BACKGROUND In patients with ischemic heart disease, coronary microvascular dysfunction is associated with cardiovascular risk factors and poor prognosis; however, data from healthy individuals are scarce. OBJECTIVES The purpose of this study was to assess the impact of cardiovascular risk factors and subclinical atherosclerosis on coronary microvascular function in middle-aged asymptomatic individuals. METHODS Myocardial perfusion was measured at rest and under stress using cardiac magnetic resonance in 453 individuals and used to generate myocardial blood flow (MBF) maps and calculate myocardial perfusion reserve (MPR). Subclinical atherosclerosis was assessed using 3-dimensional vascular ultrasound of the carotid and femoral arteries and coronary artery calcium scoring at baseline and at 3-year follow-up. RESULTS Median participant age was 52.6 years (range: 48.9-55.8 years), and 84.5% were male. After adjusting for age and sex, rest MBF was directly associated with the number of the metabolic syndrome components present (elevated waist circumference, systolic and diastolic blood pressure, fasting glucose, and triglycerides and low high-density lipoprotein cholesterol), insulin resistance (homeostatic model assessment for insulin resistance), and presence of diabetes. MPR was reduced in the presence of several metabolic syndrome components, elevated homeostatic model assessment for insulin resistance, and diabetes. Stress MBF was inversely associated with coronary artery calcium presence and with global plaque burden. Higher stress MBF and MPR were associated with less atherosclerosis progression (increase in plaque volume) at 3 years. CONCLUSIONS In asymptomatic middle-aged individuals free of known cardiovascular disease, the presence of cardiometabolic risk factors and systemic (poly-vascular) subclinical atherosclerosis are associated with impaired coronary microvascular function. Better coronary microvascular function reduces atherosclerosis progression at follow-up. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).

中文翻译：

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具有心脏代谢危险因素的无症状中年个体的冠状动脉微血管功能。


背景 在缺血性心脏病患者中，冠状动脉微血管功能障碍与心血管危险因素和不良预后相关。然而，来自健康个体的数据很少。目的 本研究的目的是评估心血管危险因素和亚临床动脉粥样硬化对中年无症状个体冠状动脉微血管功能的影响。方法 使用心脏磁共振测量 453 名个体在休息和应激状态下的心肌灌注，并用于生成心肌血流 (MBF) 图并计算心肌灌注储备 (MPR)。使用颈动脉和股动脉的 3 维血管超声以及基线和 3 年随访时的冠状动脉钙评分来评估亚临床动脉粥样硬化。结果 参与者年龄中位数为 52.6 岁（范围：48.9-55.8 岁），其中 84.5% 为男性。调整年龄和性别后，静息MBF与存在的代谢综合征成分的数量（腰围升高、收缩压和舒张压、空腹血糖、甘油三酯和低高密度脂蛋白胆固醇）、胰岛素抵抗（稳态）直接相关。胰岛素抵抗的模型评估）和糖尿病的存在。在存在多种代谢综合征成分、胰岛素抵抗稳态模型评估升高和糖尿病的情况下，MPR 降低。压力 MBF 与冠状动脉钙存在和整体斑块负荷呈负相关。较高的压力 MBF 和 MPR 与 3 年时较少的动脉粥样硬化进展（斑块体积增加）相关。 结论 在没有已知心血管疾病的无症状中年个体中，心脏代谢危险因素和全身性（多血管）亚临床动脉粥样硬化的存在与冠状动脉微血管功能受损有关。更好的冠状动脉微血管功能可减少随访时动脉粥样硬化的进展。 （早期亚临床动脉粥样硬化的进展 [PESA]；NCT01410318）。