高密度脂蛋白胆固醇水平极高者的冠状动脉钙化用于风险分层
Coronary Artery Calcium for Risk Stratification Among Persons With Very High HDL Cholesterol.
作者信息
Razavi Alexander C, Mehta Anurag, Wong Nathan D, Rozanski Alan, Budoff Matthew J, Gianos Eugenia, Vaccarino Viola, van Assen Marly, De Cecco Carlo N, Miedema Michael D, Rumberger John A, Mortensen Martin Bødtker, Shaw Leslee J, Nasir Khurram, Blumenthal Roger S, Rohatgi Anand, Quyyumi Arshed A, Sperling Laurence S, Whelton Seamus P, Blaha Michael J, Berman Daniel S, Dzaye Omar
机构信息
Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
出版信息
JACC Adv. 2024 Aug 29;3(10):101217. doi: 10.1016/j.jacadv.2024.101217. eCollection 2024 Oct.
BACKGROUND
Compared to normal high-density lipoprotein (HDL) cholesterol values, very high HDL cholesterol is associated with a higher incidence of mortality and atherosclerotic cardiovascular disease (ASCVD). As such, clinical risk stratification among persons with very high HDL cholesterol is challenging.
OBJECTIVES
Among persons with very high HDL cholesterol, the purpose was to determine the prevalence of coronary artery calcium (CAC) and compare the association between traditional risk factors vs CAC for all-cause mortality and ASCVD.
METHODS
The primary analysis was completed among 446 participants from the Cedars-Sinai Medical Center of the CAC Consortium with very high HDL cholesterol (≥77 mg/dL in men, ≥97 mg/dL in women). Cox proportional hazards regression assessed the association of CAC and traditional risk factors with all-cause mortality during a median follow-up of 10.7 years. Replication and validation analyses were performed for all-cause mortality among 119 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with very high HDL cholesterol, who also had information on incident ASCVD.
RESULTS
The mean age was 57.9 years old, 49% were women, and the median HDL cholesterol was 98 mg/dL. One-half of participants (50%) had prevalent CAC, in whom the median CAC score was 118. Prevalent CAC conferred a 3.6-fold higher risk of all-cause mortality (HR: 3.64; 95% CI: 1.21-11.01), which appeared to be a more robust predictor than individual traditional risk factors beyond age. In the validation sample, prevalent CAC but not individual traditional risk factors were associated with all-cause mortality (HR: 2.39; 95% CI: 1.07-5.34) and a 4.0-fold higher risk of ASCVD (HR: 4.06; 95% CI: 1.11-14.84).
CONCLUSIONS
Measurement of CAC may facilitate clinical risk assessment among individuals with very high HDL cholesterol.
背景
与正常的高密度脂蛋白（HDL）胆固醇值相比，极高的HDL胆固醇与更高的死亡率和动脉粥样硬化性心血管疾病（ASCVD）发生率相关。因此，对HDL胆固醇极高的人群进行临床风险分层具有挑战性。
目的
在HDL胆固醇极高的人群中，确定冠状动脉钙化（CAC）的患病率，并比较传统危险因素与CAC在全因死亡率和ASCVD方面的关联。
方法
对来自CAC联盟雪松西奈医疗中心的446名HDL胆固醇极高（男性≥77mg/dL，女性≥97mg/dL）的参与者进行了初步分析。Cox比例风险回归评估了在中位随访10.7年期间CAC和传统危险因素与全因死亡率的关联。对来自动脉粥样硬化多民族研究（MESA）的119名HDL胆固醇极高且有ASCVD发病信息的参与者进行了全因死亡率的重复和验证分析。
结果
平均年龄为57.9岁，49%为女性，HDL胆固醇中位数为98mg/dL。一半的参与者（50%）有现患CAC，其中位CAC评分为118。现患CAC使全因死亡风险增加3.6倍（HR：3.64；95%CI：1.21-11.01），这似乎是比年龄以外的个体传统危险因素更强有力的预测指标。在验证样本中，现患CAC而非个体传统危险因素与全因死亡率（HR：2.39；95%CI：1.07-5.34）以及ASCVD风险增加4.0倍（HR：4.06；95%CI：1.11-14.84）相关。
结论
测量CAC可能有助于对HDL胆固醇极高的个体进行临床风险评估。
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