肺癌低剂量CT筛查者冠状动脉钙化检出率及危险因素分析

目的探讨肺癌低剂量CT筛查人群中冠状动脉钙化检出率及相关危险因素。方法选取2013至2016年首次在我院行肺癌低剂量CT筛查的40岁以上无症状男性2722例,年龄40~81岁,其中吸烟者1052例,非吸烟者1670例。收集相关病史及血液生化检查资料,包括年龄、体质指数、吸烟史、糖尿病史及血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸、血肌酐。采用视觉评分方法进行冠状动脉钙化评分。对不同人群钙化检出率差异进行χ2检验;冠状动脉钙化与危险因素的分析采用Spearman相关分析及多因素Logistic回归。结果 2722例中,发生冠状动脉钙化者642例(23.6%),其中轻、中、重度钙化分别占88.8%、8.9%、2.3%,平均年龄为56.7±9.8岁;无冠状动脉钙化者2080例,平均年龄为49.5±7.1岁。吸烟组冠状动脉钙化检出率高于非吸烟组(25.9%比22.2%,P=0.027)。冠状动脉钙化与年龄、吸烟、高血脂、糖尿病、血肌酐升高呈显著相关,与高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸升高无显著关联。随着年龄增长,钙化检出率逐渐增加;50岁以下者,吸烟组的钙化检出率是非吸烟组的2倍多。结论无症状肺癌低剂量CT筛查人群中,轻度冠状动脉钙化检出率较高;年龄、吸烟、高血脂、糖尿病、血肌酐升高是冠状动脉钙化的危险因素。     

冠状动脉钙化在肥厚型心肌病诊断中的临床意义

评价冠状动脉钙化在肥厚型心肌病鉴别诊断中的临床价值。连续调查了 99例 30岁以上临床确诊肥厚型心肌病患者资料 ,分析其年龄、性别分布和冠状动脉钙化特点 ,并与同期同年龄段冠心病患者资料进行对比。结果发现 ,99例肥厚型心肌病患者的冠状动脉钙化积分与钙化阳性率随年龄增加而增加 ,存在性别差异 ,钙化总积分和钙化阳性率分别是 2 1.1± 4 .9和 32 .3% ,均显著低于冠心病组 (2 0 3.2± 34.9和 6 6 .7% ;P <0 .0 1) ;但仍在国人正常的钙化积分切点范围内。调整性别、年龄因素后 ,肥厚型心肌病患者的冠状动脉钙化积分和钙化阳性率仍显著低于冠心病组 (P <0 .0 1)。结果提示 ,电子束CT检测冠状动脉钙化有助于疑似或合并冠心病的肥厚型心肌病患者的鉴别诊断 ,具有重要的临床价值。     

年龄与性别在冠状动脉钙化程度和冠心病诊断价值中的影响

目的：探讨年龄和性别在电子束CT（EBCT）测定冠状动脉钙化（CAC）程度及其对冠心病诊断价值的影响。方法：2642例患行EBCT检测CAC并计算每例的总积分,分析年龄和性别与CAC检测阳性率及CAC总积分的关系;其中同期经选择性冠状动脉造影检查的患432例,评价CAC对冠心病的诊断价值及年龄和性别的影响。结果：（1）2642例患总的检测阳性率为69．3％,其中男性和女性分别为73．1％和60．4％,阳性率男性显高于女性（P＜0．001）。两性的阳性率都随年龄增大而增高;70岁以下各年龄组男性均明显高于女性,但60岁以后两性差距逐渐缩小,70岁以上各年龄组两性间比较,差异无显性;（2）男女两性钙化积分的自然对数转换值的均数都年龄增大而增高,性别差异与年龄阳性率相似;（3）CAC诊断冠心病的敏感性、CAC诊断冠心病的敏感性在≥60岁男性组最高,＜60岁女性组最低;而诊断特异性则与之相反。结论：冠状动脉钙化程度随年龄增大而加重,男性一般重于同龄女性,但60岁以后女性钙化程度迅速增加并逐渐接近同龄男性;年龄和性别对冠状动脉钙化诊断冠心病的价值有很大影响。     

