Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
Atherosclerosis. 2024 Jul;394:117186. doi: 10.1016/j.atherosclerosis.2023.117186. Epub 2023 Jul 6.
Subclinical atherosclerosis (SA) diagnosis is key to primary prevention of atherosclerotic cardiovascular disease (ASCVD). SA is common among diabetics. Ankle brachial index (ABI) and coronary artery calcium (CAC) are markers of SA. This study examined whether adding ABI and CAC to diabetic individuals improved ASCVD risk prediction beyond established risk factors.
MESA is an observational cohort of 6814 participants without clinical cardiovascular disease. All participants with diabetes and impaired fasting glucose were included in the analysis. The association between CAC, ABI, and incident ASCVD, and all-cause mortality was examined using Cox proportional hazard regression. The risk prediction models including ABI and/or CAC in addition to standard risk factors alone were compared.
Of the 1719 participants, 55% were male and average age was 64 (±9.6) years old. Participants with diabetes or impaired fasting glucose with higher CAC and lower ABI had higher ASCVD and all-cause mortality. ABI and CAC enhanced ASCVD discrimination over standard risk factors, with C-index (95% CI) of 0.689 (0.66, 0.718) for risk factors alone, 0.696 (0.668, 0.724) for ABI, 0.719 (0.691, 0.747) for CAC, and 0.721 (0.693, 0.749) for CAC + ABI. Similarly, for all-cause mortality, both CAC and ABI improved risk discrimination in addition to standard risk factors alone.
In a large population-based study of individuals with diabetes or impaired fasting glucose, the addition of ABI and CAC to conventional risk factors improved 10-year ASCVD risk prediction. ABI and CAC are non-invasive and cost-effective tests; therefore, these markers should be included into ASCVD risk stratification for primary prevention in the diabetic and impaired fasting glucose population.
亚临床动脉粥样硬化（SA）的诊断是动脉粥样硬化性心血管疾病（ASCVD）一级预防的关键。糖尿病患者中 SA 很常见。踝臂指数（ABI）和冠状动脉钙（CAC）是 SA 的标志物。本研究旨在探讨在糖尿病患者中，ABI 和 CAC 的加入是否能在传统危险因素之外改善 ASCVD 风险预测。
MESA 是一项观察性队列研究，纳入了 6814 名无临床心血管疾病的参与者。所有糖尿病和空腹血糖受损的参与者均纳入分析。采用 Cox 比例风险回归分析 CAC、ABI 与 ASCVD 事件及全因死亡率的相关性。比较了仅包含标准危险因素、同时包含 ABI 和/或 CAC 的风险预测模型。
在 1719 名参与者中，55%为男性，平均年龄为 64（±9.6）岁。CAC 较高且 ABI 较低的糖尿病或空腹血糖受损患者 ASCVD 和全因死亡率更高。ABI 和 CAC 提高了 ASCVD 风险预测的区分度，仅包含标准危险因素的风险预测模型的 C 指数（95%CI）为 0.689（0.66，0.718），ABI 为 0.696（0.668，0.724），CAC 为 0.719（0.691，0.747），ABI+CAC 为 0.721（0.693，0.749）。同样，对于全因死亡率，ABI 和 CAC 均提高了标准危险因素之外的风险预测。
在一项基于人群的糖尿病或空腹血糖受损患者的大型研究中，ABI 和 CAC 的加入提高了传统危险因素的 10 年 ASCVD 风险预测。ABI 和 CAC 是无创且具有成本效益的检测手段；因此，这些标志物应被纳入糖尿病和空腹血糖受损人群的 ASCVD 风险分层，用于一级预防。
