中年人较高的冠状动脉钙水平可能表明未来心脏病的风险较高 Higher coronary artery calcium levels in middle-age may indicate higher risk for future heart problems

新闻发布14-JUN-2019

中年人较高的冠状动脉钙水平可能表明未来心脏病的风险较高

美国心脏协会

达拉斯,2019年6月14日 – 根据美国心脏协会杂志“循环:心血管成像”的最新研究,中年高冠状动脉钙水平与未来心力衰竭相关的结构性心脏异常相关,尤其是黑人。

冠状动脉钙(CAC)是由脂肪,钙和胆固醇组成的钙化斑块的累积。在这种类型的斑块中发现的钙与膳食钙无关。血液中升高的胆固醇水平可导致斑块积聚,称为动脉粥样硬化,其使动脉内的通道变窄并减少血流量。

CAC是心脏健康问题的风险标记,CAC筛查被添加到美国心脏协会的2018年胆固醇管理指南中,以进一步改善心脏健康异常的早期发现,特别是在可能具有更高风险的人群中。 CAC评分为零表示在没有其他高风险条件的情况下风险较低,而高于零的评分表示风险增加。

在这项研究中,研究人员追踪了从年轻的成年人到中年的2,449人(白人占52%,女性占57%)。非侵入性计算机断层扫描成像测试用于衡量参与者的血管健康状况,参与者的成像测试和CAC评分在研究期间的15和25年进行比较。

到第25年,参与者的平均年龄约为50岁。该组中有72%的CAC评分为零,而十年前为77%。

“我们看到成年早期到中年,因为这是一个窗口,我们可以看到可能不会引起症状的异常,但后来可能会增加心脏病的风险,”Henrique Turin Moreira医学博士说。 ,研究共同作者和巴西圣保罗大学医院dasClínicasdeRibeirãoPreto的主治医师。 “预防和控制这些异常是关键,因此及早识别风险至关重要。”

Moreira和团队发现,CAC评分的增加与年龄增长,男性,黑人种族,收缩压升高,总胆固醇升高,糖尿病和当前吸烟以及使用药物降低血压和胆固醇独立相关。此外,他们发现:

与CAC评分为零的患者相比,那些中年CAC评分较高的患者左心室质量增加12%,左心室容量增加9%,与其他风险因素无关,包括人口统计学信息和心血管风险。左心室的异常意味着心脏必须更加努力地有效地泵血,结果变得更大和变厚,这是心力衰竭的危险因素。

这些发现在黑人中更为显着。对于CAC评分中每一个单位的变化,与白人相比,黑人的左心室质量增加了四倍。

虽然随访的CAC进展与黑人左心室质量增加密切相关,但这种关系在白人中并不显着。
黑人已经面临更大的心脏病和中风风险和负担:60%的成年黑人男性和57%的成年黑人女性患有某种形式的心血管疾病,而50%的白人男性和43%的白人女性。

“我们的研究结果中的种族差异可能是由于遗传因素或可能更多地暴露于通常在黑人中出现的心血管危险因素,”莫雷拉说。 “我们需要更多的研究来检查冠状动脉钙和心脏健康之间的联系。”

“之前的研究表明,CAC的存在和较高的CAC评分与年轻至中年人的动脉粥样硬化性心血管疾病相关。本研究的结果很重要,因为他们强调CAC的存在和较高的CAC评分也可能与超声心动图有关亚临床左心室收缩和舒张功能障碍的标志物,“Salim Virani,医学博士,美国心脏协会2018年胆固醇指南编写委员会成员,休斯敦贝勒医学院心脏病学奖学金培训项目主任说。 “鉴于与心力衰竭相关的发病率和死亡率的负担,这些是重要的发现。该队列的先前研究也表明,年轻成年期更好的风险因素与较低的CAC相关,因此,这些结果进一步突出了重要性成年早期的原始预防和危险因素调整。“

NEWS RELEASE 

Higher coronary artery calcium levels in middle-age may indicate higher risk for future heart problems

AMERICAN HEART ASSOCIATION

DALLAS, June 14, 2019 — Higher coronary artery calcium levels in middle-age were associated with structural heart abnormalities linked to future heart failure, particularly among blacks, according to new research in Circulation: Cardiovascular Imaging, an American Heart Association journal.

Coronary artery calcium (CAC) is the buildup of calcified plaque made up of fat, calcium and cholesterol. The calcium found in this type of plaque is not related to dietary calcium. Elevated cholesterol levels in the blood can contribute to plaque buildup, known as atherosclerosis, which narrows the channel within an artery and reduces blood flow.

