冠状动脉化在低风险女性中的患病率和预后影响:元分析
Maryam Kavousi1, Chintan S Desai2, Colby Ayers3
1Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
JAMA
|November 16, 2016
概括
冠状动脉 (CAC) 测试在患有心血管疾病 (CVD) 风险较低的妇女中,可以识别那些风险较高的人. 卡克存在显著提高心血管疾病风险,并适度地改善风险预测超出传统因素.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 医疗成像医学成像
背景情况:
- 目前的心血管疾病 (CVD) 预防指南对使用冠状动脉 (CAC) 测试为低风险妇女提供了有限的指导.
- 对于这种人群来说,CAC测试在完善心血管疾病风险分层方面的有用性仍然不清楚.
研究的目的:
- 评估CAC测试在估计和分层CVD风险的有效性,在最初被归类为低风险的妇女中.
- 为了确定CAC是否在已确定的风险因素之外增加了预后价值.
主要方法:
- 对5个大型基于人口的队列进行了元分析,其中包括10年动脉样硬化心血管疾病 (ASCVD) 风险低于7.5%的女性.
- 来自达拉斯心脏研究,弗雷明汉心脏研究,海因茨·尼克斯多夫回忆研究,动脉样硬化多民族研究和鹿特丹研究的数据被汇总起来.
- 冠状动脉 (CAC) 评分使用计算机断层扫描进行评估,并在7.0至11.6年的中位数随访期间跟踪发生的ASCVD事件.
主要成果:
- 在6739名低风险女性中,36.1%的女性有可检测到的CAC (CAC > 0).
- CAC的存在与ASCVD事件的风险增加了两倍以上 (HR,2.04;95% CI,1.44-2.90).
- 将CAC纳入风险模型提高了风险预测准确度 (C统计从0.73增加到0.77;cNRI = 0.20).
结论:
- CAC在约三分之一的低风险女性中普遍存在,并识别出具有明显更高ASCVD风险的个体.
- 与传统的风险因素相比,CAC测试在预后准确度上提供了适度的改善.
- 需要进一步的研究来确定CAC测试在这个人口群体中的临床实用性和成本效益.
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