Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance - An integrated index of vascular function?
Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance - An integrated index of vascular function?
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DOI：
10.1161/01.cir.0000033824.02722.f7
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发表时间：
2002-10-15
期刊：
影响因子：
37.8
通讯作者：
Gosling, RG
中科院分区：
文献类型：
--
作者：
Cruickshank, K;Riste, L;Gosling, RG
背景：动脉扩张性测量，通常是通过脉搏波速度（PWV）测量，被广泛使用，但对其与患者预后的关系知之甚少。我们测试了主动脉PWV是否能预测2型糖尿病和葡萄糖耐量测试（GTT）多种族人群样本的心血管和全因死亡率。方法与结果：参与者随机从(1)一家2型糖尿病门诊和(2)初级保健人群登记簿中抽取，其中非糖尿病对照者给予GTT。测量肱血压和多普勒主动脉PWV。获得10年随访期间的死亡率数据。在任何收缩压（SBP）水平下，糖尿病患者的主动脉PWV均高于对照组。与对照组相比，糖尿病患者（危险比2.34,95% Cl 1.5至3.74）和葡萄糖耐受不良患者（危险比2.12,95% Cl 1.11至4.0）的死亡风险增加了一倍。对于所有组，年龄、性别和收缩压预测死亡率；PWV的增加独立预测了全因死亡率和心血管死亡率（风险比1.08,95% Cl 1.03 ~ 1.14，每增加1 m/s），但移位的收压。葡萄糖耐量状况和吸烟是其他独立影响因素，非洲-加勒比人的死亡风险较低（危险比0.41,95% Cl 0.25至0.69）。结论：主动脉PWV是糖尿病和GTT人群样本中死亡率的一个强有力的独立预测因子。在取代收缩压作为预后因素的过程中，主动脉PWV可能在动脉疾病的因果通路上更进一步，并可能代表血管状态和心血管风险的有用综合指标。
Background-Arterial distensibility measures, generally from pulse-wave velocity (PWV), are widely used with little knowledge of relationships to patient outcome. We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance-tested (GTT) multiethnic population samples.Methods and Results-Participants were randomly sampled from (1) a type 2 diabetes outpatient clinic and (2) primary care population registers, from which nondiabetic control subjects were given a GTT. Brachial blood pressures and Doppler-derived aortic PWV were measured. Mortality data over 10 years' follow-up were obtained. At any level of systolic blood pressure (SBP), aortic PWV was greater in subjects with diabetes than in controls. Mortality risk doubled in subjects with diabetes (hazard ratio 2.34, 95% Cl 1.5 to 3.74) and in those with glucose intolerance (2.12, 95% Cl 1.11 to 4.0) compared with controls. For all groups combined, age, sex, and SBP predicted mortality; the addition of PWV independently predicted all-cause and cardiovascular mortality (hazard ratio 1.08, 95% Cl 1.03 to 1.14 for each 1 m/s increase) but displaced SBP. Glucose tolerance status and smoking were other independent contributors, with African-Caribbeans experiencing reduced mortality risk (hazard ratio 0.41, 95% Cl 0.25 to 0.69).Conclusions-Aortic PWV is a powerful independent predictor of mortality in both diabetes and GTT population samples. In displacing SBP as a prognostic factor, aortic PWV is probably further along the causal pathway for arterial disease and may represent a useful integrated index of vascular status and hence cardiovascular risk.