Kermanshahchi Jonathan, Kao Andrew S, Ellberg Charlotte C, Duran Edward, Criqui Michael H, Shapiro Michael D, Bhatia Harpreet S
California University of Science and Medicine, 1501 Violet St, Colton, CA 92324, United States.
Department of Internal Medicine, University of California, 9300 Campus Point Dr, San Diego, CA 92037, United States.
Prog Cardiovasc Dis. 2025 May 14. doi: 10.1016/j.pcad.2025.05.004.
To evaluate the first presentation of atherosclerotic cardiovascular disease (ASCVD) in individuals without known ASCVD.
Distribution of first ASCVD events (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]), and the association between traditional risk factors, coronary artery calcium (CAC) and lipoprotein(a) [Lp(a)] with these events in Cox proportional hazards models were evaluated in 6779 participants in the Multi-Ethnic Study of Atherosclerosis. Risk prediction improvement with addition of CAC to the pooled cohort equations (PCE) was evaluated using net reclassification improvement (NRI).
The mean age was 62.1 ± 10.2 years and 1037 participants (15.3 %) experienced an ASCVD event over a median of 15.8 years. The most common first presentation was cardiovascular death/RCA (n = 287;27.7 %). Among those with events, Black (35.6 %, p = 0.001)) individuals more often presented with death/RCA, Hispanic (29.3 %, p = 0.037) individuals more often presented with stroke compared to White individuals (24.8 % and 21.7 %, respectively). Compared to men, women more frequently presented with stroke (29.5 vs. 20.7 %, p = 0.002) and death/RCA (29.8 vs 26.3 %, p = 0.243) though this did not meet statistical significance. CAC score was significantly associated with first presentation of all events, including death/RCA (HR 1.13, 95 % CI 1.07-1.19) and improved risk prediction when added to the PCE (continuous NRI 0.6081, 95 % CI 0.4971-0.7141). Lp(a) was significantly associated with MI only (HR 1.15 per SD, 95 % CI 1.02-1.29).
In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest, particularly among women, minority groups, and those with CAC. CAC scoring may identify individuals at risk for death/resuscitated cardiac arrest as a first presentation of ASCVD.
评估无已知动脉粥样硬化性心血管疾病（ASCVD）个体中ASCVD的首次发病情况。
在动脉粥样硬化多民族研究的6779名参与者中，评估首次ASCVD事件（心绞痛、中风、心肌梗死[MI]或死亡/心肺复苏后心脏骤停[RCA]）的分布，以及Cox比例风险模型中传统危险因素、冠状动脉钙化（CAC）和脂蛋白(a)[Lp(a)]与这些事件之间的关联。使用净重新分类改善（NRI）评估在汇总队列方程（PCE）中加入CAC后风险预测的改善情况。
平均年龄为62.1±10.2岁，1037名参与者（15.3%）在中位15.8年期间发生了ASCVD事件。最常见的首次发病情况是心血管死亡/RCA（n = 287；27.7%）。在发生事件的人群中，黑人（35.6%，p = 0.001）个体更常出现死亡/RCA，西班牙裔（29.3%，p = 0.037）个体比白人个体（分别为24.8%和21.7%）更常出现中风。与男性相比，女性更常出现中风（29.5%对20.7%，p = 0.002）和死亡/RCA（29.8%对26.3%，p = 0.243），尽管这未达到统计学意义。CAC评分与所有事件的首次发病情况显著相关，包括死亡/RCA（风险比1.13，95%置信区间1.07 - 1.19），并且加入PCE后改善了风险预测（连续NRI 0.6081，95%置信区间0.4971 - 0.7141）。Lp(a)仅与MI显著相关（每标准差风险比1.15，95%置信区间1.02 - 1.29）。
在既往无症状的个体中，ASCVD最常见的首次发病情况是死亡/心肺复苏后心脏骤停，尤其是在女性、少数群体和有CAC的人群中。CAC评分可能识别出有死亡/心肺复苏后心脏骤停风险的个体，作为ASCVD的首次发病情况。
