Suzuki Yuta, Kaneko Hidehiro, Yano Yuichiro, Okada Akira, Itoh Hidetaka, Ueno Kensuke, Matsuoka Satoshi, Fujiu Katsuhito, Michihata Nobuaki, Jo Taisuke, Takeda Norifumi, Morita Hiroyuki, Yokota Isao, Node Koichi, Yasunaga Hideo, Komuro Issei
The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama 351-0197, Japan.
Eur J Prev Cardiol. 2022 Dec 21;29(18):2338-2346. doi: 10.1093/eurjpc/zwac205.
Data on the dose-dependent association of blood pressure (BP) and fasting plasma glucose (FPG) level with the risk of aortic dissection (AD) and aortic aneurysm (AA) are limited.
This observational cohort study included 3 358 293 individuals registered in a health checkup and claims database in Japan [median age, 43 (36-51) years; 57.2% men]. Individuals using BP- or glucose-lowering medications or those with a history of cardiovascular disease were excluded. In a mean follow-up period of 1 199 ± 950 days, 1 095 and 2 177 cases of AD and AA, respectively, were recorded. Compared with normal/elevated BP, hazard ratios (HRs) of Stage 1 and Stage 2 hypertension were 1.89 [95% confidence interval (CI): 1.60-2.22] and 5.87 (95% CI: 5.03-6.84) for AD and 1.37 (95% CI: 1.23-1.52) and 2.17 (95% CI: 1.95-2.42) for AA, respectively. Compared with normal FPG level, HRs of prediabetes and diabetes were 0.82 (95% CI: 0.71-0.94) and 0.48 (95% CI: 0.33-0.71) for AD and 0.94 (95% CI: 0.85-1.03) and 0.61 (95% CI: 0.47-0.79) for AA, respectively. The cubic spline demonstrated that the risk of AD and AA increased with increasing BP but decreased with increasing FPG level. Contour plots using generalized additive models showed that higher systolic BP and lower FPG level were associated with an elevated risk of AD and AA.
Our analysis showed a dose-dependent increase in the risk of AD or AA associated with BP and a similar decrease associated with FPG, and also suggested a potential interaction between hypertension and hyperglycaemia in the development of AD and AA.
关于血压（BP）和空腹血糖（FPG）水平与主动脉夹层（AD）和主动脉瘤（AA）风险的剂量依赖性关联的数据有限。
这项观察性队列研究纳入了日本健康体检和理赔数据库中登记的3358293名个体[中位年龄43（36 - 51）岁；男性占57.2%]。排除了使用降压或降糖药物的个体或有心血管疾病史的个体。在平均随访1199±950天期间，分别记录了1095例AD和2177例AA病例。与正常/血压升高相比，1期和2期高血压患者发生AD的风险比（HR）分别为1.89[95%置信区间（CI）：1.60 - 2.22]和5.87（95%CI：5.03 - 6.84），发生AA的风险比分别为1.37（95%CI：1.23 - 1.52）和2.17（95%CI：1.95 - 2.42）。与正常FPG水平相比，糖尿病前期和糖尿病患者发生AD的HR分别为0.82（95%CI：0.71 - 0.94）和0.48（95%CI：0.33 - 0.71），发生AA的HR分别为0.94（95%CI：0.85 - 1.03）和0.61（95%CI：0.47 - 0.79）。三次样条曲线显示，AD和AA的风险随BP升高而增加，但随FPG水平升高而降低。使用广义相加模型的等高线图显示，较高的收缩压和较低的FPG水平与AD和AA风险升高相关。
我们的分析表明，AD或AA风险与BP呈剂量依赖性增加，与FPG呈类似的降低，并且还提示高血压和高血糖在AD和AA发生发展过程中可能存在相互作用。
