期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 6, 期 2, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.116.005179
关键词
atherosclerosis; cardiovascular disease; carotid artery; imaging; risk factor
资金
- National Heart, Lung, and Blood Institute [N01-HC-95159, N01-HC-95169]
- National Institute of Environmental Health Sciences [ES015915]
- US Environmental Protection Agency [R831697]
- National Center for Research Resources [UL1-RR-024156, UL1-RR-025005]
- Ruth L. Kirschstein National Research Service Award from the National Heart, Lung, and Blood Institute [T32 HL 07936]
Background-Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown. Methods and Results-CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC >0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P<0.001 vs HR, 1.27; 95% CI, 1.16-1.40; P<0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38; P<0.001 vs HR, 1.35; 95% CI, 1.21-1.51; P<0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values. Conclusions-CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.
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