Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Epidemiological Study Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Eur J Vasc Endovasc Surg. 2022 Apr;63(4):641-647. doi: 10.1016/j.ejvs.2022.01.010. Epub 2022 Mar 5.
The aim was to analyse whether the association between carotid atherosclerosis (CA) and atrial fibrillation (AF), heart function, and renal function is mediated by traditional risk factors.
In the prospective, single centre, long term, population based Hamburg City Health Study citizens, between 45 and 74 years of age were studied by cross sectional analysis of the first cohort. Laboratory values, blood pressure, heart rhythm, and body mass index (BMI) were examined. Carotid intima media thickness (CIMT) and plaques were assessed by carotid ultrasound, and CA was defined as either CIMT ≥ 1 mm or presence of plaques or both. N-terminal pro-brain natriuretic peptide (NT-proBNP), and glomerular filtration rate (eGFR) were quantified as measures of heart and renal function. Association between CA and AF, NT-proBNP, and eGFR was analysed by multivariable linear and logistic regression.
Of the first 10 000 participants, carotid ultrasound was available for 9 466 (95%). Of these, 2 937 (31%) had carotid plaques, 643 (7%) had CIMT ≥ 1 mm, and 412 (4%) presented with both, so that 3 168 (34%) had CA. Participants with CA had AF more frequently (9.6% vs. 4.3%; p < .001), higher levels of NT-proBNP (median 100 vs. 73 pg/mL; p < .001), and lower eGFR (82.8 vs. 87.1 mL/min; p < .001) than those without CA. Adjusted for age and sex, CA was associated with AF (p = .01; OR 1.29) and higher NT-proBNP levels (p < .001; β = 0.12), but not with eGFR. After further adjustment for vascular risk factors and history of cardiovascular diseases, CA remained associated with NT-proBNP (p < .001; β = 0.10), but additionally adjusted for NT-proBNP (p < .001; OR 2.80) not with AF.
CA is independently associated with higher levels of NT-proBNP, through common risk factors and NT-proBNP with AF, and not with renal function. CA's association with a marker of cardiac dysfunction beyond known common risk factors supports the value of carotid ultrasound in defining patients' cardiovascular risk profile. The measures of CA, i.e., CIMT and carotid plaque, had an equally directed and additive influence.
分析颈动脉硬化（CA）与心房颤动（AF）、心功能和肾功能之间的关联是否通过传统危险因素介导。
在前瞻性、单中心、长期、基于人群的汉堡城市健康研究中，通过对第一个队列进行横断面分析，研究了 45 至 74 岁的公民。检查了实验室值、血压、心律和体重指数（BMI）。通过颈动脉超声评估颈动脉内膜中层厚度（CIMT）和斑块，将 CA 定义为 CIMT≥1mm 或存在斑块或两者兼有。用 N 端脑利钠肽前体（NT-proBNP）和肾小球滤过率（eGFR）作为心肾功能的衡量标准。通过多变量线性和逻辑回归分析 CA 与 AF、NT-proBNP 和 eGFR 之间的关系。
在最初的 10000 名参与者中，有 9466 名（95%）接受了颈动脉超声检查。其中，2937 名（31%）有颈动脉斑块，643 名（7%）CIMT≥1mm，412 名（4%）两者均有，因此 3168 名（34%）有 CA。患有 CA 的参与者发生 AF 的频率更高（9.6% vs. 4.3%；p<.001），NT-proBNP 水平更高（中位数 100 vs. 73pg/ml；p<.001），eGFR 水平更低（82.8 vs. 87.1ml/min；p<.001）。与无 CA 者相比。调整年龄和性别后，CA 与 AF（p=0.01；OR 1.29）和更高的 NT-proBNP 水平相关（p<.001；β=0.12），但与 eGFR 无关。进一步调整血管危险因素和心血管疾病史后，CA 仍与 NT-proBNP 相关（p<.001；β=0.10），但在进一步调整 NT-proBNP 后（p<.001；OR 2.80）与 AF 无关。
CA 与较高的 NT-proBNP 水平独立相关，这是通过共同的危险因素和 NT-proBNP 与 AF 相关的，而与肾功能无关。CA 与心脏功能障碍标志物的关联超出了已知的共同危险因素，支持颈动脉超声在确定患者心血管风险特征方面的价值。CA 的指标，即 CIMT 和颈动脉斑块，具有相同的方向和叠加的影响。
