| Part One Effect of brachial-ankle pulse wave velocity on cardiocerebrovascular events in different age groupsObjective:The brachial-ankle pulse wave velocity(baPWV)was used as an index of arterial stiffness to explore whether the effect of arterial stiffness on cardio-cerebrovascular events is different in different age groups.Methods:1.Subjects who participated in the health examination in Kailuan from 2010 to 2017 and completed the baPWV examination were included as observation subjects,with no previous history of cardio-cerebrovascular events and atrial fibrillation and complete main baseline data.2.The population was categorized into one age group per 10 years,namely the<50-year-old group,the 50-59-year-old group,the 60-69-year-old group,the 70-79-year-old group,and the ≥80-year-old group,and the whole population,and each group was further assigned into three groups according to the triple quartiles,namely Q1 group,Q2 group and Q3 group.3.Kaplan-Meier method was used to calculate the cumulative incidence of new-onset cardio-cerebrovascular events in the whole population and different age groups.The cumulative incidence of each group was tested by Log-rank test.4.COX regression was used to analyze the risk ratio(hazard ratio,HR)and 95%confidence interval(confidence interval,CI)of new-onset cardiocerebrovascular events and stroke in Q2 group and Q3 group of the whole population and different age groups.Results:1.The average follow-up period was 5.12 ± 2.37 years,with 986 cardio-cerebrovascular events occurring.The cumulative incidence of cardiocerebrovascular events from Q1 to Q3 in the whole population were 0.12%,3.46%and 9.43%,respectively;<50-year-old group were 0.19%,0.56%and 3.22%,respectively;50-59-year-old group were 1.30%,3.80%and 9.56%,respectively;60-69-year-old group were 3.82%,7.74%and 11.47%,respectively;70-79-year-old group were 11.93%,10.80%and 12.28%,respectively;≥80-year-old group 7.58%、10.39%and 11.74%respectively.There was no statistically significant difference in the cumulative incidence of endpoint events between the 70-79-year-old group and the≥80-year-old group,with P values of 0.15 and 0.30,respectively.2.Cox regression analysis showed that after adjusting for relevant confounding factors,compared with baPWV in the Q1 group,HR values(95%CI)of new-onset cardio-cerebrovascular events in the Q3 group was 4.14(2.98-5.75)in whole population,2.98(1.08-8.21)in<50-year-old group,4.49(2.89-7.00)in 50-59-year-old group,2.78(1.76-4.39)in 60-69-year-old group,1.39(0.86-2.24)in 70-79-year-old group,and 1.15(0.55-2.41)in ≥80-year-old group.Compared with baPWV in the Q1 group,HR values(95%CI)of new-onset stroke in the Q3 group was 4.22(3.04-5.86)in whole population,3.80(1.40-10.33)in<50-year-old group,4.54(2.91-7.06)in 50-59-year-old group,3.13(2.11-4.66)in 60-69-year-old group,1.61(0.96-2.69)in 70-79-year-old group,and 0.86(0.38-1.92)in ≥80-year-old group.For every one standard deviation increase of baPWV,the HR values(95%CI)of new-onset cardio-cerebrovascular events in the whole population,<50-yearold group,50-59-year-old group,60-69-year-old group,70-79-year-old group and ≥80-year-old group were 1.30(1.25-1.36),1.44(1.22-1.70),1.21(1.081.36),1.32(1.14-1.53),1.08(0.97-1.20)and 1.13(0.77-1.66),respectively.The HR values(95%CI)of new-onset stroke were 1.28(1.23-1.34),1.40(1.211.68),1.26(1.21-1.31),1.24(1.10-1.41),1.27(1.08-1.47)and 0.92(0.65-1.32),respectively.Conclusion:Arterial stiffness is an independent risk factor for cardiocerebrovascular events and stroke.With the increase of arterial stiffness,the risk of cardio-cerebrovascular events and stroke increases,and the increase of this risk may depend on age.As age increases,the risk of cardio-cerebrovascular diseases caused by arterial stiffness tends to decrease,even in the elderly,the predictive value of arterial stiffness for cardio-cerebrovascular events disappears.Part Two Effect of brachial-ankle pulse wave velocity on cardio-cerebrovascular events in different body mass index groupsObjective:The brachial-ankle pulse wave velocity(baPWV)was used as an index of arterial stiffness to explore whether there were differences in the effects of arterial stiffness on cardio-cerebrovascular events in people with different body mass index(BMI).Methods:1.Subjects who participated in the health examination in Kailuan from 2010 to 2017 and completed the baPWV examination were included as observation subjects,with no previous history of cardio-cerebrovascular events and atrial fibrillation and complete main baseline data.2.According to BMI,the population was divided into three groups:BMI<24kg/m2,24≤BMI<28kg/m2 and BMI≥28 kg/m2.According to the quantile of each group,the population was divided into the first quartile,the second quartile and the third quartile.3.The cumulative incidence of new-onset cardio-cerebrovascular events in different quantile groups of each BMI population was calculated by Kaplan-Meier method.The cumulative incidence of each group was tested by Log-rank test.4.The spline function curve of the effect of baPWV on cardio-cerebrovascular events was drawn to observe whether there was a linear correlation between them.5.Cox regression model was used to further analyze the risk ratio(HR)and 95%confidence interval(CI)of new-onset cardio-cerebrovascular events and stroke in each group and every one standard deviation increase of baPWV in different BMI populations.Results:1.During the mean follow-up of 5.14±2.35 years,there were 955 newonset cardio-cerebrovascular events.The cumulative incidence of cardiocerebrovascular events in the first to third quartile groups with BMI<24kg/m2 was 0.61%,2.51%and 8.32%,respectively;24≤BMI<28kg/m2 was 1.71%,4.62%and 11.8%,respectively;BMI≥28kg/m2 was 2.45%,7.49%and 10.1%,respectively.There were significant differences in cumulative incidence among different groups(P<0.01).2.In the whole population,the incidence of cardio-cerebrovascular events of BMI<24kg/m2,24≤BMI<28kg/m2 and BMI≥28kg/m2 was 1.76%,2.97%and 3.04%,respectively.