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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (6): 1153-1159. doi: 10.19723/j.issn.1671-167X.2025.06.020

• 论著 • 上一篇    下一篇

动脉硬化相关指标与死亡风险的前瞻性队列研究

范梦1, 王梦莹1, 王斯悦1, 彭和香1, 王雪珩1, 郭煌达1, 侯天姣1, 秦雪英1, 陈大方1, 胡永华1, 李劲1, 武轶群1, 吴涛1,2,*()   

  1. 1. 北京大学公共卫生学院流行病与卫生统计学系，北京 100191
    2. 重大疾病流行病学教育部重点实验室(北京大学)，北京 100191
  • 收稿日期:2023-03-02 出版日期:2025-12-18 发布日期:2025-11-07
  • 通讯作者: 吴涛
  • 基金资助:
    国家自然科学基金(82204135); 北京市自然科学基金(7232237); 中国博士后科学基金(BX2021021); 中国博士后科学基金(2022M710249)

Association between indicators of arterial stiffness and all-cause mortality and cardiovascular deaths: A prospective cohort study

Meng FAN1, Mengying WANG1, Siyue WANG1, Hexiang PENG1, Xueheng WANG1, Huangda GUO1, Tianjiao HOU1, Xueying QIN1, Dafang CHEN1, Yonghua HU1, Jin LI1, Yiqun WU1, Tao WU1,2,*()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
  • Received:2023-03-02 Online:2025-12-18 Published:2025-11-07
  • Contact: Tao WU
  • Supported by:
    the National Natural Science Foundation of China(82204135); Beijing Municipal Natural Science Foundation(7232237); China Postdoctoral Science Foundation(BX2021021); China Postdoctoral Science Foundation(2022M710249)

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摘要：

目的: 基于北京房山家系队列，探究肱-踝脉搏波传导速度(branchial-ankle pulse wave velocity，baPWV)和踝臂指数(ankle-branchial index，ABI)与全因死亡及心血管死亡风险的关联。方法: 本研究采用前瞻性队列研究设计，利用北京房山家系队列研究的基线调查数据和房山区疾病预防与控制中心的死亡监测数据开展，死因信息采用《国际疾病分类》(International Classification of Diseases，ICD)第九次和第十次修订版进行编码，主要结局事件为全因死亡和心血管疾病死亡(冠心病、脑卒中、心力衰竭、心源性猝死和心律失常等)。采用R4.2.2软件进行统计分析，采用Cox回归的frailty模型进行生存分析，探究baPWV和ABI与全因死亡和心血管疾病死亡风险的关联。结果: 共纳入7 686名研究对象，中位随访时间6.35年，共发现576例死亡，死亡密度为11.88/1 000人年，其中心血管死亡335例。Cox回归分析结果显示，调整其他混杂因素后，第四四分位数baPWV(HR=1.40，95%CI：1.02~1.92)及ABI病理异常(HR=3.32，95%CI：2.57~4.28)与全因死亡风险增加有关，相比baPWV，ABI与心血管疾病死亡风险的关联更加显著。不同亚组之间的全因死亡风险差异无统计学意义；高血压人群中，baPWV或ABI异常的心血管疾病死亡风险显著增加(HR=1.72，95%CI：1.30~2.27)。结论: baPWV和ABI与全因死亡和心血管疾病死亡风险增加有关；相比baPWV，ABI异常与心血管疾病死亡风险的关联更加显著。同时，在高血压人群中，baPWV或ABI异常与心血管疾病死亡风险增加显著相关，提示需要关注高血压人群中动脉硬化带来的严重后果。

关键词: 动脉硬化, 脉搏波传导速度, 踝臂指数, 死亡率, 队列研究

Abstract:

