在年轻到中年早期的成年人中,早期晚期冠状动脉粥样硬化疾病的风险概况和预后意义:冠状动脉钙化联盟。

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European journal of preventive cardiology Pub Date : 2025-01-16 DOI:10.1093/eurjpc/zwaf019
Ellen Boakye, Mohammadmoein Dehesh, Zeina Dardari, Olufunmilayo H Obisesan, Albert D Osei, Omar Dzaye, Kunal Jha, Alan Rozanski, Daniel S Berman, Matthew J Budoff, Michael D Miedema, Khurram Nasir, John A Rumberger, Leslee J Shaw, Michael J Blaha
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引用次数: 0

摘要

在年轻人中,过早的晚期亚临床冠状动脉粥样硬化是一种未被充分认识和独特的疾病表型,尚未得到很好的表征。方法:我们使用来自冠状动脉钙化(CAC)协会的44,047名无心血管疾病病史的参与者(59.8%为男性)的数据。我们将晚期疾病定义为CAC≥90百分位的年龄、性别和种族,并比较晚期疾病患者、无CAC患者和有CAC患者的危险因素。结果:在44,047名参与者中,18,561名(42.2%)患有CAC。在CAC患者中,有6680例(36.0%)CAC≥90百分位。值得注意的是,在CAC≥90百分位的患者中,76.4%患有多血管CAC,而在CAC患者中,这一比例为40.6%。结论:早发晚期动脉粥样硬化是一种独特的临床表型,可以强烈预测全因和病因特异性死亡率。在年轻CAC患者中,评分≥90百分位的患者早期死亡风险最高,应在未来的指南中确定为积极临床预防的重点。
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Risk Profile and Prognostic Implications of Premature Advanced Coronary Atherosclerotic Disease Among Young to Early Middle-aged Adults: The Coronary Artery Calcium Consortium.

Introduction: Premature advanced subclinical coronary atherosclerosis among young adults is an under-recognized and unique disease phenotype that has not been well characterized.

Methods: We used data from 44,047 participants with no prior CVD history (59.8% male) from the Coronary Artery Calcium (CAC) Consortium. We defined advanced disease as CAC ≥90th percentile for age, sex, and race, and compared risk factor profile of persons with advanced disease to those without CAC and those with CAC <90th percentile. Using multivariable-adjusted Cox proportional hazard and competing risks regression, we assessed the association of premature advanced disease with all-cause, cardiovascular, and CHD mortality.

Results: Of 44,047 participants, 18,561 (42.2%) had CAC. Among those with CAC, 6,680 (36.0%) had CAC ≥90th percentile. Notably, 76.4% of those with CAC ≥90th percentile had multivessel CAC compared to 40.6% of those with CAC <90th percentile. After a mean follow-up of 12.5±3.6 years, the incidence per 1,000 person-years of all-cause (2.93 vs 1.85 vs 1.11), cardiovascular (1.11 vs 0.39 vs 0.21), and CHD mortality (0.65 vs 0.19 vs 0.08) was highest in the advanced disease group compared to CAC <90th percentile and the no CAC group. Persons with CAC ≥90th percentile had a higher multivariable-adjusted risk of all-cause (HR:2.17[1.83-2.57]), cardiovascular (SHR:3.89[2.78-5.44]), and CHD mortality (SHR:5.45[3.38-8.78]), compared to those without CAC. In the subgroup analysis, there was no difference in mortality between men and women with advanced CAC.

Conclusions: Premature advanced atherosclerosis is a distinct clinical phenotype that strongly predicts all-cause and cause-specific mortality. Among persons with CAC at young age, those with scores ≥ 90th percentile have the highest risk of early death and should be identified in future guidelines as a focus for aggressive clinical prevention.

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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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