Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Vasc Med. 2024 Dec;29(6):632-639. doi: 10.1177/1358863X241270911. Epub 2024 Sep 6.
The absence of coronary artery calcium (CAC = 0) is associated with low risk of stroke events; however, predictors of incident stroke among those with CAC = 0 are not known.
Individual participant-level data were pooled from three prospective cohorts (Multi-Ethnic Study of Atherosclerosis [MESA], Jackson Heart Study, and Framingham Heart Study). Multivariable-adjusted Cox proportional hazards models were used to study the association between cardiovascular risk factors and incident adjudicated stroke among individuals with CAC = 0 who were free of clinical atherosclerotic cardiovascular disease at baseline.
Among 6180 participants (mean age 53 [SD 11] years, 62% women, and 44% White, 36% Black, and 20% other individuals), over a median (IQR) follow up of 15 (12-16) years, there were 122 strokes (95 ischemic, 27 hemorrhagic) with an overall unadjusted event rate of 2.0 per 1000 person-years. After multivariable adjustment, risk factors associated with overall stroke included (hazard ratio [95% CI]) systolic blood pressure (SBP): 1.19 (1.05-1.36) per 10-mmHg increase and carotid intima-media thickness (CIMT): 1.21 (1.04-1.42) per 0.1-mm increment. Current cigarette smoking: 2.68 (1.11-6.50), SBP: 1.23 (1.06-1.42) per 10-mmHg increase, and CIMT: 1.25 (1.04-1.49) per 0.1-mm increment were associated with ischemic stroke, whereas C-reactive protein was associated with hemorrhagic stroke risk (0.49, 0.25-0.93).
In a large cohort of individuals with CAC = 0, the rate for incident stroke was low (2.0 per 1000-person years) and was associated with modifiable risk factors.
冠状动脉钙化（CAC=0）的缺失与中风事件的低风险相关；然而，CAC=0 人群中中风事件的预测因素尚不清楚。
从三个前瞻性队列（动脉粥样硬化多民族研究[MESA]、杰克逊心脏研究和弗雷明汉心脏研究）中汇集了个体参与者水平的数据。使用多变量调整的 Cox 比例风险模型来研究 CAC=0 且基线时无临床动脉粥样硬化性心血管疾病的个体中，心血管危险因素与确诊中风事件之间的关系。
在 6180 名参与者中（平均年龄 53[11]岁，62%为女性，44%为白人，36%为黑人，20%为其他种族），中位（IQR）随访时间为 15（12-16）年期间，发生了 122 例中风（95 例缺血性，27 例出血性），总体未调整的事件发生率为每 1000 人年 2.0 例。经过多变量调整后，与总中风相关的危险因素包括（风险比[95%CI]）收缩压（SBP）：每增加 10mmHg 增加 1.19（1.05-1.36）和颈动脉内膜中层厚度（CIMT）：每增加 0.1mm 增加 1.21（1.04-1.42）。目前吸烟：2.68（1.11-6.50），SBP：每增加 10mmHg 增加 1.23（1.06-1.42），CIMT：每增加 0.1mm 增加 1.25（1.04-1.49）与缺血性中风相关，而 C 反应蛋白与出血性中风风险相关（0.49，0.25-0.93）。
在 CAC=0 的大型队列中，中风事件的发生率较低（每 1000 人年 2.0 例），与可改变的危险因素相关。
