Association between Coronary Atherosclerotic Plaque Composition and Cardiovascular Disease Risk
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摘要
Objective The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease(CVD) risk in Chinese adults. Methods We performed a cross-sectional analysis in 549 subjects without previous diagnosis or clinical symptoms of CVD in a community cohort of middle-aged Chinese adults. The participants underwent coronary computed tomography(CT) angiography for the evaluation of the presence and composition of coronary plaques. CVD risk was evaluated by the Framingham risk score(FRS) and the 10-year atherosclerotic cardiovascular disease(ASCVD) risk score. Results Among the 549 participants, 267(48.6%) had no coronary plaques, 201(36.6%) had noncalcified coronary plaques, and 81(14.8%) had calcified or mixed coronary plaques. The measures of CVD risk including FRS and ASCVD risk score and the likelihood of having elevated FRS significantly increased across the groups of participants without coronary plaques, with noncalcified coronary plaques, and with calcified or mixed coronary plaques. However, only calcified or mixed coronary plaques were significantly associated with an elevated ASCVD risk score [odds ratio(OR) 2.41; 95% confidence interval(CI) 1.09-5.32] compared with no coronary plaques, whereas no significant association was found for noncalcified coronary plaques and elevated ASCVD risk score(OR 1.25; 95% CI 0.71-2.21) after multivariable adjustment. Conclusion Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.
Objective The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease(CVD) risk in Chinese adults. Methods We performed a cross-sectional analysis in 549 subjects without previous diagnosis or clinical symptoms of CVD in a community cohort of middle-aged Chinese adults. The participants underwent coronary computed tomography(CT) angiography for the evaluation of the presence and composition of coronary plaques. CVD risk was evaluated by the Framingham risk score(FRS) and the 10-year atherosclerotic cardiovascular disease(ASCVD) risk score. Results Among the 549 participants, 267(48.6%) had no coronary plaques, 201(36.6%) had noncalcified coronary plaques, and 81(14.8%) had calcified or mixed coronary plaques. The measures of CVD risk including FRS and ASCVD risk score and the likelihood of having elevated FRS significantly increased across the groups of participants without coronary plaques, with noncalcified coronary plaques, and with calcified or mixed coronary plaques. However, only calcified or mixed coronary plaques were significantly associated with an elevated ASCVD risk score [odds ratio(OR) 2.41; 95% confidence interval(CI) 1.09-5.32] compared with no coronary plaques, whereas no significant association was found for noncalcified coronary plaques and elevated ASCVD risk score(OR 1.25; 95% CI 0.71-2.21) after multivariable adjustment. Conclusion Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.
Objective The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease(CVD) risk in Chinese adults. Methods We performed a cross-sectional analysis in 549 subjects without previous diagnosis or clinical symptoms of CVD in a community cohort of middle-aged Chinese adults. The participants underwent coronary computed tomography(CT) angiography for the evaluation of the presence and composition of coronary plaques. CVD risk was evaluated by the Framingham risk score(FRS) and the 10-year atherosclerotic cardiovascular disease(ASCVD) risk score. Results Among the 549 participants, 267(48.6%) had no coronary plaques, 201(36.6%) had noncalcified coronary plaques, and 81(14.8%) had calcified or mixed coronary plaques. The measures of CVD risk including FRS and ASCVD risk score and the likelihood of having elevated FRS significantly increased across the groups of participants without coronary plaques, with noncalcified coronary plaques, and with calcified or mixed coronary plaques. However, only calcified or mixed coronary plaques were significantly associated with an elevated ASCVD risk score [odds ratio(OR) 2.41; 95% confidence interval(CI) 1.09-5.32] compared with no coronary plaques, whereas no significant association was found for noncalcified coronary plaques and elevated ASCVD risk score(OR 1.25; 95% CI 0.71-2.21) after multivariable adjustment. Conclusion Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.
