Risk Stratification
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BACKGROUND: Whether cardiovascular risk is more tightly associated with central (cSBP) than brachial (bSBP) systolic pressure remains debated, because of their close correlation and uncertain thresholds to differentiate cSBP into normotension versus hypertension. METHODS: In a person-level meta-analysis of the International Database of Central Arterial Properties for Risk Stratification (n=5576; 54.1% women; mean age 54.2 years), outcome-driven thresholds for cSBP were determined and whether the cross-classification of cSBP and bSBP improved risk stratification was explored. cSBP was tonometrically estimated from the radial pulse wave using SphygmoCor software. RESULTS: Over 4.1 years (median), 255 composite cardiovascular end points occurred. In multivariable bootstrapped analyses, cSBP thresholds (in mm Hg) of 110.5 (95% CI, 109.1-111.8), 120.2 (119.4-121.0), 130.0 (129.6-130.3), and 149.5 (148.4-150.5) generated 5-year cardiovascular risks equivalent to the American College of Cardiology/American Heart Association bSBP thresholds of 120, 130, 140, and 160. Applying 120/130 mm Hg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (43.1%) and hypertension (48.2%) versus isolated brachial hypertension (5.0%) and isolated central hypertension (3.7%). With concordant normotension as reference, the multivariable hazard ratios for the cardiovascular end point were 1.30 (95% CI, 0.58-2.94) for isolated brachial hypertension, 2.28 (1.21-4.30) for isolated central hypertension, and 2.02 (1.41-2.91) for concordant hypertension. The increased cardiovascular risk associated with isolated central and concordant hypertension was paralleled by cerebrovascular end points with hazard ratios of 3.71 (1.37-10.06) and 2.60 (1.35-5.00), respectively. CONCLUSIONS: Irrespective of the brachial blood pressure status, central hypertension increased cardiovascular and cerebrovascular risk indicating the importance of controlling central hypertension.
- MeSH
- arteria brachialis MeSH
- hodnocení rizik MeSH
- hypertenze * diagnóza epidemiologie MeSH
- krevní tlak fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření krevního tlaku * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
OBJECTIVE: To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives. METHODS: Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included. RESULTS: The database included 10,930 subjects (54.8% women; median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 (40.1%), of which 2,713 (61.0%) were treated, and of diabetes mellitus was 629 (5.8%). The peripheral and central systolic/diastolic blood pressure averaged 129.5/78.7 mm Hg and 118.2/79.7 mm Hg, respectively. Mean aortic pulse wave velocity was 7.3 m per seconds. Among 6,871 participants enrolled in 9 longitudinal studies, the median follow-up was 4.2 years (5th-95th percentile interval, 1.3-12.2 years). During 38,957 person-years of follow-up, 339 participants experienced a composite cardiovascular event and 212 died, 67 of cardiovascular disease. CONCLUSIONS: IDCARS will provide a unique opportunity to investigate hypotheses on central hemodynamic measurements that could not reliably be studied in individual studies. The results of these analyses might inform guidelines and be of help to clinicians involved in the management of patients with suspected or established hypertension.
- MeSH
- analýza pulzové vlny MeSH
- hypertenze * diagnóza epidemiologie MeSH
- kardiovaskulární nemoci * diagnóza epidemiologie MeSH
- krevní tlak fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- průřezové studie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- MeSH
- biologické markery diagnostické užití MeSH
- dysfunkce pravé srdeční komory diagnóza patologie MeSH
- hodnocení rizik MeSH
- lidé MeSH
- natriuretický peptid typu B analýza MeSH
- plicní embolie mortalita patologie MeSH
- rizikové faktory MeSH
- troponin analýza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
I když v současné době je statisticky prokázána účinnost aminobisfosfonátů (risedronátu a alendronátu) v prevenci zlomeniny proximálního femoru, platí to jen u starých nemocných s osteoporózou a již prodělanou zlomeninou. U žen mladších 70 let, které už prodělaly osteoporotickou zlomeninu, snižují všechny dnes dostupné antiresorpční léky (raloxifen, kalcitonin, risedronát a alendronát) riziko zlomenin obratlů. Stupeň tohoto účinku je po 4-5 letech podávání u všech uvedených léků obdobný, i když se uplatňuje rozdílnými mechanismy. Raloxifen, risedronát a alendronát prokazatelně snižují riziko zlomeniny obratlů při postmenopauzální osteoporóze také u žen bez dosud prodělané zlomeniny. Pouze raloxifen prokazatelně snižuje riziko první zlomeniny obratle i u žen, které mají v proximálním femoru jen osteopenii. Požadavky dlouhodobé léčby osteoporózy splňují uvedené antiresorpční léky v rozdílné míře. Liší se dlouhodobým zachováním účinnosti (snížení rizika zlomeniny), stupněm dlouhodobého zlepšování kvality kosti, dlouhodobě příznivými účinky léčby na tkáně jiné než kost a dlouhodobě přijatelnými riziky nežádoucích účinků. To vše jsou také podmínky dlouhodobé compliance a setrvání nemocných na léčbě. Uvedená kritéria by při zahajování léčby nemocných s postmenopauzální osteoporózou měla být uplatňována s přihlédnutím k jejich věku, individuálním rizikům zlomenin během dalších 5-10 let a rizikům jiných zdravotních komplikací.
