美国健康白人和非裔美国人之间动脉僵硬度的种族差异：一项荟萃分析。
Racial Disparities in Arterial Stiffness Between Healthy Whites and African Americans in the United States: A Meta-analysis.
机构信息
Medical University of South Carolina WISSDOM Center, 96 Jonathan Lucas St., CSB 301, MSC 606, Charleston, SC 29425, USA.
Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, USA.
出版信息
J Natl Med Assoc. 2019 Feb;111(1):7-17. doi: 10.1016/j.jnma.2018.06.001. Epub 2018 Jul 4.
BACKGROUND
African Americans (AAs) present with cardiovascular disease (CVD) risk factors at younger ages than whites. Consequently, CVD and stroke occur at a higher incidence and at earlier decades in life in AA populations. Arterial stiffness is a predictor of CVD outcomes and partially explains the CVD risk experienced by racial minorities. We evaluated the differences in arterial stiffness observed in AAs and whites through a systematic review and meta-analysis.
METHODS
We searched PubMed and SCOPUS for comparative studies published March 1995 to November 29, 2017 comparing arterial stiffness assessments (pulse wave velocity, augmentation index, and central blood pressure) between AAs and whites. Two independent reviewers examined 195 titles/abstracts, 85 full text articles and 11 articles were included in the meta-analysis using random effects modeling approaches.
MAIN RESULTS
A total of 5060 white and 3225 AAs were included across 11 relevant studies. Carotid-femoral pulse wave velocity (cfPWV) measures were statistically different between AAs and whites (mean difference = -0.44, 95% confidence interval [CI]: -[-0.67, -0.21], p = 0.0002). Aortic femoral pulse wave velocity was significantly different between AAs and whites (mean difference = -0.21, [95% CI] -0.35, -0.07, p = 0.003) regardless of sex. Augmentation index (AIx) and Augmentation index at a 75 beats per minutes heart rate (AIx @75) was also significantly different between AA and whites (mean difference = -4.36 [95% CI] = -6.59, -2,12, p = 0.0001 and -6.26, [95% CI] = -9.19, -3.33, p < 0.0001, respectively).
CONCLUSIONS
Racial disparities in arterial stiffness persist among African American racial groups in the United States. The lack of homogeneity in studies capturing racial disparities in cfPWV suggest that additional studies are needed to understand the magnitude of racial differences in African Americans and whites that might be clinically relevant.
背景
非裔美国人（African Americans，AAs）患心血管疾病（cardiovascular disease，CVD）的风险因素的年龄比白人更早。因此，非裔美国人的 CVD 和中风的发病率更高，且发病年龄更早。动脉僵硬度是 CVD 结局的预测因子，并部分解释了少数族裔所经历的 CVD 风险。我们通过系统评价和荟萃分析评估了非裔美国人和白人之间观察到的动脉僵硬度差异。
方法
我们在 PubMed 和 SCOPUS 中搜索了 1995 年 3 月至 2017 年 11 月 29 日发表的比较研究，比较了非裔美国人和白人之间的动脉僵硬度评估（脉搏波速度、增强指数和中心血压）。两名独立的审查员检查了 195 个标题/摘要，85 篇全文文章，11 篇文章被纳入使用随机效应模型方法的荟萃分析。
主要结果
共有 5060 名白人患者和 3225 名非裔美国人患者纳入了 11 项相关研究。非裔美国人和白人之间的颈股脉搏波速度（carotid-femoral pulse wave velocity，cfPWV）测量值存在统计学差异（平均差异=-0.44，95%置信区间[-0.67，-0.21]，p=0.0002）。无论性别如何，主动脉股脉搏波速度在非裔美国人和白人之间也存在显著差异（平均差异=-0.21，95%置信区间[0.35，-0.07]，p=0.003）。增强指数（augmentation index，AIx）和心率为 75 次/分钟时的增强指数（augmentation index at a 75 beats per minutes heart rate，AIx@75）在非裔美国人和白人之间也存在显著差异（平均差异=-4.36，95%置信区间[-6.59，-2.12]，p=0.0001 和-6.26，95%置信区间[-9.19，-3.33]，p<0.0001）。
结论
在美国，非裔美国人种族群体中动脉僵硬度的种族差异仍然存在。在捕捉 cfPWV 中种族差异的研究中缺乏同质性，这表明需要进一步研究以了解非裔美国人和白人之间种族差异的程度，这可能具有临床意义。
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