Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA.
Obesity (Silver Spring). 2023 Sep;31(9):2240-2248. doi: 10.1002/oby.23832. Epub 2023 Aug 3.
The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied.
Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression.
Mean BMI was 34.5 (SD 4.4) kg/m (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1-99, 100-299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49-2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81-6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02-14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m , CAC ≥ 300 remained significantly associated with the highest risk.
Among individuals with obesity, including moderate-severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.
在肥胖患者中，冠状动脉钙化（CAC）对风险分层的有效性尚未得到很好的研究，因为成像的信号噪声比降低，通常受到限制。
该研究使用了来自 CAC 联盟的 9334 名参与者（平均年龄：53.3±9.7 岁；67.9%为男性）的数据，这些参与者 BMI≥30kg/m2，来自一个回顾性的队列，没有既往心血管疾病（CVD）。使用多变量调整的 Cox 比例风险和竞争风险回归评估 CAC 对全因和病因特异性死亡率的预测价值。
平均 BMI 为 34.5（标准差 4.4）kg/m2（22.7%为 II 类肥胖，10.8%为 III 类肥胖），5461 人（58.5%）有 CAC。与 CAC=0 相比，CAC=1-99、100-299 和≥300Agatston 单位的全因（每 1000 人年）发生率（1.97 比 3.5 比 5.2 比 11.3）、CVD（0.4 比 1.1 比 1.5 比 4.2）和冠心病（CHD）死亡率（0.2 比 0.6 比 0.6 比 2.5）分别更高，平均随访 10.8±3.0 年后。在调整了传统心血管危险因素后，CAC≥300 与全因（危险比[HR]：2.05；95%置信区间[CI]：1.49-2.82）、CVD（亚分布 HR：3.48；95%CI：1.81-6.70）和 CHD 死亡率（亚分布 HR：5.44；95%CI：2.02-14.66）的风险显著增加相关，与 CAC=0 相比。当将样本限制在 BMI≥35kg/m2 的个体中时，CAC≥300 仍然与最高风险显著相关。
在肥胖患者中，包括中重度肥胖患者，CAC 强烈预测全因、CVD 和 CHD 死亡率，并且可以作为一种有效的心血管风险分层工具，优先为体重管理分配治疗。
