Jonathan Kermanshahchi, Andrew S Kao, Charlotte C Ellberg, Edward Duran, Michael H Criqui, Michael D Shapiro, Harpreet S Bhatia
{"title":"先前健康个体首次出现动脉粥样硬化性心血管疾病：动脉粥样硬化的多种族研究","authors":"Jonathan Kermanshahchi, Andrew S Kao, Charlotte C Ellberg, Edward Duran, Michael H Criqui, Michael D Shapiro, Harpreet S Bhatia","doi":"10.1016/j.pcad.2025.05.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the first presentation of atherosclerotic cardiovascular disease (ASCVD) in individuals without known ASCVD.</p><p><strong>Methods: </strong>Distribution of first ASCVD events (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]), and the association between traditional risk factors, coronary artery calcium (CAC) and lipoprotein(a) [Lp(a)] with these events in Cox proportional hazards models were evaluated in 6779 participants in the Multi-Ethnic Study of Atherosclerosis. Risk prediction improvement with addition of CAC to the pooled cohort equations (PCE) was evaluated using net reclassification improvement (NRI).</p><p><strong>Results: </strong>The mean age was 62.1 ± 10.2 years and 1037 participants (15.3 %) experienced an ASCVD event over a median of 15.8 years. The most common first presentation was cardiovascular death/RCA (n = 287;27.7 %). Among those with events, Black (35.6 %, p = 0.001)) individuals more often presented with death/RCA, Hispanic (29.3 %, p = 0.037) individuals more often presented with stroke compared to White individuals (24.8 % and 21.7 %, respectively). Compared to men, women more frequently presented with stroke (29.5 vs. 20.7 %, p = 0.002) and death/RCA (29.8 vs 26.3 %, p = 0.243) though this did not meet statistical significance. CAC score was significantly associated with first presentation of all events, including death/RCA (HR 1.13, 95 % CI 1.07-1.19) and improved risk prediction when added to the PCE (continuous NRI 0.6081, 95 % CI 0.4971-0.7141). Lp(a) was significantly associated with MI only (HR 1.15 per SD, 95 % CI 1.02-1.29).</p><p><strong>Conclusions: </strong>In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest, particularly among women, minority groups, and those with CAC. CAC scoring may identify individuals at risk for death/resuscitated cardiac arrest as a first presentation of ASCVD.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"First presentation of atherosclerotic cardiovascular disease in previously healthy individuals: The multi-ethnic study of atherosclerosis.\",\"authors\":\"Jonathan Kermanshahchi, Andrew S Kao, Charlotte C Ellberg, Edward Duran, Michael H Criqui, Michael D Shapiro, Harpreet S Bhatia\",\"doi\":\"10.1016/j.pcad.2025.05.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>To evaluate the first presentation of atherosclerotic cardiovascular disease (ASCVD) in individuals without known ASCVD.</p><p><strong>Methods: </strong>Distribution of first ASCVD events (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]), and the association between traditional risk factors, coronary artery calcium (CAC) and lipoprotein(a) [Lp(a)] with these events in Cox proportional hazards models were evaluated in 6779 participants in the Multi-Ethnic Study of Atherosclerosis. Risk prediction improvement with addition of CAC to the pooled cohort equations (PCE) was evaluated using net reclassification improvement (NRI).</p><p><strong>Results: </strong>The mean age was 62.1 ± 10.2 years and 1037 participants (15.3 %) experienced an ASCVD event over a median of 15.8 years. The most common first presentation was cardiovascular death/RCA (n = 287;27.7 %). Among those with events, Black (35.6 %, p = 0.001)) individuals more often presented with death/RCA, Hispanic (29.3 %, p = 0.037) individuals more often presented with stroke compared to White individuals (24.8 % and 21.7 %, respectively). Compared to men, women more frequently presented with stroke (29.5 vs. 20.7 %, p = 0.002) and death/RCA (29.8 vs 26.3 %, p = 0.243) though this did not meet statistical significance. CAC score was significantly associated with first presentation of all events, including death/RCA (HR 1.13, 95 % CI 1.07-1.19) and improved risk prediction when added to the PCE (continuous NRI 0.6081, 95 % CI 0.4971-0.7141). Lp(a) was significantly associated with MI only (HR 1.15 per SD, 95 % CI 1.02-1.29).