(P<0.01).3.The overall association and nonlinear association between baPWV and new-onset cardio-cerebrovascular events were statistically significant(both P<0.001),and they were nonlinear.4.Every one standard deviation increase of baPWV,the HR value(95%CI)of new-onset cardio-cerebrovascular events in the three groups were 1.31(1.21-1.42),1.27(1.17-1.38)and 1.20(1.05-1.38)respectively.The HR values(95%CI)of new-onset stroke were 1.33(1.22-1.45),1.29(1.19-1.41)and 1.19(1.02-1.39),respectively.5.Compared with the first quartile group,the HR values(95%CI)of new-onset cardio-cerebrovascular events in the second quartile and the third quartile of BMI<24kg/m2 were 3.07(1.50-5.47)and 8.26(4.03-16.94),respectively;24≤BMI<28kg/m2 were 1.78(1.23-2.58)and 3.21(2.22-4.63),respectively;BMI≥28kg/m2 were 2.34(1.52-4.12)and 2.62(1.47-4.67),respectively.Conclusion:With the increase of BMI,the incidence of cardio-cerebrovascular disease increases gradually.Arterial stiffness is an independent risk factor for cardio-cerebrovascular disease in different BMI populations.Exposure to arterial stiffness has different effects on cardio-cerebrovascular events in people with different BMI,and the impact of arterial stiffness on cardio-cerebrovascular disease is more significant in people with low BMI.Part Three Effects of pulse pressure and brachial-ankle pulse wave velocity on cardio-cerebrovascular events and their combined effectsObjective:The brachial-ankle pulse wave velocity(baPWV)was used as an index of arterial stiffness to explore the effects of pulse pressure(PP)and arterial stiffness and their combination on cardio-cerebrovascular events.Methods:1.Subjects who participated in the health examination in Kailuan from 2010 to 2017 and completed the baPWV examination were included as observation subjects,with no previous history of cardio-cerebrovascular events and atrial fibrillation and complete main baseline data.2.According to PP and baPWV,the subjects were divided into low PP combined with low baPWV group,low PP combined with high baPWV group,high PP combined with low baPWV group and high PP combined with high baPWV group.3.The cumulative incidence of new-onset cardio-cerebrovascular events in different groups was calculated by Kaplan-Meier method.The cumulative incidence of each group was tested by Log-rank test.4.Cox proportional hazard model was used to analyze the effects of PP,baPWV and PP combined with baPWV on new-onset cardio-cerebrovascular events and stroke.Results:1.During the mean follow-up of 5.16±2.38 years,there were 975 cases of new-onset cardio-cerebrovascular events.The cumulative incidences of new-onset cardio-cerebrovascular events in low PP combined with low baPWV group,low PP combined with high baPWV group,high PP combined with low baPWV group and high PP combined with high baPWV group were 2.19%,9.34%,5.38%and 11.33%,respectively,and the cumulative incidences of new-onset stroke were 1.7%,6.0%,4.6%and 9.5%,respectively.There were significant differences in cumulative incidence among different groups(P<0.01).2.Compared with low PP group,the HR value(95%CI)of new-onset cardio-cerebrovascular events in the high PP group was 1.65(1.45-1.90),and every one standard deviation increase of PP,the HR value(95%CI)of new-onset cardio-cerebrovascular events was 1.24(1.17-1.32).Compared with low baPWV group,the HR value(95%CI)of new-onset cardio-cerebrovascular events in the high baPWV group was 1.36(1.32-1.42),and every one standard deviation increase of baPWV,the HR value(95%CI)of new-onset cardio-cerebrovascular events was 1.29(1.23-1.36).Compared with low PP combined with low baPWV group,The HR values(95%CI)of new-onset cardio-cerebrovascular events in low PP combined with high baPWV group,high PP combined with low baPWV group and high PP combined with high baPWV group were 3.25(2.37-4.46),1.86(1.53-2.25)and 3.52(2.65-4.25),respectively.Conclusion:Arterial stiffness and PP are independent risk factors of new-onset cardio-cerebrovascular events,and they have a combined promoting effect on the impact of new-onset cardio-cerebrovascular events.The phenomenon of "mismatch" between PP and arterial stiffness is widespread.Compared with PP,arterial stiffness has a more significant effect on new-onset cardio-cerebrovascular events.Arterial stiffness may be more valuable than PP in predicting cardio-cerebrovascular events.Arterial stiffness combined with pulse pressure is helpful to screen people at high risk of cardio-cerebrovascular diseases. |
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