CAC is a risk marker for heart health problems, and CAC screening was added to the American Heart Association’s 2018 cholesterol management guidelines to further improve early detection of heart health abnormalities, especially among people who might be at a higher risk. A CAC score of zero indicates there is low risk in the absence of other high-risk conditions, while a score above zero indicates increasing risk.

In this study, researchers tracked 2,449 people (52% white, 57% women) from young adulthood to middle-age. Non-invasive computed tomography imaging tests were used to gauge the participants’ vascular health, with participants’ imaging tests and CAC scores compared at years 15 and 25 of the study period.

By year 25, participants’ average age was about 50. Seventy-two percent of the group had a CAC score of zero compared with 77% a decade earlier.

“We looked at early adulthood to middle-age because this is a window in which we can see abnormalities that might not be causing symptoms, but could later increase the risk of heart problems,” said Henrique Turin Moreira, M.D., Ph.D., study co-author and an attending physician at Hospital das Clínicas de Ribeirão Preto at the University of São Paulo in Brazil. “Prevention and control of these abnormalities are key, so early identification of risks can be crucial.”

Moreira and team found that increases in CAC scores were independently related to increasing age, male sex, black race, higher systolic blood pressure, higher total cholesterol, diabetes mellitus and current smoking, as well as the use of medications to lower blood pressure and cholesterol. Additionally, they found:

  • Compared with patients who had CAC scores of zero, those who had higher CAC scores at middle-age had a 12% increase in left ventricular mass and a 9% increase in left ventricular volume, independent of other risk factors including demographic information and cardiovascular risks. Abnormalities in the left ventricle means the heart had to work harder to effectively pump blood, and as a result, became enlarged and thickened, a risk factor for heart failure.
  • These findings were even more significant among blacks. For every one-unit change in a CAC score, blacks had four times higher increase in left ventricular mass compared with whites.
  • While progression in CAC over the follow-up was strongly related to higher left ventricular mass in blacks, this relationship was not significant in whites.

Blacks already face a greater risk and burden of heart disease and stroke: 60% of adult black men and 57% of adult black women have some form of cardiovascular disease, compared with 50% of white men and 43% of white women.

“Racial differences in our findings may be due to genetic factors or perhaps greater exposure to cardiovascular risk factors that usually appear earlier in blacks,” Moreira said. “We need more research to examine the link between coronary artery calcium and heart health.”

“Prior studies have shown that presence of CAC and higher CAC scores are associated with atherosclerotic cardiovascular disease in young to middle aged adults. The results of this study are important as they highlight that presence of CAC and higher CAC scores may also be associated with echocardiographic markers of subclinical LV systolic and diastolic dysfunction,” said Salim Virani, M.D., a member of the writing committee for the American Heart Association’s 2018 cholesterol guidelines and director of the Cardiology Fellowship Training Program at Baylor College of Medicine in Houston. “Given the burden of morbidity and mortality associated with heart failure, these are important findings. Prior studies from this cohort have also shown that a better risk factors profile in young adulthood is associated with much lower CAC and therefore, these results further highlight the importance of primordial prevention and risk factor modification in early adulthood.”

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Co-authors are: Guilherme S. Yared, M.D.; Bharath A. Venkatesh, Ph.D.; Henrique D. Vasconcellos, M.D., M.Sc.; Chike C. Nwabuo, M.D., M.P.H.; Mohammad R. Ostovaneh, M.D.; Jared P. Reis, Ph.D.; Donald M. Lloyd-Jones, M.D., M.Sc.; Pamela J. Schreiner, Ph.D.; Cora E. Lewis, M.D., M.S.P.H.; Stephen Sidney, M.D., M.P.H.; John Jeffrey Carr, M.D., M.Sc.; Samuel S. Gidding, M.D.; and João A.C. Lima, M.D. Author disclosures are on the manuscript.

Data from The CARDIA study was used for this research. The CARDIA study is supported by the National Heart, Lung, and Blood Institute (NHLBI), the Intramural Research Program of the National Institute on Aging (NIA), and an intra-agency agreement between NIA and NHLBI.

Additional Resources:

Available multimedia is on right column of release link – https://newsroom.heart.org/news/higher-coronary-artery-calcium-levels-in-middle-age-may-indicate-higher-risk-for-future-heart-problems?preview=8451abc3a782780bac49beb62f283057

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