Hypertension-ABPM Center, Papageorgiou Hospital, 39 Zaka, Panorama 55236, Thessaloniki. Greece.
Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki. Greece.
Curr Pharm Des. 2017;23(22):3200-3204. doi: 10.2174/1381612823666170328142433.
Cardiovascular damage is clinically manifested as coronary artery disease, heart failure, stroke and peripheral artery disease. The prevalence of these adverse conditions is higher with advancing age. Although many patients present cardiovascular damage late in their life, it is common to see patients with early atherosclerosis in cardiovascular intensive care units at ages lower than 50 years in men and 55 for women.
In this review of the literature we identified risk factors of early vascular damage. The classic risk factors such as age, gender, diabetes mellitus, dyslipidemia, smoking, alcohol, hypertension, obesity, family history and newer biomarkers such as hs-CRP, folic acid, homocysteine, fibrinogen are neither strong nor predictive of the individual patient's risk to present early cardiovascular disease. All these risk factors have been used to propose risk scores for possible future events but we still lack a single strong marker indicating new onset of disease that will predict the future independently of the classical factors. The role of vascular imaging techniques to identify patients with subclinical atherosclerotic vascular damage before clinical disease, including the effect of known and unknown risk factors on the vascular tree, seems to be very important for intensifying preventive measures in high risk patients. Early arteriosclerosis measured from pulse wave velocity is associated with reduced arterial elasticity and is associated with future cardiovascular events.
Vascular measurements may better represent the continuum of cardiovascular disease from a young healthy to an aged diseased vessel that is going to produce adverse clinical events.
心血管损伤临床上表现为冠状动脉疾病、心力衰竭、中风和外周动脉疾病。这些不良情况的患病率随着年龄的增长而升高。尽管许多患者在晚年出现心血管损伤，但在心血管重症监护病房中，年龄低于 50 岁的男性和 55 岁的女性中，常见到有早期动脉粥样硬化的患者。
在对文献的回顾中，我们确定了早期血管损伤的危险因素。经典的危险因素，如年龄、性别、糖尿病、血脂异常、吸烟、饮酒、高血压、肥胖、家族史和更新的生物标志物，如 hs-CRP、叶酸、同型半胱氨酸、纤维蛋白原，既不强也不能预测个体患者发生早期心血管疾病的风险。所有这些危险因素都被用于提出可能未来事件的风险评分，但我们仍然缺乏一个能够独立于经典因素预测未来疾病的单一强标志物。血管成像技术在临床疾病之前识别有亚临床动脉粥样硬化血管损伤的患者的作用，包括已知和未知危险因素对血管树的影响，对于强化高危患者的预防措施似乎非常重要。从脉搏波速度测量的早期动脉硬化与动脉弹性降低有关，并与未来的心血管事件有关。
血管测量可能更好地代表从年轻健康到老年患病血管的心血管疾病连续体，这将产生不良的临床事件。