主动脉瓣钙化在冠心病诊断中的临床价值

目的探讨主动脉瓣钙化与冠心病的临床意义。方法选取156例经胸心脏彩超明确的主动脉瓣钙化并行冠状动脉造影的患者,冠脉造影明确冠脉病变情况,并记录血管病变支数、Gensini评分,同时记录年龄、性别、血压、血脂以及吸烟史、糖尿病史等一般情况。另选取110例无主动脉瓣钙化并行冠状动脉造影的患者作为对照组。比较两组冠心病发生率、冠脉病变严重程度。Logistic回归分析年龄、性别、血压、血脂以及吸烟、糖尿病与主动脉瓣钙化对冠心病的预测价值。结果主动脉瓣钙化患者冠心病发病率较对照组明显增高(91.03%vs65.45%,P<0.01),而且主动脉瓣钙化患者严重病变冠心病多见,三支血管病变比例和Gensini评分均高于无主动脉瓣钙化患者(P<0.05)。冠心病患者主动脉瓣钙化检出率明显高于非冠心病患者(66.36%vs26.92%,P<0.01),多元回归分析发现主动脉瓣钙化为冠心病的独立预测因子(P<0.05)。结论主动脉瓣钙化患者有更高的冠心病发病率,并且严重冠脉病变多见,主动脉瓣钙化可以作为冠心病无创评估的一个参考指标。     

北京社区自然人群冠状动脉钙化的多排螺旋CT初步研究

目的利用64排螺旋CT(64multi-detector computed tomography,64-MDCT)初步评价北京社区人群的冠状动脉钙化(coronary artery calcium,CAC)情况。方法对北京地区社区人群进行抽样研究,利用64-MDCT(GE,LightSpeed VCT)对1480例研究对象进行冠状动脉钙化扫描,应用Agatston积分法分别计算其冠状动脉钙化积分(coronary artery calcium score,CACS),观察CAC分布特征,以性别及年龄分组比较组间的CAC差别。结果总样本CAC阳性率为29.9%;男性组的CAC阳性率为37.6%,明显高于女性组的23.1%(P0.01)。同一性别各年龄组的CACS均呈正偏态分布,CAC阳性率和CACS均随年龄增加而显著增高(P0.01);40～、50～岁组的CAC阳性率以及40～、50～、60～岁组的CACS存在性别间的显著性差异。1480例研究对象有206例(13.9%)为单支钙化,237例(16.0%)为多支钙化;总样本共5920支冠状动脉中以前降支(26.8%)及右冠状动脉(13.5%)钙化阳性率为高(P0.01)。结论 64-MDCT能够方便、快速地量化检测社区人群的CAC的发病情况,评价人群中的CAC分布特征及规律,从而初步判定人群中的冠状动脉粥样硬化病变的流行病学特征。     

云南农村自然人群冠状动脉钙化情况的调查研究

目的 观察云南农村自然人群冠状动脉钙化及冠状动脉钙化积分情况.方法 对云南农村自然人群进行单纯随机抽样,采用16排螺旋CT对174例研究对象进行冠状动脉扫描,计算冠状动脉钙化,并应用Agatston积分法计算钙化积分,观察冠状动脉钙化及钙化积分的分布特征,按性别、年龄、种族进行分组,比较组间钙化率及钙化积分的差别.结果 174例入选研究对象中39例发现钙化(阳性率22.4％)及钙化积分≥l.51～60岁组、61～7l岁组钙化阳性率分别为15.5％、34.4％,钙化积分分别为11.2±52.4、38.0±82.0.钙化阳性率及钙化积分在不同年龄组间有显著性差异(P＜0.05),而在性别和种族之间无显著性差异.冠状动脉钙化阳性率为前降支＞回旋支=右冠状动脉＞左主干.结论 云南农村51～71岁自然人群中冠状动脉钙化及钙化积分存在年龄间的差异.钙化发生率最高在前降支,其次为回旋支和右冠状动脉.     

