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Title: Carotid-femoral pulse wave velocity as a cardiovascular risk factor in Cracow inhabitants at the age between 45 and 70 yo

Abstract:

Cardio-vascular diseases are still the most common cause of death in Poland (around 45% of all cases). It is due to atherosclerosis, which initially leads to increased arterial stiffness, and can finally cause a critical narrowing of the vessel. The presence of cardio-vascular risk factors (markers) such as: systemic hypertension, dyslipidemia, diabetes mellitus, obesity, cigarettes smoking and inflammatory factors substantially influence this process.Recent tests of aortic stiffness are widely used for measurment of the level of atherosclerosis. Aortic stiffness is defined in a descriptive manner and sets qualitative characteristics determining the ability of the vessel to change its’ volume due to blood pressure acting on it. Carotid-femoral Pulse Wave Velocity (cfPWV) is the most common method, widely used for aortic stiffness measurement. There are proven prognostic correlations between cfPWV, age and some cardio-vascular risk factors. CfPWV is also an independent predictor of coronary artery disease (CAD) as well as stroke. It belongs to so called “new cardio-vascular risk factors” of cardio-vascular morbidity and mortality. CfPWV value> 10m / s has been arbitrarily adopted by the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) as a marker of cardiovascular risk, which statement is tantamount to acceptance of the patient to increased risk regardless of the presence of other factors. Numerous trials reveal the correlation between cfPWV and other cardio-vascular risk factors. CfPWV provides a general overview, and influence of risk factors on the circulatory system.Currently in Poland there are no reliable epidemiological studies that would determine the distribution and range of reference values carotid-femoral pulse wave velocity (cfPWV). In the presented study of doctoral dissertation cfPWV was carried out on a random group of people from the general population, including the recommended method of matching measurements and standards for cfPWV. Objectives of the research:1. Evaluation of distribution and defining the referential value of cfPWV in the general population sample of adults. 2. Estimation of correlations between cfPWV and cardio-vascular risk factors measured on the basis of classical risk scores. 3. Determination of the usefulness of cfPWV in predicting coronary artery stenosis. ; Material and methodologyThe study included 700 consecutive patients aged 45-70 years participating in the Polish part of the research program HAPIEE (Health, Alcohol and Psychosocial factors in Eastern Europe), because in this period of life often results in clinical manifestations of atherosclerosis and its complications. Patients were enrolled after completing a specially prepared questionnaire which examines the overall well-being, lifestyle, diet, socioeconomic conditions, and psychosocial predispositions. The draw was done in particular sex, age, and habitation groups.All responders were examined according to equal protocol: history, physical examination and laboratory tests. Patients were asked about the presence of cardio-vascular risk factors such as: systemic hypertension, diabetes mellitus, dyslipidemia, cigarretes smoking and obesity, about presence of positive cardio-vascular family history. Heart rate measurment, pulse examination, blood pressure measurement, weight, height were taken. Laboratory test for total cholesterol and all its’ fractions, triglicerydes and glucose. CfPWV was measured using an automated computer recorder and a system Complior® used for non-invasive assessment of aortic pulse wave velocity. Ultrasound of the carotid arteries (USG) - carried out in accordance with the consensus of Mannheim (8). Thanks to SR 3.0.0 software M'Ath automatic arterial wall thickness measurements (called. Intima-media thickness, IMT) were possible: The maximum, minimum and average. The program also automatically evaluated the quality and accuracy of measurements. Our study inclusion criteria for further analysis of the results was to obtain accurate values of the index QI > 0.9 (Figure 4). In accordance with the consensus Mannheim the plaque was domed each focal intima - media into the lumen of at least 0.5 mm, each of the bold at least 50% relative to the adjacent sections in the complex, and any thickening of the complex of at least 1, 5 mm.The collected results were analyzed statistically using Statistica PL 6.0. The project was approved by the Bioethics Committee of the Jagiellonian University (opinion of the EC / 99/03 / B / 284 of 25.03.1999r the amendment of 13.03.2008). ; Results:The mean age was 58.5 years and ranged from 45 years to 70 years. On the basis of subjective and objective examination diagnosed with coronary artery disease (25%), hypertension (56%), diabetes mellitus (13.3%), hypercholesterolemia (80.4%), hypertriglyceridemia (33.6%). Regular smoking was declared by 22.6% and 2.8% occasionally. On the basis of the SCORE tables for Polish after excluding patients with known cardiovascular disease and diabetes, 22.5% of people qualified for the group of significantly increased risk of death from cardiovascular causes.The average value for cfPWV was 12.9m/s and for IMT 0.79mm. Increased value for cfPWV (>10m/s) was in 271 responders (37,6%, IMT in 123responders (17,1%) and atherosclerotic plaques were diagnosed in 265 people (37,8%). CfPWV values were significantly higher in patients with hypertension, abdominal obesity and in subsequent quartile ranges for the age of the respondents. There were no statistically significant correlations between cfPWN and diabetes mellitus, hipercholesterolemia, hipertriglicerydemia, cigarette smoking and family history in order to coronary disease incidences.There was a significant correlation (p <0.001) between cfPWV (m / s) and the overall cardiovascular risk by SCORE tables. CfPWV cut-off point, according to. ROC curve for 5% risk of death during the 10 years (by SCORE) is 11,7m / s - 58.6% sensitivity and 71.3% specificity.A significant increase in cfPWV and positive correlation has been demonstrated in patients with thickened IMT> 0.9 mm and the occurrence of atherosclerotic plaques (p <0.001). CfPWV values were significantly higher in patients with coronary artery disease (13.6 ± 5.0 vs 12.6 ± 4.6 m / s, p = 0.005). Based on the ROC analysis it was found that the value of cfPWV = 16.1 m / s preferably distinguishes patients with and without coronary artery disease (p <0.001). This value was characterized by a high specificity (88.1%) but very low sensitivity (26.4%).Conclusions:1. The average value cfPWV in a random population aged for 12.9 m / s. The majority (78%) cfPWV value is greater than normal.2. In a randomized metropolitan Polish population in middle age (from 45 to 70years) coronary artery disease occurs in 27% of women and 23% men, and the most common risk factors in this population are hypercholesterolemia (80%), hypertension (57%) and cardiovascular disease in family history (52%), hypertriglyceridemia (33.6%), low levels of HDL cholesterol (20.7 %) and diabetes mellitus (13.4%).3. The most important risk factors are associated with cfPWV age, hypertension and obesity.4. CfPWV value that best identifies patients most at risk is 11.7 m / s patients with coronary heart disease is 16 m / s.5. The majority (51%) of this group is at high or very high risk estimated based on the SCORE tables or the occurrence of cardiovascular disease or diabetes mellitus.6. The value of cfPWV is increased in patients with atherosclerotic disease (coronary heart disease, atherosclerotic plaque in the carotid arteries, the increased thickness of the intima-media carotid artery).

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu krążenia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Jadwiga Nessler

Date issued:

2015

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:4072

Call number:

ZB-124223

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

May 24, 2021

In our library since:

Apr 15, 2016

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ZB-124223 May 24, 2021
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