건강검진자에서 임상전단계 관상동맥 죽상경화증과 혈중 호모시스테인치와의 연관성
Association of Homocysteine Levels with Subclinical Coronary Atherosclerosis in Asymptomatic Subjects
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배경: 혈중 호모시스테인의 증가는 혈전생성과 혈관의 산화적인 손상 및 혈관내피세포의 기능장애을 일으키며, 이는 죽상경화반의 진행과 관련이 있다고 알려져 있다. 그러나 임상전단계의 관상동맥 죽상경화증과 혈중 호모시스테인치의 연관성은 불분명하다. 그러므로 본 연구에서는 무증상의 건강검진자들에서 임상전단계의 죽상경화증과 혈중 호모시스테인치의 관련성을 알아보고자 하였다. 방법: 관상동맥 CT조영술(coronary CT angiography)을 받은 20세 이상 성인 2,968명(남자, 1,374명; 여자, 1,594명)을 대상으로 하였고, 이들을 혈중 호모시스테인치에 따라 사분위수로 나누었다. 로지스틱 회귀분석을 이용하여, 호모시스테인 사분위수에 따른 관상동맥석회화수치, 관상동맥경화반, 관상동맥협착과의 연관성을 알아보았다. 결과: 높은 사분위수의 호모시스테인은 연령, 남성, 체질량지수, 허리둘레, 혈압, 고밀도 콜레스테롤, 중성지방, 혈당, 당화혈색소, 고감도 C반응성단백질 및 관상동맥석회화지수와 유의하게 관련이 있었다. 관상동맥경화반도 더 높은 사분위수인 경우에 더 많이 관찰되었고(21.3%, 28.8%, 34.4%, 34.3%; P<0.001), 관상동맥의 50% 이상 협착도 더 많이 관찰되었다(1.8%, 5.4%, 5.0%, 6.6%; P< 0.001). 관상동맥석회화수치와 연관된 인자는 연령, 호모시스테인, 당화혈색소 및 고감도 C반응성단백질이었고, 석회화수치>400인 경우와 호모시스테인과의 연관성은 제1사분위수에 비해 제3사분위수에서는 3.980배(95% 신뢰구간: 1.723-9.195) (P=0.001), 제4사분위수에서는 7.355배(95% 신뢰구간: 3.291-16.439) (P<0.001,) 더 높았다. 결론: 혈중 호모시스테인치는 임상전단계의 죽상경화증과 연관이 있었다.
Abstract
Background: Progression of atherosclerotic plaques is known to be correlated with elevated circulating homocysteine (Hcy). However, whether the level of Hcy is related with coronary atherosclerosis in the subclinical state is unclear. Therefore, we performed this study to investigate the relationship between blood Hcy levels and subclinical atherosclerosis in asymptomatic self-referred subjects. Methods: We retrospectively enrolled 2,968 self-referred asymptomatic subjects (1,374 men, 1,594 women) who had undergone both coronary CT angiography (CCTA) and coronary artery calcium scoring. The relationships between atherosclerosis, Hcy, and other clinical factors were assessed. Results: Higher levels of Hcy were related with age, male gender, body mass index (BMI), waist circumference, blood pressure, high density lipoprotein (HDL), triglyceride, blood glucose, HbA1c, hsCRP, and coronary artery calcium score (CACS). Coronary plaque was more frequently found in higher Hcy quartile groups (21.3%, 28.8%, 34.4%, and 34.3%, P<0.001). Significant coronary artery stenosis (stenosis>50%) was also more frequent in higher Hcy quartile groups (1.8%, 5.4%, 5.0%, and 6.6%, P<0.001). The factors associated with CACS included age, male gender, levels of HbA1c, Hcy and hsCRP. Logistic regression analysis adjusted for gender and confounding factors showed that the third- and fourth-quartile Hcy groups had higher odds ratios [odd ratio (OR) 3.980 (1.723-9.194), P=0.001, 7.355 (3.291-16.439), P<0.001, respectively] for high CACS (CACS >400) than the first quartile group. Conclusions: Blood Hcy levels were associated with an increased risk of the presence and extent of subclinical atherosclerosis in asymptomatic subjects.
