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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (3): 514-520. doi: 10.19723/j.issn.1671-167X.2020.03.018

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Predictive value of vascular health indicators on newly cardiovascular events: Preliminary validation of Beijing vascular health stratification system

Huan LIU1,2,Ying-dong HE3,Jin-bo LIU1,2,Wei HUANG1,Na ZHAO1,Hong-wei ZHAO1,Xiao-hua ZHOU2,3,△(),Hong-yu WANG1,2,△()   

  1. 1. Vascular Medicine Center, Peking University Shougang Hospital, Beijing 100144, China
    2. Vascular Health Research Center of Peking University Health Science Center, Beijing 100191, China
    3. Department of Biostatistics, Peking University, Beijing International Center for Mathematical Research, Beijing 100871, China
  • Received:2020-03-03 Online:2020-06-18 Published:2020-06-30
  • Contact: Xiao-hua ZHOU,Hong-yu WANG E-mail:azhou@math.pku.edu.cn;dr.hongyuwang@foxmail.com
  • Supported by:
    Capital Project of Scientific and Technological Development of Traditional Chinese Medicine in Beijing(NQ2016-07);Beijing Health Scientific and Technological Achievements and Appropriate Technology Promotion Project(TG-2017-66);Key Clinical Projects in Peking University Shougang Hospital(2017-hospital-clinical-01);Key Clinical Projects in Peking University Shougang Hospital(SGYYZ201610);Key Clinical Projects in Peking University Shougang Hospital(SGYYQ201605);Capital Funds for Health Improvement and Research(2011-4026-02);Science and Technology Plan Project of Shijingshan District Committee of Science and Technology

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Abstract:

Objective: To explore the predictive value of carotid femoral artery pulse wave velocity (CF-PWV), carotid radial artery pulse wave velocity (CR-PWV), cardio-ankle vascular index (CAVI), and ankle brachial index (ABI) on coronary heart disease (CHD) and cerebral infarction (CI), and the preliminary validation of Beijing vascular health stratification (BVHS).Methods: Subjects with at least 2 in-patient records were included into the study between 2010 and 2017 from Vascular Medicine Center of Peking University Shougang Hospital. Subjects with CHD or CI, and without data of vascular function at baseline were excluded. Eventually, 467 subjects free of CHD [cohort 1, mean age: (63.4±12.3) years, female 42.2%] and 658 subjects free of CI [cohort 2, mean age: (64.3±12.2) years, female 48.7%] at baseline were included. The first in-patient records were as the baseline data, the second in-patient records were as a following-up data. Cox proportional hazard regression was used to establish the predictive models of CHD or CI derived from BVHS by multivariable-adjusted analysis.Results: The median follow-up time of cohort 1 and cohort 2 was 1.9 years and 2.1 years, respectively. During the follow-up, 164 first CHD events occurred in cohort 1 and 117 first CI events occurred in cohort 2. Four indicators were assessed as continuous variables simultaneously by multivariable-adjusted analysis. In cohort 1, CF-PWV, CR-PWV, ABI, and CAVI reached statistical significance in the multivariable-adjusted models (P<0.05). In cohort 2, only CAVI (P<0.05) was of statistical significance. In addition, the higher CF-PWV became a protector of CHD or CI (P<0.05). The prediction value of BVHS reached the statistical significance for CHD and CI in the unadjusted models (all P<0.05), however, BVHS could only predict the incidence of CHD (P<0.05), but not the incidence of CI (P>0.05) in the multivariable-adjusted models. CF-PWV, CR-PWV, ABI, and CAVI were associated factors of CHD independent of each other (P<0.05), only CAVI (P<0.05) was the risk factor of CI independent of the other three.Conclusion: The different vascular indicators might have different effect on CHD or CI. CAVI might be a stable predictor of both CHD and CI. Higher baseline CF-PWV was not necessarily a risk factor of CHD or CI because of proper vascular health management. BVHS was a potential factor for the prediction of CHD, and further research is needed to explore the prediction value for CI.

Key words: Cardiovascular disease, Risk factors, Cohort studies, Beijing vascular health stratification

CLC Number: 

  • R541.4

Figure 1

Flow diagram of subject inclusion process CHD, coronary heart disease; CI, cerebral infarction."

