以前健康的人首次出现心血管疾病:多种族动脉粥样硬化研究

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American journal of preventive cardiology Pub Date : 2024-09-01 DOI:10.1016/j.ajpc.2024.100746
Jonathan Kermanshahchi BA
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引用次数: 0

摘要

治疗领域ASCVD/心血管疾病风险评估背景初次出现动脉粥样硬化性心血管疾病(ASCVD)可能是一种严重的结果,有时甚至是致命的结果,因此需要更好地了解和识别无症状个体的 ASCVD。方法利用多种族动脉粥样硬化研究(MESA)中 6779 名未患已知心血管疾病的参与者的数据,在 cox 比例危险模型中评估了传统危险因素和冠状动脉钙(CAC)与首次 ASCVD 事件(心绞痛、中风、心肌梗死或死亡/心脏骤停抢救[RCA])之间的关系。结果在15.8年的中位随访期间,共有1037名参与者(15.3%)经历了首次ASCVD事件。最常见的首次事件是死亡/RCA(27.7%)。CAC>0者出现心绞痛的几率明显高于CAC=0者(26.0% vs 13.0%,总P<0.001)。黑人(35.6%)和中国人(28.7%)比白人(24.8%,总体 p=0.011)更容易出现死亡/心绞痛,黑人(25.7%)和西班牙裔(29.3%)比白人(21.7%,总体 p<0.001)更容易出现中风。女性比男性更容易出现死亡/RCA(29.8% vs 26.3%,总体 p<0.001)。年龄、收缩压、糖尿病和吸烟与首次出现死亡/RCA显著相关,而女性性别和高密度脂蛋白胆固醇则成反比。CAC(ln-transformed)也与首次出现死亡/心脏骤停显著相关(HR 1.15,95% CI 1.10-1.22),当加入到集合队列方程中时(连续 NRI 0.6081,95% CI 0.4971-0.7141),其风险预测能力有所提高。除了传统的风险因素外,CAC还与死亡/心脏骤停的初始表现相关,并且在加入传统风险因素后,还能改善死亡/心脏骤停的风险预测。这些研究结果表明,CAC评分可能有助于识别首次出现ASCVD时有死亡或心脏骤停复苏风险的人。
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FIRST PRESENTATION OF CARDIOVASCULAR DISEASE IN PREVIOUSLY HEALTHY INDIVIDUALS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS

Therapeutic Area

ASCVD/CVD Risk Assessment

Background

The initial presentation of atherosclerotic cardiovascular disease (ASCVD) may be a severe, sometimes fatal outcome, and there is need for improved understanding and identification of ASCVD in asymptomatic individuals.

Methods

Using data from 6,779 participants the Multi-Ethnic Study of Atherosclerosis (MESA) without known cardiovascular disease, we evaluated the association between traditional risk factors and coronary artery calcium (CAC) with first ASCVD event (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]) in cox proportional hazards models.

Results

Overall, 1037 participants (15.3%) experienced a first ASCVD event over median follow-up of 15.8 years. The most common first presentation was death/RCA (27.7%). Those with CAC>0 were significantly more likely to present with angina than those with CAC=0 (26.% vs 13.0%, overall p<0.001). Black (35.6%) and Chinese (28.7%) individuals were more likely to present with death/RCA than White individuals (24.8%, overall p=0.011) and Black (25.7%) and Hispanic (29.3%) individuals were more likely to present with stroke than White (21.7%, p<0.001 overall) individuals. Women were more likely to present with death/RCA than men (29.8 vs 26.3%, overall p<0.001). Age, systolic blood pressure, diabetes, and smoking were significantly associated with a first presentation of death/RCA, while female sex and HDL-C were inversely associated. CAC (ln-transformed) was also significantly associated with first presentation of death/RCA (HR 1.15, 95% CI 1.10-1.22) and improved risk prediction when added to the Pooled Cohort Equations (continuous NRI 0.6081, 95% CI 0.4971-0.7141).

Conclusions

In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest. In addition to traditional risk factors, CAC was associated with an initial presentation of death/RCA, and improved risk prediction for death/RCA when added to traditional risk factors. These findings suggest CAC scoring may help to identify individuals at risk for death or resuscitated cardiac arrest as a first presentation of ASCVD.
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来源期刊
American journal of preventive cardiology
American journal of preventive cardiology Cardiology and Cardiovascular Medicine
CiteScore
6.60
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审稿时长
76 days
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