Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Hypertens. 2013 Mar;31(3):477-83; discussion 483. doi: 10.1097/HJH.0b013e32835c5c23.
We examined the relationship between brachial-ankle pulse wave velocity and the development of cardiovascular disease in a general Japanese population.
A total of 2916 community-dwelling Japanese individuals without history of cardiovascular disease aged at least 40 years were followed up for an average of 7.1 years, and the relationship between brachial-ankle pulse wave velocity and the cardiovascular risk was estimated using the Cox proportional hazards model. To compare the accuracy of the risk assessment for cardiovascular events between the models adjusted for known cardiovascular risk factors with and without brachial-ankle pulse wave velocity, the area under the receiver-operating characteristic curve and net reclassification improvement were computed.
During the follow-up period, 126 patients experienced cardiovascular events. Age and sex-adjusted incidence rates of cardiovascular disease increased linearly with elevating brachial-ankle pulse wave velocity levels (P for trend <0.001). After adjusting for confounding factors, every 20% increment in brachial-ankle pulse wave velocity was associated with a 1.30-fold [95% confidential interval (CI) 1.10-1.53] greater cardiovascular risk. When brachial-ankle pulse wave velocity was incorporated into a model with known cardiovascular risk factors, the area under the receiver-operating characteristic curve was significantly increased (0.776 vs. 0.760; P = 0.01), and the net reclassification improvement was 0.085 (P = 0.008).
Our findings suggest that brachial-ankle pulse wave velocity is a significant predictive factor for cardiovascular disease in the general Japanese population and that information on brachial-ankle pulse wave velocity substantially improves cardiovascular risk assessment beyond that achieved by a model based on potential risk factors in general practice.
我们在一般日本人群中研究了肱踝脉搏波速度与心血管疾病发展之间的关系。
共纳入 2916 名无心血管疾病史、年龄至少 40 岁的社区居民进行平均 7.1 年的随访，使用 Cox 比例风险模型估计肱踝脉搏波速度与心血管风险之间的关系。为了比较调整已知心血管风险因素与不调整肱踝脉搏波速度的模型对心血管事件风险评估的准确性，计算了受试者工作特征曲线下面积和净重新分类改善。
在随访期间，126 例患者发生心血管事件。年龄和性别调整后的心血管疾病发生率随肱踝脉搏波速度水平的升高呈线性增加（趋势 P<0.001）。调整混杂因素后，肱踝脉搏波速度每增加 20%，心血管风险增加 1.30 倍（95%可信区间 1.10-1.53）。当将肱踝脉搏波速度纳入包含已知心血管风险因素的模型时，受试者工作特征曲线下面积显著增加（0.776 比 0.760；P=0.01），净重新分类改善为 0.085（P=0.008）。
我们的研究结果表明，肱踝脉搏波速度是日本一般人群心血管疾病的重要预测因素，并且与基于一般实践中潜在风险因素的模型相比，肱踝脉搏波速度信息可显著改善心血管风险评估。
