本文摘自2014年1月15日刊《美国医学会杂志》，JAMA：
Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events
冠脉斑块的钙化密度与心血管事件风险
Importance Coronary artery calcium (CAC), measured by computed tomography (CT), has strong predictive value for incident cardiovascular disease (CVD) events. The standard CAC score is the Agatston, which is weighted upward for greater calcium density. However, some data suggest increased plaque calcium density may be protective for CVD.
背景：利用计算机断层扫描（CT）评估了冠脉钙化（CAC），对预测心血管疾病（CVD）有着重要预测意义。目前的常规CAC评分为Agatston评分，钙密度越高则得分越高。然而，有研究报道高密度的钙化灶可能具有CVD保护作用。
Objective To determine the independent associations of CAC volume and CAC density with incident CVD events.
目的：明确CAC体积和CAC密度与CVD事件之间的联系。
Design, Setting, and Participants Multicenter, prospective observational MESA study (Multi-Ethnic Study of Atherosclerosis), conducted at 6 US field centers of 3398 men and women from 4 race/ethnicity groups; non-Hispanic white, African American, Hispanic, and Chinese. Participants were aged 45-84 years, free of known CVD at baseline, had CAC greater than 0 on their baseline CT, and were followed up through October 2010.
设计、设定和参与者：多中心前瞻性观察性MESA研究，在6家美国医疗中心进行，共招募3398名男性和女性患者，分为4个种族/人种组别：非西班牙裔白人、非裔美国人、西班牙裔和中国人。参与者为45~84岁之间，入组时均未出现CVD，且CT检查显示CAC大于0（即存在冠脉钙化），随访至2010年10月。
Main Outcomes and Measures Incident coronary heart disease (CHD) and all CVD events
主要转归和测定：冠心病（CHD）和所有CVD事件。
Results During a median of 7.6 years of follow-up, there were 175 CHD events and an additional 90 other CVD events for a total of 265 CVD events. With both lnCAC volume and CAC density scores in the same multivariable model, the lnCAC volume score showed an independent association with incident CHD, with a hazard ratio (HR) of 1.81 (95% CI, 1.47-2.23) per standard deviation (SD?=?1.6) increase, absolute risk increase 6.1 per 1000 person-years, and for CVD an HR of 1.68 (95% CI, 1.42-1.98) per SD increase, absolute risk increase 7.9 per 1000 person-years. Conversely, the CAC density score showed an independent inverse association, with an HR of 0.73 (95% CI, 0.58-0.91) per SD (SD?=?0.7) increase for CHD, absolute risk decrease 5.5 per 1000 person-years, and an HR of 0.71 (95% CI, 0.60-0.85) per SD increase for CVD, absolute risk decrease 8.2 per 1000 person years. Area under the receiver operating characteristic curve analyses showed significantly improved risk prediction with the addition of the density score to a model containing the volume score for both CHD and CVD. In the intermediate CVD risk group, the area under the curve for CVD increased from 0.53 (95% CI, 0.48-0.59) to 0.59 (95% CI, 0.54-0.64), P?=?.02.
结果：平均随访7.6年间，共记录175例CHD事件和90例其它CVD事件，共计265例。在包括lnCAC体积和CAC密度评分的同一多变量模型中，lnCAC体积评分与CHD之间存在显著的独立相关性：每标准差（SD=1.6）增加的风险比（HR）为1.81，其绝对风险增加6.1/1000人年；对CVD而言，每SD增加的HR为1.68，绝对风险增加7.9/1000人年。与之相反，CAC密度评分与为负相关关系。对CHD而言，CAC密度每SD增加（SD=0.7）的HR为0.73，绝对风险降低5.5/1000人年；至于CVD，CAC密度每SD增加的HR为0.71，绝对风险降低8.2/1000人年。ROC曲线下面积分析显示，如果针对CHD和CVD的预测模型中包含CAC密度，那么风险预测准确性将显著改善。在CVD中等风险组别中，CVD曲线下面积从0.53增加至0.59。
Conclusions and Relevance CAC volume was positively and independently associated with CHD and CVD risk. At any level of CAC volume, CAC density was inversely and significantly associated with CHD and CVD risk. The role of CAC density should be considered when evaluating current CAC scoring systems.
结论：CAC体积与CHD和CVD风险之间存在独立的正相关关系。在相同的CAC体积时，CAC密度与CHD和CVD风险之间存在独立的负相关关系。目前的CAC评分系统应考虑CAC密度中的作用。
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