Despite a statistically proven efficacy of aminobisphosphonates (risedronate and alendronate) in preventing fractures of the proximal femur, their effect only applies to elderly osteoporotic patients who already suffered a fracture. In women under to who already suffered an osteoporotic fracture, all available antiresorptive drugs (raloxifene, calcitonin, risedronate and alendronate) are capable of decreasing the risk of vertebral fracture. The magnitude of this effect after 4-5 years therapy using all the above-mentioned drugs is similar, even though different mechanisms are exerted. Raloxifene, risedronate and alendronate all demonstrably decrease the vertebral fracture risk associated with postmenopausal osteoporosis in women without any previous fracture. Only raloxifene demonstrably decreases fracture risk in women with osteopenia of the proximal femur. The above-mentioned antiresorptive drugsmeet the requirements for successful long-term osteoporosis treatment to a varyiing degree. They differ in efficacy (fracture risk reduction), degree of bone quality improvement, beneficial effects on tissues other than bone and acceptable risk of long-term side effects. All of these criteria are prerequisite for long-term compliance and adherence to treatment. They should applied prior to treatment initiation in patients with postmenopausal osteoporosis considering their age, individual fracture risk within the next 5-10 years and other health conditions.
- MeSH
- infarkt myokardu komplikace MeSH
- náhlá srdeční smrt MeSH
- riziko MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- dospělí MeSH
- faktorová analýza statistická MeSH
- infarkt myokardu MeSH
- ischemická choroba srdeční diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- prognóza metody MeSH
- recidiva psychologie MeSH
- rizikové faktory MeSH
- senioři MeSH
- syndrom omráčeného myokardu diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular and coronary endpoints associated with PPA, as assessed by the SphygmoCor software, were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5608). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement. Age ranged from 30 to 96 years (median 53.6). Over 4.1 years (median), 255 and 109 participants experienced a cardiovascular or coronary endpoint. In a randomly defined discovery subset of 3945 individuals, the rounded risk-carrying PPA thresholds converged at 1.3. The HRs for cardiovascular and coronary endpoints contrasting PPA < 1.3 vs ≥1.3 were 1.54 (95% confidence interval [CI]: 1.00-2.36) and 2.45 (CI: 1.20-5.01), respectively. Models were well calibrated, findings were replicated in the remaining 1663 individuals analyzed as test dataset, and NRI was significant for both endpoints. The HRs associating cardiovascular and coronary endpoints per PPA threshold in individuals <60 vs ≥60 years were 3.86 vs 1.19 and 6.21 vs 1.77, respectively. The proportion of high-risk women (PPA < 1.3) was higher at younger age (<60 vs ≥60 years: 67.7% vs 61.5%; P < 0.001). In conclusion, over and beyond common risk factors, a brachial-to-central PP ratio of <1.3 is a forerunner of cardiovascular coronary complications and is an underestimated risk factor in women aged 30-60 years. Our study supports pulse wave analysis for risk stratification.
- MeSH
- analýza pulzové vlny MeSH
- arteria brachialis fyziologie MeSH
- dospělí MeSH
- kardiovaskulární nemoci * patofyziologie MeSH
- krevní tlak * fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
