低动脉粥样硬化性心血管疾病风险的肝脂肪变性患者的冠状动脉疾病和主要不良心血管事件
Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low Atherosclerotic Cardiovascular Disease Risk.
作者信息
Karady Julia, Mayrhofer Thomas, Foldyna Borek, Lu Michael T, Meyersohn Nandini, Hoffmann Udo, Balogon Oluwafemi, Pagidipati Neha, Shah Svati, Douglas Pamela S, Ferencik Maros, Corey Kathleen
机构信息
Cardiovascular Imaging Research Center, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA.
Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
出版信息
Aliment Pharmacol Ther. 2025 Feb;61(3):558-569. doi: 10.1111/apt.18415. Epub 2024 Nov 29.
BACKGROUND
Hepatic steatosis (HS) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5% are associated with increased risk for cardiovascular events.
AIM
To assess underlying coronary artery disease (CAD) and major adverse cardiovascular event (MACE) among those with and without HS at different ASCVD risk.
METHODS
We evaluated stable chest pain patients receiving coronary computed tomography (CT) in the PROMISE trial. HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non-fatal myocardial infarction, and all-cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD < 7.5%.
RESULTS
One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD < 7.5% and 20.3% (244/1204) of them had HS. Individuals with HS were younger (54.3 ± 5.2 vs. 55.8 ± 5.2; p < 0.001), more often males (40.2% [98/244] vs. 27.1% [260/960]; p < 0.001), had more risk factors/person (2.06 ± 0.89 vs. 1.93 ± 0.91; p = 0.047). CAD characteristics were similar between HS vs. non-HS patients at ASCVD < 7.5% and ASCVD ≥ 7.5% (all p > 0.05). Patients with HS had greater MACE rate compared to non-HS patients (ASCVD < 7.5%: 3.75%[9/244] vs. 1.5% [14/960]; p = 0.027 and ASCVD ≥ 7.5%: 4.7% [33/696] vs. 3.1% [56/1802]; p = 0.043). In patients without HS, MACE rate was higher in the ASCVD ≥ 7.5% vs. < 7.5% (3.1% [56/1802] vs. 1.5% [14/960]; p = 0.011). In patients with HS, MACE rates were not significantly different between ASCVD ≥ 7.5% vs. < 7.5% (4.7% [33/696] vs. 3.7% [9/244]; p = 0.484). In ASCVD < 7.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01-5.43; p = 0.048), independent of CAD characteristics.
CONCLUSIONS
Individuals with HS at ASCVD < 7.5% risk had similar CAD characteristics as patients without HS at < 7.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD ≥ 7.5%.
背景
肝脂肪变性（HS）和10年动脉粥样硬化性心血管疾病（ASCVD）风险≥7.5%与心血管事件风险增加相关。
目的
评估不同ASCVD风险水平下有和无HS患者的潜在冠状动脉疾病（CAD）及主要不良心血管事件（MACE）。
方法
我们在PROMISE试验中评估了接受冠状动脉计算机断层扫描（CT）的稳定性胸痛患者。HS和CAD终点在冠状动脉CT上定义。MACE定义为不稳定型心绞痛、非致命性心肌梗死和全因死亡。多变量Cox回归在调整CAD特征后，评估ASCVD<7.5%时HS与MACE的关联。
结果
3702例患者中有1204例（32.5%）ASCVD<7.5%，其中20.3%（244/1204）有HS。有HS的个体更年轻（54.3±5.2岁对55.8±5.2岁；p<0.001），男性比例更高（40.2%[98/244]对27.1%[260/960]；p<0.001），每人的危险因素更多（2.06±0.89对1.93±0.91；p=0.047）。在ASCVD<7.5%和ASCVD≥7.5%的患者中，HS与非HS患者的CAD特征相似（所有p>0.05）。与非HS患者相比，有HS的患者MACE发生率更高（ASCVD<7.5%：3.75%[9/244]对1.5%[14/960]；p=0.027；ASCVD≥7.5%：4.7%[33/696]对3.1%[56/1802]；p=0.043）。在无HS的患者中，ASCVD≥7.5%组的MACE发生率高于<7.5%组（3.1%[56/1802]对1.5%[14/960]；p=0.011）。在有HS患者中，ASCVD≥7.5%组与<7.5%组的MACE发生率无显著差异（4.7%[33/696]对3.7%[9/244]；p=0.484）。在ASCVD<7.5%时，HS可预测MACE（校正风险比：2.34，95%置信区间：1.01-5.43；p=0.048），独立于CAD特征。
结论
ASCVD风险<7.5%的有HS个体与ASCVD风险<7.5%的无HS患者具有相似的CAD特征，但经历的MACE发生率与ASCVD≥7.5%的患者相当。
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