A Research Of Functional Change Of Artery Evaluated By Cardio-ankle Vascular Index

Arteriosclerosis and vascular disease are the main reasons leading to cardiovascular andcerebrovascular events. It’s important to prevent vascular disease emergencies byaccurate detection, discovery and evaluation on early abnormal arterial structure andfunction. As the assessment of early vascular lesion, noninvasive detection technology,such as Carotid Artery Ultrasound and Pulse Wave Velocity (PWV), has been usedwidely. In recent years, PWV has been used to derive a new technology—Cardio-anklevascular index (CAVI) and it has drawn more and more attention. So analysing andresearch on discovery and screening effectively on arteriosclerosis in healthy populationby CAVI, exploring the influence factors, and finding out valid inspection methods ofatherosclerotic disease ealier, can strengthen to monitor risky population ofcardiovascular and can also prevent Vasculare disease emergencies, which is the clinicalusage.Objective1. It’s good to early screening high risky group of arteriosclerosis and to controllingrisk factors of arteriosclerosis and to provide the evidence for promoting healthy bloodvessels and preventing cardiovascular disease effectively, when we research oninfluencing factors of CAVI of physical examination population and discuss thedifference between nomal blood vessles’risk factors and CAVI.2. Research on validity and applicability of CAVI—the new index of assessment ofarterial stiffness. Compare difference of CAVI value and various trend between differentage group; according to ROC analysis on neck arteriosclerosis,explored the bestboundary value of CAVI to predict arteriosclerosis, analyse the difference between international standards and ours; it’s good to mornitor the domestic risky group ofcardiocerebrovascular disease and to prevent emergencies.Methods1. Subject of research: Choose229cases of those both have CAVI and Carotidultrasonography test among1305cases of physical examination population who havephysical examination and CAVI inspection in physical examination center of the1staffiliated hospital of Anhui medical university during March2010to September2011.2. Method of study:2.1CAVI inspection: automatically test pulse wave and blood pressure of subject’sbilateral upper and lower limbs and calculate CAVI value with a VS-1000arteriosclerosis detector (Fukuda Denshi, Tokyo, Japan).CAVI normal value which isrecognized domestic and abroad at present, is defined at9.0. That is normal ifCAVI<9.0, and increasing if CAVI≥9.0. We treat CAVI increasement of any side asCAVI increasement. This suggest that arterial stiffiness increasement and possibility ofarteriosclerosis.2.2Routine inspection and the blood specimen collection:collect body height andweight and blood pressure data from each subject and calculate constitutional index.Take venous blood sample of subjects at their fasting state. Collect biochemicalindicators, such as TC, TG, LDL-C, HDL-C,Glu,etc., with Roche Automatic biochemicalanalyzer Modular.2.3Carotid ultrasound insection: inspect with XARIO SSA-660A color Dopplerultrasound diagnostic apparatus (Toshiba, Tokyo, Japan) which is manufactured byJapnese TOSHIBA Company.The subjects lie in supine position and resting state,inspect the initial part,trunk and branch of arteria carotis, quantitatively determinedIntima-media thickness (IMT) and record whether it has plaque or not.3. Statistical methods: Establish a database and have a statistical analysis with software SPSS13.0; draw Receiver Operation Characteristic Curve (ROC) with MedCalc12.1.3.0;show measurement data as x sand counting data as percentage (%); compare twoteams of measurement data with independent sample t test; compare measurement datawhich more than two teams with variance analysis, and each two of the samples werecompared with SNK-q test; compare counting data with2test; multiple factoranalysis is taken by multivariate stepwise Logistic regressive analysis, and estimaterelative risk by OR and95%CI; use Spearman for correlate analysis; analyse theprediction value of CAVI to arteriosclerosis by ROC curve analysis; the difference ofP<0.05has statistical significance.Results1. Discuss the influencing factor of CAVI of physical examination population.1.1According to result of CAVI, the subjects are divided inot CAVI normalgroup(CAVI<9.0) and increasing group(CAVI≥9.0). And the difference of age, sex,systolic presure, kiastolic pressure, pulse pressure and blood glucose of two groups hasstatistical significance.1.2Divide cholesterol,glyerin three greases, low density lipoprotein and high densitylipoproterin into groups according to different level. Compare CAVI positive rate ofeach group. The result showes that CAVI positive rate difference of each groups ofglyerin three greases has statistical significance(P<0.05),while difference of cholesteroland low density lipoprotein has no statistical significance.1.3We find that age, systolic pressure, level of glyerin three greases and blood glucoseare positively correlated with CAVI through multivatiate stepwise Logistic regressiveanalysis, and high density lipoproterin and constitutional index are negatively correlatedwith CAVI; sex, kiastolic pressure and pulse pressure is eliminated gradually in theprocess of introducing equation so as to show that they hasn’t obviouse relationshipwith CAVI in this research. 2. The research and analysis on the validity and applicability of domestic application ofCAVI—the new index of assessment of arterial stiffness.2.1Divide subjects according to age group, we find out that the CAVI value increase asthey age, and the difference of CAVI value between each group has statisticalsignificance. Besides, CAVI average value of neck arteriosclerosis group is obviouselyhigher than non-neck arteriosclerosis group (P<0.05).2.2Take neck arteriosclerosis as reference, ROC curve of CAVI, which is predictedarteriosclerosis, is made out. As this research treated increase of any side of CAVI asincreasing of CAVI, and pointed out the possabillity of arteriosclerosis, the higher valueof both sides of CAVI is taken to ROC analysis as unique variables, the result will showthat the area under ROC curve is0.774(95%CI:0.714-0.827,P<0.0001), and the bestboundary value is8.1(sensibility:0.656, specificity:0.758).2.3Divide subjects according to age group, find that positive detective rate of neckarteriosclerosis ultrasound in group under40years old is low and difference has nostatistical significance; in group of40to49years old, positive detective rate of CAVI isbigger than that of neck arteriosclerosis ultrasound(P=0.029); positive detective rate ofCAVI and neck arteriosclerosis ultrasound are high in group over50years old, anddifference has no statistical significance.Conclusion1. Our study finds out that CAVI is changed according to factors of age, blood pressure,blood lipid, blood glucise and body index, etc. And increasement of age, systolicpressure, glyerin three greases and blood glucose, or reducement of the high densitylipoprotein, will casuse increasement of CAVI and risk of arterial stiffiness. Classicalindex of body index BMI probably can’t reflect properly relationship between fatnessand arterial stiffness. As there is no analysement on types and degrees of obesity in outstudy, further reseach is required, especially on effect of abdominal obesity on vascular function.2. This research suggests that functional change of artery has already occurred if CAVI ismore than8.1and more attention should be taken, and it will be useful to find earlyblood vessel disease. So normal value standard (CAVI<9.0), which is used in foreigncountries, is not fit for Chinese, and large-scale of domestic investigation and researchof this new index should be taken to make national CAVI diagnostic code morerepresentatively, and to monitor risky groups of cardiovascular and cerebrovasculardisease more effectively, and to provide a better time to prevent vascular diseaseemergencies.3. CAVI is an effective new index for the evaluation of early atherosclerosis. It reflectsthe abnormal situation of arterial stiffness in the early changeable period of vascularlesions. It can find out the abnormal situation earlier than ultrasonic inspection, so it ismore suitable for early period of arteriosclerosis or screening of risky groups.