Risk assessment indicators and brachial-ankle pulse wave velocity to predict atherosclerotic cardiovascular disease

Brachial-ankle pulse wave velocity (baPWV) is used for predicting the severity of vascular damage and prognosis of atherosclerotic cardiovascular disease (ASCVD) in people with hypertension and diabetes mellitus. This correlation study aimed to compare the baPWV with other risk indicators for identification of subclinical vascular disease for primary prevention and to determine the clinical utility of baPWV-guided therapy in improving prognosis in high-risk subjects.We included 4881 subjects who underwent voluntary health examination at Mackay Memorial Hospital, Taiwan between 2014 and 2019. Participants were categorized into the low-risk (<5%), borderline-risk (5%–7.4%), intermediate-risk (7.5%–19.9%), and high-risk (≥20%) groups based on the 10-year risk for ASCVD. The predictive risk criteria, that is, the metabolic syndrome score, Framingham Risk Score, estimated glomerular filtration rate, and baPWV were compared among these groups. The chief cause of induced responses and the relationships between parameters were identified using principal component analysis. The participants’ ages, body mass index, systolic, diastolic blood pressure, triglycerides, fasting glucose, hemoglobin A1c, creatinine, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, metabolic syndrome, Framingham Risk Score, and age-related arterial stiffness (vascular age) increased significantly from the low-risk to high-risk groups (P < .001). The mean estimated glomerular filtration rate decreased significantly from the low- to high-risk groups (P < .001). The predicted vascular age and actual age differed significantly between the intermediate- and high-risk groups (P < .001). High-density lipoprotein levels plummeted significantly among the 4 groups (P < .001). The right and left baPWV and ankle brachial index differed significantly among the 4 groups (all P < .001) and increased from the low-risk to high-risk groups (P < .001). Carotid Doppler ultrasonography revealed a significant increase in plaque formation (23.5%, 35.4%, 46.3%, and 61.5% for the low-, borderline-, intermediate, and high-risk groups, respectively). The total explanatory variation was 61.9% for 2 principal variation factors (baPWV, 36.8% and creatinine, 25.1%). The vascular age predicted using baPWV greatly exceeded the chronological age. Plaque formation was significant even in the low-risk group, and its frequency increased with the predicted ASCVD risk. Risk indicators and baPWV are useful predictors of ASCVD, which in conjunction with conventional pharmacotherapy could be useful for primary prevention of plaque formation in subjects with cardiovascular comorbidities.     

估算的脉搏波传导速度与臂踝脉搏波传导速度的分布及一致性分析

目的观察估算的脉搏波传导速度(ePWV)和臂踝脉搏波传导速度(baPWV)在开滦研究人群中的分布特征并分析二者的一致性(差异及关联)。方法选择参加baPWV检测且基线资料完整的43 235例开滦集团公司职工作为观察人群。将研究对象按有无传统心血管危险因素分为风险人群和正常人群。在两人群中分别采用多元线性回归建立baPWV与年龄、年龄的平方、平均动脉压(MAP)的回归方程,并以此分别计算两人群的ePWV。观察ePWV和baPWV在人群中的分布特征并采用配对样本t检验和线性回归分析二者的差异和关联。结果在正常人群中,ePWV与baPWV分别为11.38±0.70 m/s和12.90±1.17 m/s;在风险人群中,ePWV与baPWV分别为14.29±1.85 m/s和15.74±1.76 m/s。无论在正常人群还是风险人群中,ePWV与baPWV均随年龄的增加而增加,男性的ePWV与baPWV均高于女性。同时,baPWV略高于ePWV(P0.01),在正常人群和风险人群中,二者平均差值分别为1.80 m/s和2.17 m/s。线性回归分析结果提示,二者在总人群、正常人群和风险人群中的线性R~2分别为0.428、0.279和0.388。结论 ePWV与baPWV具有相似的年龄、性别分布特征。二者差值相对较小且具有良好的线性关联。因此,ePWV可作为baPWV的良好替代指标。     

Higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis in end-stage renal disease.