Objective: To assess the associations between brachial-ankle pulse wave velocity (baPWV), ankle brachial index (ABI) and all-cause and cardiovascular mortality in a rural population in north China. Methods: The current study utilized the baseline data of Beijing Fangshan family cohort study and the data of the death surveillance system of the Beijing Fangshan District Center for Disease Prevention and Control. The main outcomes were all-cause mortality and cardiovascular mortality. Cardiovascular deaths which included deaths from coronary heart disease (CHD), stroke, heart failure, sudden cardiac death and arrhythmia, were coded according to the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10). The R4.2.2 software was used for statistical analysis, and the adjusted hazard ratios (HR) for all-cause and CVD mortality associated with baPWV and ABI were calculated using Cox proportional hazards regressions with shared frailty models. Results: A total of 7 686 participants were followed up for a median of 6.35 years in Fangshan District, Beijing, China. Totally 576 deaths were identified, with a mortality density of 11.88/1 000 person-years, of which 335 deaths were from cardiovascular diseases. We found that baPWV (HR=1.40, 95%CI: 1.02-1.92) and ABI (HR=3.32, 95%CI: 2.57-4.28) were associated with all-cause mortality after adjusting for confounding factors. ABI was more strongly associated with cardiovascular mortality than baPWV. There was no significant difference in the risk of all-cause mortality among different subgroups. The risk of cardiovascular mortality was significantly increased in the participants with hypertension (HR=1.72, 95%CI: 1.30-2.27). Conclusion: baPWV and ABI were associated with all-cause and cardiovascular mortality in a rural population of north China. The association of ABI and cardiovascular mortality was more significant than that of baPWV. And abnormal baPWV or ABI was associated with cardiovascular mortality, especially in people with hypertension.

Key words: Arterial stiffness, Pulse wave velocity, Ankle brachial index, Mortality, Cohort studies

中图分类号: 

  • R181.32

表1

研究对象基线特征情况"

Variables First quartile group
(n=1 914)		 Second quartile group
(n=1 927)		 Third quartile group
(n=1 923)		 Fourth quartile group
(n=1 922)		 P value
Age/years, ${\bar x}$±s 50.51±10.15 56.82±8.73 58.12±9.60 63.96±8.65 < 0.001
Male, n(%) 892 (46.60) 977 (50.70) 982 (51.07) 859 (44.69) < 0.001
Education level, n(%) < 0.001
  Primary school or below 512 (26.75) 726 (37.68) 811 (42.17) 1 101 (57.28)
  Junior high school or more 1 402 (73.25) 1 201 (62.32) 1 112 (57.83) 821 (42.72)
Smoking status, n(%) < 0.001
  Never 1 139 (59.51) 1 049 (54.44) 1 003 (52.16) 1 040 (54.11)
  Former smoker 203 (10.61) 291 (15.10) 298 (15.50) 383 (19.93)
  Current smoker 572 (29.89) 587 (30.46) 622 (32.35) 499 (25.96)
Drinking status, n(%) < 0.001
  Never 1 268 (66.25) 1 209 (62.74) 1 243 (64.64) 1 271 (66.13)
  Former drinker 115 (6.01) 174 (9.03) 173 (9.00) 180 (9.37)
  Current drinker 531 (27.74) 544 (28.23) 507 (26.37) 471 (24.51)
Exercise status (regularly), n(%) 256 (13.38) 261 (13.54) 120 (6.24) 189 (9.83) < 0.001
BMI/(kg/m2), ${\bar x}$±s 26.22±3.72 26.34±3.61 26.26±3.58 25.73±3.46 0.004
LDL-C/(mmol/L), ${\bar x}$±s 2.21±0.80 2.24±0.92 2.60±0.88 2.30±0.97 < 0.001
HDL-C/(mmol/L), ${\bar x}$±s 0.98±0.32 0.92±0.33 1.19±0.47 0.93±0.33 < 0.001
TG/(mmol/L), M (P25, P75) 1.18 (0.77, 1.77) 1.26 (0.83, 1.87) 1.47 (0.94, 2.16) 1.31 (0.86, 2.02) < 0.001
Diabetes mellitus, n(%) 558 (29.15) 818 (42.45) 696 (36.19) 1 029 (53.54) < 0.001
Hypertension, n(%) 778 (40.65) 1 367 (70.94) 1 505 (78.26) 1 736 (90.32) < 0.001
CHD, n(%) 441 (23.04) 563 (29.22) 337 (17.52) 727 (37.83) < 0.001
Stroke, n(%) 387 (20.22) 669 (34.72) 694 (36.09% 901 (46.88) < 0.001

表2

baPWV和死亡风险之间的Cox回归分析结果"

