| Part One Comparison of predictive value of ankle to brachial mean arterial pressure ratio and ankle-brachial index for cardiovascular event and all-cause death Objective: To evaluate and compare the predictive value of ankle to brachial mean arterial pressure ratio(MAPR)and ankle-brachial index(ABI)for cardiovascular event and all-cause death.Methods:1.A total of 37803 active and retired employees of Kailuan Group who participated in simultaneously measurement of four-limb blood pressure and had completed physical examination data during 2010 and 2017 were selected as the observation cohort.2.The predictive value of MAPR and ABI for cardiovascular event and all-cause mortality was compared by calculating the area under the receiver operating characteristic curve(AUC).3.The associations of MAPR and ABI with cardiovascular event and all-cause death were analyzed using restricted cubic spline curves.4.Multivariate cox regression models were used to analyze the effects of MAPR and ABI on cardiovascular event and all-cause death.Results:1.After an average follow-up of 3 years,a total of 589 cardiovascular events and 570 all-cause deaths occurred.The MAPR was significantly more effective than ABI for predicting cardiovascular event and all-cause death(AUC for cardiovascular event: 0.55 vs 0.51,P<0.001;AUC for all-cause death: 0.60 vs 0.55,P<0.001).2.After adjusting for confounders,the restricted cubic spline curve indicated the MAPR and ABI were associated with cardiovascular event and all-cause death in an approximate J-shaped relationship,with inflection points of 1.06 and 1.12,respectively.3.After adjustment for confounders,each 0.1 unit increase in MAPR prior to the inflection point of the curve(1.06)associated with a 14%(HR0.86,95%CI 0.77-0.96)and 23%(HR 0.77,95%CI 0.70-0.84)reduction in the risk of cardiovascular event and all-cause death,respectively.In the participants with an ABI of ? 1.12,each 0.1 unit increase in ABI was associated with a 12%(HR 0.88,95%CI 0.79-0.97)and 22%(HR 0.78,95%CI 0.72-0.85)reduction in the risk of cardiovascular event and all-cause mortality,respectively.Summary: Low MAPR and low ABI were both independent predictors of cardiovascular event and all-cause mortality.Moreover,the MAPR was better than the ABI in predicting cardiovascular event and all-cause mortality.Part Two The association between brachial-ankle pulse wave velocity and new-onset atrial fibrillation Objective: To evaluate the association between brachial-ankle pulse wave velocity(baPWV)and new-onset atrial fibrillation(AF)in Chinese.Methods:1.A total of 43261 adult participants with complete data of baPWV and without AF history at baseline were followed up in the Chinese Kailuan Cohort Study.2.The study population was divided into two groups according to baPWV value,namely normal arterial stiffness group(baPWV < 14 m/s)and elevated arterial stiffness group(baPWV ? 14 m/s).3.The cumulative incidence of AF in the two groups was calculated by life table method and compared by log-rank test.4.Multivariate cox regression models were used to analyze the effect of baPWV on new-onset AF.Results:1.During a mean follow-up of 3.88 years,we observed 62 AF events.The cumulative incidence of AF was significantly higher in participants with a baPWV of ? 14 m/s than in those with a baPWV of < 14 m/s(0.42% vs.0.10%,P < 0.001).2.After adjustment for confounders,the AF risk in participants with a baPWV of ? 14 m/s was 2.29(95%CI 1.04-5.07)times greater than in those with a baPWV of < 14 m/s.Each 1 m/s increase in baPWV was associated with a 10%(HR 1.10,95%CI 1.02-1.18)increase in the risk of AF.3.When participants were stratified by sex or median of systolic blood pressure(SBP),each 1 m/s increase in baPWV was still associated with incident AF in women(HR 1.17,95%CI 1.07-1.29)and those with an SBP level of < 130 mmHg(HR 1.20,95%CI 1.08-1.32).But in men or in those with an SBP level of ? 130 mmHg,there were no associations between baPWV and incident AF.Summary: Higher baPWV was an independent risk factor for AF,especially in women and in those with an SBP level of < 130 mmHg.Therefore,delaying the progression of atherosclerosis may help reduce the risk of AF.Part Three The predictive value of CHADS2 score for cardiovascular events and all-cause death in Chinese population without atrial fibrillation Objective: To evaluate the predictive value of CHADS2 score for cardiovascular events and all-cause death in Chinese population without AF.Methods:1.A total of 99755 adult participants(including 515 cases of AF)with complete data at baseline were followed for up to 10 years in the Chinese Kailuan Cohort Study.2.The AUC was calculated for each outcome event.3.Adjusted cox proportional hazard models were used to evaluate the associations between CHADS2 score and cardiovascular events and all-cause death.Results:1.The incidence of cardiovascular events and all-cause death increased with CHADS2 score among the participants with or without AF.However,in each CHADS2 score group,the incidence of all the events in