成人一生中各阶段的无症状动脉粥样硬化患病率
完整摘要 · 中文译文
背景：动脉粥样硬化可能始于成年早期，并在心血管疾病显现之前数十年保持临床沉默。尽管沉默性动脉粥样硬化与心血管事件和死亡相关，且独立于传统心血管疾病危险因素，但其年龄和性别特异性患病率、血管区域分布以及整个成年期的斑块体积仍未完全明确。 方法：我们在丹麦和西班牙开展了一项前瞻性队列研究。年龄18至70岁、无已知动脉粥样硬化性心血管疾病的成年人被纳入五个预先设定的年龄分层，各层纳入女性与男性人数均衡。基线时通过颈动脉和股动脉三维血管超声以及冠状动脉计算机断层扫描血管造影评估沉默性动脉粥样硬化。 结果：共有16,808名成年人纳入研究。参与者的平均（±标准差）年龄为45±12岁，51.4%为女性。57.1%的参与者存在无症状动脉粥样硬化（95%置信区间，56.3至58.0）。在最年轻年龄层（18至29岁）中，8.7%的男性和6.7%的女性存在动脉粥样硬化；患病率随年龄增长而升高，女性在中年期的上升出现较晚且更为陡峭。在较年轻年龄层的参与者中，动脉粥样硬化最常见于外周且局限于单一血管区域；随着年龄增长，斑块体积呈指数增加，多动脉受累的患病率变得更加常见。孤立性冠状动脉粥样硬化在各个年龄层中均不常见（男性≤9.3%，女性≤5.0%）。 结论：这项关于无症状动脉粥样硬化的研究表明，该疾病在成年早期即可被检出，患病率随年龄和性别在多个动脉区域升高，且斑块体积显著增加。（由诺和诺德基金会资助；REACT ClinicalTrials.gov注册号，NCT06692127。）
完整摘要 · 英文原文
BACKGROUND: Atherosclerosis may begin in early adulthood and remain clinically silent for decades before cardiovascular disease manifests. Although silent atherosclerosis is associated with cardiovascular events and death independent of traditional cardiovascular disease risk factors, its age- and sex-specific prevalence, vascular territory distribution, and plaque volume across adult life remain incompletely defined. METHODS: We conducted a prospective cohort study in Denmark and Spain. Adults 18 to 70 years of age without known atherosclerotic cardiovascular disease were enrolled in five prespecified age strata that included balanced numbers of women and men. Silent atherosclerosis was assessed at baseline with three-dimensional vascular ultrasonography of the carotid and femoral arteries and with coronary computed tomographic angiography. RESULTS: A total of 16,808 adults were enrolled in the study. The mean (±SD) age of the participants was 45±12 years, and 51.4% were women. Silent atherosclerosis was present in 57.1% of the participants (95% confidence interval, 56.3 to 58.0). In the youngest age stratum (18 to 29 years), atherosclerosis was present in 8.7% of the men and 6.7% of the women; prevalence increased with age, with a later, steeper midlife rise among women. Among participants in the younger age strata, atherosclerosis was most often peripheral and confined to a single vascular territory; with increasing age, plaque volume increased exponentially and the prevalence of multiarterial involvement became more frequent. Isolated coronary-artery atherosclerosis was uncommon in every age stratum (≤9.3% of men and ≤5.0% of women). CONCLUSIONS: This study of silent atherosclerosis showed that the disease was detectable in early adulthood, with age- and sex-associated increases in prevalence across arterial territories and marked increases in plaque volume. (Funded by the Novo Nordisk Foundation; REACT ClinicalTrials.gov number, NCT06692127.).