Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).
Circ Cardiovasc Imaging. 2022 Mar;15(3):e013762. doi: 10.1161/CIRCIMAGING.121.013762. Epub 2022 Mar 15.
Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease. Extracoronary calcification (ECC)-measured at the aortic valve, mitral annulus, ascending thoracic aorta, and descending thoracic aorta-is an indicator of systemic atherosclerosis. This study examined whether favorable CVH was associated with a lower risk of ECC.
We analyzed data from MESA (Multi-Ethnic Study of Atherosclerosis) participants aged 45 to 84 years without cardiovascular disease at baseline. ECC was measured by noncontrast cardiac computed tomography scan at baseline and after an average of 2.4 years. Prevalent ECC was defined as an Agatston score >0 at the baseline scan. Incident ECC was defined as Agatston score >0 at the follow-up scan among participants with Agatston score of 0 at the baseline scan. Each CVH metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose) was scored 0 to 2 points, with 2 indicating ideal; 1, intermediate; and 0, poor. The aggregated CVH score was 0 to 14 points (0-8, inadequate; 9-10, average; 11-14, optimal). We used Poisson and linear mixed-effects regression models to examine the association between CVH and ECC adjusted for sociodemographic factors.
Of 6504 participants, 53% were women with a mean age (SD) of 62 (10) years. Optimal and average CVH scores were associated with lower ECC prevalence, incidence, and extent. For example, optimal CVH scores were associated with 57%, 56%, 70%, and 54% lower risk of incident aortic valve calcification, mitral annulus calcification, ascending thoracic aorta calcification, and descending thoracic aorta calcification, respectively. In addition, optimal and average CVH scores were associated with lower ECC progression at 2 years, although these associations were only significant for mitral annulus calcification and descending thoracic aorta calcification.
In this multiethnic cohort, favorable CVH was associated with a lower risk of extracoronary atherosclerosis. These findings emphasize the importance of primordial prevention as an intervention to reduce the burden of cardiovascular disease.
理想的心血管健康（CVH）与心血管疾病的发病率较低相关。冠状动脉外钙化（ECC）——在主动脉瓣、二尖瓣环、升主动脉和降主动脉处测量——是全身动脉粥样硬化的一个指标。本研究探讨了有利的 CVH 是否与 ECC 风险降低相关。
我们分析了无基线心血管疾病的 MESA（多民族动脉粥样硬化研究）参与者的数据，这些参与者年龄在 45 至 84 岁之间。ECC 通过基线和平均 2.4 年后的非对比心脏计算机断层扫描测量。在基线扫描中，Agatston 评分>0 定义为现患 ECC。在基线扫描中 Agatston 评分为 0 的参与者中，在随访扫描中 Agatston 评分>0 定义为新发 ECC。每个 CVH 指标（吸烟、体力活动、体重指数、饮食、血压、总胆固醇和血糖）得分为 0 至 2 分，2 分表示理想；1 分表示中等；0 分表示较差。总 CVH 评分为 0 至 14 分（0-8 分，不足；9-10 分，平均；11-14 分，最佳）。我们使用泊松和线性混合效应回归模型，在调整了社会人口因素后，检验 CVH 与 ECC 之间的关联。
在 6504 名参与者中，53%为女性，平均年龄（标准差）为 62（10）岁。最佳和平均 CVH 评分与较低的 ECC 患病率、发生率和程度相关。例如，最佳 CVH 评分与主动脉瓣钙化、二尖瓣环钙化、升主动脉钙化和降主动脉钙化的发生率分别降低 57%、56%、70%和 54%相关。此外，最佳和平均 CVH 评分与 2 年内 ECC 的进展相关，尽管这些关联仅在二尖瓣环钙化和降主动脉钙化中具有统计学意义。
在这个多民族队列中，有利的 CVH 与冠状动脉外动脉粥样硬化的风险降低相关。这些发现强调了原始预防作为一种干预措施来减轻心血管疾病负担的重要性。
