Association of Small Artery Elasticity With Incident Cardiovascular Disease in Older Adults The Multi-Ethnic Study of Atherosclerosis
Association of Small Artery Elasticity With Incident Cardiovascular Disease in Older Adults The Multi-Ethnic Study of Atherosclerosis
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DOI：
10.1093/aje/kwr120
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发表时间：
2011-09-01
影响因子：
5
通讯作者：
Kronmal, Richard A.
中科院分区：
文献类型：
--
作者：
Duprez, Daniel A.;Jacobs, David R., Jr.;Kronmal, Richard A.
大动脉弹性（LAE）和小动脉弹性（SAE）等功能性生物标志物可以预测血压以外的心血管疾病（CVD）事件。作者在6，235名最初年龄为45-84岁且无症状性CVD的多种族动脉粥样硬化研究参与者中检查了LAE和SAE对临床CVD事件的预后价值。LAE和SAE来自舒张期脉搏轮廓分析。在2000年至2008年的中位5.8年随访期间，发生了454例裁定的CVD事件，包括256例冠心病（CHD），93例中风和126例心力衰竭（可能有多种诊断）。校正年龄、人种/种族、性别、诊所、身高、心率、体重指数、收缩压和舒张压、降压和降胆固醇药物的使用、吸烟、总胆固醇、高密度脂蛋白胆固醇、甘油三酯、糖尿病和高敏C反应蛋白后，SAE中任何CVD/标准差增加的风险比为0.71（95%置信区间：0.61，0.83; P < 0.0001）。最低（最严格）SAE四分位数与最高（最具弹性）四分位数的风险比为2.28（95%置信区间：1.55，3.36）。以基本风险为条件的净重新分类指数为0.11。SAE与未来CHD、卒中和心力衰竭显著相关。校正后，LAE与CVD无显著相关性。在无明显CVD的无症状受试者中，较低的SAE增加了CVD、CHD、卒中和心力衰竭事件的预后信息。
Functional biomarkers like large artery elasticity (LAE) and small artery elasticity (SAE) may predict cardiovascular disease (CVD) events beyond blood pressure. The authors examined the prognostic value of LAE and SAE for clinical CVD events among 6,235 Multi-Ethnic Study of Atherosclerosis participants who were initially aged 45-84 years and without symptomatic CVD. LAE and SAE were derived from diastolic pulse contour analysis. During a median 5.8 years of follow-up between 2000 and 2008, 454 adjudicated CVD events occurred, including 256 cases of coronary heart disease (CHD), 93 strokes, and 126 heart failures (multiple diagnoses were possible). After adjustment for age, race/ethnicity, sex, clinic, height, heart rate, body mass index, systolic and diastolic blood pressure, use of antihypertensive and cholesterol-lowering medications, smoking, total cholesterol, high density lipoprotein cholesterol, triglycerides, diabetes, and high-sensitivity C-reactive protein, the hazard ratio for any CVD per standard-deviation increase in SAE was 0.71 (95% confidence interval: 0.61, 0.83; P < 0.0001). The lowest (stiffest) SAE quartile had a hazard ratio of 2.28 (95% confidence interval: 1.55, 3.36) versus the highest (most elastic) quartile. The net reclassification index, conditional on base risk, was 0.11. SAE was significantly associated with future CHD, stroke, and heart failure. After adjustment, LAE was not significantly related to CVD. In asymptomatic participants free of overt CVD, lower SAE added prognostic information for CVD, CHD, stroke, and heart failure events.