Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District.
Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Xicheng District.
J Hypertens. 2023 Sep 1;41(9):1411-1419. doi: 10.1097/HJH.0000000000003481. Epub 2023 Jun 8.
The brachial-ankle pulse-wave velocity (baPWV) is regarded as the gold standard in the evaluation of arterial stiffness. Its prognostic significance for major adverse cardiovascular events (MACE) has been demonstrated. However, the factors influencing the association between baPWV and MACE risk have not been determined. In this study, we investigated the association of baPWV and MACE risk and whether it is affected by the risk factors for different cardiovascular diseases (CVDs).
This was a prospective cohort study that initially enrolled 6850 participants from 12 communities in Beijing. The participants were divided into three subgroups according to their baPWV values. The primary outcome was the first occurrence of MACE, defined as hospitalization from cardiovascular diseases, first occurrence of a nonfatal myocardial infarction, or nonfatal stroke. Cox proportional hazards regression and restricted cubic spline analyses were used to examine the association between baPWV and MACE. The effect of CVD risk factors on the relationship between baPWV and MACE was explored in subgroup analyses.
The final study population consisted of 5719 participants. During a median follow-up of 34.73 months, MACE occurred in 169 participants. The restricted cubic spline analysis indicated a positive linear relationship between baPWV and MACE risk. After adjustment for cardiovascular risk factors, the hazard ratio (HR) for MACE risk per SD increase in baPWV was 1.272 [95% confidence interval (CI): 1.149-1.407, P < 0.001], and the HR for MACE in the high-baPWV vs. the low-baPWV group was 1.965 (95% CI: 1.296-2.979, P = 0.001). Adding baPWV to the conventional cardiovascular risk factors significantly improved the model's prediction performance and the net reclassification (NRI) [NRI: 0.379 (95% CI: 0.072-0.710), P = 0.025] in MACE discrimination. However, in the subgroup analysis, two CVD risk factors, stable coronary heart disease and hypertension, showed significant interaction effects ( Pinteraction both < 0.05). This result indicated that the effect of CVD risk factors must be taken into account when assessing the relationship between baPWV and MACE.
baPWV is a potential marker to improve the identification of MACE risk in the general population. A positive linear correlation was firstly determined between baPWV and MACE risk, but it may not be valid in participants with stable coronary heart disease and hypertension.
肱踝脉搏波速度（baPWV）被认为是评估动脉僵硬度的金标准。其对主要不良心血管事件（MACE）的预后意义已得到证实。然而，影响 baPWV 与 MACE 风险关联的因素尚未确定。在这项研究中，我们调查了 baPWV 与 MACE 风险的关联，以及它是否受不同心血管疾病（CVD）危险因素的影响。
这是一项前瞻性队列研究，最初纳入了来自北京 12 个社区的 6850 名参与者。根据其 baPWV 值，参与者被分为三组。主要结局是 MACE 的首次发生，定义为心血管疾病住院、首次发生非致命性心肌梗死或非致命性卒中。使用 Cox 比例风险回归和限制性立方样条分析来检验 baPWV 与 MACE 之间的关联。在亚组分析中探讨了 CVD 危险因素对 baPWV 与 MACE 之间关系的影响。
最终的研究人群包括 5719 名参与者。在中位数为 34.73 个月的随访期间，169 名参与者发生了 MACE。限制性立方样条分析表明，baPWV 与 MACE 风险之间存在正线性关系。在调整心血管危险因素后，baPWV 每增加一个标准差，MACE 风险的危险比（HR）为 1.272[95%置信区间（CI）：1.149-1.407，P<0.001]，高 baPWV 组与低 baPWV 组相比，MACE 的 HR 为 1.965（95%CI：1.296-2.979，P=0.001）。将 baPWV 添加到常规心血管危险因素中显著提高了模型的预测性能和净重新分类（NRI）[NRI：0.379（95%CI：0.072-0.710），P=0.025]。然而，在亚组分析中，两个 CVD 危险因素，稳定型冠心病和高血压，显示出显著的交互作用（P 交互均<0.05）。这一结果表明，在评估 baPWV 与 MACE 之间的关系时，必须考虑 CVD 危险因素的影响。
baPWV 是一种潜在的标志物，可以提高普通人群对 MACE 风险的识别能力。首次确定了 baPWV 与 MACE 风险之间的正线性相关性，但在患有稳定型冠心病和高血压的患者中可能无效。
