冠状动脉钙评分对疑似非酒精性脂肪性肝病患者预测动脉粥样硬化性心血管疾病的预后价值：来自动脉粥样硬化多民族研究的结果。
Prognostic value of coronary artery calcium score for the prediction of atherosclerotic cardiovascular disease in participants with suspected nonalcoholic hepatic steatosis: Results from the multi-ethnic study of atherosclerosis.
机构信息
Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA.
Department of Biostatistics, University of Washington, Seattle, WA.
出版信息
Am Heart J. 2023 Nov;265:104-113. doi: 10.1016/j.ahj.2023.07.008. Epub 2023 Jul 28.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) events; thus, a diagnostic approach to help identify NAFLD patients at high risk is needed. In this study, we hypothesized that coronary artery calcium (CAC) screening could help stratify the risk of ASCVD events in participants with suspected nonalcoholic hepatic steatosis.
METHODS
A total of 713 participants with suspected nonalcoholic hepatic steatosis without previous cardiovascular events from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for the occurrence of incident ASCVD. Nonalcoholic hepatic steatosis was defined using nonenhanced computed tomography and liver/spleen attenuation ratio <1. Cox proportional hazards regression models were used to estimate hazard ratios (HR). C-statistics and areas under the time-dependent receiver operating characteristic curves (tAUC) were used to compare incremental contributions of CAC score when added to the clinical risk factors.
RESULTS
In multivariable analyses, CAC score was found to be independently associated with incident ASCVD (HR = 1.33, 95% CI = 1.22-1.44, P < .001). The addition of CAC score to clinical risk factors increased the C-statistic from 0.677 to 0.739 (P < .001) and tAUC at 10 years from 0.668 to 0.771, respectively. In subgroup analyses, the incremental prognostic value of CAC score was more significant in participants with low/borderline- (<7.5%) and intermediate- (7.5%-20%) 10-year ASCVD risk scores.
CONCLUSIONS
The inclusion of CAC score in global risk assessment was found to significantly improve the classification of incident ASCVD events in participants with suspected nonalcoholic hepatic steatosis, indicating a potential role for CAC screening in risk assessment.
背景
非酒精性脂肪性肝病（NAFLD）与动脉粥样硬化性心血管疾病（ASCVD）事件的风险增加相关；因此，需要一种诊断方法来帮助识别患有非酒精性肝脂肪变性的高风险患者。在这项研究中，我们假设冠状动脉钙（CAC）筛查可以帮助分层有可疑非酒精性肝脂肪变性的参与者发生 ASCVD 事件的风险。
方法
共纳入来自动脉粥样硬化多民族研究（MESA）的 713 名无先前心血管事件的疑似非酒精性肝脂肪变性患者，随访其 ASCVD 事件的发生情况。非酒精性肝脂肪变性使用非增强 CT 并通过肝脏/脾脏衰减比<1 来定义。使用 Cox 比例风险回归模型估计风险比（HR）。C 统计量和时间依赖性接收器操作特征曲线（tAUC）下的面积用于比较 CAC 评分添加到临床危险因素后对增量贡献。
结果
在多变量分析中，CAC 评分与 ASCVD 事件的发生独立相关（HR=1.33，95%CI=1.22-1.44，P<0.001）。将 CAC 评分添加到临床危险因素后，C 统计量从 0.677 增加到 0.739（P<0.001），10 年 tAUC 从 0.668 增加到 0.771。在亚组分析中，在 10 年 ASCVD 风险评分低/边界（<7.5%）和中（7.5%-20%）的患者中，CAC 评分的增量预后价值更为显著。
结论
在疑似非酒精性肝脂肪变性患者的整体风险评估中纳入 CAC 评分可显著改善 ASCVD 事件的分类，表明 CAC 筛查在风险评估中具有潜在作用。
Zotero 插件