patients with AF was significantly higher than that in participants without AF.2.The AUC for myocardial infarction,cerebral infarction,cerebral hemorrhage,total cardiovascular event and all-cause death was 0.67,0.60,0.62,0.63 and 0.60,respectively in patients with AF,and 0.66,0.67,0.66,0.67 and 0.69,respectively in participants without AF.3.In patients with AF,each 1 point increase in CHADS2 score was not associated with cerebral infarction,cerebral hemorrhage and all-cause death except myocardial infarction(HR 2.07,95%CI 1.17-3.66)and total cardiovascular event(HR 1.45,95%CI 1.07-1.98)after adjusting for confounders.But it was associated with all the events in participants without AF,the HR(95%CI)for myocardial infarction,cerebral infarction,cerebral hemorrhage,total cardiovascular events and all-cause death was1.09(1.00-1.18),1.21(1.15-1.27),1.13(1.02-1.26),1.17(1.13-1.22)and1.12(1.08-1.15),respectively.Summary: CHADS2 score is an independent predictor for cardiovascular events and all-cause death in the Chinese population without AF,and its predictive value is not inferior to that in patients with AF.Part Four Stage 1 hypertension defined by the 2017 ACC/AHA guideline and risk of cardiovascular events:a cohort study from China Objective: To examine the association between stage 1 hypertension(at baseline and longitudinal changes)defined by the 2017 ACC/AHA guideline and risk of cardiovascular events in Chinese.Methods:1.A total of 97126 active and retired workers aged 18 to 98 years free of cardiovascular disease at baseline were followed for up to 10 years in the Chinese Kailuan Cohort Study.2.The 97126 participants were divided into four groups according to baseline blood pressure: the normal blood pressure group included participants with blood pressure <120/80 mmHg;the elevated blood pressure group included participants with blood pressure 120-129/<80 mmHg;the stage 1hypertension group included participants with blood pressure 130-139/80-89 mmHg;and the stage 2 hypertension group included participants with blood pressure ?140/90 mmHg,or taking antihypertensive medication.The normal blood pressure group was regarded as reference.3.Adjusted cox proportional hazard models were used to evaluate the associations between stage 1 hypertension(at baseline)and risk of cardiovascular events.4.For further analysis,we selected 20922 patients with stage 1hypertension who further participated in the healthy physical examination in2010-2011 and had no cardiovascular events or cancers between the two examinations as the observation cohort,and followed them up for 6 years.5.The 20922 participants were divided into four groups according to the changes in blood pressure from the 2006 to 2010 examination: blood pressure lowering group 1(blood pressure: 130-139/ 80-89 mmHg in 2006 and <120/80 mmHg in 2010),blood pressure lowering group 2(blood pressure:130-139/ 80-89 mmHg in 2006 and 120-129/ <80 mmHg in 2010),invariant blood pressure group(blood pressure: 130-139/ 80-89 mmHg in 2006 and2010),and blood pressure elevating group(blood pressure: 130-139/ 80-89 mmHg in 2006 and ?140/ 90 mmHg,or taking antihypertensive medication in2010).The blood pressure lowering group 1 was regarded as reference.6.Adjusted cox proportional hazard models were used to evaluate the associations between different groups of blood pressure changes and risk of cardiovascular events.Results:1.Participants with stage 1 hypertension at baseline accounted for 31.1%of the cohort.2.Compared with normal blood pressure(<120/ 80 mmHg),stage 1hypertension had a significant higher risk of total cardiovascular event,cerebral infarction and cerebral hemorrhage,with the HR(95%CI)was1.25(1.11-1.40),1.31(1.13-1.52),and 1.45(1.07-1.97),respectively.3.Over a four-year period,36.3% of participants with stage 1hypertension at baseline progressed to stage 2 hypertension and 43.1% of those maintained stage 1 hypertension,.4.Compared with the decreased blood pressure from stage 1hypertension to normal blood pressure,the maintained stage 1 hypertension had a significant higher risk of total cardiovascular event and cerebral infarction,with the HR(95%CI)was 1.78(1.16-2.72)and 1.94(1.14-3.30).Summary: The Chinese adults with stage 1 hypertension defined by the2017 ACC/AHA guideline still have a relatively high risk for cardiovascular events.They should be given appropriate antihypertensive interventions.Conclusions:1.Low MAPR and low ABI were both independent predictors of cardiovascular event and all-cause mortality.Moreover,the MAPR was better than the ABI in predicting cardiovascular event and all-cause mortality.2.Higher baPWV was an independent risk factor for AF,especially in women and those with an SBP level of < 130 mmHg.3.CHADS2 score was an independent predictor for cardiovascular events and all-cause death in the Chinese population without AF.4.The Chinese adults with stage 1 hypertension defined by the 2017ACC/AHA guideline still have a relatively high risk for cardiovascular events. |
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