참고문헌 (23)
- Choi EK, "Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals", J Am Coll Cardiol, 52, pp.357~365 (2008)
- Myerburg RJ, "Frequency of sudden cardiac death and profiles of risk", Am J Cardiol, 80, pp.10~19F (1997)
- Schaffer A, "Relationship between homocysteine and coronary artery disease. Results from a large prospective cohort study", Thromb Res, 134, pp.288~293 (2014)
- Klerk M, "MTHFR 677C-->T polymorphism and risk of coronay heart disease: a meta-analysis", JAMA, 288, pp.2023~2031 (2002)
- Rasouli ML, "Plasma homocysteine predicts progression of atherosclerosis", Atherosclerosis, 181, pp.159~165 (2005)
- Kullo IJ, "Association of plasma homocysteine with coronary artery calcification in different categories of coronary heart disease risk", Mayo Clin Proc, 81, pp.177~182 (2006)
- Taylor AJ, "Do conventional risk factors predict subclinical coronary artery disease? Results from the Prospective Army Coronary Calcium Project", Am Heart J, 141, pp.463~468 (2001)
- Hunt ME, "C-reactive protein is not associated with the presence or extent of calcified subclinical atherosclerosis", Am Heart J, 141, pp.206~210 (2001)
- Agatston AS, "Quantification of coronary artery calcium using ultrafast computed tomography", J Am Coll Cardiol, 15, pp.827~832 (1990)
- Austen WG, "A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association", Circulation, 51(4 Suppl), pp.5~40 (1975)
- Lin T, "Association of C-reactive protein and homocysteine with subclinical coronary plaque subtype and stenosis using low-dose MDCT coronary angiography", Atherosclerosis, 21, pp.501~506 (2010)
- Nasir K, "Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals", Radiology, 264, pp.637~649 (2012)
- Kunita E, "Utsunomiya H, et al. Prognostic value of coronary artery calcium and epicardial adi pose tissue assessed by non-contrast cardiac computed tomography", Atherosclerosis, 233, pp.447~453 (2014)
- Stuhlinger MC, "Homocysteine impairs the nitric oxide synthase pathway: role of asymmetric dimethylarginine", Circulation, 104, pp.2569~2575 (2001)
- Ungvari Z, "Increased superoxide production in coronary arteries in hyperhomocysteinemia: role of tumor necrosis factor-alpha, NAD(P)H oxidase, and inducible nitric oxide synthase", Arterioscler Thromb Vasc Biol, 23, pp.418~424 (2003)
- Jin L, "Homocysteine induces endothelial dysfunction via inhibition of arginine transport", J Physiol Pharmacol, 58, pp.191~206 (2007)
- Bienvenu T, "Elevated total plasma homocysteine, a risk factor for thrombosis. Relation to coagulation and fibrinolytic parameters", Thromb Res, 70, pp.123~129 (1993)
- Woo KS, "Hyper-homocyst(e)inemia is a risk factor for arterial endothelial dysfunction in humans", Circulation, 96, pp.2542~2544 (1997)
- Kullo IJ, "Association of plasma homocysteine with coronary artery calcification in different categories of coronary heart disease risk", Mayo Clin Proc, 81, pp.177~182 (2006)
- Grundy SM, "Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cariology", Circulation, 100, pp.1481~1492 (1999)
- Graham IM, "Plasma homocysteine as a risk factor for vascular disease. The European Concerted Action Project", JAMA, 277, pp.1775~1781 (1997)
- Selhub J, "Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis", N Engl J Med, 332, pp.286~291 (1995)
- Van den Berg M, "Plasma homocysteine and severity of atherosclerosis in young patients with lower-limb atherosclerotic disease", Arterioscler Thromb Vasc Biol, 16, pp.165~171 (1996)