分类：骨质疏松

CAC与冠心病

心血管疾病是发达地区及国家的第一杀手。当你感到胸闷胸痛或心肌梗塞，你的心血管病可能已经到了不可或者是难以逆转的程度。与所有慢性疾病一样，心血管病是可以预防的。但你首先要了解你现在的心血管疾病程度。有充分的研究显示冠状动脉钙沉积指数（CAC）是最好的预测指标，更优于FRS（Framingham Risk Assessment）及ASCVD分数（Astherosclerotic CVD Risk Assessment）等（PMID: 30216389，30212857，参见我的公众号2018.6.25文章”你有冠状动脉粥样硬化吗?“）。

冠状动脉硬化本身不可怕，可怕的是如果不断进展，最终会导致如心肌梗塞或中风等其他心血管意外。如果查出来CAC＞0（即冠状动脉有钙沉积，冠心病风险升高），你也不用惊慌，因为这很是可以阻止的，甚至是可以逆转的。

关于CAC的，我在我的公众号2018.6.25文章”你有冠状动脉粥样硬化吗?“文章中已有充分描述。国内医院估计大部分都不单独做CAC（因为这是预防性的），似乎是在CTA里一起做的。但大部分CT都能做。我找了熟人，开单“胸部CT平扫”，但主要做的是冠脉钙沉积指数（CAC) ，建议你做一下。不要等到出现冠心病了，那时恐怕太晚了。

更多关于CAC。足够的研究显示CAC对心血管意外及全因死亡率具有高度预测性。2018年二个大型研究再次证实CAC的重要性。最近（2018年）一个对872名无症状, 无心血管疾病史, 约50-60岁的人群（男817名, 女55名）研究结果再次表明, CAC与心血管意外风险成正比。报告显示：CAC分数＞1但＜100的人, 他们患隐性心肌梗塞（unrecognized myocardial infarction, UMI）风险为1%；但CAC在100-400之间的人, UMI风险升高6倍；而CAC＞400者，UMI风险升高14.5倍! CAC作为冠心病预测指标，比FRS（Framingham Risk Assessment）及ASCVD风险指数（Atheroslcerotic Cardiovascular Disease）更好（PMID30216389)。二周前（2018年9月）欧洲CAC联盟（CAC Consortium）公布一项对63215名无症状男女，平均随访了12.6年的大型研究结果。报道显示CAC分数与年龄基本呈线性正比关系。35岁的人，CAC阳性率约20%（男），10%（女）；50岁，55%（男），25%（女）；60岁，78%（男），48%（女）；80岁，98%（男），96%（女）。CAC越高，心血管死亡率越高（CAC 分数1-100；心血管死亡率 ～1%；CAC分数101-399，男性为2.5%，女性约5%；而CAC＞400，男性约8%，女性约14%。

成长 医学博士 生物化学博士
Richard Cheng, M.D., Ph.D.
微信: RichardCheng322789

Long-Term Oral Bisphosphonate Therapy and Fractures in Older Women: The Women’s Health Initiative.

Drieling RL, et al. J Am Geriatr Soc. 2017.

Show full citation

Abstract

OBJECTIVES: To examine the association between long-term bisphosphonate use and fracture in older women at high risk of fracture.

DESIGN: Retrospective cohort.

SETTING: Women’s Health Initiative.

PARTICIPANTS: Older women who reported at least 2 years of bisphosphonate use in 2008-09 (N = 5,120).

MEASUREMENTS: Exposure data were from a current medications inventory. Outcomes (hip, clinical vertebral, wrist or forearm, any clinical fracture) were ascertained annually. Using multivariate Cox proportional hazards models, the association between duration of bisphosphonate use (3-5, 6-9, 10-13 years) and fracture was estimated, using 2 years as the referent group.

RESULTS: On average participants were 80 years old and were followed for 3.7 ± 1.2 years. There were 127 hip, 159 wrist or forearm, 235 clinical vertebral, and 1,313 clinical fractures. In multivariate-adjusted analysis, 10 to 13 years of bisphosphonate use was associated with higher risk of any clinical fracture than 2 years of use (hazard ratio (HR) = 1.29, 95% confidence interval (CI) = 1.07-1.57). This association persisted in analyses limited to women with a prior fracture (HR = 1.30, 95% CI = 1.01-1.67) and women with no history of cancer (HR = 1.36, 95% CI = 1.10-1.68). The association of 10 to 13 years of use, compared with 2 years of use, was not statistically significant for hip (HR = 1.66, 95% CI = 0.81-3.40), clinical vertebral (HR = 1.65, 95% CI = 0.99-2.76), or wrist fracture (HR = 1.16, 95% CI = 0.67-2.00).

CONCLUSION: In older women at high risk of fracture, 10 to 13 years of bisphosphonate use was associated with higher risk of any clinical fracture than 2 years of use. These results add to concerns about the benefit of very long-term bisphosphonate use.