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Velocidade da Onda de Pulso e EstratificaĆ§Ć£o do Risco Cardiovascular
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Advisor(s)
Abstract(s)
IntroduĆ§Ć£o: A compliance arterial ou
distensibilidade Ć© uma determinante
fundamental nas doenƧas cardiovasculares,
apresentando grande interesse a sua mediĆ§Ć£o
nĆ£o invasiva. A velocidade da onda de pulso
(VOP) Ć© usada, actualmente, como um Ćndice
de distensibilidade arterial.
Objectivos: Avaliar se a VOP constitui um
factor de risco, independente, para doenƧa
das artƩrias coronƔrias (DAC). Investigar se
a determinaĆ§Ć£o da mesma pode constituir
uma ferramenta Ćŗtil, na estratificaĆ§Ć£o do
risco cardiovascular, tanto nos indivĆduos
assintomƔticos, como nos doentes com DAC
PopulaĆ§Ć£o e MĆ©todos: 811 indivĆduos,
301 consecutivos com DAC, confirmada
por coronƔrio-angiografia, mƩdia de idade
53,7Ā±10,0 anos e 510 assintomĆ”ticos,
seleccionados das listas eleitorais, mƩdia
de idade 46,1Ā±10,0 anos. Os indivĆduos
assĆntomĆ”ticos formavam o grupo A e eram
subdivididos em A1 (grupo sem HTA,
dislipidƩmia e ou diabetes) e A2 (grupo com
HTA, dislipidƩmia, e ou diabetes). Os doentes
coronƔrios constituiam o grupo B, tambƩm
sub dividido em B1 sem HTA, dislipidƩmia e
ou diabetes e B2 com HTA, dislipidemia e ou
diabetes. Os dados foram expressos em mƩdia
Ā± desvio padrĆ£o (DP). O teste t de Student foi
usado para comparar as variĆ”veis contĆnuas e
o c2 para comparar as variĆ”veis categĆ³ricas.
A forƧa da correlaĆ§Ć£o independente entre
as variĆ”veis contĆnuas foi avaliada segundo
Pearson. Finalmente, foi efectuado um modelo
de regressĆ£o logĆstica (step by step) para
avaliar quais as variƔveis que se relacionavam de forma significativa e independente com
a DAC. A anĆ”lise estatĆstica foi efectuada
atravƩs do software SPSS for Windows, sendo o
valor de p <0,05 considerado significativo.
Resultados: Comparando os dois grupos,
A1 e A2, no primeiro, a mƩdia da VOP foi
significantemente mais baixa em relaĆ§Ć£o ao
A2. Comparando o grupo B1 e B2, tambƩm no
grupo B1 a mƩdia da VOP Ʃ mais baixa. No
grupo A1 a VOP correlacionou-se, segundo
Pearson, com a idade, pressĆ£o arterial sistĆ³lica
(PAS), diastĆ³lica e mĆ©dia, IMC, glicĆ©mia,
colesterol total, LDL, relaĆ§Ć£o CT/HDL, ApoB,
triglicerĆdeos, ingestĆ£o de Ć”lcool, relaĆ§Ć£o
cintura/anca (C/A), e proteĆna C reactiva(as).
A correlaĆ§Ć£o foi inversa com o colesterol HDL.
No grupo A2 a correlaĆ§Ć£o da VOP foi positiva
com a idade, PAS, PAM, PAD, glicƩmia, CT/
HDL e pressĆ£o do pulso (PP). No grupo B1
a correlaĆ§Ć£o foi positiva e significante com a
idade, PAS, PAM, PAD e PP. Foi inversa com
a fracĆ§Ć£o de ejecĆ§Ć£o do VE. No grupo B2, foi
positiva e significante com a idade, PAS, PAM,
relaĆ§Ć£o C/A, PP e homocisteĆna.
ConclusĆ£o: A VOP foi sempre, quer nos
indivĆduos assintomĆ”ticos quer nos doentes
coronƔrios, mais elevada nos grupos com
maior nĆŗmero de factores de risco. Esta
constataĆ§Ć£o sugere influĆŖncia cumulativa
dos factores de risco, no processo de rigidez
arterial. Correlacionou-se de forma positiva
e significativa, com alguns dos factores de
risco clƔssicos e alguns dos novos marcadores
bioquĆmicos de risco. ApĆ³s anĆ”lise de
regressĆ£o logĆstica, manteve-se na equaĆ§Ć£o de
forma significativa, mostrando ser um factor
de risco independente para DAC. Assim, a
avaliaĆ§Ć£o da distensibilidade arterial, atravĆ©s
da mediĆ§Ć£o da VOP, poderĆ” representar um
mĆ©todo simples, rĆ”pido e nĆ£o invasivo, capaz
de estratificar o risco de DAC, tanto nos
indivĆduos assintomĆ”ticos com nos doentes
coronƔrios.