Table 1

Simplified BVHS system"

Artery stenosis Arterial stiffness Simplified BVHS
1 0 0
1 1
2 0 2
1 3
3 0 4
1 5
4 0 6
1 7

Table 2

Baseline characteristics of cohort 1 and cohort 2"

Variable Cohort 1
(n=467)		 Cohort 2
(n=658)
Age/years 63.4±12.3 64.3±12.2
Female/% 42.2 48.7
Body mass index/(kg/m2) 25.2±3.8 25.6±6.1
Heart rate/(beats/min) 70.3±11.6 71.7±42.6
Mean artery pressure/mmHg 101.8±11.9 101.6±14.5
Smoking/% 30.0 26.6
Drinking/% 27.0 23.1
Diabetes/% 23.3 29.7
Hypertension/% 62.7 64.6
Hyperlipidemia/% 57.8 64.2
Coronary heart disease
(baseline/endpoint)/%		 52.1/66.1
Cerebral infarction
(baseline/endpoint)/%		 32.8/41.8
CF-PWV/(m/s) 11.6±2.9 11.6±2.7
CR-PWV/(m/s) 9.2±1.7 9.1±1.8
CAVI 8.7±1.9 8.6±1.9
ABI 1.02±0.20 1.01±0.21
Median follow-up time/years 1.9 2.1
Number of events 164 117

Table 3

Risk of coronary heart disease event in cohort 1 in groups classified by four arterial health indicators (high vs. low) and per 1-SD increase in them"

Items Binary (high vs. low) Continuous (per 1-SD increase)
Unadjusted Multivariable-adjusted Unadjusted Multivariable-adjusted
CF-PWV
HR (95%CI) 0.82 (0.60-1.11) 0.68 (0.48-0.96) 0.92 (0.78-1.08) 0.65 (0.54-0.77)
P value 0.198 0.028 0.298 <0.001
CR-PWV
HR (95%CI) 0.64 (0.47-0.87) 0.70 (0.59-0.83) 0.70 (0.59-0.83) 0.64 (0.53-0.76)
P value 0.004 <0.001 <0.001 <0.001
ABI
HR (95%CI) 0.90 (0.66-1.23) 1.01 (0.73-1.41) 0.80 (0.70-0.91) 0.85 (0.73-1.00)
P value 0.526 0.946 <0.001 0.044
CAVI
HR (95%CI) 1.33 (0.97-1.81) 1.54 (1.09-2.18) 1.29 (1.12-1.49) 1.19 (0.99-1.43)
P value 0.075 0.014 <0.001 0.062

Table 4

Risk of cerebral infarction event in cohort 2 in groups classified by four arterial health indicators (high vs. low) and per 1-SD increase in them"

Items Binary (high vs. low) Continuous (per 1-SD increase)
Unadjusted Multivariable-adjusted Unadjusted Multivariable-adjusted
CF-PWV
HR (95%CI) 0.79 (0.55-1.14) 0.62 (0.42-0.91) 1.14 (0.95-1.36) 0.80 (0.66-0.97)
P value 0.209 0.016 0.159 0.025
CR-PWV
HR (95%CI) 0.95 (0.66-1.37) 0.75 (0.51-1.12) 0.87 (0.72-1.07) 0.90 (0.73-1.12)
P value 0.784 0.170 0.182 0.344
ABI
HR (95%CI) 0.97 (0.67-1.39) 1.01 (0.69-1.49) 0.86 (0.72-1.01) 1.04 (0.85-1.27)
P value 0.852 0.949 0.076 0.697
CAVI
HR (95%CI) 1.93 (1.32-2.83) 1.86 (1.27-2.80) 1.57 (1.36-1.81) 1.35 (1.12-1.64)
P value <0.001 0.003 <0.001 0.002

Table 5

Risk of coronary heart disease event in cohort 1 per 1-SD increase in four arterial health indicators"

Model Indicator HR (95%CI) P value
Unadjusted CF-PWV 0.82 (0.69-0.97) 0.023
CR-PWV 0.75 (0.63-0.88) <0.001
ABI 0.78 (0.67-0.90) <0.001
CAVI 1.42 (1.22-1.64) <0.001
Multivariable-adjusted CF-PWV 0.71 (0.59-0.86) <0.001
CR-PWV 0.70 (0.57-0.84) <0.001
ABI 0.84 (0.71-0.99) 0.042
CAVI 1.32 (1.11-1.58) 0.002

Table 6

Risk of cerebral infarction event in cohort 2 per 1-SD increase in four arterial health indicators"

Model Indicator HR (95%CI) P value
Unadjusted CF-PWV 1.04 (0.87-1.25) 0.639
CR-PWV 0.87 (0.72-1.06) 0.177
ABI 0.86 (0.72-1.03) 0.105
CAVI 1.55 (1.35-1.78) <0.001
Multivariable-adjusted CF-PWV 0.83 (0.69-1.00) 0.055
CR-PWV 0.92 (0.74-1.13) 0.417
ABI 0.99 (0.80-1.23) 0.947
CAVI 1.33 (1.11-1.60) 0.002

Table 7

Predictive value of simplified BVHS in prediction of coronary heart disease and cerebral infarction events"

Events Model HR (95%CI) P value
Coronary
heart disease		 Unadjusted 1.20 (1.13-1.27) <0.001
Multivariable-adjusted 1.17 (1.10-1.25) <0.001
Cerebral
infarction		 Unadjusted 1.20 (1.00-1.45) 0.048
Multivariable-adjusted 1.07 (0.87-1.32) 0.518
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