引文
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2.Park GM,Yun SC,Cho YR,et al.Prevalence of coronary atherosclerosis in an Asian population:findings from coronary computed tomographic angiography.Int J Cardiovasc Imaging,2015;31,659-68.
3.Alexopoulos N,Raggi P.Calcification in atherosclerosis.Nat Rev Cardiol,2009;6,681-8.
4.Nance JW Jr,Schlett CL,Schoepf UJ,et al.Incremental prognostic value of different components of coronary atherosclerotic plaque at cardiac CT angiography beyond coronary calcification in patients with acute chest pain.Radiology,2012;264,679-90.
5.Pundziute G,Schuijf JD,Jukema JW,et al.Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease.JAm Coll Cardiol,2007;49,62-70.
6.Ren C,Zhang J,Xu Y,et al.Association between carotid intima-media thickness and index of central fat distribution in middle-aged and elderly Chinese.Cardiovasc Diabetol,2014;13,139.
7.Ding L,Peng K,Lin L,et al.The impact of fat distribution on subclinical coronary atherosclerosis in middle-aged Chinese adults.Int J Cardiol,2017;235,118-23.
8.Liu Y,Xu M,Xu Y,et al.Positive correlation between chronic hyperglycemia and serum fetuin-A levels in middle-aged and elderly Chinese.J Diabetes,2012;4,351-8.
9.Jensen MD,Ryan DH,Apovian CM,et al.2013 AHA/ACC/TOSguideline for the management of overweight and obesity in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.J Am Coll Cardiol,2014;63,2985-3023.
10.Vidal-Petiot E,Elbez Y,Lüscher TF,et al.The 2018 ESC-ESHguidelines for the management of arterial hypertension leave clinicians facing a dilemma in half of the patients.Eur Heart J,2018;39,4040-1.
11.Chinese guidelines on prevention and treatment of dyslipidemia in adults Joint Committee for Developing Chinese guidelines on Prevention and Treatment of Dyslipidemia in Adults.J Cardiol,2007;35,390-419.(In Chinese)
12.World Health Organization.Definition,diagnosis and classification of diabetes mellitus and its complications:report of a WHO Consultation.Part 1.Diagnosis and classification of diabetes mellitus.Geneva:World Health Organization,1999.
13.Levy JC,Matthews DR,Hermans MP.Correct homeostasis model assessment(HOMA)evaluation uses the computer program.Diabetes Care,1998;21,2191-2.
14.Austen WG,Edwards JE,Frye RL,et al.A reporting system on patients evaluated for coronary artery disease.Report of the Ad Hoc Committee for Grading of Coronary Artery Disease,Council on Cardiovascular Surgery,American Heart Association.Circulation,1975;51,5-40.
15.Stone NJ,Robinson JG,Lichtenstein AH,et al.2013 ACC/AHAguideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2014;63,2889-934.
16.Goff DC Jr,Lloyd-Jones DM,Bennett G,et al.2013 ACC/AHAguideline on the assessment of cardiovascular risk:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation,2014;129,S49-73.
17.Wilson PW,D'Agostino RB,Levy D,et al.Prediction of coronary heart disease using risk factor categories.Circulation,1998;97,1837-47.
18.Malik S,Wong ND.Metabolic syndrome,cardiovascular risk and screening for subclinical atherosclerosis.Expert Rev Cardiovasc Ther,2009;7,273-80.
19.van Werkhoven JM,Schuijf JD,Gaemperli O,et al.Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease.J Am Coll Cardiol,2009;53,623-32.
20.Lin F,Shaw LJ,Berman DS,et al.Multidetector computed tomography coronary artery plaque predictors of stress-induced myocardial ischemia by SPECT.Atherosclerosis,2008;197,700-9.
21.Lee H,Yoon YE,Kim YJ,et al.Presence and extent of coronary calcified plaque evaluated by coronary computed tomographic angiography are independent predictors of ischemic stroke in patients with suspected coronary artery disease.Int JCardiovasc Imaging,2015;31,1469-78.
