Arterial stiffness independently predicts cardiovascular events in an elderly community -: Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study
Arterial stiffness independently predicts cardiovascular events in an elderly community -: Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study
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DOI：
10.1016/s0753-3322(05)80008-3
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发表时间：
2005-10-01
影响因子：
7.5
通讯作者：
Ozawa, T
中科院分区：
文献类型：
--
作者：
Matsuoka, O;Otsuka, K;Ozawa, T
我们通过多变量COX模型研究了动脉僵硬对评估老年社区居民心血管风险的预测价值。对298名75岁以上的老年人(男性120名，女性178名，平均年龄79.6岁)，在仰卧位测量右臂至踝部之间的脉搏波速度(BaPWV)，丁香研究于2000年7月25日开始，每年重复一次会诊，最后一次随访于2004年11月30日结束。在这1227天的随访期间，有9名心血管疾病死亡，死因是两名男性和三名女性的心肌梗塞或两名男性和两名女性的中风。在Cox比例风险模型中，baPWV以及年龄、简易智力状态检查(MMSE)。修订的长谷川痴呆量表(HDSR)和低频/高频(LF/HF)比率与心血管死亡的发生有统计学意义的相关性。简明精神状态量表和高密度脂蛋白胆固醇评分每增加2分，心血管死亡的相对危险度(RR)分别为0.776(P=0.0369)和0.753(P=0.0029)。低频/高频比值也有显著差异(P=0.025)，而心率变异性的其他指标无显著差异。调整年龄和HDSR后，BaPWV200 cm/S增加30.2%(RR=1.302，95%CI：1.110~1.525)，BaPWV500 cm/S增加93.3%(RR=1.933，95%CI：1.300~2.874，P=0.0011)，而LF/HF比值不再与心血管死亡率增加显著相关。在老年社区居民中，通过baPWV测量的动脉僵硬可以预测心血管死亡的发生，而不是年龄、性别、血压和认知功能提供的预测，在各种临床环境中，应该将baPWV添加到心血管评估中，包括现场医学调查和预防性筛查。通过时钟及早发现风险，可以及时制定预防措施，从而将重点从康复转移到康复医学，作为日本几个城镇的公共服务。(C)2005年爱思唯尔集团。版权所有。
We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years ( 120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a Supine position, The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE). Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% Cl:1.110-1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% Cl: 1.300-2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions, baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns. (c) 2005 Elsevier SAS. All rights reserved.