踝血压指数与 2 型糖尿病患者和非 2 型糖尿病患者主要不良心血管事件的关系。

Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes.

机构信息

Population Health Research Institute, McMaster University, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada.

Université de Bordeaux, INSERM, BMC, U1034, Avenue de Magellan, 33604, Pessac, France.

出版信息

Cardiovasc Diabetol. 2024 Sep 3;23(1):325. doi: 10.1186/s12933-024-02383-z.

DOI:10.1186/s12933-024-02383-z

PMID:39227845

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11373129/

Abstract

BACKGROUND

The relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes.

METHODS

We used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke.

RESULTS

Among 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98-1.12), 1.17 (1.08-1.25), and 1.54 (1.54-1.65) for ankle SBP; HR 1.06 (0.99-1.14), 1.26 (1.17-1.35), and 1.48 (1.38-1.58) for ABI; and HR 1.02 (0.95-1.10), 1.15 (1.07-1.23), and 1.48 (1.38-1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90-1.21], 1.21 [1.05-1.40], and 1.93 [1.68-2.22]), and APPD (HRs 1.08 [0.93-1.26], 1.30 [1.12-1.50], and 1.97 [1.72-2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05).

CONCLUSIONS

Inverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes.

摘要

背景

踝部血压（BP）与心血管疾病之间的关系仍不清楚。我们研究了已知和新的踝部 BP 指数与 2 型糖尿病患者和非糖尿病患者主要心血管结局之间的关系。

方法

我们使用了 3 项大型试验的数据，这些试验测量了踝部收缩压（SBP）、踝臂指数（ABI，踝部 SBP 除以臂部 SBP）和踝部脉搏压差（APPD，踝部 SBP 减去臂部脉搏压）。主要结局是心血管死亡率、心肌梗死、心力衰竭住院或中风的综合结果。次要结局包括心血管原因导致的死亡、总（致死性和非致死性）心肌梗死、心力衰竭住院和总中风。

结果

在 42929 名参与者（年龄 65.6 岁，女性 31.3%，2 型糖尿病 50.1%，来自 53 个国家）中，5 年随访期间发生了 7230 例（16.8%）主要结局（糖尿病患者为 19.4%，非糖尿病患者为 14.3%）。随着踝部 BP 指数的降低，结局的发生率增加。与踝部 BP 指数处于最高四分位数的患者相比，每个较低四分位数的多变量校正后的风险比（HR，95%CI）分别为 1.05（0.98-1.12）、1.17（1.08-1.25）和 1.54（1.54-1.65），踝部 SBP；HR 分别为 1.06（0.99-1.14）、1.26（1.17-1.35）和 1.48（1.38-1.58），ABI；以及 HR 分别为 1.02（0.95-1.10）、1.15（1.07-1.23）和 1.48（1.38-1.58），APP。与心力衰竭住院相关的踝部 SBP（HRs 1.05 [0.90-1.21]、1.21 [1.05-1.40] 和 1.93 [1.68-2.22]）和 APPD（HRs 1.08 [0.93-1.26]、1.30 [1.12-1.50] 和 1.97 [1.72-2.25]）的效应量最大，而与中风的相关性仅略有关联。在有和没有糖尿病的患者中，这些关系是相似的（所有 p 交互作用均大于 0.05）。