22.Hadamitzky M,Achenbach S,Al-Mallah M,et al.Optimized prognostic score for coronary computed tomographic angiography:results from the CONFIRM registry(COronary CTAngiography EvaluatioN For Clinical Outcomes:An InteRnational Multicenter Registry).J Am Coll Cardiol,2013;62,468-76.
23.Rumberger JA,Simons DB,Fitzpatrick LA,et al.Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area.A histopathologic correlative study.Circulation,1995;92,2157-62.
24.Stary HC,Chandler AB,Dinsmore RE,et al.A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis.A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis,American Heart Association.Circulation,1995;92,1355-74.
25.Nicholls SJ,Tuzcu EM,Wolski K,et al.Coronary artery calcification and changes in atheroma burden in response to established medical therapies.J Am Coll Cardiol,2007;49,263-70.
26.Lee RT,Grodzinsky AJ,Frank EH,et al.Structure-dependent dynamic mechanical behavior of fibrous caps from human atherosclerotic plaques.Circulation,1991;83,1764-70.
27.Richardson PD,Davies MJ,Born GV.Influence of plaque configuration and stress distribution on fissuring of coronary atherosclerotic plaques.Lancet,1989;2,941-4.
28.Arad Y,Goodman KJ,Roth M,et al.Coronary calcification,coronary disease risk factors,C-reactive protein,and atherosclerotic cardiovascular disease events:the St.Francis Heart Study.J Am Coll Cardiol,2005;46,158-65.
29.Blaha MJ,Nasir K,Rivera JJ,et al.Gender differences in coronary plaque composition by coronary computed tomography angiography.Coron Artery Disease,2009;20,506-12.
30.Nasir K,Gopal A,Blankstein R,et al.Noninvasive assessment of gender differences in coronary plaque composition with multidetector computed tomographic angiography.Am JCardiol,2010;105,453-8.
31.Makino K,Yoshitama T,Kanda S,et al.Relation of coronary plaque composition determined by 64-slice multidetector computed tomography in patients with suspected coronary heart disease.Am J Cardiol,2011;107,1624-9.
32.Lin T,Liu JC,Chang LY,et al.Association of metabolic syndrome and diabetes with subclinical coronary stenosis and plaque subtypes in middle-aged individuals.Diabet Med,2011;28,493-9.
33.Budoff MJ,Achenbach S,Blumenthal RS,et al.Assessment of coronary artery disease by cardiac computed tomography:a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention,Council on Cardiovascular Radiology and Intervention,and Committee on Cardiac Imaging,Council on Clinical Cardiology.Circulation,2006;114,1761-91.
34.Liu Y,Wang K,Maisonet M,et al.Associations of lifestyle factors(smoking,alcohol consumption,diet and physical activity)with type 2 diabetes among American adults from National Health and Nutrition Examination Survey(NHANES)2005-2014.J Diabetes,2017;9,846-54.
35.Bluemke DA,Achenbach S,Budoff M,et al.Noninvasive coronary artery imaging:magnetic resonance angiography and multidetector computed tomography angiography:a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention,and the councils on clinical cardiology and cardiovascular disease in the young.Circulation,2008;118,586-606.
36.Ferket BS,Genders TS,Colkesen EB,et al.Systematic review of guidelines on imaging of asymptomatic coronary artery disease.J Am Coll Cardiol,2011;57,1591-600.
37.Muhlestein JB,LappéDL,Lima JA,et al.Effect of screening for coronary artery disease using CT angiography on mortality and cardiac events in high-risk patients with diabetes:the FACTOR-64 randomized clinical trial.JAMA,2014;312,2234-43.
38.Greenland P,Knoll MD,Stamler J,et al.Major risk factors as antecedents of fatal and nonfatal coronary heart disease events.JAMA,2003;290,891-7.
