广州超2万人随访14年研究登柳叶刀子刊:老胸片新用途!主动脉弓钙化或可预测全因死亡与多种心血管疾病风险!

2022-05-06 LILYMED MedSci原创

The Lancet Regional Health-Western Pacific:主动脉弓钙化与全因死亡和心血管疾病风险:广州生物样本库队列研究

血管疾病(CVD)是全球致残和过早死亡的主要原因。在过去的几十年里,高收入国家的年龄标准化心血管疾病死亡率一直在下降,而在低收入和中等收入国家(LMICs)下降趋势并不明显,突出了识别被忽视的心血管疾病风险因素的必要性,尤其是在中低收入国家。

血管钙化是动脉粥样硬化、血管损伤和慢性肾脏疾病的常见病理表现。冠状动脉、腹主动脉、胸主动脉和多部位冠状动脉钙化与一般人群死亡和心血管疾病的高风险相关,但关于主动脉弓钙化(AAC)的相关证据有限。以前关于AAC的大多数研究都是在终末期肾病患者中进行的,并且它们始终显示与AAC相关的CVD风险较高。

研究人员仅发现了一项美国的基于人群的前瞻性队列研究,涉及116309名参与者,随访时间为28年。这项研究表明,在1964-1973年体检时通过胸部X光片测量的AAC与两性非致命性和致命性冠心病(CHD)和女性缺血性中风的风险较高有关。来自广州生物银行队列研究(GBCS)的论文显示,中年到老年中国人的AAC基线患病率似乎高于美国研究中类似年龄组的基线患病率。然而,20多年前美国的结果是否可以推广到当代亚洲人和其他人群尚不清楚。

计算机断层扫描(CT)是测量血管钙化的金标准。然而,高成本和电离辐射限制了CT在大型流行病学研究中的应用。胸部 X 线检查的 AAC 等级与 CT 确定的冠状动脉钙化评分呈正相关。然而,胸片上AAC的存在是否预示着全因死亡和心血管疾病的风险仍有待进一步研究。

此外,在透析患者中,血管钙化是左心室肥厚(LVH)的预测因子,后者与全因死亡和心血管疾病的风险较高有关。AAC和LVH的共存是否会增加全因死亡和CVD的风险尚不清楚。因此,本研究使用GBCS的数据检查了通过胸部X射线测量的AAC与一般人群中全因死亡率和CVD(非致命和致命)的关联。

通过胸部X射线测量AAC的存在和严重程度(0-2级),并通过广州生物银行队列研究中27166名50岁以上无CVD的中国人的12导联心电图鉴定LVH。多变量Cox回归用于检查AAC和LVH与结局的关联。表1显示,在基线时,与没有AAC的参与者相比,AAC患者中男性更多、年龄较大、受教育程度和个人年收入较低、其他工作、饮酒和积极体力活动患病率较低、吸烟、CVD家族史和慢性病(高血压糖尿病,LVH)较高(所有P从<0.001到0.04)。

此外,基线时AAC患者BMI较低,其他血管危险因素水平较高(腰围,收缩压和舒张压,LDL-胆固醇,空腹血糖和白细胞计数(WBC)),eGFR较低,UA较高(所有P均为<0.001至0.02)。

表2显示,在调整性别,年龄,教育,职业,个人年收入,身体活动,酒精使用,吸烟状况,糖尿病,CVD家族史,BMI,高血压,LDL-胆固醇和WBC后,AAC的存在与更高的全因死亡(HR 1.24,95%CI 1.17-1.31),CVD(1.22,1.14-1.30)、IHD (1.31, 1.17-1.46)、MI (1.40, 1.19-1.65)、IHD和缺血性卒中 (1.20, 1.11-1.29)、卒中 (1.14, 1.04-1.24) 和出血性卒中 (1.35, 1.09-1.69)风险相关。使用AAC等级作为AAC严重程度的指标,严重AAC(2级)的参与者的全因死亡、CVD、IHD、MI、IHD和缺血性卒中、卒中和出血性卒中的风险更高。发现存在AAC与缺血性卒中无显著关联(1.02, 0.98-1.06, P=0.35),但重度AAC的HR略显著(1.05, 1.00-1.10, P=0.04)。

表2还显示,在9115名参与者中,eGFR和UA的进一步调整并没有实质性地改变AAC与全因死亡、CVD、IHD、MI、IHD和缺血性卒中的关联。然而,在调整eGFR和UA后,AAC与卒中(包括出血性和缺血性卒中)的关联减弱为不显著。

Kaplan-Meier分析显示,AAC严重程度与全因死亡、CVD、IHD和卒中(所有P<0.001)的风险较高,存在显著的剂量反应关联(图1)。没有发现任何证据表明这些关联因性别、年龄(<62 / ≥62岁)、吸烟状况(从不/从未)或糖尿病(是/否)而异(所有相互作用的P值≥0.10)。表3显示,与没有AAC和LVH的受试者相比,只有LVH的受试者与全因死亡率、CVD和特定事件无关(所有P值>0.05),而AAC受试者仅具有显着更高的风险,并且具有AAC和LVH共存的受试者具有最高的风险。AAC和LVH共存组的HR(95%CI)在全因死亡为1.72(1.37-2.15),CVD为1.80(1.40-2.32),IHD为1.89(1.27-2.81),IHD为1.76(1.32-2.35),脑卒中为1.76(1.29-2.40),出血性脑卒中为3.33(1.82-6.07),缺血性卒中为2.76(1.86-4.10)。具有AAC和LVH的参与者具有最高的全因死亡,CVD,IHD和中风风险(图2)。

 

综上所述,这个研究首次发现胸片测定的AAC是一般人群全因死亡和心血管疾病的独立危险因素,且存在LVH时,该危险进一步增加。由于在中国和其他地方,首次入院的健康筛查和住院患者通常会进行胸部x线片检查,而使用胸部x线片检查AAC不需要额外的成像,额外的读数开销最小,而且很方便,本研究结果表明,部X光片在已经完成时具有进一步的实用性,以帮助社区和临床环境中的心血管风险分层。

 

原文来源:

Wen Bo Tian, et al. Aortic arch calcification and risk of all-cause mortality and cardiovascular disease: The Guangzhou Biobank Cohort Study. The Lancet Regional Health - Western Pacific 2022;23: 100460 Published online xxx https://doi.org/10.1016/j. lanwpc.2022.100460.

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    2022-05-07 hukaixun
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    2022-05-07 xulv123

    认真学习~~

    0

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    2022-05-07 1064510_1039

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Front Cardiovasc Med:一天中膳食维生素摄入时间与心血管疾病和全因死亡率的关系。