Age-Specific Approach to Arterial Stiffness Prediction in Apparently Healthy Patients.

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Journal of clinical medicine research Pub Date : 2024-09-01 Epub Date: 2024-09-12 DOI:10.14740/jocmr5271
Anna Bragina, Yulia Rodionova, Natalia Druzhinina, Timur Gamilov, Ekaterina Udalova, Artem Rogov, Lubov Vasileva, Rustam Shikhmagomedov, Oksana Avdeenko, Anna Kazadaeva, Kirill Novikov, Valeriy Podzolkov
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Abstract

Background: The high prevalence of traditional cardiovascular risk factors among the patients without cardiovascular disease (CVD) allows us to predict an increase in cardiovascular morbidity rate in the future. Arterial stiffness is one of the most important predictors and pathogenetic mechanisms of CVD development. The aim of our study was to evaluate the predictive differences of age-related and age-independent (universal) cardio-ankle vascular index (CAVI) reference values for detecting increased arterial stiffness in individuals without CVD.

Methods: The study included 600 patients (43% men and 57% women, mean age 36.0 ± 18.3 years). All the patients underwent anthropometric measurements with obesity markers evaluation, assessment of arterial stiffness by sphygmomanometry. To create predictive models, we used universal and age-related CAVI thresholds: ≥ 9.0 (CAVI≥ 9) and CAVIAge according to the "Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice".

Results: In the < 50 years group, both the CAVIAge and CAVI≥ 9 models were significant (CAVIAge: b = 4.8, standard error b (st.err.b) = 0.27, P < 0.001; CAVI≥ 9: b = 3.2, st.err.b = 1.6, P < 0.001). The CAVIAge model demonstrated high sensitivity and specificity (> 70%) compared to the CAVI≥ 9 model (sensitivity 62%, specificity 58%). In the receiver operating characteristic (ROC) curve analysis, the CAVIAge model had a significantly higher area under the ROC curve (AUC) = 0.802 than the CAVI≥ 9 model: AUC = 0.674. In the ≥ 50 years group, both models were significant: CAVIAge (b = 2.6, st.err.b = 1.13, P < 0.001) and CAVI≥ 9 (b = 5.3, st.err.b = 0.94, P < 0.001). Both models demonstrated high sensitivity and specificity (> 70%). When ROC curves were analyzed for the CAVIAge model, the AUC value of 0.675 was significantly lower when compared to the CAVI≥ 9 model (AUC = 0.787, P = 0.031).

Conclusions: In the < 50 years group, the model based on age-specific CAVI thresholds has the higher predictive value, sensitivity, and specificity for identifying individuals with increased arterial stiffness. In contrast, in the ≥ 50 years group, a predictive model using a universal threshold value of CAVI≥ 9 has advantages.

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按年龄预测貌似健康患者动脉僵硬度的方法
背景:在没有心血管疾病(CVD)的患者中,传统心血管风险因素的发病率很高,这使我们能够预测未来心血管疾病发病率的上升。动脉僵化是心血管疾病最重要的预测因素和发病机制之一。我们的研究旨在评估与年龄相关的心踝关节血管指数(CAVI)参考值和与年龄无关的(通用)心踝关节血管指数(CAVI)参考值在检测无心血管疾病患者动脉僵化增加方面的预测差异:研究包括 600 名患者(43% 为男性,57% 为女性,平均年龄为 36.0 ± 18.3 岁)。所有患者都接受了人体测量和肥胖标志物评估,并通过血压计评估了动脉僵化程度。为了建立预测模型,我们使用了通用的和与年龄相关的 CAVI 临界值:≥ 9.0(CAVI≥ 9)和根据 "俄罗斯专家关于临床实践中动脉僵化评估的共识 "确定的 CAVIAge:在小于 50 岁组中,CAVIAge 和 CAVI≥ 9 模型均有显著性(CAVIAge:b = 4.8,标准误差 b (st.err.b) = 0.27,P < 0.001;CAVI≥ 9:b = 3.2,st.err.b = 1.6,P < 0.001)。与 CAVI≥ 9 模型(灵敏度 62%,特异性 58%)相比,CAVIAge 模型显示出较高的灵敏度和特异性(> 70%)。在接受者操作特征(ROC)曲线分析中,CAVIAge 模型的 ROC 曲线下面积(AUC)= 0.802 明显高于 CAVI≥ 9 模型:AUC = 0.674。在≥50 岁组中,两个模型都有显著性:CAVIAge (b = 2.6, st.err.b = 1.13, P < 0.001) 和 CAVI≥ 9 (b = 5.3, st.err.b = 0.94, P < 0.001)。两个模型都显示出较高的灵敏度和特异性(> 70%)。在对CAVIAge模型进行ROC曲线分析时,与CAVI≥9模型(AUC = 0.787,P = 0.031)相比,CAVIAge模型的AUC值0.675明显较低:结论:在小于 50 岁的人群中,基于年龄特异性 CAVI 临界值的模型对识别动脉僵化增加的个体具有更高的预测值、灵敏度和特异性。相比之下,在≥50 岁组中,使用 CAVI≥ 9 这一通用阈值的预测模型具有优势。
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