Homocysteine level is associatedwith aortic stiffness in elderly: cross-sectional results from the B-PROOF study
Homocysteine level is associatedwith aortic stiffness in elderly: cross-sectional results from the B-PROOF study
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DOI：
10.1097/hjh.0b013e32835eb6b9
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发表时间：
2013-05-01
影响因子：
4.9
通讯作者：
van der Velde, Nathalie
中科院分区：
文献类型：
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作者：
van Dijk, Suzanne C.;Smulders, Yvo M.;van der Velde, Nathalie
目的：同型半胱氨酸已被证明比基于经典危险因素的模型更准确地预测老年人心血管疾病死亡率。动脉硬化是一种参与心血管疾病通路的结构异常。我们希望这种潜在的病理生理学可以解释同型半胱氨酸与心血管疾病风险之间的关系，特别是在老年人中。方法：使用B-PROOF研究的基线横断面数据来确定同型半胱氨酸与血管功能和结构结局之间的关系。B-PROOF研究纳入心血管亚组[n = 560, 58%男性，年龄72.6 +/- 5.5岁，中位同型半胱氨酸水平14.2 mu mol/l (IQR 13.0-16.6)]。我们评估了颈动脉扩张系数、颈动脉顺应性系数、主动脉脉波速度（aPWV）、增强指数（AIx）和主动脉脉压（aortic pulse pressure， PP）。使用线性回归分析和ANCOVA对相关性进行检验，并对可能的混杂因素进行校正，包括年龄、性别、肾功能、平均动脉压和心率。结果：ln -同型半胱氨酸与aPWV密切相关[- 0.005 95%可信区间（0.001-0.009）]。此外，这种关联是年龄依赖的（P = 0.02），在年龄较高的五分之一（77-98岁）中最为强烈。在AIx、颈动脉扩张性系数、顺应性系数和主动脉PP中，未观察到与ln-同型半胱氨酸的显著相关性。性别分层显示，ln-同型半胱氨酸与aPWV的相关性仅在男性中显著。结论：在老年人中，同型半胱氨酸与主动脉僵硬有关，主要发生在老年人中。这表明，同型半胱氨酸与老年人心血管死亡率之间的强烈关联可能是由主动脉僵硬介导的。
Objective: Homocysteine has been shown to be a more accurate predictor of cardiovascular mortality in very old persons than models based on classical risk factors. Arterial stiffening is a structural abnormality involved in the pathway of cardiovascular disease. We expect this underlying pathophysiology to be a possible explanation for the association between homocysteine and cardiovascular risk, particularly in older populations.Methods: Baseline cross-sectional data of the B-PROOF study were used to determine associations between homocysteine and outcomes of vascular function and structure. The cardiovascular subgroup of the B-PROOF study was included [n = 560, 58% men, age 72.6 +/- 5.5 years, median homocysteine level 14.2 mu mol/l (IQR 13.0-16.6)]. We assessed carotid distensibility coefficient, carotid compliance coefficient, aortic pulse wave velocity (aPWV), augmentation index (AIx) and aortic pulse pressure (aortic PP). Associations were tested using linear regression analysis and ANCOVA and were adjusted for possible confounders including age, sex, renal function, mean arterial pressure and heart rate.Results: Ln-homocysteine was strongly associated with aPWV [beta 0.005 95% confidence interval (0.001-0.009)]. Furthermore, this association was shown to be age-dependent (P = 0.02) and it was most strong in the upper tertile of age (77-98 years). No significant associations with ln-homocysteine were observed for AIx, carotid distensibility coefficient and compliance coefficient and aortic PP. Sex stratification shows the association between ln-homocysteine and aPWV is only significant in men.Conclusion: In older persons, homocysteine is associated with aortic stiffness, predominantly in the oldest old. This suggests that the strong association between homocysteine and cardiovascular mortality in the elderly may be mediated by aortic stiffness.