Abe Temidayo A, Yan Fengxia, Olanipekun Titilope, Blaha Michael, Effoe Valery, Udongwo Ndausung, Mentz Robert J, Oshunbade Adebamike, Terry James G, Ghali Jalal K, Yimer Wondwosen K, Kamanu Chukwuemezie, Onuorah Ifeoma, Hall Michael, Onwuanyi Anekwe, Correa Adolfo, Echols Melvin
Division of Cardiology, Department of Medicine (T.A.A.), Vanderbilt University Medical Center, Nashville, TN.
Division of Cardiology, Department of Medicine (F.Y., V.E., N.U., J.K.G., A. Onwuanyi), Morehouse School of Medicine, Atlanta, GA.
Circ Cardiovasc Imaging. 2024 Dec;17(12):e016775. doi: 10.1161/CIRCIMAGING.124.016775. Epub 2024 Nov 27.
Black adults show heightened cardiovascular risk compared with other groups despite comparable or lower coronary artery calcium (CAC) scores, indicating potential cardiovascular risk underestimation by CAC. Abdominal aortic calcification (AAC), preceding CAC, may predict cardiovascular events better in Black adults who are prone to early atherosclerotic cardiovascular disease and excess events at low CAC scores.
We included 2551 participants from the JHS (Jackson Heart Study) visit 2 examination (2005-2008) without cardiovascular disease, followed through 2016. Cox regression estimated hazard ratios for incident cardiovascular events defined as a composite of myocardial infarction, stroke, heart failure, and all-cause mortality. The predictive value of CAC and AAC, when added to the American College of Cardiology/American Heart Association cardiovascular risk algorithm (pool cohort equation), was assessed.
Mean age was 57±10 years; 66% were women. Over a follow-up period of 12.6 years, 287 (11.3%) cardiovascular events and 360 (14.1%) mortality cases were observed. Adjusting for demographic and clinical variables, each 2-fold increase in CAC and AAC was associated with cardiovascular events (CAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]; AAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]) and all-cause mortality CAC: hazard ratio, 1.04 [95% CI, 1.01-1.08]; AAC: hazard ratio, 1.05 [95% CI, 1.01-1.08]). The incremental value of CAC (0.17 [95% CI, 0.08-0.23]) and AAC (0.15 [95% CI, 0.07-0.29]) to the pool cohort equation by net reclassification index was comparable. Notably, 45% of participants with 0 CAC showed some degree of AAC. Each 2-fold increase in AAC was associated with an increased risk of cardiovascular events (hazard ratio, 1.07 [95% CI, 1.01-1.19]) but not all-cause mortality among participants with 0 CAC.
AAC is comparable to CAC in predicting cardiovascular events and all-cause mortality among Black adults, potentially valuable when CAC is absent.
尽管黑人成年人的冠状动脉钙化（CAC）评分与其他群体相当或更低，但他们的心血管风险却更高，这表明CAC可能低估了潜在的心血管风险。在CAC之前出现的腹主动脉钙化（AAC），可能在易患早期动脉粥样硬化性心血管疾病且在低CAC评分时发生过多心血管事件的黑人成年人中，能更好地预测心血管事件。
我们纳入了来自杰克逊心脏研究（JHS）第二次检查（2005 - 2008年）的2551名无心血管疾病的参与者，并随访至2016年。Cox回归估计了定义为心肌梗死、中风、心力衰竭和全因死亡率综合指标的心血管事件发生风险比。评估了将CAC和AAC添加到美国心脏病学会/美国心脏协会心血管风险算法（汇总队列方程）后的预测价值。
平均年龄为57±10岁；66%为女性。在12.6年的随访期内，观察到287例（11.3%）心血管事件和360例（14.1%）死亡病例。在调整了人口统计学和临床变量后，CAC和AAC每增加2倍与心血管事件相关（CAC：风险比，1.10 [95%置信区间，1.06 - 1.13]；AAC：风险比，1.10 [95%置信区间，1.06 - 1.13]）以及全因死亡率相关（CAC：风险比，1.04 [95%置信区间，1.01 - 1.08]；AAC：风险比，1.05 [95%置信区间，1.01 - 1.08]）。通过净重新分类指数评估，CAC（0.17 [95%置信区间，0.08 - 0.23]）和AAC（0.15 [95%置信区间，0.07 - 0.29]）对汇总队列方程的增量价值相当。值得注意的是，45%的CAC为0的参与者存在一定程度的AAC。在CAC为0的参与者中，AAC每增加2倍与心血管事件风险增加相关（风险比，1.07 [95%置信区间，1.01 - 1.19]），但与全因死亡率无关。
在预测黑人成年人的心血管事件和全因死亡率方面，AAC与CAC相当，当不存在CAC时可能具有重要价值。