Brachial-ankle pulse wave velocity is a new measure of arterial stiffness. We examined whether higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis and left ventricular hypertrophy in patients with end-stage renal disease, and whether this effect would be mediated by the influence of wave reflection on central arterial pressure. In 68 patients with end stage renal disease, we examined blood pressures, brachial-ankle pulse wave velocity and the augmentation index of the left common carotid artery, a measure of the impact of wave reflection on the systolic peak in central arteries. The degree of carotid atherosclerosis was quantified by a plaque score and maximum intimal-medial thickness. Echocardiography was used to determine the left ventricular mass index. In simple regression analysis, brachial-ankle pulse wave velocity was correlated with both plaque score and maximum intimal-medial thickness (r = 0.420, p < 0.001 and r = 0.452, p < 0.0005, respectively) but not with left ventricular mass index. Multiple regression analysis was performed with the plaque score or maximum intimal-medial thickness as the dependent variable and brachial-ankle pulse wave velocity and known clinical risk factors as the independent variables. The brachial-ankle pulse wave velocity was an independent risk factor for both plaque score (beta = 0.006, p = 0.004) and maximum intimal-medial thickness (beta = 0.008, p = 0.04). Independent risk factors for left ventricular mass index were left ventricular diastolic dimension (beta = 3.509, p = 0.000007) and augmentation index (beta = 0.580, p = 0.04). The brachial-ankle pulse wave velocity was unrelated to augmentation index in patients with end stage renal disease. In conclusion, higher brachial-ankle pulse wave velocity was found to be a risk factor for carotid atherosclerosis in patients with end-stage renal disease; this effect was independent of the influence of wave reflection on central arterial pressure. The brachial-ankle pulse wave velocity was unrelated to left ventricular structure.     

糖代谢异常和臂踝脉搏波传导速度与颈动脉内膜中层厚度间的关系

目的研究从糖耐量正常、糖耐量减低至糖尿病的发展过程中臂踝脉搏波传导速度(baPWV)的变化,探讨其与糖尿病早期动脉硬化颈动脉内膜中层厚度(IMT)的关系。方法90例患者,其中糖耐量正常、糖耐量减低、2型糖尿病各30例。每例均采用全自动动脉硬化仪测定其baPWV及超声检测IMT。结果从糖耐量正常、糖耐量减低至糖尿病,随着糖代谢异常的加重,颈动脉内膜中层逐渐增厚(F=13.40,P<0.05)、baPWV逐渐升高(F=15.26,P<0.01),且两者变化之间呈正相关(r=0.856,P<0.01)。结论baPWV与IMT具有良好的相关性,二者均对了解糖尿病早期动脉硬化及其程度有一定的价值。     

Central pulse wave velocity is responsible for increased brachial-ankle pulse wave velocity in subclinical hypothyroidism

Objective Subclinical hypothyroidism affects 5–15% of the general population, and is associated with increased morbidity from cardiovascular disease. We recently reported a significant increase in brachial‐ankle pulse wave velocity (baPWV), a parameter of arterial stiffening and an independent predictor for the presence of cardiovascular disease, in subclinical hypothyroidism. The current study was performed to assess which arterial segment is responsible for enhanced baPWV in subclinical hypothyroidism. Patients and methods Central PWV (PWV in heart‐femoral segments), peripheral PWV (PWV in femoral‐ankle segments), and baPWV were measured in subclinical hypothyroid patients and normal subjects. Results Central PWV, baPWV, and peripheral PWV were significantly higher in subclinical hypothyroid patients than in normal subjects. BaPWV was significantly and positively correlated with central and peripheral PWV in both groups. However, a significant and positive correlation between central and peripheral PWV in normal subjects was not found in subclinical hypothyroid patients. Moreover, stepwise regression analysis showed that the association of central PWV with baPWV was stronger than that of peripheral PWV, whereas in normal subjects central PWV was not associated with baPWV. Conclusions Our results demonstrate that central and peripheral PWV are significantly higher in subclinical hypothyroid patients, and that the increase in baPWV depends more strongly on central PWV than on peripheral PWV in these patients. This suggests that increased elastic arterial stiffening of the aorta, rather than of peripheral muscular arteries, might be more responsible for increased general arterial stiffening in subclinical hypothyroid patients.     

Nomogram of the relation of brachial-ankle pulse wave velocity with blood pressure.

