Estimated pulse wave velocity can predict the incidence of new-onset atrial fibrillation: A 11-year prospective study in a Chinese population.

Background: Arterial stiffness, a risk factor for atrial fibrillation (AF), is rarely applied in clinical practice because of the difficulty and high cost of its measurement. Estimated pulse wave velocity (ePWV) is a simple, reproducible, and non-invasive index of arterial stiffness. This study was to assess the predictive value of ePWV for the risk of new-onset AF. Methods: Subjects were selected from the Kailuan cohort study population who underwent initial physical examination between 2006 and 2008. A total of 96,561 subjects were ultimately included in the final analysis. ePWV was divided into four groups according to quartiles. The Kaplan-Meier method was used to calculate the cumulative incidence of AF. A Cox regression model was used to assess the predictive value of estimated arterial stiffness for new-onset AF. Results: Mean age of subjects was 51.47 ± 9.68 years, while 76,968 (79.65%) were male and 19,663 (20.35%) were female. During mean follow-up period of 11.77 years, 1,215 AF events occurred. Results of the Kaplan-Meier analysis showed that the incidence of new-onset AF increased with increase in ePWV. Cox regression analysis showed that in the total population, the incidence of new-onset AF was 1.64, 1.90, and 2.64 times higher in the medium, medium-high, and high ePWV groups, respectively, compared with the low ePWV group. When stratified according to sex, ePWV had higher predictive value in the female population. Conclusions: Increased ePWV increases the incidence of new-onset AF, and may promote application of more aggressive primary prevention. Trial registry name: Risk factors and intervention for cardiology, cerebrovascular and related disease (Kailuan Study); URL: http://www.chictr.org.cn/showproj.aspx?proj=8050; Registration number: ChiCTR-TNRC-11001489.

Does an increase in estimated pulse wave velocity increase the incidence of hypertension?

OBJECTIVE: As a risk indicator of hypertension, arterial stiffness is difficult to measure. Thus, we aimed to evaluate the association between estimated pulse wave velocity (ePWV) as a convenient indicator and the incidence of hypertension. METHODS: The Kailuan cohort was selected for statistical analysis and 54 849 individuals were included in the final cohort. Multiple linear regression was used to analyse the correlation between ePWV and mean SBP (SBP_m) measured at five time points over a 10-year period and between ePWV and mean DBP (DBP_m) measured at five time points over a 10-year period. Logistic regression was used to analyse the effect of estimated arterial stiffness on hypertension. RESULTS: The mean age of individuals was 48.44 ±â€Š9.32 years, and 41 419 individuals (75.51%) were male. A multiple linear regression analysis showed that ePWV was positively correlated with both SBP_m and DBP_m. For every 1 cm/s increase in ePWV, SBP_m and DBP_m increased by 5.60 and 2.12 mmHg, respectively. A logistic regression analysis showed that in the total cohort, the incidence of hypertension in populations with moderate, moderate-high and high ePWV values was 3.03, 5.44 and 7.87-times higher, respectively, compared with individuals with low ePWV values. ePWV had a higher predictive value in female and middle age population compared with male and the eldly population grouped by sex and age respectively. CONCLUSION: ePWV positively correlates with both SBP_m and DBP_m, and an increase in ePWV is associated with an increase in the incidence of hypertension.

Total cholesterol, arterial stiffness, and systolic blood pressure: a mediation analysis.

On the basis of 45,092 participants (mean age of 54.04 ± 13.09 years) from the Kailuan study, this study was performed to explore the relationships among total cholesterol (TC), brachial-ankle pulse wave velocity (BaPWV), and systolic blood pressure (SBP) and quantify their separate effects. The correlations among TC, SBP, and BaPWV were analyzed using multivariate linear regression models. Mediation analysis was performed to determine whether the effect of TC on SBP can be explained by arterial stiffness. Multivariate linear regression analysis showed that for every one standard deviation increase in TC and BaPWV, SBP increased by 0.33 mmHg and 0.044 mmHg, respectively; for every one standard deviation increase in TC, BaPWV increased by 5.34 cm/s. Mediation analysis showed that the TC-induced SBP elevation was mediated by arterial stiffness in more than half of the whole cohort (indirect effect, 0.73; percent mediated, 54.5%). Furthermore, the TC-induced SBP elevation was mediated by arterial stiffness in less than half of the males (indirect effect, 0.70; percent mediated, 47.9%); however, the results were not statistically significant in females. In conclusion, TC and BaPWV are positively correlated with SBP, whereas TC is positively correlated with BaPWV. Almost half of the increase in SBP contributed to TC is mediated by arterial stiffness.

Effect of visit-to-visit blood pressure variability on cardiovascular events in populations with different body mass indexes: a prospective cohort study.

