Arterial stiffness and cardiovascular events: the Framingham Heart Study.
Arterial stiffness and cardiovascular events: the Framingham Heart Study.
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DOI：
10.1161/circulationaha.109.886655
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发表时间：
2010-02-02
期刊：
影响因子：
37.8
通讯作者：
Benjamin EJ
中科院分区：
文献类型：
--
作者：
Mitchell GF;Hwang SJ;Vasan RS;Larson MG;Pencina MJ;Hamburg NM;Vita JA;Levy D;Benjamin EJ
动脉硬度和波反射的各种措施已被提出作为心血管风险标志物。以前的研究没有评估关系的一个全面的面板僵硬措施，预后在社区。我们使用比例风险模型分析了2232名参与心脏研究的受试者（平均年龄63岁，58%为女性）中首次发生的主要心血管疾病（CVD）事件（心肌梗死、不稳定型心绞痛、心力衰竭或卒中）与动脉僵硬度（脉搏波速度，PWV）、波反射（增强指数，颈动脉-肱动脉压放大）和中心脉压的关系。在中位随访7.8年（范围0.2至8.9年）期间，2232名参与者中有151名（6.8%）发生了事件。在校正年龄、性别、收缩压、抗高血压治疗使用、总胆固醇和HDL胆固醇浓度、吸烟和糖尿病的多变量模型中，主动脉PWV升高与CVD风险增加48%相关（95%CI，1.16 - 1.91/SD，P=0.002）。在标准危险因素模型中加入PWV后，综合辨别力改善为0.7%（95%CI，0.05 - 1.3%，P<0.05）。相反，在多变量模型中，增强指数、中心脉压和脉压放大与CVD结果无关。PWV评估的主动脉僵硬度较高与首次心血管事件风险增加相关。主动脉PWV增加到标准风险因素时可改善风险预测，并可能代表社区CVD风险的有价值的生物标志物。
Various measures of arterial stiffness and wave reflection have been proposed as cardiovascular risk markers. Prior studies have not assessed relations of a comprehensive panel of stiffness measures to prognosis in the community. We used proportional hazards models to analyze first-onset major cardiovascular disease (CVD) events (myocardial infarction, unstable angina, heart failure or stroke) in relation to arterial stiffness (pulse wave velocity, PWV), wave reflection (augmentation index, carotid-brachial pressure amplification) and central pulse pressure in 2232 participants (mean age 63 years, 58% women) in the Framingham Heart Study. During median follow-up of 7.8 (range 0.2 to 8.9) years, 151 of 2232 participants (6.8%) had an event. In multivariable models adjusting for age, sex, systolic blood pressure, use of antihypertensive therapy, total and HDL cholesterol concentrations, smoking and presence of diabetes, higher aortic PWV was associated with a 48% increase in CVD risk (95% CI, 1.16 to 1.91 per SD, P=0.002). After adding PWV to a standard risk factor model, integrated discrimination improvement was 0.7% (95% CI, 0.05 to 1.3%, P<0.05). In contrast, augmentation index, central pulse pressure and pulse pressure amplification were not related to CVD outcomes in multivariable models. Higher aortic stiffness assessed by PWV is associated with increased risk for a first cardiovascular event. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of CVD risk in the community.