The present study was conducted to make a nomogram of the relation of brachial-ankle pulse wave velocity (baPWV) with blood pressure. In 11,375 subjects (age range: 30 to 79 years) in whom we measured baPWV, multivariate linear regression analysis demonstrated that age, systolic blood pressure, and gender were significant determinants of baPWV. Of them, we selected 5,302 subjects (2,630 men and 2,672 women, age 46 +/- 11 years) with either normal blood pressure or with high blood pressure without other atherosclerotic risk factors. Using data from these subjects, we tried to make an age-derived nomogram and a systolic blood pressure-derived nomogram for in both genders. The regression curve analysis demonstrated significant quadratic curves for both associations. The obtained nomograms were applied to 297subjects with coronary heart disease. Their measured baPWV (1,569 +/- 344 cm/s) was significantly higher than the values calculated from the age-derived nomogram (1,502 +/- 241 cm/s) and the systolic blood pressure-derived nomogram (1,418 +/- 236 cm/s) (p < 0.01). Thus, a nomogram of the relation of baPWV with blood pressure was obtained. The comparison of the measured baPWV with the values calculated from the nomograms may be useful to not to underestimate the real risk for atherosclerotic cardiovascular diseases, including the severity of atherosclerotic vascular damage, reflected by measured baPWV in subjects with different blood pressure levels.     

体检人群中老年人超重、肥胖与踝臂脉搏波传导速度和颈动脉斑块的相关性

目的探讨不同体重指数与踝臂脉搏波传导速度(ba PWV)和颈动脉斑块的相关性。方法在2014年1~12月健康体检无重大慢性疾病相对健康人群中,按单纯随机数字分类法收集1 243例40岁以上者,按体重指数(BMI)分为体重正常组(BMI<24.0 kg/m2)、超重组(BMI24.0~27.9 kg/m2)和肥胖组(BMI>28.0 kg/m2),比较3组间ba PWV的差异以及各组颈动脉斑块形成情况。结果随着BMI增高,ba PWV呈逐渐上升趋势,体重正常组为(1 361.4±189.8)cm/s,超重组为(1 527.8±221.4)cm/s,肥胖组为(1 636.5±305.7)cm/s;颈动脉斑块形成正常体重组为60例(8.32%),超重组为98例(25.45%),肥胖组为62例(45.26%);差异显著(均P<0.01)。结论超重、肥胖与踝臂脉搏波传导速度增快密切相关。控制体重,使体重指数保持在正常范围内,对维护血管健康、减缓动脉硬化的发展有重要意义。     

Association of serum lycopene and brachial-ankle pulse wave velocity with metabolic syndrome

Metabolic syndrome (MetS) is known to inversely correlate with antioxidant status. Recently, it has been reported that MetS is associated with arterial stiffness, a composite risk factor for early atherosclerosis. In addition, our recent study for healthy women showed an inverse relationship between arterial stiffness and circulating lycopene. Therefore, this study aimed to investigate the interrelationship between arterial stiffness, antioxidant status, and the risk of MetS. Korean men (N = 299) were subgrouped according to the number of MetS risk factors (RF 0, RF 1-2, RF ≥3). Anthropometric parameters, brachial-ankle pulse wave velocity (baPWV; a marker of arterial stiffness), antioxidants (lycopene, β-carotene, α-tocopherol), lipid profiles, glucose, insulin, and oxidative stress (low-density lipoprotein [LDL] particle size, oxidized LDL) were measured. Corresponding to the number of MetS RF, baPWV (1306 ± 17, 1364 ± 16, and 1420 ± 33 cm/s; P < .001) and insulin resistance (1.5 ± 0.1, 1.9 ± 0.1, and 2.7 ± 0.2; P < .001) gradually increased after adjustment for age, body mass index, smoking, and drinking, whereas serum lycopene among antioxidants and LDL particle size gradually decreased (0.036 ± 0.001, 0.031 ± 0.001, and 0.028 ± 0.001 mmol/L; P = .004 and 23.9 ± 0.1, 23.7 ± 0.1, and 23.3 ± 0.1 nm; P < .001, respectively). Brachial-ankle pulse wave velocity inversely correlated with serum lycopene after adjustment for the above confounders, blood pressure, insulin resistance, and oxidative stress (r = −0.136, P < .05). Oxidative stress markers also significantly correlated with baPWV as well as serum lycopene. Study subjects were divided into 2 groups by the median level of serum lycopene. When serum lycopene was lower than median level (≤0.0294 mmol/L), baPWV was significantly higher in MetS subjects than non-MetS subjects (1436 ± 41 vs 1367 ± 23 cm/s) after adjustment for age, body mass index, smoking, drinking, and oxidative stress (P = .041). However, when serum lycopene levels were high, no statistically significant difference was observed between the 2 subject groups (1386 ± 36 vs 1326 ± 13 cm/s). In conclusion, our result shows the interrelationship between circulating lycopene, baPWV, and MetS. In addition, much enhanced baPWV in MetS may be associated with lower lycopene concentration.     

