Alshawabkeh Laith I, Yee Laura M, Gardin Julius M, Gottdiener John S, Odden Michelle C, Bartz Traci M, Arnold Alice M, Mukamal Kenneth J, Wallace Robert B
Division of Cardiovascular Medicine, University of Iowa, Iowa City, IA (L.I.A.) Carver College of Medicine and the College of Public Health, University of Iowa, Iowa City, IA (L.I.A., R.B.W.).
Department of Biostatistics, University of Washington, Seattle, WA (L.M.Y., T.M.B., A.M.A.).
J Am Heart Assoc. 2015 Apr 23;4(4):e001745. doi: 10.1161/JAHA.114.001745.
As the U.S. population grows older, there is greater need to examine physical independence. Previous studies have assessed risk factors in relation to either disability or mortality, but an outcome that combines both is still needed.
The Cardiovascular Health Study is a population-based, prospective study where participants underwent baseline echocardiogram, measurement of carotid intima-media thickness (IMT), and various biomarkers, then followed for up to 18 years. Years of able life (YAL) constituted the number of years the participant was able to perform all activities of daily living. Linear regression was used to model the relationship between selected measures and outcomes, adjusted for confounding variables. Among 4902 participants, mean age was 72.6 ± 5.4 years, median YAL for males was 8.8 (interquartile range [IQR], 4.3 to 13.8) and 10.3 (IQR, 5.8 to 15.8) for females. Reductions in YAL in the fully adjusted model for females and males, respectively, were: -1.34 (95% confidence interval [CI], -2.18, -0.49) and -1.41 (95% CI, -2.03, -0.8) for abnormal left ventricular (LV) ejection fraction, -0.5 (95% CI, -0.78, -0.22) and -0.62 (95% CI, -0.87, -0.36) per SD increase in LV mass, -0.5 (95% CI, -0.7, -0.29) and -0.79 (95% CI, -0.99, -0.58) for IMT, -0.5 (95% CI, -0.64, -0.37) and -0.79 (95% CI, -0.94, -0.65) for N-terminal pro-brain natriuretic peptide, -1.08 (95% CI, -1.34, -0.83) and -0.73 (95% CI, -0.97, -0.5) for high-sensitivity troponin-T, and -0.26 (95% CI, -0.42, -0.09) and -0.23 (95% CI, -0.41, -0.05) for procollagen-III N-terminal propeptide. Most tested variables remained significant even after adjusting for incident cardiovascular (CV) disease.
In this population-based cohort, variables obtained by CV imaging and biomarkers of inflammation, coagulation, atherosclerosis, myocardial injury and stress, and cardiac collagen turnover were associated with YAL, an important outcome that integrates physical ability and longevity in older persons.
随着美国人口老龄化，对身体独立性的研究需求日益增加。以往的研究评估了与残疾或死亡率相关的风险因素，但仍需要一个综合两者的结果。
心血管健康研究是一项基于人群的前瞻性研究，参与者接受了基线超声心动图、颈动脉内膜中层厚度（IMT）测量及各种生物标志物检测，随后随访长达18年。健康生活年限（YAL）是指参与者能够进行所有日常生活活动的年数。采用线性回归模型分析选定指标与结果之间的关系，并对混杂变量进行校正。4902名参与者的平均年龄为72.6±5.4岁，男性YAL中位数为8.8（四分位间距[IQR]，4.3至13.8），女性为10.3（IQR，5.8至15.8）。在对女性和男性的完全校正模型中，YAL的减少量分别为：左心室（LV）射血分数异常时为-1.34（95%置信区间[CI]，-2.18，-0.49）和-1.41（95%CI，-2.03，-0.8）；LV质量每增加1个标准差时为-0.5（95%CI，-0.78，-0.22）和-0.62（95%CI，-0.87，-0.36）；IMT为-0.5（95%CI，-0.7，-0.29）和-0.79（95%CI，-0.99，-0.58）；N末端脑钠肽前体为-0.5（95%CI，-0.64，-0.37）和-0.79（95%CI，-0.94，-0.65）；高敏肌钙蛋白T为-1.08（95%CI，-1.34，-0.83）和-0.73（95%CI，-0.97，-0.5）；III型前胶原N末端前肽为-0.26（95%CI，-0.42，-0.09）和-0.23（95%CI，-0.41，-0.05）。即使在对心血管（CV）疾病发病情况进行校正后，大多数检测变量仍具有显著性。
在这个基于人群的队列中，通过CV成像获得的变量以及炎症、凝血、动脉粥样硬化、心肌损伤和应激以及心脏胶原代谢的生物标志物与YAL相关，YAL是一个综合了老年人身体能力和寿命的重要结果。
