Ryliškytė Ligita, Navickas Rokas, Šerpytis Pranas, Puronaitė Roma, Zupkauskienė Jūratė, Jucevičienė Agnė, Badarienė Jolita, Rimkienė Mantė Agnė, Ryliškienė Kristina, Skiauterytė Eglė, Laucevičius Aleksandras
a Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania.
b Faculty of Medicine , Vilnius University , Vilnius , Lithuania.
Blood Press. 2019 Apr;28(2):131-138. doi: 10.1080/08037051.2019.1569461. Epub 2019 Jan 30.
The objective of this study was to assess predictive value of various arterial markers for cardiovascular (CV) events in patients with metabolic syndrome (MetS).
A longitudinal study with the follow-up period of 3.9 ± 1.7 years investigated 2728 middle-aged (53.9 ± 6.2 years old, 63% women) MetS subjects without overt CV disease. The study cohort was comprised of the participants of the Lithuanian High Cardiovascular Risk primary prevention program. The baseline assessment included the evaluation of brachial flow-mediated dilatation (FMD), carotid intima-media thickness (cIMT), carotid stiffness index, aortic pulse wave velocity (aPWV), aortic augmentation index (AIx), and cardio-ankle vascular index). The data on the cardiovascular outcome (fatal or non-fatal myocardial infarction or stroke) was collected by using the databases of the two major national registries.
Over the follow-up period, 83 (3%) patients had at least one cardiovascular event. In a univariate analysis, occurrence of CV events was associated with the following parameters: higher mean blood pressure, aPWV, AIx and cIMT, and lower FMD (all p < .05). In Cox proportional hazard regression analysis, the occurrence of CV event was associated with an increase in aPWV (HR 1.29, 95% CI 1.04-1.60, p = .019), AIx (HR 1.53, 95% CI 1.16-2.02, p = .003), and cIMT (HR 1.31, 95% CI 1.14-1.50, p < .001), and with the decrease in FMD (HR 0.83, 95% CI 0.71-0.97, p = .016) even after the adjustment for age, gender, and common cardiometabolic risk factors. In a two-level survival trees analysis, we established that patients with cIMT > 794 mcm had higher CV risk (p < .001) and their prognosis was further compromised by aPWV > 11.1 m/s (p = .023). Meanwhile, in patients with cIMT ≤ 794mcm, the FMD cut-off point of 6.5% further stratified the risk (p = .003).
In our prospective study, CV risk in the middle-aged patients with MetS was associated with an increase in cIMT and aPWV, and with a decrease in FMD.
本研究旨在评估各种动脉标志物对代谢综合征（MetS）患者心血管（CV）事件的预测价值。
一项随访期为3.9±1.7年的纵向研究，调查了2728名无明显心血管疾病的中年（53.9±6.2岁，63%为女性）MetS患者。研究队列由立陶宛高心血管风险一级预防项目的参与者组成。基线评估包括肱动脉血流介导的舒张功能（FMD）、颈动脉内膜中层厚度（cIMT）、颈动脉僵硬度指数、主动脉脉搏波速度（aPWV）、主动脉增强指数（AIx）和心-踝血管指数的评估。心血管结局（致命或非致命心肌梗死或中风）的数据通过两个主要国家登记处的数据库收集。
在随访期间，83名（3%）患者至少发生了一次心血管事件。单因素分析中，CV事件的发生与以下参数相关：较高的平均血压、aPWV、AIx和cIMT，以及较低的FMD（均p<0.05）。在Cox比例风险回归分析中，即使在调整了年龄、性别和常见心脏代谢危险因素后，CV事件的发生仍与aPWV升高（HR 1.29，95%CI 1.04-1.60，p=0.019）、AIx升高（HR 1.53，95%CI 1.16-2.02，p=0.003）和cIMT升高（HR 1.31，95%CI 1.14-1.50，p<0.001）以及FMD降低（HR 0.83，95%CI 0.71-0.97，p=0.016）相关。在两级生存树分析中，我们确定cIMT>794μm的患者具有较高的CV风险（p<0.001），而aPWV>11.1m/s会进一步损害其预后（p=0.023）。同时，在cIMT≤794μm的患者中，FMD切点为6.5%可进一步分层风险（p=0.003）。
在我们的前瞻性研究中，中年MetS患者的CV风险与cIMT和aPWV升高以及FMD降低相关。