臂踝脉搏波传导速度与心血管危险因素的相关性

目的:探讨臂踝脉搏波传导速度(baPWV)与心血管危险因素及国人缺血性心血管疾病(ICVD)危险评分的相关性。方法: 2010年3月~7月天津市人民医院体检人群232例进行常规体检,应用全自动动脉硬化测定仪VBP-9测定双肢的baPWV,按代谢异常组分进行分组,分别比较各组临床基本资料、baPWV 及ICVD风险评分。结果: 随着代谢异常组分的增加,baPWV逐渐增加,代谢异常各组baPWV均高于对照组,各组间差异均有统计学意义(P<0.05)。不同组之间,体质量指数、收缩压、舒张压、空腹血糖、三酰甘油、10年风险评估随着代谢异常数目的增高而呈上升趋势,高密度脂蛋白胆固醇（HDL-C）随着代谢异常数目的增加而降低,各组间差异具有统计学意义（P<0.05）,糖尿病史、高血压病史、吸烟史各组间差异有统计学意义（P<0.05）。Logistic回归分析:baPWV影响因素中年龄 OR=1.06295%CI(1.009-1.118)、收缩压OR=1.08595%CI(1.032-1.139)、糖尿病史OR=5.65095%CI(1.735-18.395);国人ICVD危险评分与baPWV存在回归关系（r=0.531,P＜0.01）。 结论: 年龄、收缩压、糖尿病史是早期动脉粥样硬化的影响因素,各种主要心血管危险因素与baPWV测定值相关,ICVD评分与baPWV相关。     

BMI轨迹与肱踝脉搏波传导速度的关联

目的探讨体质指数(BMI)与动脉硬化的关联。方法对6143例完成2006-2007、2008-2009、2010-2011年体检并且完成2010-2011年肱踝脉搏波传导速度(BaPWV)检测的观察对象进行分析,平均年龄为49.68岁。其中,男性4230例(68.9%);依据BMI轨迹将总人群分为四组:低稳定组、中低稳定组、中高稳定组和高稳定组。对BMI轨迹与动脉硬化进行χ~2检验以及多因素Logistic回归分析,观察BMI轨迹对动脉硬化的影响。结果随着BMI轨迹的增高,动脉硬化的检出率逐渐增加,各BMI轨迹组动脉硬化的检出率分别为52.4%、63.3%、67.9%、70.1%;在多因素Logistic回归分析中校正了年龄、性别等各种混杂因素后,与低稳定组相比,其余三组踝臂指数(ABI)0.9的OR值(95%CI)分别为1.34(1.08~1.66)、1.57(1.16~2.13)、1.77(1.13~2.79)。结论高的BMI轨迹是动脉硬化前期的危险因素且独立于其他引起靶器官损害的危险因素。     

Impact of metabolic syndrome on brachial-ankle pulse wave velocity in Japanese.

