Endothelial Function in Resistance and Conduit Arteries and 5-Year Risk of Cardiovascular Disease
Endothelial Function in Resistance and Conduit Arteries and 5-Year Risk of Cardiovascular Disease
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DOI：
10.1161/circulationaha.110.984047
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发表时间：
2011-04-12
期刊：
影响因子：
37.8
通讯作者：
Sundstrom, Johan
中科院分区：
文献类型：
--
作者：
Lind, Lars;Berglund, Lars;Sundstrom, Johan
内皮功能受损是心血管疾病的一个原因。在一般人群中，对阻力和管道动脉内皮功能的测量与心血管疾病的关系知之甚少，也没有对现有的技术进行比较。乌普萨拉老年人血管系统基于人群的前瞻性研究（PIVUS）研究（70岁）（52%的女性），我们测量了内皮依赖性血管舒张使用侵入性前臂技术与乙酰胆碱给予肱动脉，肱动脉超声技术与测量流量介导的扩张，和脉搏波分析为基础的方法与β-2-激动剂特布他林激发。在5年的随访中，101名参与者经历了心肌梗死、中风或死亡的复合终点，不包括基线时有心肌梗死或中风病史的85人。在校正了几个已建立的和新的心血管疾病危险因素和药物的logistic回归模型中，通过有创前臂技术用乙酰胆碱进行的内皮依赖性血管舒张与终点风险相关（比值比，0.72/SD; 95%置信区间，0.56 - 0.93; P = 0.01）。其他2种方法的内皮功能与终点风险无关。此外，内皮依赖性血管舒张的Fragrance风险评分改善歧视的风险endpoint. Conclusions-内皮依赖性血管舒张阻力动脉，但不是在肱动脉导管（流量介导的扩张），与5年的风险的复合终点死亡，心肌梗死，或中风独立的主要心血管疾病的危险因素。在老年人群中，将血管测量添加到已建立的风险评分中时，可改善风险区分。（循环。2011;123：1545-1551）。
Background-Impaired endothelial function has been implicated as a cause of cardiovascular disease. Little is known of the relations of measures of endothelial function in resistance and conduit arteries to incident cardiovascular disease in the general population, and available techniques have not been compared.Methods and Results-In 1016 participants (70 years of age) of the population-based Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study (52% women), we measured endothelium-dependent vasodilation using the invasive forearm technique with acetylcholine given in the brachial artery, the brachial artery ultrasound technique with measurement of flow-mediated dilatation, and the pulse-wave analysis-based method with beta-2-agonist terbutaline provocation. During 5 years of follow-up, 101 participants experienced a composite end point of myocardial infarction, stroke, or death, excluding the 85 persons with a history of myocardial infarction or stroke at baseline. In logistic regression models adjusted for several established and novel cardiovascular disease risk factors and medications, endothelium-dependent vasodilation by the invasive forearm technique with acetylcholine was associated with risk of the end point (odds ratio, 0.72 per SD; 95% confidence interval, 0.56 to 0.93; P = 0.01). Endothelial function by the other 2 methods was not related to risk of the end point. Addition of endothelium-dependent vasodilation to the Framingham risk score improved discrimination of risk of the end point.Conclusions-Endothelium-dependent vasodilation in resistance arteries, but not in the brachial conduit artery (flow-mediated dilatation), was associated with 5-year risk of a composite end point of death, myocardial infarction, or stroke independently of major cardiovascular disease risk factors. This vascular measurement improved risk discrimination when added to an established risk score in an elderly population. (Circulation. 2011;123:1545-1551.)