老年人心脏瓣膜钙化的临床病理研究北大核心CSCD

目的总结已行尸体解剖老年患者中心脏瓣膜钙化的检出率,并分析临床与病理间的相关性。方法人选北京医院病理科1954年11月7日至2016年3月7日,年龄60～106岁的老年患者的系统病理解剖资料,共1047例。回顾性分析经尸检病理证实的心脏瓣膜钙化的病例,总结瓣膜钙化检出率与年龄、临床疾病及冠状动脉粥样硬化的相关性。结果（1）1047例尸检病例中,主动脉瓣钙化、二尖瓣钙化、主动脉瓣合并二尖瓣钙化及心脏瓣膜钙化检出率分别为15．2％（159例）、9．6％（101例）、5．4％（57例）、19．4％（203例）。（2）60～岁、70～岁、80～岁、90～106岁不同年龄组心脏瓣膜钙化检出率分别为6．4％（15／234）、12．8％（37／289）、22．5％（70／311）、38．0％（81／213）,趋势x^2=82．52,P〈0．01;合并病理冠状动脉狭窄或高血压、冠心病、糖尿病、慢性肾病的患者心脏瓣膜钙化检出率较高。（3）多因素回归分析,不同临床因素对发生瓣膜钙化的风险分别为年龄（OR=1．066,959CI：1．048～1．086,P〈0．01）、高血压（OR=1．223,95％CI：0．859～1．741,P〉0．05）、冠心病（OR=2．238,95％CI：1．396～3．589,P〈0．01）、糖尿病（OR=1．053,95％CI：0．700～1．586,P〉0．05）、慢性肾病（OR=0．924,95％CI：0．610～1．399,P〉0．05）。（4）与无心脏瓣膜钙化患者比较,心脏瓣膜钙化患者发生冠状动脉粥样硬化的风险增加（OR=2．983,95％CI：1．868～4．765,P〈0．01）。结论随增龄,老年人心脏瓣膜钙化发生率增加;冠心病患者具有较高的发生瓣膜钙化的风险;瓣膜钙化与冠状动脉粥样硬化相关。     

2型糖尿病合并无症状冠状动脉钙化的相关危险因素分析

目的 分析2型糖尿病合并无症状冠状动脉钙化的危险因素.方法 选取2013年6月至2014年3月在大连医科大学附属二院住院治疗的2型糖尿病患者共199例作为研究对象.(1)根据患者有无胸闷、气短及与冠心病相关的异位疼痛等症状分为有症状组(89例)和无症状组(110例),颈部血管超声结果确定无症状组均有动脉硬化,两组均行冠状动脉CT检查.(2)根据冠状动脉钙化积分将有症状组与无症状组再分为钙化积分＞10分与钙化积分＜10分两个亚组.结果 (1)与有症状钙化积分＞10分组相比,无症状钙化积分＞10分组的体重指数、尿酸水平降低,尿微量白蛋白与尿肌酐比值(UACR)、高血压发生率、神经病变发生率较高(t=-1.990,-2.440,2.923,x2=4.459,10.941,P均＜0.05).(2)无症状钙化积分＜10分组平均糖尿病病程、年龄、UACR、高血压发生率、视网膜病变发生率、下肢动脉粥样硬化发生率明显小于无症状钙化积分＞10分组(t=-3.700,-3.440,-5.170,x2=4.880,6.761,4.951,P均＜0.05).(3)高龄、糖尿病病程长、UACR高的2型糖尿病患者发生无症状冠状动脉钙化的优势比(OR)值(95％CI)分别为1.059 (1.010～1.112),1.1 10 (1.021～1.207),1.009(1.000～1.019).结论 年龄、糖尿病病程、UACR是2型糖尿病合并无症状冠状动脉钙化异常的独立危险因素.     

无症状中年男性低剂量胸部CT冠状动脉钙化的影响因素及应用价值分析

目的]分析无症状中年男性低剂量胸部CT中冠状动脉钙化发生情况及其影响因素,探讨低剂量胸部CT在心血管疾病早期筛查中的应用价值。 [方法]选取2022年1月—12月在东部战区总医院体检中心行健康体检的2 571例40～65岁无症状男性受检者,采集一般资料、血液指标、胸部CT等数据,根据胸部CT是否提示冠状动脉钙化,分为钙化组(n＝422)和非钙化组(n＝2 149),分析两组间差异性及冠状动脉钙化的影响因素。 [结果]2 571例无症状中年男性受检者中,冠状动脉钙化阳性率为16.41%。组间比较显示,钙化组的年龄、体质指数、收缩压、舒张压、脉搏、腰围、谷丙转氨酶、谷草转氨酶、血清尿素氮、甘油三酯、空腹血糖、糖化血红蛋白均显著高于非钙化组,钙化组红细胞计数显著低于非钙化组(均P＜0.05)。单因素Logistic回归分析显示,年龄、体质指数、收缩压、舒张压、脉搏、腰围、红细胞计数、谷丙转氨酶、谷草转氨酶、血清尿素氮、甘油三酯、空腹血糖、糖化血红蛋白对冠状动脉钙化的影响有统计学意义(均P＜0.05)。多因素Logistic回归分析显示,年龄、体质指数、舒张压、红细胞计数、谷草转氨酶是冠状动脉钙化的独立危险因素(均P＜0.05)。 [结论]年龄、体质指数、舒张压、红细胞计数、谷草转氨酶增高是无症状中年男性低剂量胸部CT中冠状动脉钙化的独立危险因素。健康体检胸部CT在心血管疾病筛查中有一定价值。     

