Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Provincial Key Laboratory of Geriatric Disease, Shengli Clinical Medical College of Fujian Medical University, 134 East Street, Fuzhou, 350001, Fujian, China.
Department of ophthalmology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
BMC Cardiovasc Disord. 2020 Mar 24;20(1):145. doi: 10.1186/s12872-020-01425-0.
We hypothesized that discriminating the early subclinical organ damage would serve as a great opportunity for prevention against atherosclerotic cardiovascular disease (ASCVD). Brachial-ankle pulse wave velocity (baPWV), low retinal vascular fractal dimension, and albuminuria are surrogates of subclinical vascular changes.
The aim of this study was to use Pooled Cohort Equations (PCE) and ASCVD risk equations derived from "Prediction for ASCVD Risk in China project (CHINA-PAR)" to observe the prevalence of macro- and microcirculation abnormalities. A total of 2166 subjects were involved. Characteristics were investigated using questionnaire and physical examinations. We calculated the urine albumin to creatinine ratio (UACR). The baPWV was measured using a fully automatic arteriosclerosis detector. The retinal vascular fractal dimension was measured by a semiautomated computer-based program. The 10-year ASCVD risk was estimated using the PCE and CHINA-PAR model.
The cut-off values for the elevated baPWV were 2.82 and 2.92% in the PCE model and CHINA-PAR model, respectively, with nearly 85% sensitivity and an average specificity of 74%. For low retinal fractal dimension, at the cut-off point of 3.8%, we acquired an acceptable sensitivity of 66.27-68.24% and specificity of 62.57-67.45%. All the C-statistics presented a significant improvement from the PCE model to the CHINA-PAR model (P < 0.05). For all categories-net reclassification improvement (NRI) values were significant and clearly varied (0.329, 0.183, and 0.104, respectively) depending on the cut-off set at 3%.
Our study demonstrated that the CHINA-PAR equations rather than PCE could provide better identification of macro- and microcirculation abnormalities. A lower cut-off point for the subclinical vascular changes may be selected in a population from southeast China.
我们假设，早期亚临床器官损伤的鉴别将为预防动脉粥样硬化性心血管疾病（ASCVD）提供绝佳机会。臂踝脉搏波速度（baPWV）、低视网膜血管分形维数和白蛋白尿是亚临床血管变化的替代指标。
本研究旨在使用 Pooled Cohort Equations（PCE）和源自“中国动脉粥样硬化性心血管疾病风险预测项目（CHINA-PAR）”的 ASCVD 风险方程来观察宏观和微循环异常的患病率。共纳入 2166 名受试者。通过问卷调查和体格检查来研究特征。我们计算了尿白蛋白与肌酐比值（UACR）。使用全自动动脉硬化检测仪测量 baPWV。使用半自动基于计算机的程序测量视网膜血管分形维数。使用 PCE 和 CHINA-PAR 模型估计 10 年 ASCVD 风险。
PCE 模型和 CHINA-PAR 模型中，baPWV 升高的截断值分别为 2.82%和 2.92%，具有近 85%的灵敏度和平均 74%的特异性。对于低视网膜分形维数，在截断点为 3.8%时，我们获得了可接受的灵敏度 66.27%-68.24%和特异性 62.57%-67.45%。所有 C 统计量均显示出从 PCE 模型到 CHINA-PAR 模型的显著改善（P<0.05）。所有类别-净重新分类改善（NRI）值均有显著差异（分别为 0.329、0.183 和 0.104），这取决于设定为 3%的截断值。
我们的研究表明，CHINA-PAR 方程而非 PCE 可以更好地识别宏观和微观循环异常。在中国东南部人群中，亚临床血管变化的截断值可能会更低。
