C5Research, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
C5Research, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Heart Lung Circ. 2024 Nov;33(11):1593-1599. doi: 10.1016/j.hlc.2024.06.1031. Epub 2024 Oct 2.
BACKGROUND & AIM: The extent and composition of coronary plaque, and its progression differ with patients' age. The interplay of patient's age with respect to risk factor control, upon atheroma progression has not been evaluated. We tested the hypothesis that risk factor control modulates the association between age and coronary atheroma progression.
We performed a posthoc pooled analysis of data from 10 prospective, randomised trials involving serial coronary intravascular ultrasonography (IVUS) (n=5,823). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque.
Mean overall age was 58±9 years (28% women). In a fully adjusted multivariable analysis (following adjustment of sex, body mass index, systolic blood pressure [SBP], smoking, high-density lipoprotein and low-density lipoprotein [LDL]-cholesterol, triglyceride levels, peripheral vascular disease, diabetes mellitus, trial, region, and baseline PAV), an increase in age by one standard deviation was linked with PAV progression (β-estimate 0.097; 95% confidence interval 0.048-0.15; p<0.001). In patients with good risk factor control (LDL-cholesterol <1.8 mmol/L and SBP <130 mmHg), increasing age remained associated with PAV progression (0.123; 0.014-0.23; p=0.027). Lower effect sizes for the association of age with PAV progression were observed for patients with partial control of LDL-cholesterol and SBP and were not significantly associated with PAV progression when both LDL-cholesterol and SBP were not controlled (0.099; 0.032-0.167; p=0.004 and 0.042; -0.056 to 0.14; p=0.40, respectively).
Patient age is directly associated with coronary atheroma progression independently of traditional cardiovascular risk factors. In the setting of poor risk factor control, the influence of age on coronary artery disease progression is attenuated.
冠状动脉斑块的范围和组成以及其进展在不同患者之间存在差异。患者年龄与动脉粥样硬化进展方面的风险因素控制之间的相互作用尚未得到评估。我们检验了这样一个假设，即风险因素控制调节了年龄与冠状动脉粥样硬化进展之间的关联。
我们对涉及连续冠状动脉血管内超声（IVUS）的 10 项前瞻性随机试验的数据进行了事后汇总分析（n=5823）。动脉粥样斑块体积百分比（PAV）计算为整个血管壁被粥样斑块占据的比例。
平均总体年龄为 58±9 岁（28%为女性）。在经过充分调整的多变量分析（校正性别、体重指数、收缩压 [SBP]、吸烟、高密度脂蛋白和低密度脂蛋白 [LDL]-胆固醇、甘油三酯水平、外周血管疾病、糖尿病、试验、地区和基线 PAV 后），年龄标准偏差增加与 PAV 进展相关（β估计值 0.097；95%置信区间 0.048-0.15；p<0.001）。在具有良好风险因素控制（LDL-胆固醇<1.8 mmol/L 和 SBP<130 mmHg）的患者中，年龄增加仍然与 PAV 进展相关（0.123；0.014-0.23；p=0.027）。对于 LDL-胆固醇和 SBP 控制部分的患者，年龄与 PAV 进展的关联的效应大小较小，当 LDL-胆固醇和 SBP 均不受控制时，与 PAV 进展无显著相关性（0.099；0.032-0.167；p=0.004 和 0.042；-0.056 至 0.14；p=0.40）。
患者年龄与冠状动脉粥样硬化进展直接相关，独立于传统心血管风险因素。在风险因素控制不佳的情况下，年龄对冠状动脉疾病进展的影响减弱。