The aim of this study was to determine the effect of metabolic syndrome on brachial-ankle pulse wave velocity (baPWV) by using the new guidelines for diagnosis of this syndrome in Japan. We examined 525 men and women without a history of cardiovascular disease or cancer, and an ankle-brachial index < 0.9. The baPWV was measured using a device (Form PWV/ABI) that simultaneously monitored bilateral brachial and ankle pressure wave forms. Metabolic syndrome was defined as a waist circumference > or = 85 (90) cm in men (women) and two or more of the following risk factors: hypertension, dyslipidemia, and glucose intolerance diagnosed by a 75 g oral glucose tolerance test. The baPWV showed a significant linear relationship with waist circumference, waist-to-hip ratio, body fat, systolic and diastolic blood pressure, triglycerides, fasting glucose, 2-h-postload glucose, fasting insulin, and glycosylated hemoglobin-A1c, after adjusting for sex and age. These factors were also strongly related to fasting insulin levels. When subjects were classified into six groups based on waist circumference and the number of risk factors for metabolic syndrome (0, 1, and > or =2), we found that more risk factors clearly increased the odds ratios for an elevated baPWV in those subjects in the highest quartile of the baPWV distribution in multivariate logistic models. An increase in odds ratio was observed despite a normal waist circumference and may well have been due to increased fasting insulin and blood pressure levels. An increase in the number of risk factors for metabolic syndrome was highly correlated with an increased baPWV, probably due to insulin resistance.     

累积甘油三酯暴露与臂踝脉搏波传导速度的关联

目的探讨累积甘油三酯暴露(cumTG)与臂踝脉搏波传导速度(BaPWV)的关系。方法选择开滦研究人群中卒中队列、老年人群队列和妊娠高血压队列23499例组成观察人群,最终纳入研究队列的为14662例。根据cumTG将研究对象进行四分位分组。采用偏相关分析cumTG与BaPWV的相关性,多因素线性回归和多因素Logistic回归分析cumTG对BaPWV的影响。结果随着cumTG的增加,平均BaPWV水平和BaPWV≥1400 cm/s的检出率均呈上升趋势。偏相关分析结果表明,cumTG与BaPWV呈正相关(r=0.512,P0.05);校正了年龄、性别后cumTG与BaPWV仍呈正相关(r=0.322,P0.05)。多因素线性回归分析显示,cumTG每增加1 mmol/L·year,BaPWV增加4.507 cm/s。Logistic回归分析表明,校正了其他混杂因素后,与cumTG第一分位组相比,cumTG第二分位组、第三分位组、第四分位组均是BaPWV≥1400 cm/s的危险因素,OR值(95%CI)分别为1.667(1.505~1.845)、2.384(2.111~2.691)、3.287(2.887~3.741)。结论 cumTG与BaPWV呈正相关关系。cumTG是脉搏波传导速度增加的危险因素。     

Usefulness of brachial-ankle pulse wave velocity measurement: correlation with abdominal aortic calcification.

At present, brachial-ankle pulse wave velocity (baPWV) can be measured easily and noninvasively. We studied the correlation between aortic damage estimated by baPWV and that determined by measuring the length of abdominal aortic calcification (AAC) on X-ray films, which parameter has been significantly associated with cardiovascular morbidity and mortality. baPWV was measured using the form PWV/ankle brachial index (ABI) device in 97 patients free of end-stage renal failure or peripheral arterial disease. baPWV correlated significantly with age (r2=0.625, p<0.0001), was significantly higher in hypertensives than in normotensives (2,109+/-67 vs. 1,623+/-93 cm/s, p<0.0001), and correlated significantly with systolic blood pressure (r2=0.64, p<0.0001) and diastolic blood pressure (r2=0.397, p<0.0001). baPWV was significantly higher in diabetic patients than in nondiabetics (2,068+/-73 vs. 1,813+/-97 cm/s, p<0.05), but was similar in normolipidemic and hyperlipidemic patients. baPWV did not correlate with body mass index, fasting plasma glucose, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol or triglyceride levels, but correlated significantly with AAC length (r2=0.599, p<0.0001). Multiple regression analysis indicated that age, systolic blood pressure and AAC length were independent determinants of baPWV. Our results indicate that baPWV is useful for estimating aortic damage and could be a potentially useful predictor of vascular morbidity and mortality.     

