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背景动脉粥样硬化生物标记利于对有心血管病风险者做出临床决策。研究以确定表面健康男性内皮功能预后的重要性和其他血管标记为目的。方法和结果入选人群由1 574例无血管病男性(49.4岁)组成。测量包括血流介导的扩张及其微血管刺激,充血速度、颈动脉内膜中层厚度和C反应蛋白。Cox比例风险模型评估血管标记、Framingham风险评分与血管病死亡、血管再通术、心肌梗死、心绞痛和脑卒中首发心血管终点之间的关系。参试者有过低中位Framingham风险评分(7.9%)。平均跟踪(7.2±1.7)年,有71例被试发生心血管事件(111个事件)。血流介导扩张与后发心血管事件无关(危害比0.92;P=0.54)。含Framingham风险评分(每单位SD)多变量分析中发现,除C反应蛋白(P=0.35)外,充血速度[危害比0.70,95%CI(0.54,0.90);P=0.006]和颈动脉内膜中层厚度[HR 1.45,CI(1.15,1.83);P=0.002]两者均与事件相关。此外,经对中间风险组5年跟踪后,充血速度附加于Framingham风险评分所产生的净临床改叙改善28.7%(P<0.001)。充血速度总净改叙改善为6.9%(P=0.24)。结论男性,充血速度,即血流介导扩张的刺激,而非血流本身介导的扩张为负性心血管结果的重要风险标记。为传统风险因子和颈动脉内膜中层厚度增添了预后价值。充血速度成为微血管功能的新标记,也为层化低风险健康男性风险的新工具。
Background Atherosclerosis biomarkers facilitate clinical decision-making for persons at risk of cardiovascular disease. The aim of the study was to determine the importance of the prognosis of endothelial function in healthy males and other vascular markers. Methods and Results The enrolled population consisted of 1 574 non-vascular men (49.4 years). Measurements include flow-mediated dilatation and its microvascular stimulation, rate of congestion, carotid intima-media thickness, and C-reactive protein. Cox proportional hazards model was used to assess the relationship between vascular markers, Framingham risk score, and vascular death, revascularization, myocardial infarction, angina pectoris, and primary end point of stroke. Participants had too low a median Framingham risk score (7.9%). In a mean follow-up of (7.2 ± 1.7) years, 71 subjects developed cardiovascular events (111 events). Flow-mediated dilation was not associated with subsequent cardiovascular events (hazard ratio 0.92; P = 0.54). In the multivariate analysis with Framingham risk score (per unit SD), the rate of congestion [hazard ratio 0.70, 95% CI (0.54, 0.90); P = 0.006] and carotid intima Membrane thickness [HR 1.45, CI (1.15, 1.83); P = 0.002] both correlated with events. In addition, the net clinical recanalization resulting from the addition of the congestion rate to the Framingham risk score improved 28.7% (P <0.001) after a 5-year follow-up of the intermediate risk group. The total net recapture rate improved to 6.9% (P = 0.24). Conclusions Male, the rate of congestion, the stimulation of blood flow-mediated dilatation, is an important risk marker of negative cardiovascular outcomes rather than the dilation mediated by blood flow itself. Prognostic value for traditional risk factors and intima-media thickness of carotid artery. The rate of congestion becomes a new marker of microvascular function and is also a new tool to stratify the risk of low-risk healthy men.