Left Main Coronary Artery Calcium and Diabetes Confer Very-High-Risk Equivalence in Coronary Artery Calcium >1,000

冠状动脉钙 心脏病学 内科学 无症状的 医学 糖尿病 比例危险模型 人口 心肌梗塞 危险系数 冠状动脉钙评分 亚临床感染 冠状动脉疾病 置信区间 内分泌学 环境卫生
作者
Alexander C. Razavi,Leslee J. Shaw,Daniel S. Berman,Matthew J. Budoff,Nathan D. Wong,Viola Vaccarino,Marly van Assen,Carlo N. De Cecco,Arshed A. Quyyumi,Anurag Mehta,Paul Muntner,Michael D. Miedema,Alan Rozanski,John A. Rumberger,Khurram Nasir,Roger S. Blumenthal,Laurence S. Sperling,Martin Bødtker Mortensen,Seamus P. Whelton,Michael J. Blaha,Omar Dzaye
出处
期刊:Jacc-cardiovascular Imaging [Elsevier BV]
被引量:5
标识
DOI:10.1016/j.jcmg.2023.12.006
摘要

Although a coronary artery calcium (CAC) of ≥1,000 is a subclinical atherosclerosis threshold to consider combination lipid-lowering therapy, differentiating very high from high atherosclerotic cardiovascular disease (ASCVD) risk in this patient population is not well-defined. Among persons with a CAC of ≥1,000, the authors sought to identify risk factors equating with very high-risk ASCVD mortality rates. The authors studied 2,246 asymptomatic patients with a CAC of ≥1,000 from the CAC Consortium without a prior ASCVD event. Cox proportional hazards regression modelling was performed for ASCVD mortality during a median follow-up of 11.3 years. Crude ASCVD mortality rates were compared with those reported for secondary prevention trial patients classified as very high risk, defined by ≥2 major ASCVD events or 1 major event and ≥2 high-risk conditions (1.4 per 100 person-years). The mean age was 66.6 years, 14% were female, and 10% were non-White. The median CAC score was 1,592 and 6% had severe left main (LM) CAC (vessel-specific CAC ≥300). Diabetes (HR: 2.04 [95% CI: 1.47-2.83]) and severe LM CAC (HR: 2.32 [95% CI: 1.51-3.55]) were associated with ASCVD mortality. The ASCVD mortality per 100 person-years for all patients was 0.8 (95% CI: 0.7-0.9), although higher rates were observed for diabetes (1.4 [95% CI: 0.8-1.9]), severe LM CAC (1.3 [95% CI: 0.6-2.0]), and both diabetes and severe LM CAC (7.1 [95% CI: 3.4-10.8]). Among asymptomatic patients with a CAC of ≥1,000 without a prior index event, diabetes, and severe LM CAC define very high risk ASCVD, identifying individuals who may benefit from more intensive prevention therapies across several domains, including low-density lipoprotein-cholesterol lowering.
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