Objective: To compare the prevalence and progression of subclinical atherosclerosis (SA) in populations with different cardiovascular disease (CVD) risks in China, and clarify the relationship between CVD risk stratification and SA. Methods: All participants were from Beijing Community-Based Cohort of Atherosclerosis. A total of 1 462 participants underwent carotid ultrasound and coronary computed tomography scan during 2008-2009 and 2013-2014. After excluding 191 participants with history of CVD and incomplete baseline data, 1 271 participants were included in final analysis. The 10-year CVD risk for participants were calculated based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) equation, and risk stratification was performed. The prevalence and progression of SA was determined by carotid intima-media thickness (cIMT), carotid plaque score and coronary artery calcification (CAC) score. Results: In the participants included in this study, 536 (42.2%), 418 (32.9%) and 317 (24.9%) were classified to have low, intermediate and high 10-year risk, respectively. With the rising level of 10-year risk, the proportion of patients with SA and SA progression increased. In low, intermediate and high CVD risk groups, the proportions of participants with CAC were 16.4%, 36.4% and 52.0% (trend P<0.001); and 15.4%, 36.4% and 53.6% had progression of CAC during follow-up, respectively (trend P<0.001); compared with low-risk group, RRs for CAC progression of intermediate and high-risk groups were 2.316 (95%CI: 1.714-3.129) and 3.322 (95%CI: 2.472-4.463), respectively (trend P<0.001). The trend of relationship between CVD risk stratification and cIMT and carotid plaque progression were consistent with CAC. Conclusions: This current study shows CVD risk stratification is closely related to the prevalence and progression of atherosclerosis in Chinese population. However, many people with low CVD risk have atherosclerotic change in their carotid and coronary artery.
目的： 比较中国不同心血管疾病（CVD）风险分层人群中，颈动脉及冠状动脉粥样硬化及进展情况，探讨CVD风险分层与动脉粥样硬化及进展的关系。 方法： 1 462例研究对象来自北京社区动脉粥样硬化队列，分别于2008-2009年和2013-2014年进行2次颈动脉超声和冠状动脉计算机断层扫描检查。剔除191例有CVD病史和危险因素信息缺失的个体后，共1 271例研究对象纳入分析。采用中国动脉粥样硬化性CVD风险预测研究模型计算研究对象的10年CVD风险预测值，并进行风险分层分析。动脉粥样硬化情况通过颈动脉内中膜厚度（cIMT）、颈动脉斑块评分和冠状动脉钙化评分进行评估。 结果： 10年CVD风险低危、中危和高危者分别为536例（42.2%）、418例（32.9%）和317例（24.9%）。随着风险等级升高，存在动脉粥样硬化和发生进展者的占比增加。CVD风险低危、中危和高危的人群中，基线时分别有16.4%、36.4%和52.0%的研究对象存在冠状动脉钙化（趋势P<0.001）；随访期间分别有15.4%、36.4%和53.6%发生了冠状动脉钙化进展（趋势P<0.001）；与低危人群相比，中危和高危人群发生冠状动脉钙化进展的RR值（95%CI）分别为2.316（1.714~3.129）和3.322（2.472~4.463）（趋势P<0.001）。CVD风险分层与cIMT和颈动脉斑块及进展之间的关系趋势与冠状动脉钙化结果一致。 结论： 中国CVD风险分层与人群动脉粥样硬化和进展密切相关。但在CVD风险低危和中危的人群中，仍有相当部分人群存在动脉粥样硬化和发生进展。.