估计脉搏波传导速度与血压升高人群全因死亡风险及心脑血管疾病死亡风险的关联

The association between estimated pulse wave velocity and the risk of all-cause mortality and cardiovascular mortality in populations with elevated blood pressure

    摘要
  • 摘要:
    目的 探讨估计脉搏波传导速度（ePWV）与血压升高患者全因死亡、脑血管疾病死亡风险的关系。
    方法 本研究基于美国国家健康与营养调查（NHANES）数据库1999—2018年间连续10个周期的数据，纳入4816例血压升高患者。首先，基于限制性立方样条（RCS）分析所确定的阈值，以ePWV = 8.054为临界值，将研究队列划分为低ePWV组（ePWV≤8.054）与高ePWV组（ePWV＞8.054）。其次，采用Kaplan-Meier生存曲线、竞争风险累积发生率曲线、Cox比例风险模型、竞争风险模型和亚组分析探讨ePWV与血压升高患者全因死亡和心脑血管疾病死亡风险的关系。最后，利用具有全国代表性的中国健康与养老追踪调查（CHARLS）数据库的独立样本进行外部验证。
    结果 随访期间，高ePWV组全因死亡发生率为15.4%，其中心脑血管疾病死亡发生率为3.7%；低ePWV组全因死亡发生率为2.8%，其中心脑血管疾病死亡发生率0.5%。组间比较显示，高ePWV组的死亡风险更高（全因死亡：χ2 = 158.407，P＜0.001；心脑血管疾病死亡：χ2 = 42.999，P＜0.001）。多因素Cox回归分析结果显示，高ePWV组的全因死亡及心脑血管疾病死亡风险均显著增加HR分别为4.46 (95%CI：2.94～6.67)、5.68 (95%CI：2.23～14.45)。以非心脑血管疾病死亡作为竞争事件，Fine-Gray模型结果显示，高ePWV组的心脑血管疾病死亡子分布风险比（sHR）为5.48 (95%CI：2.78～10.81)。亚组分析结果未观察到交互作用。此外，对CHARLS数据库的分析得出相似的结果。
    结论 ePWV与血压升高患者死亡风险升高相关，可作为该人群预后评估的重要指标，在未来风险分层和个体化治疗决策中具有潜在的临床应用价值。

     

    Abstract:
    Objective  To evaluate the association between estimated pulse wave velocity (ePWV) and the risk of all-cause mortality and cardiovascular mortality in patients with elevated blood pressure.
    Methods This study was based on data from the National Health and Nutrition Examination Survey (NHANES) covering 10 consecutive cycles from 1999 to 2018, including 4 816 patients with elevated blood pressure. First, based on the threshold determined by restricted cubic spline (RCS) analysis, the study subjects was divided into a low ePWV group (ePWV≤8.054) and a high ePWV group (ePWV＞8.054) using an ePWV cutoff of 8.054. Second, Kaplan-Meier survival curves, cumulative incidence function curves for competing risks, Cox proportional hazards models, competing risk models, and subgroup analyses were employed to investigate the association between ePWV and the risk of all-cause mortality and cardiovascular mortality in patients with elevated blood pressure. Finally, external validation was performed using independent samples from the nationally representative China Health and Retirement Longitudinal Study (CHARLS) database.
    Results During the follow-up period, in the high ePWV group, the all-cause mortality rate was 15.4%, the cardiovascular mortality rate was 3.7%; and in the low ePWV group, the all-cause mortality rate was 2.8%, and the cardiovascular mortality rate was 0.5%. Intergroup comparisons showed that the mortality risk in the high ePWV group was significantly higher (all-cause mortality: χ2 = 158.407, P＜0.001; cardiovascular mortality: χ2 = 42.999, P＜0.001). Multivariate Cox proportional hazards regression analysis indicated that both all-cause and cardiovascular mortality risks were significantly higher in the high ePWV group (HR = 4.46, 95%CI: 2.94 to 6.67; HR = 5.68, 95%CI: 2.23 to 14.45, respectively). Considering non-cardiovascular death as a competing event, the Fine-Gray model showed that the subdistribution hazard ratio (sHR) for cardiovascular death in the high ePWV group was 5.48 (95%CI: 2.78 to 10.81). No significant interaction was observed in the subgroup analysis. Additionally, similar results were obtained from the CHARLS database.
    Conclusions ePWV is significantly associated with an increased risk of all-cause and cardiovascular mortality in patients with elevated blood pressure. It may serve as a valuable tool for prognostic assessment in this population, demonstrating potential for future application in risk stratification and personalized treatment strategies.

     

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