冠心病合并冠状动脉钙化相关危险因素分析

目的分析冠心病(CHD)合并冠状动脉钙化的相关危险因素及临床意义。方法收集2014年12月~2016年9月在我院行冠状动脉CT检查,同时在我院心导管室经选择性冠状动脉造影检查(CAG)诊断为CHD的患者80例,根据冠状动脉有无钙化分为钙化组(50例)及非钙化组(30例)。采用单因素及多因素Logistic回归分析方法,观察两组患者性别、年龄、白细胞计数(WBC)、中性粒细胞百分比(Neut%)、淋巴细胞百分比(Lym%)、直接胆红素(Dbl L)、间接胆红素(IblL)、γ谷氨酰转肽酶(GGT)、白蛋白(ALB)、前白蛋白(PA)、肌酐(CREA)、尿酸(UA)、血钙(Ca)、血磷(P)甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和有无高血压、糖尿病病史与冠状动脉钙化的相关性。结果 (1)年龄、性别、糖尿病发病率两组差异有统计学意义(P0.05);与非钙化组相比,钙化组Neut%、LDL-C显著增高,而PA、Lym%显著降低,差异有统计学意义(P0.05);(2)年龄、糖尿病Ne%是冠心病合并冠脉钙化的独立危险因素(OR=1.054、3.943、1.064,P=0.027);(3)与低四分位数水平的冠心病合并冠脉钙化患者比较,年龄、Neut%处在较高四分位数水平患者冠脉钙化发生率显著增高(P0.05)。结论高龄、糖尿病、较高水平Neut%是冠心病合并冠脉钙化的独立危险因素。     

Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults

Electron beam tomography (EBT) is a noninvasive method used to detect coronary artery calcium (CAC). Due to the age-associated increase in incidence and magnitude of CAC, interpretation of results can be difficult. The purpose of this study was to develop a set of age- and gender-stratified CAC distributions to serve as standards for the clinical interpretation of EBT scans. Between 1993 and 1999, 35,246 asymptomatic subjects, 30 to 90 years of age, were self-referred for CAC screening using an Imatron EBT scanner. CAC score was calculated based on the number, areas, and peak computed tomographic density for each detected calcific lesion. CAC score in each coronary artery was equal to the sum of all lesions for that artery and the total CAC score was equal to the sum of the score of each artery. Total CAC scores were assigned to a percentile according to age and gender. CAC scores were reported at the 10th, 25th, 50th, 75th, and 90th percentiles for 16 age and/or gender groups. The prevalence of CAC increased with age for men and women. The extent of CAC differed significantly between men and women in the same age group. In summary, this study reports the distribution of CAC score by age and gender. Knowledge of the distribution of CAC, the effect of age on the total CAC score as well as the differences in total CAC scores that exist between men and women of similar age will assist the clinician in interpreting EBT CAC results.     

Gender and age differences in the prevalence of coronary artery calcification in 953 Chinese subjects

BACKGROUND: To investigate gender and age differences in coronary artery calcium (CAC) as determined by electron beam computed tomography (EBCT) in a Chinese population. METHODS: Consecutive patients undergoing EBCT were subdivided into groups based on gender and decades of life. They were further subdivided into three groups with respect to symptoms of coronary artery disease: typical, atypical and asymptomatic. Total calcium score was calculated for each patient and means calculated for each subgroup. Groups were then compared with respect to age, gender and symptoms. RESULTS: During the study period, 953 patients (736 men and 217 female) aged 17-86 years (mean 55+/-11 years) underwent EBCT. The prevalence of CAC increased significantly with increasing age. The mean total calcium score also increased with increasing age in males and females of each symptom subgroup. The prevalence of coronary artery calcification was significantly higher in males than females until age in excess of 69 years (p<0.05). The prevalence of coronary artery calcification and mean calcium scores were significantly different between each symptom subgroup (p<0.001) with higher scores and prevalence in patients with typical symptoms of coronary disease. CONCLUSIONS: There is an increase in the prevalence of coronary artery calcification with age in Chinese subjects. Male subjects are more likely than female subjects to have detectable coronary calcification up until an age in excess of 69 years. Patients under the age of 70 years, with typical symptoms of coronary artery disease have a higher prevalence and mean calcium score than those with atypical or no symptoms.     

