Abe Temidayo A, Olanipekun Titilope, Yan Fengxia, Effoe Valery, Udongwo Ndausung, Oshunbade Adebamike, Thomas Victoria, Onuorah Ifeoma, Terry James G, Yimer Wondwosen K, Ghali Jalal K, Correa Adolfo, Onwuanyi Anekwe, Michos Erin D, Benjamin Emelia J, Echols Melvin
Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Internal Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.
Am J Hypertens. 2024 Mar 15;37(4):290-297. doi: 10.1093/ajh/hpae008.
We aim to determine the added value of carotid intima-media thickness (cIMT) in stroke risk assessment for hypertensive Black adults.
We examined 1,647 participants with hypertension without a history of cardiovascular (CV) disease, from the Jackson Heart Study. Cox regression analysis estimated hazard ratios (HRs) for incident stroke per standard deviation increase in cIMT and quartiles while adjusting for baseline variables. We then evaluated the predictive capacity of cIMT when added to the pool cohort equations (PCEs).
The mean age at baseline was 57 ± 10 years. Each standard deviation increase in cIMT (0.17 mm) was associated with approximately 30% higher risk of stroke (HR 1.27, 95% confidence interval: 1.08-1.49). Notably, cIMT proved valuable in identifying residual stroke risk among participants with well-controlled blood pressure, showing up to a 56% increase in the odds of stroke for each 0.17 mm increase in cIMT among those with systolic blood pressure <120 mm Hg. Additionally, the addition of cIMT to the PCE resulted in the reclassification of 58% of low to borderline risk participants with stroke to a higher-risk category and 28% without stroke to a lower-risk category, leading to a significant net reclassification improvement of 0.22 (0.10-0.30).
In this community-based cohort of middle-aged Black adults with hypertension and no history of CV disease at baseline, cIMT is significantly associated with incident stroke and enhances stroke risk stratification.
我们旨在确定颈动脉内膜中层厚度（cIMT）在高血压黑人成年人中风风险评估中的附加价值。
我们对来自杰克逊心脏研究的1647名无心血管（CV）疾病病史的高血压参与者进行了检查。Cox回归分析估计了cIMT每增加一个标准差和四分位数时发生中风的风险比（HRs），同时对基线变量进行了调整。然后，我们评估了将cIMT添加到汇总队列方程（PCEs）中的预测能力。
基线时的平均年龄为57±10岁。cIMT每增加一个标准差（0.17毫米），中风风险就会增加约30%（HR 1.27，95%置信区间：1.08 - 1.49）。值得注意的是，cIMT在识别血压控制良好的参与者中的残余中风风险方面被证明是有价值的，对于收缩压<120毫米汞柱的参与者，cIMT每增加0.17毫米，中风几率最高可增加56%。此外，将cIMT添加到PCE中导致58%中风风险低至临界的参与者重新分类为更高风险类别，28%未中风的参与者重新分类为更低风险类别，导致显著的净重新分类改善0.22（0.10 - 0.30）。
在这个以社区为基础的中年黑人高血压队列中，基线时无CV疾病病史，cIMT与中风事件显著相关，并增强了中风风险分层。
