Dong Gaiying, Wu Tingting, Gu Xiaofan, Wu Liangliang
Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.
Department of Thoracic Surgery, Anhui Public Health Clinical Center, the First Affiliated Hospital of Anhui University North District, Hefei, Anhui, China.
J Clin Hypertens (Greenwich). 2025 Apr;27(4):e70057. doi: 10.1111/jch.70057.
Emerging evidence links the Endothelial Activation and Stress Index (EASIX) and mortality risk in coronary artery disease, but its relevance in hypertensive patients remains unclear. This study examines the association between EASIX and all-cause and cardiovascular mortality in hypertensive individuals. The analysis included 6138 hypertensive patients from seven National Health and Nutrition Examination Survey (NHNES) cycles (2003-2016), with mortality data obtained from the National Death Index (NDI). Over a median follow-up of 98 months, 1435 (23.4%) participants died, including 400 (6.5%) from cardiovascular causes. Restricted cubic spline analysis revealed a positive association between EASIX and both all-cause and cardiovascular mortality. Weighted multivariable Cox regression indicated that each 1-unit increase in EASIX corresponding to a 25% and 23% rise in mortality risk, respectively. Based on the optimal cutoff value determined using the maximally selected rank statistics method, participants were stratified into higher (>0.79) and lower (≤0.79) EASIX groups. Higher EASIX was significantly associated with increased all-cause mortality risk (HR 1.46, 95% CI 1.23-1.73, p < 0.0001). Higher EASIX scores were associated with increased cardiovascular mortality, especially in former/current smokers and those with diabetes/prediabetes. Time-dependent receiver operating characteristic analysis assessed the predictive accuracy of EASIX, yielding area under the curve (AUC) for 1-, 3-, 5-, and 10-year survival of 0.71, 0.67, 0.67, and 0.67 for all-cause mortality and 0.79, 0.73, 0.73, and 0.71 for cardiovascular mortality. In conclusion, elevated EASIX is independently associated with increased all-cause and cardiovascular mortality in hypertensive patients, suggesting its potential as a predictive biomarker in clinical practice.
新出现的证据表明内皮激活与应激指数（EASIX）与冠状动脉疾病的死亡风险有关，但其在高血压患者中的相关性仍不清楚。本研究探讨了EASIX与高血压个体全因死亡率和心血管死亡率之间的关联。分析纳入了来自七轮国家健康与营养检查调查（NHNES，2003 - 2016年）的6138例高血压患者，死亡数据来自国家死亡指数（NDI）。在中位随访98个月期间，1435例（23.4%）参与者死亡，其中400例（6.5%）死于心血管原因。受限立方样条分析显示EASIX与全因死亡率和心血管死亡率均呈正相关。加权多变量Cox回归表明，EASIX每增加1个单位，死亡风险分别增加25%和23%。根据使用最大选择秩统计方法确定的最佳截断值，将参与者分为EASIX较高（>0.79）和较低（≤0.79）两组。较高的EASIX与全因死亡风险增加显著相关（HR = 1.46，95%CI 1.23 - 1.73，p < 0.0001）。较高的EASIX评分与心血管死亡率增加相关，尤其是在既往/当前吸烟者以及患有糖尿病/糖尿病前期的患者中。时间依赖性受试者工作特征分析评估了EASIX的预测准确性，全因死亡率的1年、3年、5年和10年生存曲线下面积（AUC）分别为0.71、0.67、0.67和0.67，心血管死亡率的分别为0.79、0.73、0.73和0.71。总之，EASIX升高与高血压患者全因死亡率和心血管死亡率增加独立相关，表明其在临床实践中作为预测生物标志物的潜力。
