Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Mount Sinai Fuster Heart Hospital, New York, New York, USA.
Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Cardiology Department, Hospital Clínic Barcelona and August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
J Am Coll Cardiol. 2024 Oct 8;84(15):1391-1403. doi: 10.1016/j.jacc.2024.06.045.
Atherosclerosis is a dynamic process. There is little evidence regarding whether quantification of atherosclerosis extent and progression, particularly in the carotid artery, in asymptomatic individuals predicts all-cause mortality.
This study sought to evaluate the independent predictive value (beyond cardiovascular risk factors) of subclinical atherosclerosis burden and progression and all-cause mortality.
A population of 5,716 asymptomatic U.S. adults (mean age 68.9 years, 56.7% female) enrolled between 2008 and 2009 in the BioImage (A Clinical Study of Burden of Atherosclerotic Disease in an At Risk Population) study underwent examination by vascular ultrasound to quantify carotid plaque burden (cPB) (the sum of right and left carotid plaque areas) and by computed tomography for coronary artery calcium (CAC). Follow-up carotid vascular ultrasound was performed on 732 participants a median of 8.9 years after the baseline exam. All participants were followed up for all-cause mortality, the primary outcome. Trend HRs are the per-tertile increase in each variable.
Over a median 12.4 years' follow-up, 901 (16%) participants died. After adjustment for cardiovascular risk factors and background medication, baseline cPB and CAC score were both significantly associated with all-cause mortality (fully adjusted trend HR: 1.23; 95% CI: 1.16-1.32; and HR: 1.15; 95% CI: 1.08-1.23), respectively (both P < 0.001), thus providing additional prognostic value. cPB performed better than CAC score. In participants with a second vascular ultrasound evaluation, median cPB progressed from 29.2 to 91.3 mm. cPB progression was significantly associated with all-cause mortality after adjusting for cardiovascular risk factors and baseline cPB (HR: 1.03; 95% CI: 1.01-1.04 per absolute 10-mm change; P = 0.01).
Subclinical atherosclerosis burden (cPB and CAC) in asymptomatic individuals was independently associated with all-cause mortality. Moreover, atherosclerosis progression was independently associated with all-cause mortality.
动脉粥样硬化是一个动态的过程。关于无症状个体的动脉粥样硬化程度和进展的定量评估，尤其是在颈动脉，是否能预测全因死亡率，目前证据有限。
本研究旨在评估亚临床动脉粥样硬化负担和进展以及全因死亡率的独立预测价值（超出心血管危险因素之外）。
这项研究纳入了 5716 名无症状的美国成年人（平均年龄 68.9 岁，56.7%为女性），他们于 2008 年至 2009 年期间参加了 BioImage（一个处于危险人群中的动脉粥样硬化疾病负担的临床研究）研究，通过血管超声检查来定量颈动脉斑块负担（cPB）（右侧和左侧颈动脉斑块面积之和），并通过计算机断层扫描进行冠状动脉钙（CAC）检查。在基线检查后中位数为 8.9 年时，对 732 名参与者进行了随访颈动脉血管超声检查。所有参与者均随访全因死亡率，这是主要终点。趋势 HR 是每个变量每增加一个百分位的增加。
在中位数为 12.4 年的随访期间，901 名（16%）参与者死亡。在调整了心血管危险因素和背景药物治疗后，基线 cPB 和 CAC 评分均与全因死亡率显著相关（完全调整的趋势 HR：1.23；95%CI：1.16-1.32；和 HR：1.15；95%CI：1.08-1.23）（均 P<0.001），从而提供了额外的预后价值。cPB 优于 CAC 评分。在接受第二次血管超声评估的参与者中，中位数 cPB 从 29.2 毫米进展到 91.3 毫米。在调整了心血管危险因素和基线 cPB 后，cPB 进展与全因死亡率显著相关（HR：1.03；95%CI：1.01-1.04，每绝对 10 毫米变化；P=0.01）。
无症状个体的亚临床动脉粥样硬化负担（cPB 和 CAC）与全因死亡率独立相关。此外，动脉粥样硬化进展与全因死亡率独立相关。