空腹血糖受损患者臂踝动脉脉搏波传导速度的变化

目的探讨空腹血糖受损(IFG)患者臂踝动脉脉搏波传导速度(baPWV)的变化。方法随机分层抽取唐山开滦(集团)有限责任公司在职及离退休职工中年龄≥40岁、既往无缺血性脑卒中、短暂性脑缺血发作、心肌梗死者共5440例为调查对象,排除资料不完整者,最终纳入统计分析的为5192人。进行血液生化及baPWV检查,根据2003年美国糖尿病学会IFG诊断标准分为理想血糖组、IFG组、糖尿病组,用多因素Logistic回归分析IFG与baPWV的关系。结果与理想血糖组比较,IFG组baPWV较高[左侧:(1580±379)比(1516±380)cm/s;右侧:(1568±344)比(1507±368)cm/s;均P<0.05]。校正了年龄、性别、吸烟、饮酒、收缩压、体质量指数、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、C反应蛋白后,IFG仍是baPWV增加的独立危险因素(OR=1.314,95%CI1.104～1.563)。结论 IFG是baPWV增加的独立危险因素。     

Association of microalbuminuria with brachial-ankle pulse wave velocity: the Ohasama study

BACKGROUND: Microalbuminuria is recognized as a marker of generalized vascular dysfunction. However, the associations between microalbuminuria and pulse wave velocity (PWV), carotid intima-media thickness (IMT), and ambulatory blood pressure (ABP), respectively, have not been investigated. METHODS: Brachial-ankle PWV (baPWV), IMT, and ABP were determined in 328 individuals (mean age, 65.7 +/- 6.4 years) from the general population of Ohasama, a rural Japanese community. The participants were assigned to groups with microalbuminuria and with normoalbuminuria, and their characteristics were compared. We also examined the association between microalbuminuria and baPWV, IMT, and ABP, respectively, using multivariate analyses. RESULTS: Seventy-nine participants (24%) with microalbuminuria had significantly higher baPWV (P < 0.001) and 24-h systolic BP (SBP) (P = 0.006) than those with normoalbuminuria, although 24-h pulse pressure and mean IMT did not significantly differ between the groups. Multiple logistic regression analyses showed that baPWV, but not 24-h ABP, was independently associated with microalbuminuria (P = 0.002) when adjusted for various confounding factors. After further adjustment for 24-h SBP, the association between baPWV and microalbuminuria remained significant (P = 0.012). The trend was significant even when daytime or nighttime SBP was used instead of 24-hour SBP in this model. CONCLUSIONS: Microalbuminuria appears to be associated with baPWV more closely than with IMT and ABP, and its association with baPWV is independent of ABP and other cardiovascular risk factors.     

Associations of plasma homocysteine level with brachial-ankle pulse wave velocity, LDL atherogenicity, and inflammation profile in healthy men

Aims

To investigate the association of plasma total homocysteine (tHcy) with arterial stiffness, measured as brachial-ankle pulse wave velocity (baPWV), LDL atherogenicity, and inflammation profile in healthy men.

Methods and Results

In this cross-sectional study, 612 healthy men aged 31-79 years were classified into quartiles according to plasma tHcy concentration. In the total study population, tHcy concentration showed positive correlation with age (r = 0.083, P = 0.040), interleukin (IL)-1β (r = 0.249, P < 0.001), TNF-α (r = 0.150, P < 0.001), IL-6 (r = 0.154, P < 0.001), oxidized LDL (oxLDL) (r = 0.161, P = <0.001), and baPWV (r = 0.087, P = 0.032); and negative correlation with folate (r = −0.353, P < 0.001) and vitamin B₁₂ (r = −0.269, P < 0.001). In subgroup analysis based on plasma tHcy level, tHcy was associated with baPWV in men with high levels of tHcy (≥13.1 μmol/L, n = 153; r = 0.258, P = 0.001), but not in those with low-tHcy (<13.1 μmol/L, n = 459; r = −0.033, P = 0.478). The association between tHcy and baPWV in the high-tHcy group remained significant after adjustment for age, BMI, smoking, drinking, folate, and vitamin B₁₂. In the high-tHcy group, tHcy level was also positively correlated with IL-1β, TNF-α, oxLDL, and blood pressure; and negatively correlated with LDL particle size. In addition, baPWV showed negative correlation with LDL particle size and positive correlation with oxLDL in the high-tHcy group.

Conclusion

This study shows an association between high levels of plasma tHcy and more advanced arterial stiffness, smaller LDL particle size, and higher levels of oxLDL and cytokines in men with hyperhomocysteinemia. Enhanced arterial stiffness in hyperhomocysteinemia might be attributed, in part, to Hcy-related LDL atherogenicity.     

