Coronary Artery Calcium Density and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis.

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2024-08-25 DOI:10.1016/j.jcmg.2024.07.024

Yuanqi Yong, Julian Giovannucci, Sow Neng Pang, Wei Hong, Donghee Han, Daniel S Berman, Damini Dey, Stephen J Nicholls, Nitesh Nerlekar, Andrew Lin

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引用次数: 0

Abstract

Background: There is increasing evidence that coronary artery calcium (CAC) density is inversely associated with plaque vulnerability and atherosclerotic cardiovascular disease risk.

Objectives: A systematic review and meta-analysis were performed to examine the predictive value of CAC density for future cardiovascular events in asymptomatic individuals undergoing noncontrast CAC scoring computed tomography.

Methods: Electronic databases were searched for studies reporting CAC density and subsequent cardiovascular disease (CVD) or coronary heart disease (CHD) events. Two independent reviewers performed data extraction. Random-effects models were used to estimate pooled HRs and 95% CIs. Subgroup analyses were performed with studies stratified by CVD vs CHD events and by statin use.

Results: Of 5,029 citations, 5 studies with 6 cohorts met inclusion criteria. In total, 1,309 (6.1%) cardiovascular events occurred in 21,346 participants with median follow-up ranging from 5.2 to 16.7 years. Higher CAC density was inversely associated with risk of cardiovascular events following adjustment for clinical risk factors and CAC volume (HR: 0.80 per SD of density [95% CI: 0.72-0.89]; P < 0.01; I² = 0%). There was no significant difference in the pooled HRs for CVD vs CHD events (HR: 0.80 per SD [95% CI: 0.71-0.90] vs 0.74 per SD [95% CI: 0.59-0.94] respectively; P = 0.59). The protective association between CAC density and event risk persisted among statin-naive patients (HR: 0.79 per SD [95% CI: 0.70-0.89]; P < 0.01) but not statin-treated patients (HR: 0.97 per SD [95% CI: 0.77-1.22]; P = 0.78); the test for interaction indicated no significant between-group differences (P = 0.12).

Conclusions: Higher CAC density is associated with a lower risk of cardiovascular events when adjusted for risk factors and CAC volume. Future work may expand the contribution of CAC density in CAC scoring, and enhance its role in CVD risk assessment, treatment, and prevention.

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冠状动脉钙密度与心血管事件风险：系统回顾与元分析》。

背景：越来越多的证据表明，冠状动脉钙（CAC）密度与斑块脆弱性和动脉粥样硬化性心血管疾病风险成反比：目的：通过系统回顾和荟萃分析，研究CAC密度对接受非对比CAC评分计算机断层扫描的无症状人群未来心血管事件的预测价值：在电子数据库中搜索了报告 CAC 密度和未来心血管疾病 (CVD) 或冠心病 (CHD) 事件的研究。两名独立审稿人进行数据提取。随机效应模型用于估算汇总的HRs和95% CIs。根据心血管疾病与冠心病事件以及他汀类药物的使用情况对研究进行了分组分析：在 5,029 篇引用文献中，有 5 项研究的 6 个队列符合纳入标准。21,346 名参与者中共发生了 1,309 起（6.1%）心血管事件，中位随访时间从 5.2 年到 16.7 年不等。在对临床风险因素和CAC体积进行调整后，较高的CAC密度与心血管事件风险成反比（HR：密度每SD 0.80 [95% CI：0.72-0.89]；P < 0.01；I2 = 0%）。心血管疾病与冠心病事件的汇总 HRs 无明显差异（HR：分别为 0.80 per SD [95% CI: 0.71-0.90] vs 0.74 per SD [95% CI: 0.59-0.94]; P = 0.59）。他汀类药物无效的患者（HR：0.79 per SD [95% CI：0.70-0.89]；P <0.01），而他汀类药物治疗的患者（HR：0.97 per SD [95% CI：0.77-1.22]；P =0.78）中，CAC密度与事件风险之间的保护性关联持续存在；交互作用检验表明组间差异不显著（P =0.12）：结论：经风险因素和CAC体积调整后，较高的CAC密度与较低的心血管事件风险相关。未来的工作可能会扩大 CAC 密度在 CAC 评分中的贡献，并增强其在心血管疾病风险评估、治疗和预防中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.