Neuhauser Hannelore K, Büschges Julia, Schaffrath Rosario Angelika, Schienkiewitz Anja, Sarganas Giselle, Königstein Karsten, Schweizer Dieter, Schmidt-Trucksäss Arno
Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany (H.K.N., J.B., A.S.R., A.S., G.S.).
DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (H.K.N., J.B., A.S., G.S., K.K.).
Hypertension. 2022 Jun;79(6):1167-1176. doi: 10.1161/HYPERTENSIONAHA.121.18521. Epub 2022 Mar 8.
This study aimed to derive carotid intima media thickness (CIMT) percentiles from a population-based sample of adolescents and young adults using improved technology, standardization and quality control, and to investigate the association of CIMT with hypertensive blood pressure (BP) and obesity.
Four thousand seven hundred nine 14- to 28-year-old participants of the German KiGGS cohort 11-year follow-up, which was based on a nationwide population sample, had B-mode ultrasound CIMT measurement with semi-automated edge-detection and automatic ECG-gated real-time quality control. CIMT percentiles were estimated from far wall CIMT during 2 to 6 heart cycles using the GAMLSS statistical model. Hypertensive BP, overweight, obesity, and a risk score from added Z scores of triglycerides, total/HDL (high-density lipoprotein)-cholesterol ratio, and glycated hemoglobin were based on standardized measurements at baseline and follow-up.
CIMT differed by sex at all ages, furthermore by age and height in a nonlinear fashion. Percentiles were estimated simultaneously by age and height. Hypertensive BP and obesity were associated cross-sectionally and longitudinally with a higher risk of CIMT ≥75th percentile in log-binomial regression models adjusted for age, sex, height, current smoking, and cardiovascular risk score. For CIMT ≥90th percentile, the relative risk effect estimates were consistently >1 but often had large confidence intervals including 1, largest adjusted relative risk 3.37 (95% CI, 1.41-8.04) for the combination of hypertensive BP and obesity at follow-up.
Based on state-of-the-art measurements and statistical techniques, these population-based CIMT percentiles by sex, age and height add unbiased evidence for the association of subclinical atherosclerosis with hypertensive BP and obesity in the young.
本研究旨在利用改进的技术、标准化和质量控制，从以人群为基础的青少年和青年样本中得出颈动脉内膜中层厚度（CIMT）百分位数，并研究CIMT与高血压血压（BP）和肥胖症之间的关联。
基于全国人群样本的德国KiGGS队列11年随访中的4709名14至28岁参与者，采用半自动边缘检测和自动心电图门控实时质量控制进行B型超声CIMT测量。使用GAMLSS统计模型在2至6个心动周期内根据远壁CIMT估计CIMT百分位数。高血压BP、超重、肥胖以及甘油三酯、总胆固醇/高密度脂蛋白（HDL）胆固醇比值和糖化血红蛋白的Z评分相加得出的风险评分，均基于基线和随访时的标准化测量。
CIMT在所有年龄段均存在性别差异，此外还随年龄和身高呈非线性变化。百分位数通过年龄和身高同时进行估计。在针对年龄、性别、身高、当前吸烟情况和心血管风险评分进行调整的对数二项回归模型中，高血压BP和肥胖症在横断面和纵向均与CIMT≥第75百分位数的较高风险相关。对于CIMT≥第90百分位数，相对风险效应估计值始终>1，但置信区间通常较大，包括1，随访时高血压BP和肥胖症组合的最大调整相对风险为3.37（95%CI，1.41 - 8.04）。
基于先进的测量和统计技术，这些按性别、年龄和身高划分的基于人群的CIMT百分位数为年轻人中亚临床动脉粥样硬化与高血压BP和肥胖症之间的关联提供了无偏倚证据。
