Short-Term Prognostic Impact of Arterial Stiffness in Older Adults Without Prevalent Cardiovascular Disease
Short-Term Prognostic Impact of Arterial Stiffness in Older Adults Without Prevalent Cardiovascular Disease
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DOI：
10.1161/hypertensionaha.119.13496
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发表时间：
2019-12-01
期刊：
影响因子：
8.3
通讯作者：
Matsushita, Kunihiro
中科院分区：
文献类型：
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作者：
Kim, Esther D.;Ballew, Shoshana H.;Matsushita, Kunihiro
动脉僵硬以颈动脉-股动脉脉搏波速度(CfPWV)表示，可预测心血管疾病(CVD)。然而，在老年人群中，这种联系似乎减弱了。此外，脉搏波速度在不同动脉段和较新参数如心踝血管指数(CAVI)的预后价值仍不清楚，特别是在美国老年人中。在3034名没有心血管疾病的社区动脉粥样硬化风险(ARIC)研究参与者(66-90岁)中，我们研究了4种脉搏波速度测量(cfPWV、心-股、臂-踝、心-踝)和2种新的动脉硬度测量(分别来自心-踝和心-股动脉的腔静脉和心股血管指数)与心血管事件(冠心病、中风和心力衰竭)和全因死亡率的关系。在中位数4.4年的随访中，共有168例心血管事件和244例死亡。总体而言，僵硬测量与心血管疾病没有很强的相关性，除了cfPWV，即使在调整了潜在的混杂因素(风险比，顶部四分位数为1.83[95%可信区间，1.08-3.09]，底部四分位数为1.97[1.14-3.39]与第二底部四分位数相比，风险比为1.83[95%CI，1.08-3.09]后仍显示出J型关联)。当单独检查每种心血管疾病时，心力衰竭与较高的cfPWV密切相关，而中风与较低的cfPWV密切相关。与全因死亡率没有显著关联。在脉搏波速度的不同测量中，cfPWV与心血管疾病，特别是在没有心血管疾病的老年人心力衰竭之间显示出最强的相关性。其他脉搏波速度测量没有很强的相关性。我们的发现进一步支持cfPWV作为动脉僵硬的指数测量和动脉僵硬与心力衰竭发展的联系，但也表明整体而言，动脉僵硬在老年人中的预后价值有限。
Arterial stiffness, represented as carotid-femoral pulse wave velocity (cfPWV), predicts cardiovascular disease (CVD). In older populations, however, this association seems attenuated. Moreover, the prognostic values of pulse wave velocity at different arterial segments and newer parameters like cardio-ankle vascular index (CAVI) remain unclear, especially in US older adults. In 3034 Atherosclerosis Risk in Communities (ARIC) study participants (66-90 years) without CVD, we examined the associations of 4 pulse wave velocity measures (cfPWV, heart-femoral, brachial-ankle, heart-ankle) and 2 new measures of arterial stiffness (CAVI and cardio-femoral vascular index derived from heart-ankle and heart-femoral, respectively) with incident CVD (coronary disease, stroke, and heart failure) and all-cause mortality. Over a median follow-up of 4.4 years, there were 168 incident CVD events and 244 deaths. Overall, stiffness measures did not show strong associations with CVD, except cfPWV, which demonstrated a J-shaped association even after adjusting for potential confounders (hazard ratio, 1.83 [95% CI, 1.08-3.09] in top quartile and 1.97 [1.14-3.39] in bottom quartile versus second bottom quartile). When each CVD was examined separately, heart failure was most robustly associated with higher cfPWV, and stroke was strongly associated with lower cfPWV. There were no significant associations with all-cause mortality. Among different measures of pulse wave velocity, cfPWV showed the strongest associations with CVD, especially heart failure, in older adults without CVD. Other pulse wave velocity measures had no strong associations. Our findings further support cfPWV as the index measure of arterial stiffness and the link of arterial stiffness to heart failure development but also suggest somewhat limited prognostic value of arterial stiffness in older adults overall.