低危和中危心血管风险人群亚临床动脉粥样硬化的发生率。
The incidence of subclinical atherosclerosis in subjects with low and moderate cardiovascular risk.
机构信息
Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China.
Department of Cardiology, Chui Yang Liu Hospital affiliated to Tsinghua University, Beijing, China.
出版信息
Clin Cardiol. 2023 Oct;46(10):1260-1267. doi: 10.1002/clc.24087. Epub 2023 Jul 31.
BACKGROUND
The cardiovascular risk models and subclinical atherosclerotic indicators are both recommended for cardiovascular risk stratification. The accordance between the incidence of subclinical atherosclerosis and subjects with low and moderate cardiovascular risk is unclear.
HYPOTHESIS
Subjects with low and moderate cardiovascular risk have a lower incidence of subclinical atherosclerosis compared with subjects with high risk.
METHODS
Brachial-ankle pulse wave velocity (BaPWV) and brachial flow-mediated dilation (BFMD) were measured in 421 subjects without a history of atherosclerotic cardiovascular disease (ASCVD) from October 2016 to January 2020. All subjects were classified into low, moderate, and high risk based on Framingham and China-par risk models respectively.
RESULTS
Mean age was 57.05 ± 9.35 years and 248 (58.9%) were male. In subjects with low, moderate, and high risk assessed by Framingham and China-par risk models, the percentage of abnormal BaPWV ( > 1400 cm/s) was 42.9%, 70.1%, 85.7%, and 40.4%, 71.4%, 89.7%, respectively. Meanwhile, the percentage of abnormal BFMD ( ≤ 7%) was 43.8%, 68.5%, 77.3%, and 44.9%,72.1%, and 76.6%. According to Framingham-based high-risk categories, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for BaPWV abnormality were 85.7%, 39.4%, 36.1%, and 87.5%, respectively. For BFMD abnormality, the values were 77.3%, 40.1%, 34.1%, and 81.8%, respectively. According to China-par high-risk categories, the values for BaPWV abnormality were 89.7%, 43.8%, 45.6%, and 89.0%, respectively. For BFMD abnormality, the values were 76.6%, 41.3%, 40.7%, and 77%, respectively. In multivariate analysis, age and blood pressure were the independent predictors for subclinical atherosclerosis in subjects with low-moderate risk.
CONCLUSIONS
More than one-half of subjects with low and moderate risk already have detectable subclinical atherosclerosis, indicating higher cardiovascular risk beyond the traditional stratification.
背景
心血管风险模型和亚临床动脉粥样硬化指标均被推荐用于心血管风险分层。低危和中危人群与高危人群相比，亚临床动脉粥样硬化的发生率尚不清楚。
假说
与高危人群相比，低危和中危人群的亚临床动脉粥样硬化发生率较低。
方法
2016 年 10 月至 2020 年 1 月，对 421 例无动脉粥样硬化性心血管疾病（ASCVD）病史的患者进行肱踝脉搏波速度（BaPWV）和肱动脉血流介导的舒张功能（BFMD）检测。所有患者均根据Framingham 和中国 PAR 风险模型分别分为低危、中危和高危。
结果
平均年龄为 57.05±9.35 岁，248 例（58.9%）为男性。在Framingham 和中国 PAR 风险模型评估的低危、中危和高危患者中，BaPWV 异常（>1400cm/s）的比例分别为 42.9%、70.1%、85.7%和 40.4%、71.4%、89.7%；同时，BFMD 异常（≤7%）的比例分别为 43.8%、68.5%、77.3%和 44.9%、72.1%、76.6%。根据Framingham 高危分类，BaPWV 异常的阳性预测值（PPV）、阴性预测值（NPV）、敏感性和特异性分别为 85.7%、39.4%、36.1%和 87.5%；BFMD 异常的相应值分别为 77.3%、40.1%、34.1%和 81.8%。根据中国 PAR 高危分类，BaPWV 异常的相应值分别为 89.7%、43.8%、45.6%和 89.0%；BFMD 异常的相应值分别为 76.6%、41.3%、40.7%和 77%。多因素分析显示，年龄和血压是低危和中危人群亚临床动脉粥样硬化的独立预测因素。
结论
一半以上的低危和中危人群已经存在可检测到的亚临床动脉粥样硬化，表明其心血管风险高于传统分层。
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