Niiranen Teemu J, Kalesan Bindu, Larson Martin G, Hamburg Naomi M, Benjamin Emelia J, Mitchell Gary F, Vasan Ramachandran S
From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
Hypertension. 2017 Jun;69(6):1022-1028. doi: 10.1161/HYPERTENSIONAHA.116.08917. Epub 2017 Apr 10.
A recent study reported that the aortic-brachial arterial stiffness gradient, defined as carotid-radial/carotid-femoral pulse wave velocity (PWV ratio), predicts all-cause mortality better than carotid-femoral pulse wave velocity (CFPWV) alone in dialysis patients. However, the prognostic significance of PWV ratio for cardiovascular disease (CVD) in the community remains unclear. Accordingly, we assessed the correlates and prognostic value of the PWV ratio in 2114 Framingham Heart Study participants (60±10 years; 56% women) free of overt CVD. Mean PWV ratio decreased from 1.36±0.19 in participants aged <40 years to 0.73±0.21 in those aged ≥80 years. In multivariable linear regression, older age, male sex, higher body mass index, diabetes mellitus, lower high-density lipoprotein cholesterol, higher mean arterial pressure, and higher heart rate were associated with lower PWV ratio (<0.001 for all). During a median follow-up of 12.6 years, 248 first CVD events occurred. In Cox regression models adjusted for standard CVD risk factors, 1-SD changes in CFPWV (hazard ratio, 1.33; 95% confidence interval, 1.10-1.61) and PWV ratio (hazard ratio, 1.32; 95% confidence interval, 1.09-1.59) were associated with similar CVD risks. Models that included conventional CVD risk factors plus CFPWV or PWV ratio gave the same C statistics (C=0.783). Although PWV ratio has been reported to provide incremental predictive value over CFPWV in dialysis patients, we could not replicate these findings in our community-based sample. Our findings suggest that the prognostic significance of PWV ratio may vary based on baseline CVD risk, and CFPWV should remain the criterion standard for assessing vascular stiffness in the community.
最近一项研究报告称，主动脉-肱动脉僵硬度梯度（定义为颈动脉-桡动脉/颈动脉-股动脉脉搏波速度比值，即PWV比值）在预测透析患者全因死亡率方面优于单独使用颈动脉-股动脉脉搏波速度（CFPWV）。然而，PWV比值对社区心血管疾病（CVD）的预后意义仍不明确。因此，我们评估了2114名弗明汉心脏研究参与者（年龄60±10岁；56%为女性）中PWV比值的相关因素及其预后价值，这些参与者无明显CVD。平均PWV比值从年龄<40岁参与者的1.36±0.19降至年龄≥80岁参与者的0.73±0.21。在多变量线性回归中，年龄较大、男性、较高的体重指数、糖尿病、较低的高密度脂蛋白胆固醇、较高的平均动脉压和较高的心率与较低的PWV比值相关（所有P值均<0.001）。在中位随访12.6年期间，发生了248例首次CVD事件。在针对标准CVD危险因素进行调整的Cox回归模型中，CFPWV的1-SD变化（风险比，1.33；95%置信区间，1.10-1.61）和PWV比值的1-SD变化（风险比，1.32；95%置信区间，1.09-1.59）与相似的CVD风险相关。包含传统CVD危险因素加上CFPWV或PWV比值的模型具有相同的C统计量（C=0.783）。尽管在透析患者中，PWV比值据报道比CFPWV具有更高的预测价值，但我们在基于社区的样本中未能重现这些发现。我们的研究结果表明，PWV比值的预后意义可能因基线CVD风险而异，CFPWV应仍然是社区评估血管僵硬度的标准指标。
