Department of Vascular Disease, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital, Kateřinská 1660/32, 121 08, Nové Město, Czech Republic; Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Kateřinská 1660/32, 121 08, Nové Město, Czech Republic.
Atherosclerosis. 2022 May;348:25-35. doi: 10.1016/j.atherosclerosis.2022.03.030. Epub 2022 Apr 1.
Atherosclerosis has a long preclinical phase, and the risk of cardiovascular (CV) events may be high in asymptomatic subjects. Conventional risk factors provide information for the statistical probability of developing CV events, but they lack precision in asymptomatic subjects. This review aims to summarize the role of some widely publicized indicators of early atherosclerosis in predicting CV events. The earliest measurable indicator of the atherosclerotic process is endothelial dysfunction, measured by flow-mediated dilation (FMD) of the brachial artery. However, reduced FMD is a stronger predictor of future CV events in patients with existing CV disease than in apparently healthy persons. Alternatively, measurement of carotid artery intima-media thickness does not improve the predictive value of risk factor scores, while detection of asymptomatic atherosclerotic plaques in carotid or common femoral arteries by ultrasound indicates high CV risk. Coronary calcium is a robust and validated help in the estimation of vascular changes and risk, which may improve risk stratification beyond traditional risk factors with relatively low radiation exposure. Arterial stiffness of the aorta, measured as the carotid-femoral pulse wave velocity is an independent marker of CV risk at the population level, but it is not recommended as a routine procedure because of measurement difficulties. Low ankle-brachial index (ABI) indicates flow-limiting atherosclerosis in the lower limbs and indicates high CV risk, while normal ABI does not rule out advanced asymptomatic atherosclerosis. Novel circulating biomarkers are associated with the atherosclerotic process. However, because of limited specificity, their ability to improve risk classification at present remains low.
动脉粥样硬化有一个很长的临床前期，心血管（CV）事件的风险可能在无症状患者中很高。传统的危险因素提供了发生 CV 事件的统计概率信息，但在无症状患者中缺乏准确性。本综述旨在总结一些广泛宣传的早期动脉粥样硬化指标在预测 CV 事件中的作用。动脉粥样硬化过程最早可测量的指标是血管内皮功能障碍，通过肱动脉血流介导的扩张（FMD）来测量。然而，在存在 CV 疾病的患者中，FMD 降低比在明显健康人群中更能预测未来的 CV 事件。或者，颈动脉内膜中层厚度的测量并不能提高危险因素评分的预测价值，而通过超声检测颈动脉或股总动脉中无症状的动脉粥样硬化斑块表明存在高 CV 风险。冠状动脉钙是评估血管变化和风险的强大且经过验证的方法，可以通过相对较低的辐射暴露来改善传统危险因素以外的风险分层。主动脉的动脉僵硬度，以颈股脉搏波速度测量，是人群中 CV 风险的独立标志物，但由于测量困难，不建议作为常规程序。低踝臂指数（ABI）表明下肢血流受限性动脉粥样硬化，并表明存在高 CV 风险，而正常 ABI 并不能排除晚期无症状的动脉粥样硬化。新型循环生物标志物与动脉粥样硬化过程有关。然而，由于特异性有限，目前它们改善风险分类的能力仍然较低。
