PDF(Pubmed)
Abstract：
BACKGROUND: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression.
METHODS: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years.
RESULTS: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI.
CONCLUSIONS: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments.
BACKGROUND: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.
METHODS: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years.
RESULTS: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI.
CONCLUSIONS: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments.
BACKGROUND: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.
摘要：
背景：动脉僵硬度的心踝血管指数（CAVI）测量与普遍的心血管危险因素有关，而其对心血管事件的预测价值尚待确定。目的是确定CAVI与心血管疾病（主要结局）和全因死亡率（次要结局）的关系，并建立CAVI进展的决定因素。
方法：三刚度，一项国际多中心前瞻性纵向研究，在来自18个欧洲国家的32个中心招募>2000名≥40岁的受试者。其中,1250名受试者（55％的女性）的随访中位数为3.82（2.81-4.69）年。
结果：根据CAVI分层的未调整累积结局发生率在最高层较高（CAVI>9）。Cox回归与年龄调整，性别,和心血管危险因素显示CAVI与心血管疾病发病率增加相关(HR1.25/1增加;95%置信区间,CI：1.03-1.51）和全因死亡率（HR1.37/1增加；95％CI：1.10-1.70）≥60岁受试者的风险。在ROC分析中，在≥或<60岁的受试者中，CAVI最佳阈值为9.25（c指数0.598;0.542-0.654）和8.30（c指数0.565;0.512-0.618），分别,预测CV病态增加。最后,年龄,平均动脉血压,抗糖尿病和降脂治疗是经基线CAVI校正的每年CAVI进展的独立预测因子.
结论：本研究确定了校正CV危险因素后CAVI预测结果的附加价值，特别是对于≥60岁的受试者。CAVI进展可能是治疗可改变的危险因素。
背景：国际血管健康学会（ISVH）和福田登石，日本。
方法：三刚度，一项国际多中心前瞻性纵向研究，在来自18个欧洲国家的32个中心招募>2000名≥40岁的受试者。其中,1250名受试者（55％的女性）的随访中位数为3.82（2.81-4.69）年。
结果：根据CAVI分层的未调整累积结局发生率在最高层较高（CAVI>9）。Cox回归与年龄调整，性别,和心血管危险因素显示CAVI与心血管疾病发病率增加相关(HR1.25/1增加;95%置信区间,CI：1.03-1.51）和全因死亡率（HR1.37/1增加；95％CI：1.10-1.70）≥60岁受试者的风险。在ROC分析中，在≥或<60岁的受试者中，CAVI最佳阈值为9.25（c指数0.598;0.542-0.654）和8.30（c指数0.565;0.512-0.618），分别,预测CV病态增加。最后,年龄,平均动脉血压,抗糖尿病和降脂治疗是经基线CAVI校正的每年CAVI进展的独立预测因子.
结论：本研究确定了校正CV危险因素后CAVI预测结果的附加价值，特别是对于≥60岁的受试者。CAVI进展可能是治疗可改变的危险因素。
背景：国际血管健康学会（ISVH）和福田登石，日本。