</p><p><strong>Conclusions: </strong>In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest, particularly among women, minority groups, and those with CAC. CAC scoring may identify individuals at risk for death/resuscitated cardiac arrest as a first presentation of ASCVD.</p>\",\"PeriodicalId\":94178,\"journal\":{\"name\":\"Progress in cardiovascular diseases\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-05-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Progress in cardiovascular diseases\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.pcad.2025.05.004\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Progress in cardiovascular diseases","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.pcad.2025.05.004","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：评价未发现动脉粥样硬化性心血管疾病（ASCVD）的患者首次出现ASCVD的情况。方法：在多民族动脉粥样硬化研究的6779名参与者中，评估了首次ASCVD事件（心绞痛、卒中、心肌梗死[MI]或死亡/复苏性心脏骤停[RCA]）的分布，以及Cox比例风险模型中传统危险因素、冠状动脉钙（CAC）和脂蛋白（Lp(a)）与这些事件的关系。在合并队列方程（PCE）中加入CAC对风险预测的改善使用净重分类改善（NRI）进行评估。结果：平均年龄为62.1 ± 10.2 岁，1037名参与者（15.3 %）经历了ASCVD事件，中位时间为15.8 年。最常见的首发表现是心血管死亡/RCA （n = 287;27.7 %）。在这些事件中，黑人（35.6 %,p = 0.001）更常出现死亡/RCA，西班牙裔（29.3 %,p = 0.037）个体比白人（分别为24.8 %和21.7 %）更常出现中风。与男性相比，女性更频繁地出现中风（29.5 vs 20.7 %,p = 0.002）和死亡/RCA (29.8 vs 26.3 %,p = 0.243)，尽管这没有统计学意义。CAC评分与所有事件的首次出现均显著相关，包括死亡/RCA （HR 1.13, 95 % CI 1.07-1.19）以及添加PCE后改善的风险预测（连续NRI 0.6081, 95 % CI 0.4971-0.7141）。Lp(a)仅与心肌梗死显著相关（HR 1.15 / SD, 95 % CI 1.02-1.29）。结论：在先前无症状的个体中，ASCVD最常见的初始表现是死亡/复苏性心脏骤停，特别是在女性、少数民族和CAC患者中。CAC评分可以作为ASCVD的首次表现来识别有死亡/复苏性心脏骤停风险的个体。
First presentation of atherosclerotic cardiovascular disease in previously healthy individuals: The multi-ethnic study of atherosclerosis.
Aim: To evaluate the first presentation of atherosclerotic cardiovascular disease (ASCVD) in individuals without known ASCVD.
Methods: Distribution of first ASCVD events (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]), and the association between traditional risk factors, coronary artery calcium (CAC) and lipoprotein(a) [Lp(a)] with these events in Cox proportional hazards models were evaluated in 6779 participants in the Multi-Ethnic Study of Atherosclerosis. Risk prediction improvement with addition of CAC to the pooled cohort equations (PCE) was evaluated using net reclassification improvement (NRI).
Results: The mean age was 62.1 ± 10.2 years and 1037 participants (15.3 %) experienced an ASCVD event over a median of 15.8 years. The most common first presentation was cardiovascular death/RCA (n = 287;27.7 %). Among those with events, Black (35.6 %, p = 0.001)) individuals more often presented with death/RCA, Hispanic (29.3 %, p = 0.037) individuals more often presented with stroke compared to White individuals (24.8 % and 21.7 %, respectively). Compared to men, women more frequently presented with stroke (29.5 vs. 20.7 %, p = 0.002) and death/RCA (29.8 vs 26.3 %, p = 0.243) though this did not meet statistical significance. CAC score was significantly associated with first presentation of all events, including death/RCA (HR 1.13, 95 % CI 1.07-1.19) and improved risk prediction when added to the PCE (continuous NRI 0.6081, 95 % CI 0.4971-0.7141). Lp(a) was significantly associated with MI only (HR 1.15 per SD, 95 % CI 1.02-1.29).
Conclusions: In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest, particularly among women, minority groups, and those with CAC. CAC scoring may identify individuals at risk for death/resuscitated cardiac arrest as a first presentation of ASCVD.
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