An Analysis of Prospective Risk Factors for Aortic Stiffness in Men 20-Year Follow-Up From the Caerphilly Prospective Study
An Analysis of Prospective Risk Factors for Aortic Stiffness in Men 20-Year Follow-Up From the Caerphilly Prospective Study
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DOI：
10.1161/hypertensionaha.110.150896
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发表时间：
2010-07-01
期刊：
影响因子：
8.3
通讯作者：
Wilkinson, Ian B.
中科院分区：
文献类型：
--
作者：
McEniery, Carmel M.;Spratt, Michael;Wilkinson, Ian B.
动脉僵硬度是心血管风险的重要决定因素。动脉硬化的确切危险因素尚不清楚。我们的目的是使用来自Caerphilly前瞻性研究的前瞻性暴露数据来识别潜在的风险因素。对825名男性进行了主动脉脉搏波速度和增强指数的测量，并与当前（2004年）和基线（1979-1988年）人体测量、血液动力学和生化因素相关。男性的平均年龄为74岁，平均随访时间为20年。电流速度的唯一独立基线预测因子是脉压（标准化β系数：0.58）、C反应蛋白（0.35）、血糖（0.25）和腰围（0.23）。当前增强指数的唯一基线预测因子是纤维蛋白原（0.78）。在对相应的当前危险因素进行额外调整后，脉搏波速度与C反应蛋白的累积暴露量相关性最好，而增强指数与当前水平相关性最强。速度也与基线水平的甘油三酯和吸烟，但与目前的腰围更密切相关。在整个20年中评估的脉压心率乘积与主动脉脉搏波速度独立相关，但与增强指数无关。除血压外，已确定的心血管危险因素对主动脉僵硬度和波反射只有适度的影响。炎症和重复循环应力水平是主动脉僵硬度的重要预测因子，而波反射仅由急性炎症预测。从长远来看，适当控制脉压和心率以及减少炎症可能会延缓主动脉硬化，尽管这仍有待直接测试。（高血压。2010; 56：36-43.）
Arterial stiffness is an important determinant of cardiovascular risk. The precise risk factors for arterial stiffening remain unclear. We aimed to identify potential risk factors using prospective exposure data from the Caerphilly Prospective Study. Aortic pulse wave velocity and augmentation index were measured in 825 men and related to current (2004) and baseline (1979-1988) anthropometric, hemodynamic, and biochemical factors. The mean age of the men was 74 years, with an average follow-up of 20 years. The only independent baseline predictors of current velocity were pulse pressure (standardized beta-coefficient: 0.58), C-reactive protein (0.35), glucose (0.25), and waist circumference (0.23). The sole baseline predictor of current augmentation index was fibrinogen (0.78). After additional adjustment for the corresponding current risk factor, pulse wave velocity was best related to cumulative exposure to C-reactive protein, whereas augmentation index was most strongly related to current levels. Velocity was also more strongly correlated with baseline levels of triglycerides and smoking but with current waist circumference. The pulse pressure heart rate product assessed over the whole of 20 years was independently correlated with aortic pulse wave velocity but not augmentation index. Other than blood pressure, established cardiovascular risk factors have only a modest effect on aortic stiffness and wave reflection. Inflammation and the level of repetitive cyclic stress are important predictors of aortic stiffness, whereas wave reflection is predicted by acute inflammation only. Adequate control of pulse pressure and heart rate, as well as reducing inflammation, may, in the long-term, retard aortic stiffening, although this remains to be tested directly. (Hypertension. 2010; 56: 36-43.)