2.Park GM,Yun SC,Cho YR,et al.Prevalence of coronary atherosclerosis in an Asian population:findings from coronary computed tomographic angiography.Int J Cardiovasc Imaging,2015;31,659-68.
3.Alexopoulos N,Raggi P.Calcification in atherosclerosis.Nat Rev Cardiol,2009;6,681-8.
4.Nance JW Jr,Schlett CL,Schoepf UJ,et al.Incremental prognostic value of different components of coronary atherosclerotic plaque at cardiac CT angiography beyond coronary calcification in patients with acute chest pain.Radiology,2012;264,679-90.
5.Pundziute G,Schuijf JD,Jukema JW,et al.Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease.JAm Coll Cardiol,2007;49,62-70.
6.Ren C,Zhang J,Xu Y,et al.Association between carotid intima-media thickness and index of central fat distribution in middle-aged and elderly Chinese.Cardiovasc Diabetol,2014;13,139.
7.Ding L,Peng K,Lin L,et al.The impact of fat distribution on subclinical coronary atherosclerosis in middle-aged Chinese adults.Int J Cardiol,2017;235,118-23.
8.Liu Y,Xu M,Xu Y,et al.Positive correlation between chronic hyperglycemia and serum fetuin-A levels in middle-aged and elderly Chinese.J Diabetes,2012;4,351-8.
9.Jensen MD,Ryan DH,Apovian CM,et al.2013 AHA/ACC/TOSguideline for the management of overweight and obesity in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.J Am Coll Cardiol,2014;63,2985-3023.
10.Vidal-Petiot E,Elbez Y,Lüscher TF,et al.The 2018 ESC-ESHguidelines for the management of arterial hypertension leave clinicians facing a dilemma in half of the patients.Eur Heart J,2018;39,4040-1.
11.Chinese guidelines on prevention and treatment of dyslipidemia in adults Joint Committee for Developing Chinese guidelines on Prevention and Treatment of Dyslipidemia in Adults.J Cardiol,2007;35,390-419.(In Chinese)
12.World Health Organization.Definition,diagnosis and classification of diabetes mellitus and its complications:report of a WHO Consultation.Part 1.Diagnosis and classification of diabetes mellitus.Geneva:World Health Organization,1999.
13.Levy JC,Matthews DR,Hermans MP.Correct homeostasis model assessment(HOMA)evaluation uses the computer program.Diabetes Care,1998;21,2191-2.
14.Austen WG,Edwards JE,Frye RL,et al.A reporting system on patients evaluated for coronary artery disease.Report of the Ad Hoc Committee for Grading of Coronary Artery Disease,Council on Cardiovascular Surgery,American Heart Association.Circulation,1975;51,5-40.
15.Stone NJ,Robinson JG,Lichtenstein AH,et al.2013 ACC/AHAguideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2014;63,2889-934.
16.Goff DC Jr,Lloyd-Jones DM,Bennett G,et al.2013 ACC/AHAguideline on the assessment of cardiovascular risk:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation,2014;129,S49-73.
17.Wilson PW,D'Agostino RB,Levy D,et al.Prediction of coronary heart disease using risk factor categories.Circulation,1998;97,1837-47.
18.Malik S,Wong ND.Metabolic syndrome,cardiovascular risk and screening for subclinical atherosclerosis.Expert Rev Cardiovasc Ther,2009;7,273-80.
19.van Werkhoven JM,Schuijf JD,Gaemperli O,et al.Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease.J Am Coll Cardiol,2009;53,623-32.
20.Lin F,Shaw LJ,Berman DS,et al.Multidetector computed tomography coronary artery plaque predictors of stress-induced myocardial ischemia by SPECT.Atherosclerosis,2008;197,700-9.
21.Lee H,Yoon YE,Kim YJ,et al.Presence and extent of coronary calcified plaque evaluated by coronary computed tomographic angiography are independent predictors of ischemic stroke in patients with suspected coronary artery disease.Int JCardiovasc Imaging,2015;31,1469-78.
