Arterial Elasticity, Subclinical, and Clinical CVD in MESA

MESA 中的动脉弹性、亚临床和临床 CVD

• 批准号: 8284397
• 负责人: DANIEL A DUPREZ
• 金额: $ 59.75万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-05 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8284397
• 关键词: Age; Aging-Related Process; Algorithms; Arteries; Atherosclerosis; Behavior; Blood Pressure; Blood Vessels; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Clinical; Consensus; Contracts; Coronary heart disease; Data Analyses; Diastole; Diastolic blood pressure; Disease; Disease Outcome; Drops; Elasticity; Elderly; Event; Goals; Harvest; Health; Heart failure; Hypertension; Information Dissemination; Libraries; Measures; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; Participant; Pattern; Physiologic pulse; Preventive; Property; Prospective Studies; Public Health; Risk; Risk Factors; Sample Size; Schedule; Smoking; System; Systole; Techniques; Testing; Text; Time; United States; base; blood lipid; cardiovascular risk factor; cohort; coronary artery calcification; hazard; heart disease risk; improved; indexing; middle age; pressure; prospective; public health relevance; radial artery; symposium; tonometry; Age; Aging-Related Process; Algorithms; Arteries; Atherosclerosis; Behavior; Blood Pressure; Blood Vessels; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Clinical; Consensus; Contracts; Coronary heart disease; Data Analyses; Diastole; Diastolic blood pressure; Disease; Disease Outcome; Drops; Elasticity; Elderly; Event; Goals; Harvest; Health; Heart failure; Hypertension; Information Dissemination; Libraries; Measures; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; Participant; Pattern; Physiologic pulse; Preventive; Property; Prospective Studies; Public Health; Risk; Risk Factors; Sample Size; Schedule; Smoking; System; Systole; Techniques; Testing; Text; Time; United States; base; blood lipid; cardiovascular risk factor; cohort; coronary artery calcification; hazard; heart disease risk; improved; indexing; middle age; pressure; prospective; public health relevance; radial artery; symposium; tonometry

DESCRIPTION (provided by applicant): Systolic and diastolic blood pressures are important predictors of clinical cardiovascular events and targets of clinical and preventive treatment. The arterial blood pressure waveform between these two extremes throughout the cardiac cycle adds information to systolic and diastolic blood pressure regarding cardiovascular risk. This waveform is the net result of the forward and backward pressure waves. Functional and structural changes of the arterial system have an impact on the wave reflections during the cardiac cycle, with particular patterns indicative of different levels of arterial elasticity (1/stiffness). The radial artery pulse contour can be registered noninvasively by radial artery tonometry. One method of extracting information from the pulse contour uses a modified Windkessel model to estimate arterial elasticity in the pool of large arteries (LAE) and in the pool of small arteries (SAE), based on analysis of the diastolic portion of the pulse waveform. The systolic portion of the waveform may contain additional information about arterial elastic behavior. The modified Windkessel model was utilized in a prospective observational cohort initially free of clinical cardiovascular disease, the Multi-ethnic Study of Atherosclerosis (MESA, n=6336, average age 62). Arterial elasticity was lower at greater ages. Lower SAE was related to higher incident hypertension and clinical cardiovascular disease (hazard ratios least vs. highest SAE quartile 2.85 and 2.16) independent of blood pressure, smoking, blood lipids, and level of coronary artery calcification in MESA after median 5.8 years of followup. The associations of LAE and SAE with clinical cardiovascular disease strengthened with addition of events in MESA since the initial submission, leading to a 11% Net Reclassification Index beyond Framingham risk prediction. We propose to remeasure LAE and SAE in MESA (average age 72) to assess 1) whether 10- year change in LAE and SAE adds to prediction of clinical events in MESA, beyond the baseline level of SAE, 2) to examine and compare the predictive ability of alternate measures derived from the digitized radial artery pulse waveform, and 3) to better understand mathematical and statistical properties of estimates of the waveform and of arterial elasticity, with a goal to improve reliability of the estimates. Findings from this study will contribute information about how functional changes in the arterial system over late middle age into elderly years add to the systolic and diastolic blood pressure in prediction of coronary heart disease risk. Assessing LAE and SAE twice over 10 years is a conservative test of whether their trajectories are related to disease outcomes beyond the processes of aging. The slope of arterial elasticity could potentially be helpful in the selection of therapy to slow the loss of vascular integrity, which we hypothesis will reduce disease. PUBLIC HEALTH RELEVANCE: Project Narrative Atherosclerosis and cardiovascular disease are major public health concerns and remain major causes of death in the United States. Functional problems in the arterial system are detectable through analysis of the blood pressure levels throughout the cardiac cycle, as detailed in the radial artery pulse waveform. The proposed study will provide empirical findings of functional arterial status in relation to subclinical and clinical events, as well as gather an maintain a library of over 11000 digitized pulse waveforms for analysis of any proposed new or existing measure of functional arterial status in relation to clinical cardiovascular events.