Usefulness of the Framingham risk score and body mass index to predict early coronary artery calcium in young adults (Muscatine Study)

The value of a coronary artery disease prediction algorithm, the Framingham risk score (score), for detecting coronary artery calcium (CAC) was examined in 385 men and 472 women, aged 29 to 43 years. Scores were compared in subjects with and without CAC and were also used to predict presence of CAC. Receiver-operating characteristic curves were computed to compare different prediction models. The score model was compared with age only, natural logarithm of body mass index (lnBMI) only, and score plus lnBMI models. CAC was detected in 30% of men and 16% of women. The mean score was significantly higher in men and women with CAC. For every 2-point increase in the score, the odds of CAC increased by 30% in women and 20% in men. Significant associations between CAC status and risk factors were observed for age in women, and high- density lipoprotein cholesterol and blood pressure in men and women. The area under the receiver-operating characteristic curve for the score was 0.67 and 0.57 for women and men, respectively. When lnBMI was added to the score model, the area increased to 0.76 in women (lnBMI p <0.0001, score p <0.005). For men, the area increased from 0.57 to 0.67, and the score was no longer significant (p >0.60) in the model with lnBMI (p <0.0001). Score predicts CAC in asymptomatic young adults. Inclusion of lnBMI in the score model adds significantly to the prediction of CAC in women and men. The lnBMI model has a greater predictive value than the score in this young population.     

Comparing coronary artery calcium among U.S. South Asians with four racial/ethnic groups: The MASALA and MESA studies

Objectives

South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease which cannot be explained by traditional risk factors. Few studies have examined coronary artery calcium (CAC) in South Asians.

Methods

We created a community-based cohort of South Asians in the United States and compared the prevalence and distribution of CAC to four racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA). We compared 803 asymptomatic South Asians free of cardiovascular disease to the four MESA racial/ethnic groups (2622 Whites, 1893 African Americans, 1496 Latinos and 803 Chinese Americans).

Results

The age-adjusted prevalence of any CAC was similar between White and South Asian men, but was lower in South Asian women compared to White women. After adjusting for all covariates associated with CAC, South Asian men were similar to White men and had higher CAC scores compared to African Americans, Latinos and Chinese Americans. In fully adjusted models, CAC scores were similar for South Asian women compared to all women enrolled in MESA. However, South Asian women ≥70 years had a higher prevalence of any CAC than most other racial/ethnic groups.

Conclusions

South Asian men have similarly high CAC burden as White men, but higher CAC than other racial/ethnic groups. South Asian women appear to have similar CAC burden compared to other women, but have somewhat higher CAC burden in older age. The high burden of subclinical coronary atherosclerosis in South Asians may partly explain higher rates of cardiovascular disease in South Asians.     

Comparison of coronary artery calcium detected by electron beam tomography in patients with to those without symptomatic coronary heart disease

Although the presence of coronary artery calcium (CAC) has been associated with the prevalence and incidence of coronary heart disease (CHD), it is unclear if this association has a threshold or a continuous relation. The aim of this research was to explore the relation between CAC, as detected by electron beam tomography (EBT), and CHD in a cross-sectional study of women and men who presented to a single center for elective screening with EBT from 1995 to 1998. Of 17,967 participants, patients with CHD had higher CAC levels than those without CHD. Using subjects without CAC as the referent group, the odds ratios for prevalent CHD increased significantly across increasing quartiles of CAC in the overall population and in both genders. In a subset of the population, after adjusting for CHD risk factors, CAC scores in the fourth quartile were associated with an odds ratio of 33.8 (p <0.001) for prevalent CHD. Among patients with and without CHD, men were more likely than women to have detectable CAC (58.1% vs 28.3% and 96.1% vs 68.9% respectively, p <0.001 for each); the prevalence of detectable CAC increased with age and was higher in men than in women. There was an increased risk for prevalent CHD at all levels of CAC >0, with the greatest increase in risk occurring in patients with CAC scores >95. These observations support the potential of EBT as a sensitive test for detection of CHD.     

