Association of Carotid Intima-media Thickening and Hypertension with New-onset Cardio-cerebrovascular Disease

doi:10.12114/j.issn.1007-9572.2021.00.555

Abstract

Abstract: Background　Either carotid intima-media thickening（CIMT） or hypertension is closely related to the occurrence of cardio-cerebrovascular disease（CVD），yet large-scale studies exploring the combination of the two in relation to cardio-cerebrovascular disease are rare.Objective　To investigate the association of new-onset CVD with the combination of CIMT thickening and hypertension.Methods　In this prospective cohort study，5 440 middle-aged and elderly people（≥ 40 years old） who participated in the health examination of Kailuan Group from July 2006 to January 2017 and carotid ultrasound in 2010 were randomly selected.The content of epidemiological investigation，anthropometric indices，biochemical indices and the definition of living habits were described in the previous study of our group.Participants were grouped according to CIMT thickening and hypertension prevalence：group 1：normal CIMT（CIMT<1.0 mm） without hypertension；group 2：CIMT thickening without hypertension；group 3：normal CIMT（CIMT<1.0 mm） with hypertension；group 4：CIMT thickening with hypertension.The follow-up started since the completion of 2010 physical examination，and ended on 2017-12-31 with CVD（including stroke and myocardial infarction） as the endpoint event.The CVD cumulative incidence curves of the four groups were plotted by Kaplan-Meier method，and were compared by the Log-Rank test.Multivariate Cox regression analysis was used to explore the association of CIMT thickening and hypertension with new-onset CVD.Results　The mean follow-up period was（6.84±0.89） years.The cumulative incidence of CVD for groups 1，2，3，and 4 was 1.28%，2.96%，5.73% and 8.37%，respectively，with a statistically significant difference（χ2=96.10，P<0.001）.Multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） for new-onset CVD in groups 2，3 and 4 was 1.15（0.55，2.37），3.34（2.15，5.19） and 3.16（1.91，5.12），respectively.Sex-based analysis showed that compared to men in group 1，the HR（95%CI） for new-onset CVD in those in groups 2，3 and 4 was 1.35（0.62，2.94），3.46（2.04，5.89） and 3.29（1.84，5.90），respectively.Compared to women in group 1，the HR（95%CI） for new-onset CVD in those in groups 3，4 was 2.53（1.13，5.65） and 2.67（0.98，7.31），respectively.After eliminating the interference of antihypertensive drugs，the HR value of group 4 was significantly higher than that of group 3（P<0.05）.After excluding individuals taking lipid-lowering drugs，multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） of new-onset CVD in group 4 was 3.36（2.02，5.59）.After excluding those taking antihypertensive drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.19（1.19，5.71） compared to group 1in the multivariate Cox regression.And after excluding those taking hypoglycemic drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.59（2.06，6.25） compared to group 1showed by multivariate Cox regression analysis.Conclusion　CIMT thickening with hypertension may be strongly associated with new-onset CVD，which can provide help for clinical prevention of CVD.

Key words: Hypertension, Carotid intima-media thickness, Cardiovascular diseases, Cerebrovascular disorders

摘要： 背景　颈动脉内中膜（CIMT）增厚、高血压与心脑血管疾病的发生均密切相关，然而探讨二者结合与心脑血管疾病（CVD）关系的大型研究较少见。目的　探讨CIMT增厚联合高血压与新发CVD的关系。方法　采用前瞻性队列研究，随机选取参加2006年7月—2007年1月开滦（集团）有限责任公司健康体检的中老年人群（≥40岁）5 440例作为研究对象，并于2010年复检时对该人群进行颈动脉超声检查。流行病学调查内容、人体测量学指标、生化指标及生活习惯定义见本课题组前期研究。依据患者是否存在CIMT增厚及高血压进行分组，第一组：CIMT正常（CIMT<1.0 mm）无高血压；第二组：CIMT增厚无高血压；第三组：CIMT正常（CIMT<1.0 mm）合并高血压；第四组：CIMT增厚合并高血压。以完成2010年体检时间为随访起点，以发生CVD（包括脑卒中、心肌梗死）为终点事件，随访截止日期2017-12-31。采用Kaplan-Meier法绘制CVD累积发病率的生存曲线，累积发病率比较采用Log-rank检验；采用多因素Cox比例风险回归模型分析探讨CIMT增厚联合高血压对新发CVD的影响。结果　随访时间（6.84±0.89）年，4组CVD累积发病率分别为1.28%、2.96%、5.73%和8.37%；4组CVD累计发病率比较，差异有统计学意义（χ2=96.10，P<0.001）。多因素Cox比例风险回归模型分析结果显示，与第一组相比，第二、三、四组新发CVD的HR（95%CI）分别是1.15（0.55，2.37）、3.34（2.15，5.19）、3.16（1.91，5.12）。经性别分层后，男性：与第一组相比，第二、三、四组新发CVD的HR（95%CI）分别是1.35（0.62，2.94）、3.46（2.04，5.89）、3.29（1.84，5.90）；女性：与第一组相比，第三、四组发生CVD的HR（95%CI）分别是2.53（1.13，5.65）、2.67（0.98，7.31）。排除药物干扰进行敏感性分析，在删除降压药干扰后第四组的HR高于第三组（P<0.05）。分别剔除服用降脂药、降压药、降糖药人群后，多因素Cox比例风险回归模型分析结果显示，在未服用降脂药、降压药、降糖药人群中，相对于第一组，第四组发生CVD的HR（95%CI）分别是3.36（2.02，5.59）、3.19（1.19，5.71）、3.59（2.06，6.25）。结论　CIMT增厚联合高血压与新发CVD的发生存在密切关系，可为临床预防CVD的发生提供帮助。

关键词: 高血压, 颈动脉内膜中膜厚度, 心血管疾病, 脑血管障碍

ZHANG Ying,DU Xin,LI Jie, et al. Association of Carotid Intima-media Thickening and Hypertension with New-onset Cardio-cerebrovascular Disease　[J]. Chinese General Practice, 2021, 24(20): 2532-2536. DOI: 10.12114/j.issn.1007-9572.2021.00.555.
张莹,杜鑫,李劼等. 颈动脉内中膜增厚联合高血压与新发心脑血管疾病的关系研究[J]. 中国全科医学, 2021, 24(20): 2532-2536. DOI: 10.12114/j.issn.1007-9572.2021.00.555.

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