22.Hadamitzky M,Achenbach S,Al-Mallah M,et al.Optimized prognostic score for coronary computed tomographic angiography:results from the CONFIRM registry(COronary CTAngiography EvaluatioN For Clinical Outcomes:An InteRnational Multicenter Registry).J Am Coll Cardiol,2013;62,468-76.
23.Rumberger JA,Simons DB,Fitzpatrick LA,et al.Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area.A histopathologic correlative study.Circulation,1995;92,2157-62.
24.Stary HC,Chandler AB,Dinsmore RE,et al.A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis.A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis,American Heart Association.Circulation,1995;92,1355-74.
25.Nicholls SJ,Tuzcu EM,Wolski K,et al.Coronary artery calcification and changes in atheroma burden in response to established medical therapies.J Am Coll Cardiol,2007;49,263-70.
26.Lee RT,Grodzinsky AJ,Frank EH,et al.Structure-dependent dynamic mechanical behavior of fibrous caps from human atherosclerotic plaques.Circulation,1991;83,1764-70.
27.Richardson PD,Davies MJ,Born GV.Influence of plaque configuration and stress distribution on fissuring of coronary atherosclerotic plaques.Lancet,1989;2,941-4.
28.Arad Y,Goodman KJ,Roth M,et al.Coronary calcification,coronary disease risk factors,C-reactive protein,and atherosclerotic cardiovascular disease events:the St.Francis Heart Study.J Am Coll Cardiol,2005;46,158-65.
29.Blaha MJ,Nasir K,Rivera JJ,et al.Gender differences in coronary plaque composition by coronary computed tomography angiography.Coron Artery Disease,2009;20,506-12.
30.Nasir K,Gopal A,Blankstein R,et al.Noninvasive assessment of gender differences in coronary plaque composition with multidetector computed tomographic angiography.Am JCardiol,2010;105,453-8.
31.Makino K,Yoshitama T,Kanda S,et al.Relation of coronary plaque composition determined by 64-slice multidetector computed tomography in patients with suspected coronary heart disease.Am J Cardiol,2011;107,1624-9.
32.Lin T,Liu JC,Chang LY,et al.Association of metabolic syndrome and diabetes with subclinical coronary stenosis and plaque subtypes in middle-aged individuals.Diabet Med,2011;28,493-9.
33.Budoff MJ,Achenbach S,Blumenthal RS,et al.Assessment of coronary artery disease by cardiac computed tomography:a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention,Council on Cardiovascular Radiology and Intervention,and Committee on Cardiac Imaging,Council on Clinical Cardiology.Circulation,2006;114,1761-91.
34.Liu Y,Wang K,Maisonet M,et al.Associations of lifestyle factors(smoking,alcohol consumption,diet and physical activity)with type 2 diabetes among American adults from National Health and Nutrition Examination Survey(NHANES)2005-2014.J Diabetes,2017;9,846-54.
35.Bluemke DA,Achenbach S,Budoff M,et al.Noninvasive coronary artery imaging:magnetic resonance angiography and multidetector computed tomography angiography:a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention,and the councils on clinical cardiology and cardiovascular disease in the young.Circulation,2008;118,586-606.
36.Ferket BS,Genders TS,Colkesen EB,et al.Systematic review of guidelines on imaging of asymptomatic coronary artery disease.J Am Coll Cardiol,2011;57,1591-600.
37.Muhlestein JB,LappéDL,Lima JA,et al.Effect of screening for coronary artery disease using CT angiography on mortality and cardiac events in high-risk patients with diabetes:the FACTOR-64 randomized clinical trial.JAMA,2014;312,2234-43.
38.Greenland P,Knoll MD,Stamler J,et al.Major risk factors as antecedents of fatal and nonfatal coronary heart disease events.JAMA,2003;290,891-7.