Improvement in Brachial Endothelial Vasomotor Function and Brachial-Ankle Pulse Wave Velocity Reduces the Residual Risk for Cardiovascular Events after Optimal Medical Treatment in Patients with Coronary Artery Disease.
Improvement in Brachial Endothelial Vasomotor Function and Brachial-Ankle Pulse Wave Velocity Reduces the Residual Risk for Cardiovascular Events after Optimal Medical Treatment in Patients with Coronary Artery Disease.
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DOI：
10.5551/jat.57562
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发表时间：
2021-11-01
影响因子：
4.4
通讯作者：
Kugiyama K
中科院分区：
文献类型：
--
作者：
Nakamura T;Uematsu M;Horikoshi T;Yoshizaki T;Kobayashi T;Saito Y;Watanabe Y;Nakamura K;Obata JE;Kugiyama K
目的：研究肱动脉血流介导的内皮依赖性舒张（FMD）和臂踝脉搏波速度（baPWV）的改善是否对实现传统风险因素的最佳目标具有累加效应，以降低冠心病（CAD）患者的心血管风险。 研究方法：我们评估了323例CAD和血管功能受损的患者，定义为肱动脉FMD受损（<5.5%）和baPWV增加（> 1，440 cm/sec）。在最佳药物治疗（OMT）24周时测量FMD和baPWV后，研究患者随访<60个月或直至发生心源性死亡、非致命性心肌梗死（MI）、不稳定型心绞痛或缺血性卒中的复合事件。 结果：在中位随访35个月期间，72例患者发生心血管事件。多变量考克斯风险分析显示，FMD和baPWV改善的患者未来发生心血管事件的概率最低。此外，FMD和baPWV的改善对使用净重新分类改善（NRI）和综合辨别改善（IDI）实现血压（BP）、低密度脂蛋白胆固醇（LDL-C）和血红蛋白A1 c（HbA 1c）最佳目标的预测值具有显著的增量效应。 结论：FMD和baPWV的改善对CAD患者传统危险因素达到最佳目标的风险降低具有累加效应。因此，连续测量FMD和baPWV可能有助于识别OMT后心血管不良事件剩余风险的CAD患者。
Aim: To examine whether improvement in flow-mediated endothelium-dependent dilatation (FMD) of the brachial artery and brachial-ankle pulse wave velocity (baPWV) has an additive effect on achieving optimal goals of traditional risk factors to reduce cardiovascular risk in patients with coronary artery disease (CAD). Methods: We assessed 323 patients with CAD and impaired vascular function, defined as an impaired FMD of the brachial artery (＜5.5%) and increased baPWV (＞1,440 cm/sec). After FMD and baPWV measurements at 24 weeks of optimal medical treatment (OMT), the study patients were followed up for ＜60 months or until a composite of cardiac death, nonfatal myocardial infarction (MI), unstable angina, or ischemic stroke occurs. Results: During the median follow-up period of 35 months, cardiovascular events occurred in 72 patients. Multivariate Cox hazards analysis showed that patients with an improvement in FMD and baPWV had the lowest probability of future cardiovascular events. In addition, the improvement in FMD and baPWV had a significant incremental effect on the predictive value of the achievement of optimal goals for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and hemoglobin A1c (HbA1c) using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Conclusions: The improvement in FMD and baPWV had additive effects on risk reduction of the achievement of the optimal goals of traditional risk factors in patients with CAD. Thus, serial measurements of FMD and baPWV may be useful for identifying CAD patients at residual risk for adverse cardiovascular events following OMT.
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