BACKGROUND: Arterial compliance or stiffness is an important determinant of cardiovascular disease and there is considerable interest in its noninvasive measurement. Pulse wave velocity (PWV) is widely used as an index of arterial stiffness. AIM: To determine whether PWV is useful for risk stratification in both healthy individuals and coronary patients. METHODS: Control subjects, n=510, aged 46.1 +/- 11 years, with no history of coronary disease, were selected from electoral rolls, and coronary patients, n=301, aged 53.7 +/- 10 years, were selected from hospital patients with a history of coronary artery disease (CAD) confirmed by coronary angiogram (at least 75% obstruction of one of the main coronary vessels). The asymptomatic subjects without CAD formed Group A, and were subdivided into A1 (without hypertension, dyslipidemia and/or diabetes) and A2 (with hypertension, dyslipidemia and/or diabetes). The coronary patients formed Group B, who were also subdivided into B1, without these classic risk factors, and B2 with hypertension, dyslipidemia and/or diabetes. We used the Student's t test to compare continuous variables and the chi-square test to compare categorical data. The strength of correlation between continuous variables was tested by Pearson's linear correlation. Independent variables predictive of CAD were determined by backward logistic regression analysis. The statistical analysis was performed using SPSS for Windows version 11.0 and data were expressed as means +/- SD; a p value of 0.05 was considered significant. RESULTS: Comparing the two groups A1 and A2, mean PWV was significantly lower in group A1. Comparing B1 and B2, mean PWV was also significantly lower in group B1. In group A1, PWV was significantly and positively correlated with age, body mass index, waist-to-hip ratio, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean blood pressure (BP), blood glucose, apo B, triglycerides, and high-sensitivity C-reactive protein, unlike HDL which was inversely correlated (Pearson's coefficient). In group A2, PWV was significantly and positively correlated with age, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean BP, blood glucose and pulse pressure (PP), but not HDL, which was inversely correlated with PWV. In group B1, PWV was only significantly and positively correlated with age, systolic, mean, and diastolic BP and PP, and presented a significant inverse correlation with ejection fraction. However, in the high-risk coronary population (group B2), there was a positive correlation with age, waist-to-hip ratio, systolic and mean BP, PP and homocysteine. After stepwise logistic regression, PWV remained in the model and proved to be a significant and independent risk factor for CAD. CONCLUSION: The results of our study show that PWV is higher in high-risk groups and significantly correlated with many classic and new CAD risk markers, suggesting that there is a cumulative influence of risk factors in the development of arterial stiffness. We believe that PWV is a useful index of vascular status and hence cardiovascular risk and that it may be useful for risk stratification in both asymptomatic and coronary patients.
BACKGROUND: Arterial compliance or stiffness is an important determinant of cardiovascular disease and there is considerable interest in its noninvasive measurement. Pulse wave velocity (PWV) is widely used as an index of arterial stiffness. AIM: To determine whether PWV is useful for risk stratification in both healthy individuals and coronary patients. METHODS: Control subjects, n=510, aged 46.1 +/- 11 years, with no history of coronary disease, were selected from electoral rolls, and coronary patients, n=301, aged 53.7 +/- 10 years, were selected from hospital patients with a history of coronary artery disease (CAD) confirmed by coronary angiogram (at least 75% obstruction of one of the main coronary vessels). The asymptomatic subjects without CAD formed Group A, and were subdivided into A1 (without hypertension, dyslipidemia and/or diabetes) and A2 (with hypertension, dyslipidemia and/or diabetes). The coronary patients formed Group B, who were also subdivided into B1, without these classic risk factors, and B2 with hypertension, dyslipidemia and/or diabetes. We used the Student's t test to compare continuous variables and the chi-square test to compare categorical data. The strength of correlation between continuous variables was tested by Pearson's linear correlation. Independent variables predictive of CAD were determined by backward logistic regression analysis. The statistical analysis was performed using SPSS for Windows version 11.0 and data were expressed as means +/- SD; a p value of 0.05 was considered significant. RESULTS: Comparing the two groups A1 and A2, mean PWV was significantly lower in group A1. Comparing B1 and B2, mean PWV was also significantly lower in group B1. In group A1, PWV was significantly and positively correlated with age, body mass index, waist-to-hip ratio, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean blood pressure (BP), blood glucose, apo B, triglycerides, and high-sensitivity C-reactive protein, unlike HDL which was inversely correlated (Pearson's coefficient). In group A2, PWV was significantly and positively correlated with age, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean BP, blood glucose and pulse pressure (PP), but not HDL, which was inversely correlated with PWV. In group B1, PWV was only significantly and positively correlated with age, systolic, mean, and diastolic BP and PP, and presented a significant inverse correlation with ejection fraction. However, in the high-risk coronary population (group B2), there was a positive correlation with age, waist-to-hip ratio, systolic and mean BP, PP and homocysteine. After stepwise logistic regression, PWV remained in the model and proved to be a significant and independent risk factor for CAD. CONCLUSION: The results of our study show that PWV is higher in high-risk groups and significantly correlated with many classic and new CAD risk markers, suggesting that there is a cumulative influence of risk factors in the development of arterial stiffness. We believe that PWV is a useful index of vascular status and hence cardiovascular risk and that it may be useful for risk stratification in both asymptomatic and coronary patients.
Description
Keywords
Rigidez aĆ³rtica Velocidade da onda de pulso Risco cardiovascular Aortic compliance Pulse wave velocity Cardiovascular risk Portugal Madeira
Pedagogical Context
Citation
Mendonca, M. I., Reis, R. P., Sousa, A. C., Gomes, S., Faria, P., Pereira, A., ... & Silva, J. A. (2009). Pulse wave velocity and coronary risk stratification. Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia= Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology, 28(2), 155-171.