Loading...
Publication
Velocidade da Onda de Pulso e Estratificação do Risco Cardiovascular
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 381.1 KB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: A compliance arterial ou
distensibilidade é uma determinante
fundamental nas doenças cardiovasculares,
apresentando grande interesse a sua medição
não invasiva. A velocidade da onda de pulso
(VOP) é usada, actualmente, como um índice
de distensibilidade arterial.
Objectivos: Avaliar se a VOP constitui um
factor de risco, independente, para doença
das artérias coronárias (DAC). Investigar se
a determinação da mesma pode constituir
uma ferramenta útil, na estratificação do
risco cardiovascular, tanto nos indivíduos
assintomáticos, como nos doentes com DAC
População e Métodos: 811 indivíduos,
301 consecutivos com DAC, confirmada
por coronário-angiografia, média de idade
53,7±10,0 anos e 510 assintomáticos,
seleccionados das listas eleitorais, média
de idade 46,1±10,0 anos. Os indivíduos
assíntomáticos formavam o grupo A e eram
subdivididos em A1 (grupo sem HTA,
dislipidémia e ou diabetes) e A2 (grupo com
HTA, dislipidémia, e ou diabetes). Os doentes
coronários constituiam o grupo B, também
sub dividido em B1 sem HTA, dislipidémia e
ou diabetes e B2 com HTA, dislipidemia e ou
diabetes. Os dados foram expressos em média
± desvio padrão (DP). O teste t de Student foi
usado para comparar as variáveis contínuas e
o c2 para comparar as variáveis categóricas.
A força da correlação independente entre
as variáveis contínuas foi avaliada segundo
Pearson. Finalmente, foi efectuado um modelo
de regressão logística (step by step) para
avaliar quais as variáveis que se relacionavam de forma significativa e independente com
a DAC. A análise estatística foi efectuada
através 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 média da VOP foi
significantemente mais baixa em relação ao
A2. Comparando o grupo B1 e B2, também no
grupo B1 a média da VOP é mais baixa. No
grupo A1 a VOP correlacionou-se, segundo
Pearson, com a idade, pressão arterial sistólica
(PAS), diastólica e média, IMC, glicémia,
colesterol total, LDL, relação CT/HDL, ApoB,
triglicerídeos, ingestão de álcool, relação
cintura/anca (C/A), e proteína C reactiva(as).
A correlação foi inversa com o colesterol HDL.
No grupo A2 a correlação da VOP foi positiva
com a idade, PAS, PAM, PAD, glicémia, CT/
HDL e pressão do pulso (PP). No grupo B1
a correlação foi positiva e significante com a
idade, PAS, PAM, PAD e PP. Foi inversa com
a fracção de ejecção do VE. No grupo B2, foi
positiva e significante com a idade, PAS, PAM,
relação C/A, PP e homocisteína.
Conclusão: A VOP foi sempre, quer nos
indivíduos assintomáticos quer nos doentes
coronários, mais elevada nos grupos com
maior número de factores de risco. Esta
constatação sugere influência cumulativa
dos factores de risco, no processo de rigidez
arterial. Correlacionou-se de forma positiva
e significativa, com alguns dos factores de
risco clássicos e alguns dos novos marcadores
bioquímicos de risco. Após análise de
regressão logística, manteve-se na equação de
forma significativa, mostrando ser um factor
de risco independente para DAC. Assim, a
avaliação da distensibilidade arterial, através
da medição da VOP, poderá representar um
método simples, rápido e não invasivo, capaz
de estratificar o risco de DAC, tanto nos
indivíduos assintomáticos com nos doentes
coronários.
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 aórtica Velocidade da onda de pulso Risco cardiovascular Aortic compliance Pulse wave velocity Cardiovascular risk Portugal Madeira
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.