Xia Mengying, An Jaejin, Fischer Heidi, Allen Norrina B, Xanthakis Vanessa, Zhang Yiyi
Division of General Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Am J Hypertens. 2024 Dec 16;38(1):38-45. doi: 10.1093/ajh/hpae126.
Studying the association between blood pressure (BP) trajectories during young adulthood and subsequent cardiovascular disease (CVD) risk can provide insights into how long-term BP patterns in early-life influence the development of CVD later in life.
We pooled data from 2 US cohorts (Coronary Artery Risk Development in Young Adults, Framingham Heart Study). We used latent growth curve models to identify distinct BP trajectory groups between ages 18 and 39 years. We then used Cox proportional hazards models to assess the associations between BP trajectories and CVD events (composite of coronary heart disease [CHD], stroke, and heart failure [HF]) after age 40 years.
We included 6,579 participants and identified 4 distinct systolic BP (SBP) trajectory groups during young adulthood. During a median follow-up of 18.2 years after age 40 years, 213 CHD, 139 stroke, 120 HF, and 400 composite CVD events occurred. Individuals in an elevated-increasing vs. low-stable SBP trajectory during young adulthood were associated with a higher risk of CVD after adjusting for traditional CVD risk factors, with hazard ratios (95% confidence interval) of 3.25 (1.63, 6.46) for CHD, 3.92 (1.63, 9.43) for stroke, 8.30 (2.97, 23.17) for HF, and 3.91 (2.38, 6.41) for composite CVD outcomes. Adding BP trajectory to BP at baseline improved model discrimination for all outcomes (changes in Harrell's C-index 0.0084-0.0192).
An elevated-increasing BP trajectory during young adulthood is associated with a higher risk of CVD later in life, highlighting the importance of maintaining a low-stable BP trajectory throughout the young adulthood period for prevention of CVD in later life.
研究青年期血压（BP）轨迹与随后心血管疾病（CVD）风险之间的关联，有助于深入了解生命早期的长期血压模式如何影响晚年CVD的发生发展。
我们汇总了来自2个美国队列（青年成人冠状动脉风险发展研究、弗雷明汉心脏研究）的数据。我们使用潜在增长曲线模型来识别18至39岁之间不同的血压轨迹组。然后，我们使用Cox比例风险模型来评估血压轨迹与40岁以后CVD事件（冠心病[CHD]、中风和心力衰竭[HF]的综合）之间的关联。
我们纳入了6579名参与者，并识别出青年期4种不同的收缩压（SBP）轨迹组。在40岁后的中位随访18.2年期间，发生了213例CHD、139例中风、120例HF和400例CVD综合事件。在调整传统CVD危险因素后，青年期处于升高-上升型与低-稳定型SBP轨迹的个体发生CVD的风险更高，CHD的风险比（95%置信区间）为3.25（1.63，6.46），中风为3.92（1.63，9.43），HF为8.30（2.97，23.17），CVD综合结局为3.91（2.38，6.41）。将血压轨迹纳入基线血压可改善所有结局的模型判别能力（Harrell氏C指数变化0.0084 - 0.0192）。
青年期升高-上升型血压轨迹与晚年发生CVD的较高风险相关，这凸显了在整个青年期维持低-稳定型血压轨迹以预防晚年CVD的重要性。
