Sumin A N, Bezdenezhnykh N A, Fedorova N V, Shcheglova A V, Indukaeva E V, Artamonova G V
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.
Ter Arkh. 2016;88(12):11-20. doi: 10.17116/terarkh2016881211-20.
To investigate factors associated with pathological cardio-ankle vascular and ankle-brachial indices (CAVI and ABI) in patients with carbohydrate metabolic disorders (CMD).
A cross-sectional study was conducted in the framework of the multicenter epidemiological study "Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Russian Federation" (ESSE-RF) in March to October 2013. The standard ESSE-RF protocol was extended by an additional study of peripheral arterial stiffness, by estimating CAVI and ABI automatically. A sample of 1619 people was formed in several stages, in which 311 patients with type 2 diabetes mellitus and prediabetes were identified and divided into 3 groups: 1) 41 patients with pathological CAVI values (≥9.0); 2) 241 with normal CAVI (<9.0); 3) 29 with pathological ABI (<0.9).
In the population-based sample of patients with CMD, the pathological CAVI values (≥9.0) were detected in 14.5%, and the pathological ABI was in 9.3% of the examinees. Regression analysis showed that the pathological vascular indices (both CAVI and ABI) were significantly associated with increases in blood pressure (BP) and heart rate (HR), and a decrease in glomerular filtration rate. At the same time, only the pathological CAVI was associated with advancing age (odds ratio (OR), 1.111; 95% confidence interval (CI), 1.050-1.176; p < 0.001), visceral obesity (OR, 3.088; 95% CI, 1.001-10.495; p=0.038), smoking duration (OR, 1.093; 95% CI, 1.008-1.185; p=0.009), prior stroke (OR, 4.695; 95% CI, 1.408-15.658; p=0.018), and a need for insulin therapy (OR, 18.947; 95% CI, 1.902- 87.783; p=0.006). The pathological ABI was associated with male sex (OR, 2.227; 95% CI, 1.040-4.765; p=0.039), prior myocardial infarction (OR, 8.646; 95% CI, 2.174-34.378; p=0.005), obesity (OR, 2.439; 95% CI, 1.010-5.889; p=0.034); hyperglycemia (OR, 2.439; 95% CI, 1.010-5.889; p=0.034), hyperuricemia (OR, 4.009; 95% CI, 1.850-8.684; p=0.033), and increases in triglyceride levels (OR, 2.984; 95% CI, 1.376-6.470; p=0.004) and CAVI (OR, 1.193; 95% CI, 1.034-1.377; p=0.005).
The pathological vascular indices CAVI and ABI are associated with different risk factors for cardiovascular events in a cohort of patients with CMD. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate.
研究碳水化合物代谢紊乱（CMD）患者中心脏-踝血管指数（CAVI）和踝臂指数（ABI）异常的相关因素。
在2013年3月至10月开展的多中心流行病学研究“俄罗斯联邦心血管疾病及其危险因素流行病学研究”（ESSE-RF）框架内进行了一项横断面研究。通过自动估算CAVI和ABI对标准ESSE-RF方案进行了扩展，增加了外周动脉僵硬度的研究。分几个阶段选取了1619人的样本，从中识别出311例2型糖尿病和糖尿病前期患者，并将其分为3组：1）41例CAVI值异常（≥9.0）的患者；2）241例CAVI值正常（<9.0）的患者；3）29例ABI异常（<0.9）的患者。
在以人群为基础的CMD患者样本中，14.5%的受检者CAVI值异常（≥9.0），9.3%的受检者ABI异常。回归分析表明，血管指数异常（CAVI和ABI）均与血压（BP）升高、心率（HR）加快以及肾小球滤过率降低显著相关。同时，仅CAVI值异常与年龄增长（比值比（OR），1.111；95%置信区间（CI），1.050 - 1.176；p < 0.001）、内脏肥胖（OR，3.088；95% CI，1.001 - 10.495；p = 0.038）、吸烟时长（OR，1.093；95% CI，1.008 - 1.185；p = 0.009）、既往中风（OR，4.695；95% CI，1.408 - 15.658；p = 0.018）以及胰岛素治疗需求（OR，18.947；95% CI，1.902 - 87.783；p = 0.006）相关。ABI异常与男性（OR，2.227；95% CI，1.040 - 4.765；p = 0.039）、既往心肌梗死（OR，8.646；95% CI，2.174 - 34.378；p = 0.005）、肥胖（OR，2.439；95% CI，1.010 - 5.889；p = 0.034）、高血糖（OR，2.439；95% CI，1.010 - 5.889；p = 0.034）、高尿酸血症（OR，4.009；95% CI，1.850 - 8.684；p = 0.033）以及甘油三酯水平升高（OR，2.984；95% CI，1.376 - 6.470；p = 0.004）和CAVI升高（OR，1.193；95% CI，1.034 - 1.377；p = 0.005）相关。
在CMD患者队列中，血管指数CAVI和ABI异常与心血管事件的不同危险因素相关。与CAVI和ABI均相关的共同因素是血压和心率升高以及肾小球滤过率降低。与CAVI和ABI均相关的共同因素是血压和心率升高以及肾小球滤过率降低。
