 years without known cardiovascular disease or malignancy between 1997 and 2009. Outcomes of myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE; MI, stroke, or cardiovascular death), and all-cause mortality were assessed using Cox proportional hazard models, controlling for baseline risk factors (including atrial fibrillation for stroke and MACE) and the competing risk of death or noncardiac death as appropriate. The cohort (74% men, mean age 44 years, and 76% with ≤1 cardiovascular disease risk factor) had a 20.6% prevalence of any CAC. CAC was independently predicted by age, male sex, White race, and cardiovascular disease risk factors. Over a mean of 11 years of follow-up, the relative adjusted subhazard ratio of CAC >0 was 2.9 for MI and 1.6 for MACE. CAC >100 was associated with significantly increased hazards of MI (adjusted subhazard ratio, 5.2), MACE (adjusted subhazard ratio, 3.1), stroke (adjusted subhazard ratio, 1.7), and all-cause mortality (hazard ratio, 2.1). CAC significantly improved the prognostic accuracy of risk factors for MACE, MI, and all-cause mortality by the likelihood ratio test (<0.05). Conclusions CAC was prevalent in a large sample of low-risk young adults. Those with any CAC had significantly higher long-term hazards of MACE and MI, while severe CAC increased hazards for all outcomes including death. CAC may have utility for clinical decision-making among select young adults.
背景
冠状动脉钙化（CAC）在中老年人群心血管疾病风险分层中得到了很好的验证；然而，2019 年美国心脏病学会/美国心脏协会指南指出，需要更多关于 CAC 在低危年轻人群中的表现的数据。
方法和结果
我们在 1997 年至 2009 年间测量了 13397 名年龄在 30 至 49 岁、无已知心血管疾病或恶性肿瘤的患者的 CAC。使用 Cox 比例风险模型评估心肌梗死（MI）、卒中和主要不良心血管事件（MACE；MI、卒中和心血管死亡）以及全因死亡率等结局，通过控制基线风险因素（包括卒中和 MACE 的房颤）和适当的死亡或非心血管死亡竞争风险来进行调整。该队列（74%为男性，平均年龄 44 岁，76%的患者有≤1 个心血管疾病风险因素）的任何 CAC 患病率为 20.6%。CAC 独立预测因素为年龄、男性、白种人以及心血管疾病风险因素。在平均 11 年的随访期间，CAC>0 的相对调整亚风险比为 MI 的 2.9 倍和 MACE 的 1.6 倍。CAC>100 与 MI（调整后的亚风险比，5.2）、MACE（调整后的亚风险比，3.1）、卒中和全因死亡率（危险比，2.1）的显著增加风险相关。CAC 通过似然比检验显著提高了危险因素对 MACE、MI 和全因死亡率的预后准确性（<0.05）。
结论
在大量低危年轻人群中，CAC 很常见。有任何 CAC 的患者发生 MACE 和 MI 的长期风险显著增加，而严重的 CAC 则增加了所有结局（包括死亡）的风险。CAC 可能对某些年轻成年人的临床决策有一定的实用价值。
