Microvascular Function Predicts Cardiovascular Events in Primary Prevention Long-Term Results From the Firefighters and Their Endothelium (FATE) Study
Microvascular Function Predicts Cardiovascular Events in Primary Prevention Long-Term Results From the Firefighters and Their Endothelium (FATE) Study
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DOI：
10.1161/circulationaha.110.953653
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发表时间：
2011-01-18
期刊：
影响因子：
37.8
通讯作者：
Lonn, Eva M.
中科院分区：
文献类型：
--
作者：
Anderson, Todd J.;Charbonneau, Francois;Lonn, Eva M.
背景-动脉粥样硬化的生物标记物可以改善心血管疾病风险个体的临床决策。这项研究的目的是确定血管内皮功能和其他血管标记物在表面上健康的男性中的预后意义。方法和结果-队列包括1574名男性(年龄49.4岁)，没有血管疾病。测量包括血流介导的扩张及其微血管刺激、充血速度、颈动脉内膜中层厚度和C反应蛋白。Cox比例风险模型评估了血管标记物、Framingham风险评分和到达血管死亡、血运重建、心肌梗死、心绞痛和中风的第一个复合心血管终点的时间之间的关系。受试者的弗雷明翰风险评分中位数较低(7.9%)。心血管事件发生在71名受试者(111起事件)中，平均随访时间为7.2+/-1.7年。血流介导的扩张与随后的心血管事件无关(风险比，0.92；P=0.54)。在包括单位标准差的多变量分析中，充血速度(危险比0.70；95%可信区间0.54至0.9；P=0.006)和颈动脉内中膜厚度(危险比1.45；可信区间1.15至1.83；P=0.002)与事件相关，但与C反应蛋白无关(P=0.35)。此外，在Framingham危险评分中加入充血速度后，净临床再分类改善28.7%(P
Background-Biomarkers of atherosclerosis may refine clinical decision making in individuals at risk of cardiovascular disease. The purpose of the study was to determine the prognostic significance of endothelial function and other vascular markers in apparently healthy men.Methods and Results-The cohort consisted of 1574 men (age, 49.4 years) free of vascular disease. Measurements included flow-mediated dilation and its microvascular stimulus, hyperemic velocity, carotid intima-media thickness, and C-reactive protein. Cox proportional hazard models evaluated the relationship between vascular markers, Framingham risk score, and time to a first composite cardiovascular end point of vascular death, revascularization, myocardial infarction, angina, and stroke. Subjects had low median Framingham risk score (7.9%). Cardiovascular events occurred in 71 subjects (111 events) over a mean follow-up of 7.2+/-1.7 years. Flow-mediated dilation was not associated with subsequent cardiovascular events (hazard ratio, 0.92; P=0.54). Both hyperemic velocity (hazard ratio, 0.70; 95% confidence interval, 0.54 to 0.90; P=0.006) and carotid intima-media thickness (hazard ratio, 1.45; confidence interval, 1.15 to 1.83; P=0.002) but not C-reactive protein (P=0.35) were related to events in a multivariable analysis that included Framingham risk score (per unit SD). Furthermore, the addition of hyperemic velocity to Framingham risk score resulted in a net clinical reclassification improvement of 28.7% (P