| Objective: 1.To investigate the distribution characteristics and related factors of brachial-ankle pulse wave(ba PWV)velocity in Xinjiang area;2.Estimation of baPWV reference value and its predictive value for related diseases in Xinjiang area;3.To investigate the relationship between baPWV and the outcome of cardiovascular events in patients with nonvalvular atrial fibrillation.Methods:(1)Using stratified cluster random sampling method,according to the geography population,ethnic,economic and cultural development level and the Census data of Xinjiang,seven cities,including Urumqi,Kuerle,Yili,Kashi and Akesu were selected as research sites.We selected the Han adults over the age of 18 as the research subjects.All the general information and laboratory examination were collected and baPWV were tested in all the participants.Then we analyse the distribution characteristics and related factors of ba PWV;(2)Using the correlation analysis and multiple linear regression analysis,we analyzed the main influencing factors of ba PWV.Using the 90% quantile method,according to the age and hypertension classification,we set up the range of ba PWV reference values and calculated the baPWV increased rate in Xinjiang population;(3)400 patients diagnosed with non-valvular atrial fibrillation in the First Affiliated Hospital of Xinjiang Medical University were selected in the present study.All the general information and laboratory examination were collected and cardiovascular events,including cardiovascular death,stroke,non-fatal Myocardial infarction,heart failure and hospital admission were taken as end-point event.The COX regression analysis were used to analyse the relationship between baPWV and the prognosis of non-valvular atrial fibrillation.Results:(1)In the present study,a total of 5,300 Han adults over the age of 18 were selected.5076 subjects were actually completed with the study,including 2437 males,with an average age of 52.32 ± 13.24 and 2639 females,with an average age of 52.73 ± 12.09.The BMI,systolic blood pressure,diastolic blood pressure,mean blood pressure(MBP),blood glucose,triglyceride and baPWV levels of males were significantly higher than that of females(P<0.05).The prevalence of smoking,hypertension and diabetes in males were significantly higher than that in females.The high density lipoprotein cholesterol(HDL-C)was significantly higher in females than that in males.The mean baPWV in the whole population was 1526.58cm/s,the mean baPWV in males and females were 1556.14± 436.92cm/s and 1499.27±390.57cm/s respectively.The ba PWV was significantly different between males and females(P <0.001).BaPWV increased with age in both male and female groups(P <0.001).In the age group of lower than 40 years and 40-49 years,the baPWV values were significantly higher in males than that in females(P <0.001).There exists no significant difference between male and female groups of baPWV in the age group of 50-59 years and larger than 60 years(P >0.001).Ba PWV levels may be affected by various factors such as blood pressure,glucose,smoking,blood lipids and other factors.The baPWV levels were significantly higher in the subjects with hypertension,diabetes,smoker and hyperlipidemia(P<0.05).(2)Correlation analysis showed that age,MBP,BMI,low density lipoprotein cholesterol(LDL-C),total cholesterol,triglycerides and fasting plasma glucose were all correlated with baPWV(P<0.05).The correlation coefficient between age and MBP and baPWV was 0.558 and 0.570 respectively and suggesting that age and blood pressure were strongly correlated with ba PWV.Multivariate linear regression analysis showed that age,MBP,BMI,triglycerides and fasting blood glucose were independent risk factors for ba PWV.The standardized regression coefficient for age and MBP were 0.423 and 0.434,suggesting that age and blood pressure had the greatest impact on baPWV.To verify whether other traditional cardiovascular risk factors have an impact on ba PWV after adjusting for age and blood pressure,we performed the covariance analysis.And the result showed that the effect of gender,hypertension,hyperlipidemia and smoking on ba PWV disappeared after adjustment for age and blood pressure,but there still exists effect of diabetes on baPWV(P<0.05).Therefore,we obtained 4679 cases of ba PWV reference population after excluding for diabetic patients.Using the 90% quantile method,we calculated the reference range value of baPWV based on age and blood pressure grade.In the age group of lower than 40 years,the average value of baPWV is 1230cm/s and the reference range is less than 1430cm/s in subjects with normal blood pressure;the average value of baPWV is 1430cm/s and the reference range is less than 1630cm/s in subjects with normal blood pressure in subjects with grade I hypertension;the average value of baPWV is 1540cm/s and the reference range is less than 1980cm/s in subjects with grade II and III hypertension.In the age group of 40-49 years,the average value of ba PWV is 1270cm/s and the reference