Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
JAMA Netw Open. 2022 Jun 1;5(6):e2218307. doi: 10.1001/jamanetworkopen.2022.18307.
Data are limited on the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in community populations.
To investigate the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in older, community-dwelling populations in China.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was based on the baseline survey from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based prospective cohort study that enrolled community-dwelling adults aged 50 to 75 years based on cluster sampling from 6 villages and 4 living communities of Lishui city in southeast China. Data were collected from May 2017 to September 2019 and analyzed from September to November 2021.
Atherosclerotic plaque and stenosis at baseline were assessed in multiple vascular territories. Brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries; computed tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries; and ankle-brachial index for peripheral arteries were performed at baseline survey. The extent of atherosclerosis was assessed according to the number of these 8 vascular sites affected, and polyvascular lesions were defined as at least 2 affected sites.
A total of 3433 of 4202 invited individuals consented to participate in the study. After excluding 366 participants with contraindications for MRI or CTA scanning, with life expectancies of 4 years of fewer, or with mental disease, a total of 3067 community-dwelling adults were enrolled. The mean (SD) age was 61.2 (6.7) years; 1640 (53.5%) were women, and 74 (2.4%) had prevalent ASCVD. Most participants (2870 [93.6%]) had atherosclerotic plaques in at least 1 vascular territory. Atherosclerotic plaques were mostly detected in the aorta (2419 [79.6%]) and iliofemoral arteries (2312 [75.8%]), followed by subclavian (1500 [49.8%]), coronary (1366 [44.9%]), extracranial (1110 [36.4%]), renal (873 [28.7%]), and intracranial (542 [17.7%]) arteries. A substantial proportion of participants (1180 [38.5%]) had arterial stenosis of 50% or greater, predominantly affecting the coronary (542 [17.8%]) and iliofemoral (527 [17.3%]) arteries. Polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories, and polyvascular stenosis was observed in 412 patients (13.4%).
In this study, atherosclerotic plaque was highly prevalent in the older community population in China, and a substantial proportion of individuals reach stenosis of 50% or greater.
关于社区人群中多部位动脉粥样硬化斑块和狭窄的流行情况和血管分布的数据有限。
研究中国老年社区人群中多部位动脉粥样硬化斑块和狭窄的流行情况和血管分布。
设计、地点和参与者：这项横断面研究基于多血管评估认知障碍和血管事件（PRECISE）研究的基线调查，这是一项基于人群的前瞻性队列研究，采用聚类抽样的方法，从中国东南部丽水市的 6 个村庄和 4 个生活社区中招募了 50 至 75 岁的社区居住成年人。数据收集于 2017 年 5 月至 2019 年 9 月，并于 2021 年 9 月至 11 月进行分析。
在基线评估了多个血管部位的动脉粥样硬化斑块和狭窄。进行了脑血管壁磁共振成像（MRI）评估颅内和颅外动脉；计算机断层血管造影（CTA）评估冠状动脉、锁骨下动脉、主动脉、肾动脉和髂股动脉；以及踝肱指数评估外周动脉。根据受影响的 8 个血管部位的数量评估动脉粥样硬化的程度，多血管病变定义为至少有 2 个部位受影响。
共邀请了 4202 人参加研究，其中 3433 人同意参加。排除了 366 名因 MRI 或 CTA 扫描禁忌、预期寿命少于 4 年或患有精神疾病而不能参加的参与者后，共有 3067 名社区居住的成年人被纳入研究。平均（SD）年龄为 61.2（6.7）岁；1640 名（53.5%）为女性，74 名（2.4%）患有已确诊的 ASCVD。大多数参与者（2870 [93.6%]）至少在 1 个血管部位存在动脉粥样硬化斑块。动脉粥样硬化斑块主要发生在主动脉（2419 [79.6%]）和髂股动脉（2312 [75.8%]），其次是锁骨下动脉（1500 [49.8%]）、冠状动脉（1366 [44.9%]）、颅外动脉（1110 [36.4%]）、肾动脉（873 [28.7%]）和颅内动脉（542 [17.7%]）。相当一部分参与者（1180 [38.5%]）存在狭窄程度为 50%或以上的动脉狭窄，主要影响冠状动脉（542 [17.8%]）和髂股动脉（527 [17.3%]）。2541 名参与者（82.8%）存在多部位动脉粥样硬化斑块，其中 1436 名（46.8%）有 4 个或更多血管部位的斑块，412 名（13.4%）有狭窄程度为 50%或以上的病变。
在这项研究中，中国老年社区人群中动脉粥样硬化斑块的患病率很高，很大一部分患者达到狭窄程度 50%或以上。