Using brachial-ankle pulse wave velocity to associate arterial stiffness with cardiovascular risks

Background and aimsThis study aimed to elucidate the relationship between brachial-ankle pulse wave velocity (baPWV) and conventional cardiovascular risk factors.Methods and resultsA total of 192 subjects with low to intermediate risk was enrolled in a cardiovascular evaluation program. A multiple regression model was built to find significant cardiovascular biomarkers for predicting baPWV. A logistic regression model was developed to associate baPWV and other biomarkers with the risk of cardiac diastolic dysfunction. A total of 123 men (mean age: 52.6 ± 12.0) and 69 women (mean age: 51.7 ± 10.4) was included. Age, blood pressure, C-reactive protein, serum homocysteine, heart rate, and blood urea nitrogen were positively predictive of increased pulse wave velocity. In turn, baPWV increased the risk (odds ratio: 1.257 for each m/s, 95% CI: 1.105 ∼ 1.430, p < 0.001) and high-density lipoprotein decreased the risk for cardiac diastolic dysfunction (0.962 for each mg/dl, 95% CI: 0.925 ∼ 1.000, p = 0.05). The correlation between baPWV and Framingham 10-year risk was moderate (men: r = 0.306, p = 0.002; women r = 0.548, p < 0.001).ConclusionThe results suggest that baPWV is a composite risk factor for early atherosclerotic change and a predictor for the development of diastolic dysfunction and long-term cardiovascular risk.     

Increased aortic pulse wave velocity is associated with silent cerebral small-vessel disease in hypertensive patients

Aortic stiffness predicts an excess risk of stroke, supposedly via cerebral small-vessel disease. White matter hyperintensities, silent lacunar infarcts, and brain microbleeds, manifestations of cerebral small-vessel disease on neuroimaging, may precede overt cerebrovascular disease. Therefore, we assessed whether aortic stiffness is also related to such lesions. In 167 hypertensive patients (85 men) without a history of cardiovascular or cerebrovascular disease, a mean age of 51.8+/-13.1 years, and untreated office blood pressure levels of 169+/-25/104+/-12 mm Hg, we determined aortic pulse wave velocity and office and ambulatory 24-hour pulse pressure (off medication), as well as the volume of white matter hyperintensities and the presence of lacunar infarcts and microbleeds using brain MRI. Linear and logistic regression analyses were performed to assess the relationships between the arterial stiffness measures and brain lesions. Aortic stiffness and pulse pressure were significantly related to each of the brain lesions in univariate analyses (P<0.05). Multivariate analyses, adjusted for age, sex, brain volume, mean arterial pressure, and heart rate, showed that a higher pulse wave velocity was significantly associated with a greater volume of white matter hyperintensities (unstandardized regression coefficient: 0.041; 95% CI: 0.005 to 0.078; P<0.05) and the presence of lacunar infarcts (odds ratio [per SD increase in pulse wave velocity]: 1.78; 95% CI: 1.06 to 2.99; P<0.05) but not with microbleeds. The models for pulse pressure failed to reach statistical significance in multivariate analyses. In conclusion, aortic stiffness is independently associated with manifestations of cerebral small-vessel disease in hypertensive patients, linking systemic large- to cerebral small-artery disease.     

肱-踝脉搏波传导速度对冠心病的诊断价值

目的探讨肱-踝脉搏波传导速度(ba PWV)对冠心病的诊断价值。方法选取190例受检者根据冠状动脉造影结果分为冠心病组106例和对照组84例,同时将冠心病组进一步分为单支病变组、双支病变组及严重病变组,比较冠心病各组与对照组的ba PWV水平。以冠状动脉造影为金标准,绘制ROC曲线评价ba PWV值对冠心病的筛选价值。结果冠心病组ba PWV显著高于对照组(P 0. 05)。冠心病组单支病变组、双支病变组、严重病变组ba PWV值分别为(1 620. 13±94. 47) cm/s、(1 732. 97±84. 26) cm/s和(1 913. 20±180. 75) cm/s,两两比较差异均有统计学意义(P 0. 05)。由ROC曲线特征发现,ba PWV的最佳截断点为1 535 cm/s,此时约登指数为0. 730,灵敏度为83. 4%,特异度为88. 3%。结论 ba PWV对筛选冠心病有一定的价值,并能够预测冠脉病变的严重程度。