Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran 1985717413, Iran.
Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston Salem, North Carolina 27157, USA.
Eur J Prev Cardiol. 2024 Apr 18;31(6):744-753. doi: 10.1093/eurjpc/zwae039.
Whether coronary artery calcium (CAC) testing in younger individuals with metabolic syndrome (MetS) and diabetes mellitus (DM) helps predict cardiovascular disease (CVD) and death independent of traditional risk factors (RFs) remains less clear.
We pooled data obtained from 5174 individuals aged 38-55 years from the CARDIA (Coronary Artery Risk Development in Young Adults; n = 3047, year 20) and MESA (Multi-Ethnic Study of Atherosclerosis; n = 2127, Visit 1) studies who completed computed tomography of CAC. The mean age (SD) of participants (44.7% men) was 47.3 (4.2) years. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of CVD, coronary heart disease (CHD), and all-cause death. There were 1085 participants (21.0%) with prevalent CAC at baseline. A total of 461 (8.9%) had DM, 1025 (19.8%) had MetS without DM, and 3688 (71.3%) had neither condition. Over a median follow-up of 14.2 years, 256 (5.0%) participants died, and 304 (5.9%) CVD and 188 (3.6%) CHD events occurred. The CAC score was independently associated with incident CVD in those with DM (HR: 95% CI; 1.22: 1.08-1.38), MetS (1.18: 1.08-1.31), and neither condition (1.36: 1.26-1.46). The corresponding HRs for CAC ≥ 100 were 2.70 (1.25-5.83), 3.29 (1.87-5.79), and 6.30 (4.02-9.86), respectively. Similar associations for CHD and death were found. The impact of CAC ≥ 100 on CVD and CHD was lower in the presence of DM (P interaction < 0.05). The association of CAC with all outcomes in individuals with DM remained significant after adjusting with haemoglobin A1c levels.
Coronary artery calcium score is independently associated with cardiovascular events and death over nearly 15 years after screening at ages 38-55 years, with a less pronounced impact on CVD and CHD events in the presence of DM.
在患有代谢综合征（MetS）和糖尿病（DM）的年轻个体中进行冠状动脉钙（CAC）检测是否有助于预测心血管疾病（CVD）和死亡，这一点仍然不太清楚，这种预测是否独立于传统风险因素（RFs）。
我们对来自 CARDIA（年轻人冠状动脉风险发展研究；n=3047，第 20 年）和 MESA（动脉粥样硬化多民族研究；n=2127，第 1 次就诊）研究的 5174 名年龄在 38-55 岁的个体进行了数据分析，这些个体完成了 CAC 的计算机断层扫描。参与者的平均年龄（SD）为 47.3（4.2）岁（44.7%为男性）。采用多变量 Cox 比例风险回归模型来估计 CVD、冠心病（CHD）和全因死亡的风险比（HRs）。基线时，有 1085 名（21.0%）参与者存在 CAC 阳性。共有 461 名（8.9%）患有 DM，1025 名（19.8%）患有 MetS 但无 DM，3688 名（71.3%）两者均无。中位随访 14.2 年后，256 名（5.0%）参与者死亡，304 名（5.9%）发生 CVD，188 名（3.6%）发生 CHD。在患有 DM（HR：95%CI；1.22：1.08-1.38）、MetS（1.18：1.08-1.31）和无两者情况的参与者中，CAC 评分与 CVD 的发生独立相关。对于 CAC≥100 的患者，相应的 HR 分别为 2.70（1.25-5.83）、3.29（1.87-5.79）和 6.30（4.02-9.86）。在 DM 存在的情况下，与 CHD 和死亡的类似关联也被发现。在 DM 存在的情况下，CAC≥100 对 CVD 和 CHD 的影响降低（P 交互<0.05）。在调整糖化血红蛋白（HbA1c）水平后，DM 患者 CAC 与所有结局之间的相关性仍然显著。
在 38-55 岁时进行筛查后近 15 年，冠状动脉钙评分与心血管事件和死亡独立相关，在 DM 存在的情况下，对 CVD 和 CHD 事件的影响较小。
