用于预测自发性心血管事件的肱动脉血流介导的血管舒张和颈动脉内膜中层厚度的性别差异。
Gender differences on brachial flow-mediated dilation and carotid intima-media thickness for prediction of spontaneous cardiovascular events.
作者信息
Hu Rui, Wang Wei-Qun, Lau Chu-Pak, Tse Hung-Fat
机构信息
Jinshan Hospital, Fudan University, Shanghai.
出版信息
Clin Cardiol. 2008 Nov;31(11):525-30. doi: 10.1002/clc.20314.
BACKGROUND
Impaired brachial flow-mediated dilation (FMD) and increased carotid intima-media thickness (IMT) are associated with increased risk of cardiovascular events.
METHODS
We measured brachial FMD and a mean of 12 sites maximum carotid IMT (mmIMT) in 279 patients (mean age 62 +/- 12 y; 163 men) admitted for coronary angiography due to chest pain.
HYPOTHESIS
There are gender differences in the predictive values of FMD and IMT for cardiovascular events.
RESULTS
Univariable analysis showed that impaired FMD (p < 0.001), but not increased mmIMT (p = 0.056), significantly predicted spontaneous cardiovascular events. After adjusting for the extent of coronary artery disease (CAD) and other clinical variables, age (heart rate [HR] 1.05, 95% confidence interval [CI]: 1.01-1.09, p = 0.017) and FMD (HR 0.85, 95% CI: 0.75-0.97, p = 0.012) were independent predictors for cardiovascular events. A total of 148 (53%) patients had CAD (> or =50% diameter stenosis). Over a median follow-up of 16 mo, 36 (12.9%) patients experienced spontaneous cardiovascular events (cardiovascular death, stroke, acute myocardial infarction [MI], unstable angina pectoris, and congestive heart failure [HF]). Women were more likely than men to develop cardiovascular events in patients without significant CAD (11.9% versus 1.6%, odds ratio [OR] = 8.54, p = 0.033), but not in those patients with CAD (20.4 % versus 17.2%, OR = 1.24, p = 0.66). Moreover, women accounted for 8 (88.9%) events in non-CAD patients. Furthermore, impaired FMD predicted the occurrence of cardiovascular events in both men and women (p < 0.05).
CONCLUSION
Brachial FMD, rather than carotid IMT, was an independent predictor for cardiovascular events after adjusting for the extent of CAD. Moreover, impaired brachial endothelial function in women without significant CAD was associated with an increased risk of spontaneous cardiovascular events.
背景
肱动脉血流介导的血管舒张功能（FMD）受损和颈动脉内膜中层厚度（IMT）增加与心血管事件风险增加相关。
方法
我们对279例因胸痛入院接受冠状动脉造影的患者（平均年龄62±12岁；163例男性）测量了肱动脉FMD以及12个部位的颈动脉最大IMT平均值（mmIMT）。
假设
FMD和IMT对心血管事件的预测价值存在性别差异。
结果
单变量分析显示，FMD受损（p<0.001）而非mmIMT增加（p = 0.056）可显著预测自发性心血管事件。在调整冠状动脉疾病（CAD）程度和其他临床变量后，年龄（心率[HR]1.05，95%置信区间[CI]：1.01 - 1.09，p = 0.017）和FMD（HR 0.85，95%CI：0.75 - 0.97，p = 0.012）是心血管事件的独立预测因素。共有148例（53%）患者患有CAD（直径狭窄≥50%）。在中位随访16个月期间，36例（12.9%）患者发生了自发性心血管事件（心血管死亡、中风、急性心肌梗死[MI]、不稳定型心绞痛和充血性心力衰竭[HF]）。在无显著CAD的患者中，女性比男性更易发生心血管事件（11.9%对1.6%，优势比[OR]=8.54，p = 0.033），但在患有CAD的患者中并非如此（20.4%对17.2%，OR = 1.24，p = 0.66）。此外，在非CAD患者中，8例（88.9%）心血管事件发生在女性中。而且，FMD受损在男性和女性中均能预测心血管事件的发生（p<0.05）。
结论
在调整CAD程度后，肱动脉FMD而非颈动脉IMT是心血管事件的独立预测因素。此外，无显著CAD的女性肱动脉内皮功能受损与自发性心血管事件风险增加相关。
Zotero 插件