Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Eur J Prev Cardiol. 2024 Jul 23;31(9):1173-1182. doi: 10.1093/eurjpc/zwae078.
AIMS: Both coronary artery calcification (CAC) and aortic valve calcification (AVC) are strongly associated with cardiovascular diseases (CVDs), but data about the prognostic significance of multiple cardiovascular calcifications are limited. We aim to investigate the interaction relationship between AVC and CAC for major events. METHODS AND RESULTS: We included 6695 participants from the Multi-Ethnic Study of Atherosclerosis at baseline and divided them into four groups: (i) no AVC or CAC; (ii) only AVC; (iii) only CAC; and (iv) with CAC and CAC. The Cox regression model and the Kaplan-Meier method were used to analyse CVD outcomes. We evaluated the interaction between AVC and CAC and their added predictive value based on the pooled cohort equations (PCEs). Subgroup analyses were also explored. Among 6695 participants (mean age 62.2 ± 10.2 years, 47.2% male), after follow-up, 943 cases (14.1%) of CVD and 1274 cases (19.0%) of all-cause death occurred. For participants with both AVC and CAC, the risk of CVD significantly increased [hazard ratio = 3.43 (2.69-4.37), P < 0.001], even higher than the sum of the ones with only AVC and only CAC. This trend remained the same for all-cause death and among subgroup analyses. The addictive interaction was statistically significant (P < 0.001). When AVC and CAC were added, the predictive value of PCEs increased. CONCLUSION: Our results indicated a synergistic interaction between valve calcification and coronary calcification in CVDs. Management for both AVC and CAC may bring health co-benefits in preventing poor outcomes.
目的:冠状动脉钙化(CAC)和主动脉瓣钙化(AVC)均与心血管疾病(CVDs)密切相关,但关于多种心血管钙化的预后意义的数据有限。我们旨在研究 AVC 和 CAC 之间对主要事件的相互作用关系。
方法和结果:我们纳入了基线时来自动脉粥样硬化多民族研究(Multi-Ethnic Study of Atherosclerosis)的 6695 名参与者,并将他们分为四组:(i)无 AVC 或 CAC;(ii)仅有 AVC;(iii)仅有 CAC;和(iv)有 CAC 和 CAC。使用 Cox 回归模型和 Kaplan-Meier 方法分析 CVD 结局。我们根据汇总队列方程(Pooled Cohort Equations,PCEs)评估了 AVC 和 CAC 之间的相互作用及其附加预测价值。还进行了亚组分析。在 6695 名参与者(平均年龄 62.2±10.2 岁,47.2%为男性)中,随访后发生 943 例(14.1%)CVD 和 1274 例(19.0%)全因死亡。对于同时有 AVC 和 CAC 的参与者,CVD 的风险显著增加[风险比=3.43(2.69-4.37),P<0.001],甚至高于仅有 AVC 和仅有 CAC 的参与者的总和。这种趋势在全因死亡和亚组分析中仍然存在。相加的相互作用具有统计学意义(P<0.001)。当添加 AVC 和 CAC 时,PCEs 的预测价值增加。
结论:我们的结果表明,瓣膜钙化和冠状动脉钙化在 CVDs 中存在协同作用。同时管理 AVC 和 CAC 可能会带来健康的共同益处,预防不良结局。
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