Brachial flow-mediated dilation predicts incident cardiovascular events in older adults - The Cardiovascular Health Study
Brachial flow-mediated dilation predicts incident cardiovascular events in older adults - The Cardiovascular Health Study
复制标题
DOI：
10.1161/circulationaha.106.678276
复制
发表时间：
2007-05-08
期刊：
影响因子：
37.8
通讯作者：
Herrington, David M.
中科院分区：
文献类型：
--
作者：
Yeboah, Joseph;Crouse, John R.;Herrington, David M.
背景--臂部血流介导的扩张受损(FMD)与随后的临床心血管事件之间的关系尚未得到很好的证实，尤其是在FMD经常降低的老年人中。我们在一组基于人群的老年人队列中评估了FMD预测心血管事件的假设。方法和结果--在1997年至1998年心血管健康研究临床访问期间，在美国4个诊所招募了2792名年龄在72岁至98岁的成年人(82.7%是白人，58.6%是女性)，测量了FMD。使用对数等级检验和COX比例风险模型来检验FMD和已判定的心血管事件之间的关联。在5年的随访期内，共有674名受试者(24.1%)有过被判定的事件。在心血管事件中，FMD大于性别特异性中位数的患者的无事件存活率显著高于小于或等于性别特异性中位数的患者(78.3%对73.6%，对数等级P=0.006)。在调整了年龄、性别、糖尿病、吸烟、收缩压和舒张压、基线心血管疾病状况和总胆固醇后，FMD仍然是心血管事件的重要预测因子(危险比，0.91[95%CI，0.83至0.99]，P=0.02每单位FMD)，但最佳COX模型的预测准确性仅增加约1%。在调整后的COX比例风险模型中，肱动脉内径也是心血管事件的预测指标(风险比，1.12[95%可信区间，1.02~1.28]，P=0.025)，也使我们最好的COX模型的准确度增加了近1%。结论：FMD是未来心血管事件的预测因子，但对老年人的传统心血管危险评分/因素的预测准确性增加很少。对于老年人的心血管事件，FMD和臂动脉内径可能具有相似的预测值。
Background - The relationship between impaired brachial flow-mediated dilation (FMD) and subsequent clinical cardiovascular events is not well established, especially in older adults whose FMD is often diminished. We assessed the hypothesis that FMD predicts incident cardiovascular events in a population-based cohort of older adults. Methods and Results - FMD was measured at the 1997 to 1998 Cardiovascular Health Study clinic visit in 2792 adults aged 72 to 98 years (82.7% white, 58.6% women) recruited at 4 clinic sites in the United States. Log-rank test and Cox proportional hazard models were used to examine the association between FMD and adjudicated cardiovascular events. A total of 674 subjects (24.1%) had an adjudicated event over the 5-year follow-up period. Event-free survival rates for cardiovascular events were significantly higher in subjects with FMD greater than the sex-specific medians than in subjects with FMD less than or equal to the sex-specific medians (78.3% versus 73.6%, log-rank P = 0.006). FMD remained a significant predictor of cardiovascular events after adjustment for age, gender, diabetes mellitus, cigarette smoking, systolic and diastolic blood pressure, baseline cardiovascular disease status, and total cholesterol ( hazard ratio, 0.91 [95% CI, 0.83 to 0.99], P = 0.02 per unit SD of FMD) but added only approximate to 1% to the prognostic accuracy of the best Cox model. Brachial artery diameter was also predictive of CV events in the adjusted Cox proportional hazard model (hazard ratio, 1.12 [95% CI, 1.02 to 1.28], P = 0.025) and also added approximate to 1% to the accuracy of our best Cox model. Conclusions - FMD is a predictor of future cardiovascular events but adds very little to the prognostic accuracy of traditional cardiovascular risk scores/factors in older adults. FMD and brachial artery diameter may have similar predictive values for cardiovascular events in older adults.