Metabolic syndrome and risk of incident peripheral artery disease: the cardiovascular health study.
Metabolic syndrome and risk of incident peripheral artery disease: the cardiovascular health study.
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DOI：
10.1161/hypertensionaha.113.01925
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发表时间：
2014-02
期刊：
影响因子：
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通讯作者：
Mukamal KJ
中科院分区：
文献类型：
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作者：
Garg PK;Biggs ML;Carnethon M;Ix JH;Criqui MH;Britton KA;Djoussé L;Sutton-Tyrrell K;Newman AB;Cushman M;Mukamal KJ
先前评估代谢综合征（MetS）和外周动脉疾病（PAD）的研究受到使用改良MetS标准和限制临床PAD终点的限制。我们在心血管健康研究中调查了MetS和低踝肱指数（ABI）和临床PAD的风险，这是一项以人群为基础的年龄≥65岁的成年人队列。met患者至少满足5个成人治疗组（ATP） III标准中的3个。基线“c -反应蛋白(CRP)-MetS”或“纤维蛋白原mets”被定义为6个成分中的3个，升高的CRP （> 3mg /L）或纤维蛋白原（> 341 mg/dL）作为第6个成分。事件低ABI，定义为ABI <0.9和下降≥0.15，在1899个个体的子集中进行评估，两次ABI测量间隔6年。在中位13.7年的随访中，4632名患者被随访为临床PAD，定义为血运重建术或诊断为跛行。ATP III MetS与低ABI发生率（RR 1.26; 95% CI: 1.00-1.58）和临床PAD发生率（HR 1.47; 95% CI: 1.11-1.94）相关。将CRP或纤维蛋白原纳入ATP III标准确定了另外16-20%的个体患有MetS，并且CRP-MetS和纤维蛋白原-MetS均与低ABI事件（RR 1.36; 95% CI 1.07-1.72 & RR 1.43; 95% CI: 1.13-1.81）和临床PAD （HR 1.56; 95% CI: 1.17-2.08 & HR 1.55; 95% CI 1.17-2.07分别）相关。在ATPIII MetS标准中，PAD的风险与高血压的相关性最强。
Prior studies evaluating metabolic syndrome (MetS) and incident peripheral artery disease (PAD) have been limited by use of modified MetS criteria and restriction to clinical PAD endpoints. We investigated MetS and risk of developing a low ankle-brachial index (ABI) and clinical PAD in the Cardiovascular Health Study, a population-based cohort of adults aged ≥ 65 years. Participants with MetS met at least 3 of 5 Adult Treatment Panel (ATP) III criteria. Baseline “C-reactive protein (CRP)-MetS” or “Fibrinogen-MetS” were defined as presence of 3 out of 6 components, with elevated CRP (> 3 mg/L) or fibrinogen (> 341 mg/dL) as a sixth component. Incident low ABI, defined as ABI <0.9 and decline of ≥0.15, was assessed among a subset of 1899 individuals with two ABI measurements 6 years apart. Over a median follow-up of 13.7 years, 4632 individuals were followed for clinical PAD, defined as revascularization or diagnosed claudication. ATP III MetS was associated with both incident low ABI (RR 1.26; 95% CI: 1.00-1.58) and clinical PAD (HR 1.47; 95% CI: 1.11-1.94). Incorporating CRP or fibrinogen into ATP III criteria identified an additional 16-20% of individuals as having MetS, and both CRP-MetS and Fibrinogen-MetS were associated with incident low ABI (RR 1.36; 95% CI 1.07-1.72 & RR 1.43; 95% CI: 1.13-1.81, respectively) and clinical PAD (HR 1.56; 95% CI: 1.17-2.08 & HR 1.55; 95% CI 1.17-2.07, respectively). Among ATPIII MetS criteria, risk of PAD was most strongly associated with hypertension.