无冠状动脉钙人群中动脉粥样硬化性心血管疾病事件的发生决定因素：动脉粥样硬化多民族研究。
Determinants of Incident Atherosclerotic Cardiovascular Disease Events Among Those With Absent Coronary Artery Calcium: Multi-Ethnic Study of Atherosclerosis.
机构信息
Section of Cardiology, Baylor College of Medicine, Houston, TX (M.A.R., V.N., C.M.B., S.S.V.).
The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD (M.J.B., E.D.M., R.S.B., W.S.P.).
出版信息
Circulation. 2022 Jan 25;145(4):259-267. doi: 10.1161/CIRCULATIONAHA.121.056705. Epub 2021 Dec 8.
BACKGROUND
The 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline states that statin therapy may be withheld or delayed among intermediate-risk individuals in the absence of coronary artery calcium (CAC=0). We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) events among individuals with CAC=0 over long-term follow-up.
METHODS
We included participants with CAC=0 at baseline from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of clinical ASCVD at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors (cigarette smoking, diabetes, hypertension, preventive medication use [aspirin and statin], family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers) and adjudicated incident ASCVD outcomes.
RESULTS
We studied 3416 individuals (mean [SD] age 58 [9] years; 63% were female, 33% White, 31% Black, 12% Chinese American, and 24% Hispanic). Over a median follow-up of 16 years, there were 189 ASCVD events (composite of coronary heart disease and stroke) of which 91 were coronary heart disease, 88 were stroke, and 10 were both coronary heart disease and stroke events. The unadjusted event rates of ASCVD were ≤5 per 1000 person-years among individuals with CAC=0 for most risk factors with the exception of current cigarette smoking (7.3), diabetes (8.9), hypertension (5.4), and chronic kidney disease (6.8). After multivariable adjustment, risk factors that were significantly associated with ASCVD included current cigarette smoking: hazard ratio, 2.12 (95% CI, 1.32-3.42); diabetes: hazard ratio, 1.68 (95% CI, 1.01-2.80); and hypertension: hazard ratio, 1.57 (95% CI, 1.06-2.33).
CONCLUSIONS
Current cigarette smoking, diabetes, and hypertension are independently associated with incident ASCVD over a 16-year follow-up among those with CAC=0.
背景
2018 年美国心脏协会/美国心脏病学会/多学会胆固醇指南指出，在没有冠状动脉钙（CAC=0）的情况下，中等风险人群可能会停止或延迟使用他汀类药物。我们评估了在长期随访中，CAC=0 人群中是否存在传统心血管危险因素与动脉粥样硬化性心血管疾病（ASCVD）事件的发生有关。
方法
我们纳入了基线 CAC=0 的 MESA（动脉粥样硬化多民族研究）参与者，这是一项在基线时无临床 ASCVD 的个体的前瞻性队列研究。我们使用多变量调整的 Cox 比例风险模型研究了心血管危险因素（吸烟、糖尿病、高血压、预防性药物使用[阿司匹林和他汀类药物]、早发性 ASCVD 的家族史、慢性肾脏病、腰围、血脂和炎症标志物）与经裁决的 ASCVD 事件之间的关系。
结果
我们研究了 3416 名参与者（平均[标准差]年龄 58[9]岁；63%为女性，33%为白人，31%为黑人，12%为华裔美国人，24%为西班牙裔）。在中位随访 16 年期间，有 189 例 ASCVD 事件（冠心病和中风的复合事件），其中 91 例为冠心病，88 例为中风，10 例为冠心病和中风的复合事件。除了当前吸烟（7.3）、糖尿病（8.9）、高血压（5.4）和慢性肾脏病（6.8）外，大多数危险因素中，CAC=0 的个体 ASCVD 的未调整事件率≤每 1000 人年 5 例。经过多变量调整后，与 ASCVD 显著相关的危险因素包括：当前吸烟：风险比 2.12（95%CI，1.32-3.42）；糖尿病：风险比 1.68（95%CI，1.01-2.80）；高血压：风险比 1.57（95%CI，1.06-2.33）。
结论
在 CAC=0 的人群中，经过 16 年的随访，当前吸烟、糖尿病和高血压与 ASCVD 的发生独立相关。
Zotero 插件