Association between coronary artery calcium and thoracic spine bone mineral density: Multiethnic Study of Atherosclerosis (MESA)

Background and aimsPreviously, osteoporosis and coronary artery disease were considered unrelated. However, beyond age, these two conditions appear to share common etiologies that are not yet fully understood. We examined the relationship between thoracic spine bone mineral density (BMD) and severity of coronary artery calcium (CAC) score.Methods and resultsMESA is a prospective cohort study of 6814 men and women between the ages of 45 and 84 years, without clinical cardiovascular disease. This study included participants who underwent non-contrast chest CT scans to determine CAC score and thoracic spine BMD. The thoracic spine BMD was categorized into osteoporosis (defined as T score: ≤ ?2.5), osteopenia (T-score between: ?2.5 and ?1) and normal BMD (T-score ≥ ?1). There were 3392 subjects who had CAC >0 at baseline. The prevalence of CAC >0 was 36% in normal BMD group, 49% in the osteopenia and 68% in osteoporosis group. After adjusting for risk factors of atherosclerosis, in multivariate regression models we found a significant association between CAC and osteoporosis (OR: 1.40, 95% CI 1.16–1.69, p value < 0.0004). Furthermore, we stratified our results by gender and found a statistically significant association in both men and women.ConclusionResults from this cross-sectional analysis of a large population based ethnically diverse cohort indicate a significant inverse relationship between thoracic BMD and CAC in both genders independent of other cardiovascular risk factors. Future studies need to explore the underlying pathophysiological mechanisms relating BMD and coronary artery calcification.     

Relation of uric acid levels to presence of coronary artery calcium detected by electron beam tomography in men free of symptomatic myocardial ischemia with versus without the metabolic syndrome

The objective of this study was to evaluate whether uric acid (UA) levels were associated with coronary artery calcium (CAC) in white men asymptomatic for coronary heart disease. We also evaluated whether this relation was dependent or not on the presence of the metabolic syndrome (MS). The study population consisted of 371 asymptomatic Brazilian men (48 +/- 7 years of age) who underwent a routine evaluation. The average 10-year total risk of coronary heart disease calculated by Framingham risk score was 10.8 +/- 7.8%. The age-adjusted prevalence of CAC in patients with a high UA level (fourth quartile > or =7.1 mg/dl, n = 91) was significantly higher than that in those with a normal UA level (58% vs 44%, p = 0.02). With respect to age, smoking, physical activity, and components of MS-adjusted analyses, a high UA level was independently associated with the presence of CAC (p = 0.043) and with increasing levels of CAC (p = 0.028). Prevalence of MS showed a graded increase according to serum UA values. In patients with the MS, after adjusting for age, smoking, physical activity, and white blood cell count, high levels of UA were strongly associated with the presence of any CAC (odds ratio 3.47, 95% confidence interval 1.26 to 9.53, p = 0.01) and with increasing levels of CAC (odds ratio 2.74, 95% confidence interval 1.15 to 6.50, p = 0.02). Conversely, there was no significant association of high UA levels in patients without the MS. However, the interaction between high UA level and the MS did not achieve statistical significance for the presence of CAC (p = 0.11) or higher levels of CAC (p = 0.16). In conclusion, our study suggests that, among asymptomatic moderate-risk men, high UA levels were independently associated with CAC in subjects with the MS.     

Coronary artery calcification and myocardial perfusion in asymptomatic adults: the MESA (Multi-Ethnic Study of Atherosclerosis).