Variables First quartile group Second quartile group Third quartile group Fourth quartile group Continuous
All-cause
  Model 1 Reference 0.78 (0.56-1.10) 1.17 (0.86-1.60) 1.78 (1.32-2.40) 0.74 (0.70-0.79)
  Model 2 Reference 0.78 (0.55-1.09) 1.14 (0.83-1.55) 1.77 (1.31-2.39) 0.75 (0.71-0.79)
  Model 3 Reference 0.67 (0.48-0.96) 1.05 (0.76-1.46) 1.40 (1.02-1.92) 0.77 (0.72-0.81)
CVD
  Model 1 Reference 0.96 (0.61-1.51) 1.42 (0.93-2.15) 1.77 (1.17-2.67) 0.67 (0.62-0.72)
  Model 2 Reference 0.94 (0.59-1.48) 1.33 (0.87-2.03) 1.74 (1.15-2.64) 0.67 (0.62-0.72)
  Model 3 Reference 0.76 (0.47-1.21) 1.10 (0.71-1.72) 1.22 (0.79-1.88) 0.69 (0.64-0.75)

表3

ABI和死亡风险之间的Cox回归分析结果"

Variables Group 1 Group 2 Group 3 Continuous
All-cause
  Model 1 Reference 1.45 (1.07-1.99) 3.82 (2.99-4.88) 0.74 (0.70-0.79)
  Model 2 Reference 1.44 (1.05-1.97) 3.72 (2.90-4.77) 0.75 (0.71-0.79)
  Model 3 Reference 1.39 (1.02-1.91) 3.32 (2.57-4.28) 0.77 (0.72-0.81)
CVD
  Model 1 Reference 1.60 (1.06-2.40) 5.16 (3.77-7.06) 0.67 (0.62-0.72)
  Model 2 Reference 1.56 (1.03-2.36) 4.91 (3.58-6.74) 0.67 (0.62-0.72)
  Model 3 Reference 1.50 (0.99-2.28) 4.29 (3.09-5.94) 0.69 (0.64-0.75)

表4

baPWV和ABI结合与死亡风险之间的Cox回归分析结果"

Variables ABI≥0.91 ABI≤0.90
All-cause
  baPWV < 1 800 cm/s Reference 3.67 (2.53-5.31)
  baPWV≥1 800 cm/s 1.62 (1.31-2.00) 4.76 (3.39-6.68)
CVD
  baPWV < 1 800 cm/s Reference 4.95 (3.14-7.79)
  baPWV≥1 800 cm/s 1.29 (0.97-1.72) 4.68 (2.97-7.36)

表5

不同亚组中baPWV或ABI异常与死亡风险的关联"

Variables All-cause mortality CVD mortality
HR (95%CI) P for interaction HR (95%CI) P for interaction
Age 0.489 0.734
   < 60 years 2.41 (1.67-3.48) 2.28 (1.43-3.64)
  ≥60 years 2.19 (1.75-2.75) 1.98 (1.47-2.66)
Sex 0.225 0.541
  Female 1.71 (1.25-2.33) 1.47 (0.96-2.23)
  Male 1.97 (1.53-2.55) 1.79 (1.28-2.49)
Smoking 0.568 0.415
  Never 2.22 (1.63-3.02) 1.85 (1.22-2.82)
  Former+Current 1.67 (1.31-2.14) 1.56 (1.10-2.19)
Drinking 0.138 0.512
  Never 1.96 (1.51-2.56) 1.85 (1.32-2.61)
  Former+Current 1.75 (1.30-2.37) 1.37 (0.91-2.07)
Obesity (BMI≥28 kg/m2) 0.417 0.434
  No 1.95 (1.56-2.44) 1.70 (1.26-2.30)
  Yes 1.90 (1.26-2.87) 1.66 (0.99-2.80)
Hypertension 0.193 0.505
  No 1.96 (1.17-3.27) 1.75 (0.85-3.59)
  Yes 1.90 (1.54-2.35) 1.72 (1.30-2.27)
Diabetes mellitus 0.256 0.481
  No 2.01 (1.54-2.61) 1.92 (1.31-2.81)
  Yes 1.84 (1.39-2.45) 2.53 (1.06-2.20)
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ISSN 1671-167X
CN 11-4691/R
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