| Background: With the development of economics, the cardiovascular disease has become the leading cause of death and is a main source of health care cost worldwide. Atherosclerosis is the main pathogenesis of cardiovascular disease. Detecting atherosclerosis in the early stage and providing the patients with life style intervention and drug therapy are the best methods to prevent cardiovascular events. Pulse wave velocity (PWV) reflects arterial stiffness, and it is a marker of both the severity of vascular damage and the prognosis of cardiovascular disease. Recently, brachial-ankle pulse wave velocity (baPWV) has begun to be used as a means of measuring PWV. BaPWV reflects the stiffness of both central and peripheral arteries. Hypertension, diabetes mellitus, and dyslipidemia are crucial causes of atherosclerosis. Although many studies have focused on the fact that increased PWV is involved in various cardiovascular risk factors, such as aging, hypertension, diabetes, dyslipidemia, and smoking, the studies relating PWV to cardiovascular risk factors found inconsistent correlations. There are few studies to investigate the relation between PWV and cardiovascular risk factors in Chinese population. The aims of the present study are to assess the reliability of baPWV measurement and to evaluate the impacts of blood pressure, blood lipids and blood glucose on baPWV.Methods(the first section): BaPWV measurement was performed in twenty-three patients at high risk for developing cardiovascular disease and seven healthy people by two observers on two separate days with a two weeks' interval, with two exams each day in the morning (8:30-11:00) and afternoon (13:30-16:00). The demographic data and somatometric measurements were obtained. The subjects couldn't smoke, drink, and eat before accepting measurement. The subjects didn't have arrhythmia and arteriosclerosis obliterans(ASO). Repeated measurement analysis of variance was used for comparisons between-observer and within-observer. Pearson's correlation coefficients, intra-class coefficients and Bland-Altman plot were performed for the assessments of reproducibility. All the statistic analyses were performed using the SPSS software 15.0 package. Values of P<0.05 was considered to indicate statistical significant.Results(the first section): No significant differences were observed by repeated measurement analysis of variance between-observer and within-observer. Pearson's correlation coefficients of patients between two observers and within-observer were 0.925～0.992 (P<0.01), intra-class coefficients were 0.924～0.992 (P<0.01). Pearson's correlation coefficients of healthy people between two observers and within-observer were 0.674～0.974 (P<0.05), intra-class coefficients were 0.672～0.973 (P<0.05). Inter-observer and intra-observer Bland-Altman plots showed good reproducibility.Conclusions(the first section): Under standardized measurement conditions, baPWV showed good inter-observer and intra-observer reproducibility.Methods(the second section): A follow up survey was carried out in a cohort of 770 residents aged 44-81 years old June and July in 2007. A baseline survey for those subjects was conducted in 2000 to 2001. Date was collected for this investigation including demographic, somatometric measurements, cardiovascular disease histories of subjects and their families, blood pressure, serum glucose, serum lipids, drinking, smoking and behaviors. Chi-square test, t test, analysis of covariance, multiple linear regression, and logistic regression were performed to exam the relations between baPWV and cardiovascular risk factors. All the statistic analyses were performed using the SPSS software 15.0 package. Values of P<0.05 was considered to indicate statistical significant.Results(the second section): BaPWV correlated with age, systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), total cholesterol(TC) and triglyceride(TG). Multiple linear regression analysis revealed that FPG, TC, SBP, HDL-C correlated with baPWV independently after adjusting age, BMI and smoking status.There was a significant difference of baPWV between normotension group and hypertension group after adjusting age, BMI, TG, TC, HDL-C and FPG. After adjusting age, BMI, SBP, DBP and FPG, 200mg/dl≤TC<240mg/dl and TC≥240mg/dl group's baPWV were both higher than that of TC<200mg/dl group significantly. After adjusting age, BMI, TC, TG and HDL-C, the differences of baPWV were found with statistical significances among diabetes mellitus group, impaird of fasting glucose group and nomal glucose group were significant. The diabetes mellitus group had the higest baPWV and the nomal glucose group had the lowest baPWV.The subjects who had hypertension or diabetes mellitus or hyperhpiodemia over 7 years had higher baPWV than the subjects suffering from those diseases less than 7 years.The arteriosclerosis group had significantly higher TG, FPG, TC levels and a higher hyperlipiodemia prevalence than non-arteriosclerosis group. Compared with subjects who had normal blood glucose, logistic regression analysis suggested that diabetes mellitus patients and fasting glucose intolerance patients had sixfold and twofold risks to develop arteriosclerosis respectively. Compared with TC<200mg/dl group, logistic regression analysis demonstrated that 200mg/dl≤TC<240mg/dl and TC≥240mg/dl group had 1.589 fold and 1.825 fold risks to develop arteriosclerosis respectively. Moreover compared with subjects whose ages ranging from 40-50 years, logistic regression analysis showed subjects whose ages ranging from 60-70 had 2.120 fold risks to develop arteriosclerosis. The subjects with two kinds of diseases among hypertension, diabetes mellitus and hyperlipoidemia had the highest baPWV and had about twofold risks to develop arteriosclerosis than healthy subjects.Conclusions (the second section): The result of this study indicated that baPWV positively associated with blood pressure, serum glucose, total cholesterol and HDL-C. There were statistical differences within groups classified according to blood pressure, serum glucose and total cholesterol respectively. Arteriosclerosis risk was increased with blood glucose and cholesterol level. |
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