OBJECTIVES: This study assessed the cross-sectional association between coronary artery calcification (CAC) and myocardial perfusion in an asymptomatic population. BACKGROUND: Clinical studies showed that the prevalence of stress-induced ischemia increased with CAC burden among patients with coronary heart disease (CHD). Whether an association between CAC and myocardial perfusion exists in subjects without a history of CHD remains largely unknown. METHODS: A total of 222 men and women, ages 45 to 84 years old and free of CHD diagnosis, in the Minnesota field center of the MESA (Multi-Ethnic Study of Atherosclerosis) were studied. Myocardial blood flow (MBF) was measured using magnetic resonance imaging during rest and adenosine-induced hyperemia. Perfusion reserve was calculated as the ratio of hyperemic to resting MBF. Agatston CAC score was determined from chest multidetector computed tomography. RESULTS: Mean values of hyperemic MBF and perfusion reserve, but not resting MBF, were monotonically lower across increasing CAC levels. After adjusting for age and gender, odds ratios (95% confidence intervals) of reduced perfusion reserve (<2.5) for subjects with CAC scores of 0, 0.1 to 99.9, 100 to 399, and > or =400 were 1.00 (reference), 2.16 (0.96 to 4.84), 2.81 (1.04 to 7.58), and 4.99 (1.73 to 14.4), respectively. Further adjustment for other coronary risk factors did not substantially modify the association. However, the inverse association between perfusion reserve and CAC attenuated with advancing age (p for interaction < 0.05). CONCLUSIONS: Coronary vasodilatory response was associated inversely with the presence and severity of CAC in asymptomatic adults. Myocardial perfusion could be impaired by or manifest the progression to subclinical coronary atherosclerosis in the absence of clinical CHD.     

Coronary calcification is associated with elevated serum lipoprotein (a) levels in asymptomatic men over the age of 45 years: A cross-sectional study of the Korean national health checkup data

Lipoprotein a (Lp (a)) and coronary artery calcification (CAC) are markers of coronary artery and cardiovascular diseases. However, the association between Lp (a) and CAC in asymptomatic individuals remains unclear. In this study, we aimed to determine the influence of Lp (a) on CAC in asymptomatic individuals.We included 2019 asymptomatic Korean adults who underwent testing for a coronary artery calcium score (CACS) and Lp (a) at the Gangnam Severance Hospital Health Checkup Center in Korea from January 2017 to August 2019. Participants were divided into 2 groups: CACS = 0 and CACS > 0. Factors affecting the CACS were analyzed by sex. Because age is a major risk factor for atherosclerosis, ≥45 years in men and ≥55 years in women, we further divided participants into 4 subgroups (≥45 and <45 in men, ≥55 and <55 in women). Factors affecting the CACS in the 4 groups were analyzed.There was a positive correlation between the CACS and traditional cardiovascular risk factors. Lp (a) positively correlated with the CACS in men (P < .01) and remained significant after multivariable logistic regression (P < .01). The same result was observed in men aged ≥45 years (P < .01).Lp (a) is an independently associated factor of CAC and a marker of coronary atherosclerosis in asymptomatic men aged ≥45 years. In asymptomatic men aged ≥45 years, Lp (a) should be measured, and intensive Lp (a)-lowering treatment should be considered.     

Coronary artery calcium scores and risk for cardiovascular events in women classified as "low risk" based on Framingham risk score: the multi-ethnic study of atherosclerosis (MESA)

OBJECTIVE: To assess coronary artery calcium (CAC) score and subsequent risk for coronary heart disease (CHD) and cardiovascular (CVD) events among asymptomatic women judged to be at low risk by the Framingham risk score (FRS), a common approach for determining 10-year absolute risk for CHD. Based on population survey data, 95% of American women are considered at low risk based on FRS. METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) included 3601 women aged 45 to 84 years at baseline. The CAC score was measured by coronary computed tomography. Cox proportional hazard models were used to examine the CHD and CVD risk associated with CAC score among women classified as "low risk" based on FRS. RESULTS: Excluding women with diabetes and those older than 79 years, 90% of women in MESA (mean +/- SD age, 60 +/- 9 years) were classified as "low risk" based on FRS. The prevalence of CAC (CAC score > 0) in this low-risk subset was 32% (n = 870). Compared with women with no detectable CAC, low-risk women with a CAC score greater than 0 were at increased risk for CHD (hazard ratio, 6.5; 95% confidence interval, 2.6-16.4) and CVD events (hazard ratio, 5.2; 95% confidence interval, 2.5-10.8). In addition, advanced CAC (CAC score > or = 300) was highly predictive of future CHD and CVD events compared with women with nondetectable CAC and identified a group of low-risk women with a 6.7% and 8.6% absolute CHD and CVD risk, respectively, over a 3.75-year period. CONCLUSIONS: The presence of CAC in women considered to be at low risk based on FRS was predictive of future CHD and CVD events. Advanced CAC identified a subset of low-risk women at higher risk based on current risk stratification strategies.