As an alternative indicator of atherosclerosis, the prevention of carotid intima-media thickening is conductive to the primary prevention of atherosclerosis, but contributions of cardiovascular risk factors to carotid intima-media thickening are not clear.

To identity the controllable risk factors of carotid intima-media thickening, and to perform a dominance analysis of these factors in terms of percentage of contribution in people without major diseases, so as to provide a reference for the determination of key issues related to early prevention and control of cardiovascular diseases.

A total of 738 residents were recruited from Liuzhou, Guangxi Zhuang Autonomous Region from 2019 to 2021. By use of a questionnaire survey and a physical examination, participant information was collected, including demographics, biomarkers in fasting whole blood and urine samples, carotid intima-media thickness (CIMT) and internal diameter of the common carotid artery measured by color Doppler ultrasonography. The aforementioned information was compared between residents with normal CIMT (CIMT <1 mm, n=693) and those with thickened CIMT (CIMT≥1 mm, n=45) . Logistic regression model with adaptive Lasso was established with thickened CIMT as dependent variable to screen its potentially associated factors, then the identified ones were further analyzed using multivariate logistic regression, and the percentage of contribution of each identified associated factor to thickened CIMT was estimated using dominance analysis. Moreover, potential factors associated with naturally logarithmized CIMT were screened using Adaptive Lasso linear regression, then the identified ones were further analyzed using multiple linear regression, and the percentage of contribution of identified associated factors to CIMT was estimated and ranked in descending order.

There was statistically significant difference in gender, age, ethnicity, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , smoking status, common carotid artery diameter, total cholesterol (TC) , urinary microalbumin creatinine ratio (ACR) , lipoprotein A (LPA) , vascular cell adhesion factor 1, apolipoprotein A/ Apolipoprotein B (ApoA/ApoB) , C-reactive protein (CRP) , urinary microalbumin (ALB) and physical activity level (PHYMET) (P<0.05) . Eleven factors potentially associated with thickened CIMT were identified by adaptive Lasso-logit regression analysis, including internal diameter of the common carotid artery, SBP, TC, overweight/obesity, ACR, physical activity level, CRP, LPA, renal function, VCAM-1, and ApoA/ApoB ratio. And 12 factors potentially associated with CIMT were identified by adaptive Lasso linear regression analysis, i.e., internal diameter of the common carotid artery, SBP, TC, physical activity level, ACR, smoking, alcohol consumption, CRP, LPA, ApoA/ApoB ratio, fasting plasma glucose, and family history of diabetes mellitus. Multivariate Logistic regression analysis revealed that risk factors for thickened CIMT were elevated SBP〔OR=1.032, 95%CI (1.013, 1.050) 〕, TC〔OR=1.558, 95%CI (1.049, 2.315) 〕, decreased physical activity level〔OR=2.226, 95%CI (1.289, 3.844) 〕, and elevated CRP〔OR=1.462, 95%CI (1.043, 2.050) 〕, and the percentage of contribution to thickened CIMT of them ranked from high to low was elevated SBP (63.7%) , elevated CRP (16.1%) , elevated TC (12.4%) and decreased physical activity level (7.8%) . Multiple linear regression analysis showed that SBP (β=0.017, P<0.001) , current smoking (β=0.076, P=0.021) , TC (β=0.020, P=0.021) , and physical activity level (β=0.022, P=0.034) were influential factors for CIMT (P<0.05) , and the percentage of contribution to thickened CIMT of them ranked descendingly was SBP (68.7%) , current smoking (19.9%) , TC (8.8%) , and physical activity level (2.6%) .

In our study, elevated SBP, TC, and CRP as well as reduced physical activity level were risk factors of CIMT thickening, and the percentage of contribution of them ranked from high to low was elevated SBP, elevated CRP, elevated TC, reduced physical activity level. The CIMT was significantly correlated with SBP, current smoking, TC and physical activity level, and the percentage of contribution of them ranked descendingly was SBP, current smoking, TC, physical activity level. Therefore, targeted measures for early control and prevention of cardiovascular diseases should keep in line with the controllable influencing factors and their contribution levels.