描述（由申请人提供）：收缩压和舒张压是临床心血管事件以及临床和预防性治疗目标的重要预测指标。在整个心脏周期中，这两个极端之间的动脉血压波形为心血管风险的收缩压和舒张压增加了信息。该波形是向前和向后压力波的净结果。动脉系统的功能和结构变化对心脏周期期间的波浪反射有影响，特定的模式表明了不同水平的动脉弹性（1/刚度）。径向动脉脉冲轮廓可以通过径向动脉刺激性无创登记。从脉冲轮廓中提取信息的一种方法使用改良的Windkessel模型来估计大动脉池（LAE）和小动脉（SAE）中的动脉弹性，基于对脉搏波形的舒张部分的分析。波形的收缩部分可能包含有关动脉弹性行为的其他信息。改良的Windkessel模型用于前瞻性观察队列中，最初没有临床心血管疾病，即动脉粥样硬化的多种族研究（Mesa，n = 6336，平均年龄62岁）。在更大的年龄，动脉弹性较低。较低的SAE与较高的入射高血压和临床心血管疾病（危险比最少与最高SAE四分位数2.85和2.16）有关，与血压，吸烟，血脂和冠状动脉钙化水平无关，MSA中间5.8年后，MESA中的冠状动脉钙化水平。自初次提交以来，通过在MESA中添加事件，LAE和SAE与临床心血管疾病的关联增强了，导致净重新分类指数超出了Framingham风险预测。我们建议在MESA（平均年龄72岁）重新审查LAE和SAE以评估1）LAE和SAE的10年变化是否增加了MESA中临床事件的预测，超出SAE的基线水平，2）检查和比较了替代措施的预测能力，从而从数字化的辐射脉冲波和3）中的统计范围和统计学的特性，以及数学的统计范围，并比较了数学的统计范围，并比较了数学的性能。弹性，目的是提高估计的可靠性。这项研究的结果将有助于有关中年晚期动脉系统的功能变化的信息，从而增加了预测冠心病风险的收缩压和舒张压。在10年中评估LAE和SAE两次是对其轨迹是否与衰老过程之外的疾病结局有关的保守检验。动脉弹性的斜率可能有助于选择降低血管完整性丧失的治疗，我们假设这将减少疾病。 公共卫生相关性： 项目叙事性动脉粥样硬化和心血管疾病是主要的公共卫生问题，在美国仍然是主要的死亡原因。如径向动脉脉冲波形所述，可以通过分析整个心脏周期的血压水平来检测动脉系统中的功能问题。拟议的研究将提供与亚临床和临床事件有关的功能动脉状态的经验发现，并收集一个维持超过11000个数字化脉冲波形的文库，以分析与临床心血管疾病事件有关的任何提议的新或现有功能性动脉状态的量度。