OBJECTIVE: This study was performed to explore the effects of visit-to-visit blood pressure variability (BPV) on cardiovascular events (CVEs) in people with various body mass indexes (BMIs). DESIGN: Prospective cohort study. SETTING: The average real variability of systolic blood pressure (ARVSBP) was the indicator for visit-to-visit BPV. The participants were divided into three groups: normal weight, overweight and obesity. We further divided these groups into four subgroups based on the ARVSBP. A Cox regression model was used to calculate the HRs of the ARVSBP on CVEs in the same and different BMI groups. Additionally, a competitive risk model was used to calculate the HRs of the ARVSBP on CVEs in the same BMI group. PARTICIPANTS: In total, 41 043 individuals met the inclusion criteria (no historical CVEs or tumours, no incidence of CVEs or tumours and no death during the four examinations) and had complete systolic blood pressure and BMI data. RESULTS: A total of 868 CVEs occurred. The cumulative incidence of CVEs increased as ARVSBP rose in both the normal weight and overweight groups. In same BMI groups, the risk of CVEs significantly increased as ARVSBP increased only in the normal weight group (highest quartiles of ARVSBP: HR (95% CI) 2.20 (1.46-3.31)). In the different BMI groups, the risk of CVEs in the ARVSBP subgroup in each BMI group was higher than that the least quintile of ARVSBP in the normal weight group (highest quartiles of ARVSBP in obesity: HR (95% CI) 2.28 (1.47-3.55)). The result of the competitive risk model did not change. CONCLUSIONS: As BMI and ARVSBP increase, the risk of CVEs increases. However, the risk of visit-to-visit BPV on CVEs varies in different BMI groups, especially in people of normal weight. TRIAL REGISTRATION NUMBER: CHiCTR-TNC1100 1489.

Prolonged hyperlipidemia exposure increases the risk of arterial stiffness in young adults: a cross-sectional study in a cohort of Chinese.

BACKGROUND: Hyperlipidemia is associated with arterial stiffness. Herein, We examined the effect of prolonged exposure to hyperlipidemia on the risk of arterial stiffness in young adults. METHODS: A study cohort (35-55 years old) that received health check-ups in the Kailuan study (2014-2016) were assessed. Hyperlipidemia was defined as a low-density lipoprotein cholesterol ≥160 mg/dL according to the Chinese Guidelines for the Management of Dyslipidemia in Adults. Subjects were divided into three groups based on the number of years with hyperlipidemia: normal (0 years), low exposure (1-5 years), and high exposure (5-10 years) groups. Arterial stiffness was defined as brachial-ankle pulse wave velocity > 1400 cm/s. For all subjects and subjects that did not meet statin treatment criteria under guidelines, logistics regression was used to analyze the effect of prolonged hyperlipidemia exposure on arterial stiffness in different age groups. RESULTS: Among 12,431 subjects, the mean age was 46.42 ± 5.34 years with 9000 men (72.4%). Brachial-ankle pulse wave velocity gradually increased with increased exposure duration. Logistic regression analysis showed that hyperlipidemia exposure was a risk factor for arterial stiffness in the low (1.22 times) and high (1.49 times) exposure groups compared with the normal group. In the different age groups, the risk of arterial stiffness increased with the duration of hyperlipidemia exposure, apart for the 35-40-year-old population. The effect of hyperlipidemia exposure duration on arterial stiffness in young adults that did not meet statin treatment criteria under guidelines was similar to the general population. CONCLUSIONS: Prolonged exposure to hyperlipidemia in young adults increases the risk of arterial stiffness. Young adults with this condition may benefit from more aggressive primary prevention. TRIAL REGISTRATION: Name of the registry: Risk factors and intervention for cardiology, cerebrovascular and related disease (Kailuan Study) Trial registration number: CHiCTR-TNC1100 1489 Date of registration: Aug 24, 2011 URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=8050.

Impact of body mass index on long-term blood pressure variability: a cross-sectional study in a cohort of Chinese adults.

BACKGROUND: Obesity and overweight are related to changes in blood pressure, but existing research has mainly focused on the impact of body mass index (BMI) on short-term blood pressure variability (BPV). The study aimed to examine the impact of BMI on long-term BPV. METHODS: Participants in the Kailuan study who attended all five annual physical examinations in 2006, 2008, 2010, 2012, and 2014 were selected as observation subjects. In total, 32,482 cases were included in the statistical analysis. According to the definition of obesity in China, BMI was divided into four groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24.0 ≤ BMI < 28.0 kg/m2), and obese (BMI ≥ 28.0 kg/m2). We used average real variability to evaluate long-term systolic BPV. The average real variability of systolic blood pressure (ARVSBP) was calculated as (|sbp2 - sbp1| + |sbp3 - sbp2 | + |sbp4 - sbp3| + |sbp5 - sbp4|)/4. Differences in ARVSBP by BMI group were analyzed using analysis of variance. Stepwise multivariate linear regression and multiple logistic regression analyses were used to assess the impact of BMI on ARVSBP. RESULTS: Participants' average age was 46.6 ± 11.3 years, 24,502 were men, and 7980 were women. As BMI increases, the mean value of ARVSBP gradually increases. After adjusting for other confounding factors, stepwise multivariate linear regression analysis showed that ARVSBP increased by 0.077 for every one-unit increase in BMI. Multiple logistic regression analysis indicated that being obese or overweight, compared with being normal-weight, were risk factors for an increase in ARVSBP. The corresponding odds ratios of being obese or overweight were 1.23 (1.15-1.37) and 1.10 (1.04-1.15), respectively. CONCLUSIONS: There was a positive correlation between BMI and ARVSBP, with ARVSBP increasing with a rise in BMI. BMI is a risk factor for an increase in ARVSBP. TRIAL REGISTRATION: Registration No.: CHiCTR-TNC1100 1489 ; Registration Date: June 01, 2006.