range is less than 1460cm/s in subjects with normal blood pressure;the average value of baPWV is 1410cm/s and the reference range is less than 1660cm/s in subjects with normal blood pressure in subjects with grade I hypertension;the average value of baPWV is 1570cm/s and the reference range is less than 1900cm/s in subjects with grade II and III hypertension.In the age group of 50-59 years,the average value of baPWV is 1390cm/s and the reference range is less than 1640cm/s in subjects with normal blood pressure;the average value of baPWV is 1610cm/s and the reference range is less than 1920cm/s in subjects with normal blood pressure in subjects with grade I hypertension;the average value of baPWV is 1710cm/s and the reference range is less than 2160cm/s in subjects with grade II and III hypertension.In the age group of over 60 years,the average value of ba PWV is 1600cm/s and the reference range is less than 1920cm/s in subjects with normal blood pressure;the average value of baPWV is 1840cm/s and the reference range is less than 2240cm/s in subjects with normal blood pressure in subjects with grade I hypertension;the average value of baPWV is 2030cm/s and the reference range is less than 2520cm/s in subjects with grade II and III hypertension.The abnormal increase rate of baPWV was 11.72% in the whole population and the abnormal increase rate of baPWV was 11.3%,12.34%,10.88% and 11.66 in the age group of less than 40 years,40-49,50-59 and over than 60 years.(3)Among the 400 participants selected in the present study,10 cases were lost and the rate of loss of 2.5%.The average age was 68.51 ± 10.12 and 72.62±10.83 years in subjects without and with cardiovascular events.Compared with subjects without cardiovascular events,age,SBP,heart rate and ba PWV were significantly higher in subjects with cardiovascular events(P<0.05).The prevalence of smoking,hypertension hyperlipidemia and using ACE inhibitors / angiotensin II receptor blockers(ACEI / ARB),calcium channel blockers(CCBs),antiarrhythmias were higher in subjects with cardiovascular event than that in subjects without cardiovascular event(P<0.05).The Left ventricular ejection fraction(LVEF)was significantly higher in subjects without cardiovascular events than that in subjects with cardiovascular events(P < 0.05).According to the baPWV reference value calculated in second part,the 390 subjects who completed the follow-up were divided into baPWV elevated group and ba PWV normal group.Of the 390 completed subjects,cardiovascular events occurred in 94 subjects,the incident rate was 24.10%.Among them,there are 8 cardiovascular deaths in ba PWV elevated group and 3 cardiovascular deaths in baPWV normal group,there exists no significant difference between the two groups(P>0.05).There are 24 stroke in ba PWV elevated group and 4 stroke in baPWV normal group,there exists significant difference between the two groups of stroke(P<0.05).There are 6 non-fatal myocardial infarction in baPWV elevated group and 1 non-fatal myocardial infarction in baPWV normal group,there exists significant difference between the two groups of non-fatal myocardial infarction(P<0.05).There are 39 re-admission of heart failure in baPWV elevated group and 9 in baPWV normal group.The incidence of heart failure re-admission was significantly higher in baPWV elevated group than that in baPWV normal group(P<0.05).The total number of cardiovascular events in the baPWV elevated group was 77(25.25%).The total cardiovascular events in the baPWV normal group were 17(20.00%).The incidence of cardiovascular events in the baPWV elevated group was significantly higher than that in the ba PWV normal group(P <0.05).COX regression analysis showed that age(HR=1.038,95%CI:1.023-1.089,P=0.004),hypertension(HR=3.105,95%CI: 1.862-4.582,P=0.032),SBP(HR=2.366,95%CI: 1.272-3.562,P=0.015)and ba PWV(HR=1.452,95%CI: 1.211-2.326,P=0.012)were independent risk factors of cardiovascular events in non-valvular atrial fibrillation.The LVEF(HR = 0.823,95% CI: 0.722-0.937,P = 0.023)was a independent protective factor of cardiovascular events in non-valvular atrial fibrillation.Conclusion:(1)The distribution of ba PWV in the general population,male group and female group are all related to age.Older subjects have the higher baPWV value.In addition,baPWV levels may also be related to blood pressure,blood glucose,smoking,lipids and other factors.The ba PWV value was higher in subjects with hypertension,diabetes,smoking and hyperlipidemia.(2)BaPWV was independently associated with age,MBP,BMI,triglycerides and glucose.And age and blood pressure had the greatest impact on baPWV.We then established a reference value of baPWV suitable for Xinjiang population.(3)BaPWV has a good correlation with the prognosis of cardiovascular events in patients with non-valvular atrial fibrillation.Ba PWV is an independent risk factor for cardiovascular events in patients with nonvalvular atrial fibrillation after 1-years follow-up. |
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