颈动脉内中膜厚度（CIMT）是动脉粥样硬化的替代指标，预防CIMT增厚有利于动脉粥样硬化的一级预防。目前尚不清楚相关危险因素对CIMT增厚的影响程度。

分析社区居民CIMT增厚的影响因素并对各相关因素进行优势分析以获得相应的贡献顺位，为确定心血管疾病（CVD）的早期防控重心提供参考依据。

2019—2021年在广西壮族自治区柳州市采用方便抽样的方法选取符合纳排标准的研究对象738例，收集研究对象的相关信息。采集空腹血样、尿样检测生化指标。采用彩色多普勒超声诊断仪测定研究对象的CIMT和颈总动脉内径。依据CIMT是否增厚，将患者分为CIMT正常组（CIMT<1 mm，n=693）和CIMT增厚组（CIMT≥1 mm，n=45），比较两组研究对象一般资料和颈部彩超结果。以CIMT增厚情况为因变量，采用Adaptive Lasso-logit回归分析筛选变量，采用多因素Logistic回归构建预测模型，分析CIMT增厚情况的影响因素，运用优势分析法估计各影响因素的贡献顺位。以经自然对数转换后的CIMT作为因变量，通过Adaptive Lasso linear回归分析筛选变量，采用多元线性回归构建预测模型，分析CIMT的影响因素，并估计各影响因素的贡献顺位。

两组研究对象性别、年龄、民族、收缩压（SBP）、舒张压（DBP）、吸烟情况、颈总动脉内径、总胆固醇（TC）、尿微量白蛋白肌酐比值（ACR）、脂蛋白A（LPA）、血管细胞黏附因子1、载脂蛋白A/载脂蛋白B（ApoA/ApoB）、C反应蛋白（CRP）、尿微量白蛋白（ALB）、体力活动水平（PHYMET）比较，差异有统计学意义（P<0.05）。Adaptive Lasso-logit回归分析筛选出颈总动脉内径、SBP、TC、超重肥胖、ACR、PHYMET、CRP、LPA、肾功能、VCAM-1、ApoA/ApoB 11个预测变量；Adaptive Lasso linear回归分析筛选出颈总动脉内径、SBP、TC、PHYMET、ACR、吸烟、饮酒、CRP、LPA、ApoA/ApoB、空腹血糖（GLU）、糖尿病一级亲属家族史12个预测变量。多因素Logistic回归结果显示，SBP〔OR=1.032，95%CI（1.013，1.050）〕、TC〔OR=1.558，95%CI（1.049，2.315）〕、PHYMET〔OR=2.226，95%CI（1.289，3.844）〕、CRP〔OR=1.462，95%CI（1.043，2.050）〕是CIMT增厚的影响因素（P<0.05），优势分析结果显示，各相关变量的贡献顺位依次为SBP（63.7%）、CRP（16.1%）、TC（12.4%）、PHYMET（7.8%）。多元线性回归结果显示，SBP（β=0.017，P<0.001）、当前吸烟（β=0.076，P=0.021）、TC（β=0.020，P=0.021）、PHYMET（β=0.022，P=0.034）是CIMT的影响因素（P<0.05），优势分析结果显示，各相关变量的贡献顺位依次为SBP（68.7%）、当前吸烟（19.9%）、TC（8.8%）、PHYMET（2.6%）。

SBP、TC、PHYMET、CRP是CIMT增厚的影响因素，贡献顺位依次为SBP、CRP、TC、PHYMET；SBP、当前吸烟、TC、PHYMET是CIMT的影响因素，贡献顺位依次为SBP、当前吸烟、TC、PHYMET。提示临床医师应根据各可控影响因素及其贡献顺位更有针对性的制订CVD的早期防控措施。