Kamimura Daisuke, Suzuki Takeki, Musani Solomon K, Hall Michael E, Samdarshi Tandaw E, Correa Adolfo, Fox Ervin R
Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
Department of Medicine, University of Mississippi Medical Center, Jackson, MS
J Am Heart Assoc. 2017 Jun 21;6(6):e005005. doi: 10.1161/JAHA.116.005005.
Enlargement of the proximal aorta is associated with aortic wall tissue remodeling, including fragmentation of the elastin fibers, increased synthesis of collagen, and calcification, all of which are associated with aortic wall stiffening. We hypothesized that the proximal aortic diameter (AoD) is associated with cardiovascular events in a community-based cohort of blacks.
We investigated the associations between AoD and cardiovascular events among 3018 black participants (mean age, 55.9 years; 69% women) without past history of cardiovascular disease in the Jackson Heart Study. AoD was measured using echocardiography at the level of the sinuses of Valsalva at end diastole. Cardiovascular event was defined as incident myocardial infarction, fatal coronary artery disease, stroke, or heart failure hospitalization. Cox proportional hazards regression models were used to evaluate the association between baseline AoD and cardiovascular events. Over a median follow-up of 8.3 years, there were 258 cardiovascular events (incident rate, 10.5 per 1000 person-years). After adjustment for traditional risk factors, increased AoD was significantly associated with cardiovascular events (hazard ratio per 1-cm increase, 1.72; 95% CI, 1.10-2.69; <0.05). Participants in the top AoD quintile had a higher incidence of cardiovascular events compared to those not in the top quintile (hazard ratio, 1.47; 95% CI, 1.11-1.94; <0.005) after adjustment for risk factors.
Greater AoD was associated with an increased risk of cardiovascular events in a community-based cohort of blacks. AoD may be useful as a predictor of incident cardiovascular events and further investigation is warranted.
升主动脉扩张与主动脉壁组织重塑有关，包括弹性纤维断裂、胶原蛋白合成增加和钙化，所有这些都与主动脉壁僵硬有关。我们假设，在以社区为基础的黑人队列中，升主动脉直径（AoD）与心血管事件有关。
在杰克逊心脏研究中，我们调查了3018名无心血管疾病病史的黑人参与者（平均年龄55.9岁；69%为女性）中AoD与心血管事件之间的关联。在舒张末期，使用超声心动图在主动脉瓣窦水平测量AoD。心血管事件定义为新发心肌梗死、致命性冠状动脉疾病、中风或因心力衰竭住院。使用Cox比例风险回归模型评估基线AoD与心血管事件之间的关联。在中位随访8.3年期间，发生了258例心血管事件（发生率为每1000人年10.5例）。在调整传统危险因素后，AoD增加与心血管事件显著相关（每增加1厘米的风险比为1.72；95%CI为1.10 - 2.69；P<0.05）。在调整危险因素后，AoD最高五分位数的参与者与不在最高五分位数的参与者相比，心血管事件发生率更高（风险比为1.47；95%CI为1.11 - 1.94；P<0.005）。
在以社区为基础的黑人队列中，较大的AoD与心血管事件风险增加有关。AoD可能作为新发心血管事件的预测指标，值得进一步研究。
