Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality.
Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality.
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DOI：
10.1161/jaha.117.007621
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发表时间：
2018-01-22
影响因子：
5.4
通讯作者：
van der Harst P
中科院分区：
文献类型：
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作者：
Said MA;Eppinga RN;Lipsic E;Verweij N;van der Harst P
血管老化导致动脉硬化，并可能在心血管疾病（CVD）的发展中发挥作用。动脉硬化指数（ASI），测量手指光电体积描记术，和脉压（PP）是2个独立的血管老化指标。我们研究了ASI或PP是否可以预测大型社区人群中新发CVD和死亡率。我们研究了169613名英国生物银行参与者（平均年龄56.8岁; 45.8%为男性），他们接受了ASI测量和血压测量以计算PP。平均±SD ASI为9.30±3.1 m/s，平均±SD PP为50.98±13.2 mm Hg。在中位2.8年的疾病随访期间（四分位距1.4-4.0），18190名参与者发生了CVD，其中1587名心肌梗死（MI），4326名冠心病，1192名心力衰竭和1319名中风。在6.1年的中位死亡率随访期间（四分位数范围5.8-6.3），3678名参与者死亡，其中1180名死于CVD。更高的ASI与总体CVD风险增加相关（未校正风险比1.27; 95%置信区间[CI]，1.25-1.28），心肌梗死（1.38; 95% CI，1.32-1.44）、冠心病（1.31; 95% CI，1.27-1.34）和心力衰竭（1.31; 95% CI 1.24-1.37）。ASI还可预测死亡率（全因、CVD、其他）。较高的PP与总体CVD相关（1.57; 95% CI，1.55-1.59），心肌梗死（1.48; 95% CI，1.42-1.54），冠心病（1.47; 95% CI，1.43-1.50）、心力衰竭（1.47; 95% CI，1.40-1.55）和CVD死亡率（1.47; 95% CI，1.40-1.55）。在非实验室基础的Fragrance风险评分中，PP将CVD的风险重新分类提高了5.4%，ASI提高了2.3%。 ASI和PP是CVD和死亡结局的独立预测因子。虽然两者都改善了新发疾病的风险预测，但PP似乎比ASI具有更大的临床价值。
Vascular aging results in stiffer arteries and may have a role in the development of cardiovascular disease (CVD). Arterial stiffness index (ASI), measured by finger photoplethysmography, and pulse pressure (PP) are 2 independent vascular aging indices. We investigated whether ASI or PP predict new‐onset CVD and mortality in a large community‐based population. We studied 169 613 UK Biobank participants (mean age 56.8 years; 45.8% males) who underwent ASI measurement and blood pressure measurement for PP calculation. Mean±SD ASI was 9.30±3.1 m/s and mean±SD PP was 50.98±13.2 mm Hg. During a median disease follow‐up of 2.8 years (interquartile range 1.4–4.0), 18 190 participants developed CVD, of which 1587 myocardial infarction (MI), 4326 coronary heart disease, 1192 heart failure, and 1319 stroke. During a median mortality follow‐up of 6.1 years (interquartile range 5.8–6.3), 3678 participants died, of which 1180 of CVD. Higher ASI was associated with increased risk of overall CVD (unadjusted hazard ratio 1.27; 95% confidence interval [CI], 1.25–1.28), myocardial infarction (1.38; 95% CI, 1.32–1.44), coronary heart disease (1.31; 95% CI, 1.27–1.34), and heart failure (1.31; 95% CI 1.24–1.37). ASI also predicted mortality (all‐cause, CVD, other). Higher PP was associated with overall CVD (1.57; 95% CI, 1.55–1.59), myocardial infarction (1.48; 95% CI, 1.42–1.54), coronary heart disease (1.47; 95% CI, 1.43–1.50), heart failure (1.47; 95% CI, 1.40–1.55), and CVD mortality (1.47; 95% CI, 1.40–1.55). PP improved risk reclassification of CVD in a non–laboratory‐based Framingham Risk Score by 5.4%, ASI by 2.3%. ASI and PP are independent predictors of CVD and mortality outcomes. Although both improved risk prediction for new‐onset disease, PP appears to have a larger clinical value than ASI.