Brant Luisa C C, Hamburg Naomi M, Barreto Sandhi M, Benjamin Emelia J, Ribeiro Antonio L P
Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.B., S.M.B., A.P.R.).
Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA (N.M.H., E.J.B.).
J Am Heart Assoc. 2014 Dec 15;3(6):e001279. doi: 10.1161/JAHA.114.001279.
Vascular dysfunction is an early expression of atherosclerosis and predicts cardiovascular (CV) events. Peripheral arterial tonometry (PAT) evaluates basal pulse amplitude (BPA), endothelial function (PAT ratio), and wave reflection (PAT-AIx) in the digital microvessels. In Brazilian adults, we investigated the correlations of PAT responses to CV risk factors and to carotid-femoral pulse wave velocity (PWV), a measure of arterial stiffness.
In a cross-sectional study, 1535 participants of the ELSA-Brasil cohort underwent PAT testing (52±9 years; 44% women). In multivariable analyses, more-impaired BPA and PAT ratios were associated with male sex, higher body mass index (BMI), and total cholesterol/high-density lipoprotein. Higher age and triglycerides were related to higher BPA, whereas lower systolic blood pressure, hypertension (HTN) treatment, and prevalent CV disease (CVD) were associated with lower PAT ratio. PAT-AIx correlated positively with female sex, advancing age, systolic and diastolic blood pressures, and smoking and inversely to heart rate, height, BMI, and prevalent CVD. Black race was associated with lower BPA, higher PAT ratio, and PAT-AIx. Microvessel vasodilator function was not associated with PWV. Higher PAT-AIx was modestly correlated to higher PWV and PAT ratio and inversely correlated to BPA.
Metabolic risk factors are related to impaired microvessel vasodilator function in Brazil. However, in contrast to studies from the United States, black race was not associated with an impaired microvessel vasodilator response, implying that vascular function may vary by race across populations. PAT-AIx relates to HTN, may be a valid measure of wave reflection, and provides distinct information from arterial stiffness.
血管功能障碍是动脉粥样硬化的早期表现，并可预测心血管（CV）事件。外周动脉张力测定法（PAT）可评估指端微血管的基础脉搏振幅（BPA）、内皮功能（PAT比值）和波反射（PAT-AIx）。在巴西成年人中，我们研究了PAT反应与CV危险因素以及颈动脉-股动脉脉搏波速度（PWV，一种动脉僵硬度的测量指标）之间的相关性。
在一项横断面研究中，ELSA-Brasil队列的1535名参与者接受了PAT检测（年龄52±9岁；44%为女性）。在多变量分析中，BPA和PAT比值受损程度更高与男性、更高的体重指数（BMI）以及总胆固醇/高密度脂蛋白相关。年龄较大和甘油三酯水平较高与较高的BPA相关，而收缩压较低、高血压（HTN）治疗以及存在心血管疾病（CVD）则与较低的PAT比值相关。PAT-AIx与女性、年龄增长、收缩压和舒张压、吸烟呈正相关，与心率、身高、BMI和存在的CVD呈负相关。黑人种族与较低的BPA、较高的PAT比值和PAT-AIx相关。微血管舒张功能与PWV无关。较高的PAT-AIx与较高的PWV和PAT比值呈适度相关，与BPA呈负相关。
在巴西，代谢危险因素与微血管舒张功能受损有关。然而，与美国的研究不同，黑人种族与微血管舒张反应受损无关，这意味着不同人群的血管功能可能因种族而异。PAT-AIx与HTN相关，可能是波反射的有效测量指标，并提供了与动脉僵硬度不同的信息。
