Simon A, Giral P, Levenson J
Centre de Médecine Préventive Cardiovasculaire, INSERM U 28, Hôpital Broussais, Paris, France.
Circulation. 1995 Sep 15;92(6):1414-21. doi: 10.1161/01.cir.92.6.1414.
Recent studies have suggested that knowledge of the extent of subclinical atherosclerosis may improve prognostic information in subjects at risk of cardiovascular disease. Therefore, we tested the value of extracoronary plaque detected with echography at multiple sites and that of total coronary calcification deposit evaluated with ultrafast computed tomography for predicting the risk of coronary events estimated on the basis of traditional risk factors.
We analyzed in 618 asymptomatic at-risk men the extent of extracoronary atherosclerosis, as assessed with ultrasound imaging of carotid, aortic, and femoral sites and coded as number of disease sites (none, one, two, or three) on the basis of the presence of plaque at each site, and the amount of total coronary calcification deposit, as evaluated with ultrafast computed tomography and coded as grade 0, 1, 2, or 3 on the basis of the determination of a total coronary calcium score. Concomitantly, age, systolic pressure, total and HDL cholesterol levels, current smoking, presence of diabetes, and presence of ECG left ventricular hypertrophy (ECG-LVH) were evaluated with the goal of estimating coronary risk with the use of the Framingham Study risk algorithm. The prevalence rates of at least one extracoronary disease site and coronary calcification (any grade) were high (72% and 63%). There was a strong association between the number of extracoronary disease sites and the grade of coronary calcification (P < .001). As the number of extracoronary disease sites increased, age, systolic pressure, smoking frequency, and number of risk factors increased (P < .001). As the grade of coronary calcification increased, age and systolic pressure increased (P < .001), as did the number of risk factors (P < .01). The estimated coronary risk increased with the number of extracoronary disease sites and the grade of coronary calcification (P < .001). The odds ratio of coronary risk between three and no extracoronary disease site was 2.37 (95% confidence interval [CI], 1.08 to 5.21), whereas that between grade 3 and grade 0 of coronary calcification was 1.79 (95% CI, 0.94 to 3.40).
In an apparently healthy population, the extracoronary atherosclerotic burden as measured with multiple-site echography appears to be more powerful than the ultrafast computed tomography-detected coronary calcium burden in reflecting the multifactorial coronary risk profile. However, only men were included in the present study, and the present findings cannot be extrapolated to women.
近期研究表明，了解亚临床动脉粥样硬化的程度可能会改善心血管疾病风险人群的预后信息。因此，我们测试了通过超声检查在多个部位检测到的冠状动脉外斑块的价值，以及通过超速计算机断层扫描评估的冠状动脉钙化总沉积量对于预测基于传统风险因素估计的冠状动脉事件风险的价值。
我们分析了618名无症状风险男性的冠状动脉外动脉粥样硬化程度，通过对颈动脉、主动脉和股动脉部位进行超声成像评估，并根据每个部位是否存在斑块将疾病部位数量编码为（无、一个、两个或三个），以及通过超速计算机断层扫描评估的冠状动脉钙化总沉积量，并根据总冠状动脉钙评分的测定将其编码为0级、1级、2级或3级。同时，评估年龄、收缩压、总胆固醇和高密度脂蛋白胆固醇水平、当前吸烟情况、糖尿病的存在以及心电图左心室肥厚（ECG-LVH）的存在，目的是使用弗明汉姆研究风险算法估计冠状动脉风险。至少一个冠状动脉外疾病部位和冠状动脉钙化（任何级别）的患病率很高（分别为72%和63%）。冠状动脉外疾病部位数量与冠状动脉钙化级别之间存在很强的关联（P < 0.001）。随着冠状动脉外疾病部位数量的增加，年龄、收缩压、吸烟频率和风险因素数量增加（P < 0.001）。随着冠状动脉钙化级别增加，年龄和收缩压增加（P < 0.001），风险因素数量也增加（P < 0.01）。估计的冠状动脉风险随着冠状动脉外疾病部位数量和冠状动脉钙化级别增加而增加（P < 0.001）。冠状动脉外疾病部位为三个与无冠状动脉外疾病部位相比，冠状动脉风险的优势比为2.37（95%置信区间[CI]，1.08至5.21），而冠状动脉钙化3级与0级相比，优势比为1.79（95%CI，0.94至3.40）。
在一个看似健康的人群中，通过多部位超声检查测量的冠状动脉外动脉粥样硬化负担在反映多因素冠状动脉风险概况方面似乎比超速计算机断层扫描检测到的冠状动脉钙负担更具影响力。然而，本研究仅纳入了男性，目前的研究结果不能外推至女性。
