关键词: 动脉硬化, 原发性高血压, 心血管疾病, 脑血管障碍, 联合作用, 影响因素分析, 随访研究

Abstract: Background　Either arterial stiffness or essential hypertension has been sufficiently proved to be a major risk for cardio-cerebrovascular disease，but combined association of them with cardio-cerebrovascular disease has been rarely reported. Objective　To further explore the relationship of arterial stiffness or essential hypertension with cardio-cerebrovascular disease in Chinese population in a large prospective community-based cohort study，and examine whether the former two have a combined association with the latter. Methods　Participants（n=33 820）were selected from individuals attending the four annual follow-up visits（2010—2011，2012—2013，2014—2015，2016—2017）of Kailuan study and had brachial-ankle pulse wave velocity（baPWV）measurement（without any cardio-cerebral vascular events prior to the measurement）and ABI<0.9. Age，gender，systolic blood pressure（SBP），diastolic blood pressure（DBP），baPWV，heart rate，body mass index（BMI），fasting blood glucose（FBG），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），uric acid（UA），smoking，drinking，physical exercise，education level，diabetes，and the use of antihypertensive drugs and hypoglycemic drugs were collected. The study was completed until December 31，2017，with the occurrence of a cardiovascular or cerebrovascular event as the endpoint event. Arterial stiffness was defined as baPWV > 1 400 cm/s. By the prevalence of arterial stiffness and essential hypertension during the follow-up period，participants were categorized into group 1（having no essential hypertension and arterial stiffness），group 2（having no essential hypertension but arterial stiffness），group 3（having essential hypertension and arterial stiffness），and group 4（having essential hypertension but no arterial stiffness）. Multivariate Cox regression analysis was used to further investigate the association of arterial stiffness or essential hypertension with cardio-cerebrovascular disease，and the strength of combined association of the former two with the latter. Results　The average follow-up years was（3.34±2.38）. The incidence density of cardio-cerebrovascular disease was 51.67 per 10 000 person-year. The cumulative incidence of cardio-cerebrovascular disease in groups 1-4 was 0.28%，1.94%，1.75%，4.70%，respectively. Four groups had statistically significant differences in male proportion，mean age，baPWV，BMI，FBG，TC，TG，LDL-C，HDL-C，SBP，DBP，heart rate，BMI，FBG，TC，TG，LDL-C，UA，smoking，drinking，physical exercise，diabetes，prevalence of taking antihypertensive drugs，prevalence of taking hypoglycemic drugs，and cumulative incidence of cardio-cerebrovascular disease（P<0.05）. Multivariate Cox regression analysis showed that prevalence of arterial stiffness 〔HR=2.60，95%CI（1.88，3.61）〕，baPWV-SD〔HR=1.22，95%CI（1.12，1.33）〕，prevalence of essential hypertension〔HR=2.05，95%CI（1.59，2.64）〕 and SBP-SD〔HR=1.26，95%CI（1.14，1.38）〕 were the associated with cardio-cerebrovascular disease（P<0.05）. Compared with group G1，the HR of cardio-cerebral vascular events in groups 2-4 was 3.33〔95%CI（2.08，5.33）〕，2.81〔95%CI（1.57，5.03）〕and 5.98〔95%CI（3.79，9.43）〕，respectively. The results suggested there was no interact effect between arterial stiffness and essential hypertension on cardio-cerebrovascular disease（P=0.789）. No result was changed after repeating the above analysis after excluding the population taking antihypertensive medications. Conclusion　Our study found that both arterial stiffness and essential hypertension increased the risk of cardio-cerebrovascular disease，and they had a combined association with cardio-cerebrovascular disease.

Key words: Arterial stiffness, Essential hypertension, Cardiovascular disease, Cerebrovascular disorders, Combined effect, Root cause analysis, Follow-up studies