Cardiovascular Department (D.N., C.C.), Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Institute of Clinical Physiology, Pisa, Italy (C.C.).
Circ Cardiovasc Imaging. 2024 Jul;17(7):e016481. doi: 10.1161/CIRCIMAGING.123.016481. Epub 2024 Jul 16.
We assessed whether combinations of cardiometabolic risk factors independently predict coronary plaque progression (PP) and major adverse cardiovascular events in patients with stable coronary artery disease.
Patients with known or suspected stable coronary artery disease (60.9±9.3 years, 55.4% male) undergoing serial coronary computed tomography angiographies (≥2 years apart), with clinical characterization and follow-up (N=1200), were analyzed from the PARADIGM study (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging). Plaque volumes measured in coronary segments (≥2 mm in diameter) were summed to provide whole heart plaque volume (mm) and percent atheroma volume (plaque volume/vessel volume×100; %) per patient at baseline and follow-up. Rapid PP was defined as a percent atheroma volume increase of ≥1.0%/y. Major adverse cardiovascular events included nonfatal myocardial infarction, death, and unplanned coronary revascularization.
In an interscan period of 3.2 years (interquartile range, 1.9), rapid PP occurred in 341 patients (28%). At multivariable analysis, the combination of cardiometabolic risk factors defined as metabolic syndrome predicted rapid PP (odds ratio, 1.51 [95% CI, 1.12-2.03]; =0.007) together with older age, smoking habits, and baseline percent atheroma volume. Among single cardiometabolic variables, high fasting plasma glucose (diabetes or fasting plasma glucose >100 mg/dL) and low HDL-C (high-density lipoprotein cholesterol; <40 mg/dL in males and <50 mg/dL in females) were independently associated with rapid PP, in particular when combined (odds ratio, 2.37 [95% CI, 1.56-3.61]; <0.001). In a follow-up of 8.23 years (interquartile range, 5.92-9.53), major adverse cardiovascular events occurred in 201 patients (17%). At multivariable Cox analysis, the combination of high fasting plasma glucose with high systemic blood pressure (treated hypertension or systemic blood pressure >130/85 mm Hg) was an independent predictor of events (hazard ratio, 1.79 [95% CI, 1.10-2.90]; =0.018) together with family history, baseline percent atheroma volume, and rapid PP.
In patients with stable coronary artery disease, the combination of hyperglycemia with low HDL-C is associated with rapid PP independently of other risk factors, baseline plaque burden, and treatment. The combination of hyperglycemia with high systemic blood pressure independently predicts the worse outcome beyond PP.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT02803411.
我们评估了心血管代谢危险因素的组合是否能独立预测稳定型冠状动脉疾病患者的冠状动脉斑块进展（PP）和主要不良心血管事件。
这项来自 PARADIGM 研究（通过计算机断层扫描血管造影术评估动脉粥样硬化斑块的进展）的分析纳入了已知或疑似患有稳定型冠状动脉疾病（年龄 60.9±9.3 岁，55.4%为男性）、接受连续冠状动脉计算机断层扫描血管造影（间隔≥2 年）、具有临床特征和随访（N=1200）的患者。在基线和随访时，通过测量直径≥2 毫米的冠状动脉节段的斑块体积来计算患者的总心脏斑块体积（毫米）和斑块体积百分比（斑块体积/血管体积×100%）。快速 PP 定义为斑块体积百分比每年增加≥1.0%。主要不良心血管事件包括非致死性心肌梗死、死亡和非计划性冠状动脉血运重建。
在 3.2 年（四分位间距，1.9）的扫描间隔期间，341 例（28%）患者发生快速 PP。多变量分析显示，代谢综合征定义的心血管代谢危险因素组合可预测快速 PP（优势比，1.51[95%置信区间，1.12-2.03]；=0.007），并与年龄较大、吸烟习惯和基线斑块体积百分比相关。在单个心血管代谢变量中，高空腹血糖（糖尿病或空腹血糖＞100mg/dL）和低高密度脂蛋白胆固醇（男性＜40mg/dL，女性＜50mg/dL）与快速 PP 独立相关，特别是当两者结合时（优势比，2.37[95%置信区间，1.56-3.61]；<0.001）。在 8.23 年（四分位间距，5.92-9.53）的随访中，201 例（17%）患者发生主要不良心血管事件。多变量 Cox 分析显示，高空腹血糖与高全身血压（治疗性高血压或全身血压＞130/85mmHg）的组合是事件的独立预测因子（风险比，1.79[95%置信区间，1.10-2.90]；=0.018），与家族史、基线斑块体积和快速 PP 相关。
在稳定型冠状动脉疾病患者中，高血糖与低高密度脂蛋白胆固醇的组合与快速 PP 独立相关，而与其他危险因素、基线斑块负担和治疗无关。高血糖与高全身血压的组合独立预测了除 PP 以外的更差结局。
