Should we calculate arterial stiffness gradient in middle-aged women with increased cardiovascular risk?

<b>Purpose:</b> The study was designed to evaluate clinical and laboratory determinants pulse wave velocity (PWV) ratio in women at the age of 50–65 years without overt cardiovascular disease but having elevated cardiovascular risk, such as hypertension, obesity, diabetes and hypercholesterolemia. <b>Materials and methods:</b> We analyzed data from 1170 women enrolled in the national-wide primary prevention program. Univariate and multivariate linear regression analysis was used to establish independent risk factors in groups based on clinical data, laboratory values, and comorbidities. Arterial stiffness was evaluated using applanation tonometry technique (SphygmoCor). The PWV ratio was calculated by dividing cfPWV to crPWV. <b>Results:</b> In multivariate logistic regression analysis, age (OR = 1.109, <i>p &lt;</i> .001), waist circumference (OR = 1.021, <i>p</i> = .001) and mean arterial pressure (OR = 1.031, <i>p &lt;</i> .001) were found as independent clinical determinants of PWV ratio, while independent laboratory determinants were urine albumin to creatinine ratio (OR = 1.189, <i>p =</i> .010), triglycerides (OR = 1.161, <i>p =</i> .034), glucose (OR = 1.28, <i>p =</i> .001) and eGFR (OR = 0.998, <i>p =</i> .007). Diabetes (OR = 1.811, <i>p =</i> .029), hypertension (OR = 2.784, <i>p =</i> .042) and menopause (OR = 1.054, <i>p =</i> .018) were established as independent factors in comorbidities group. The analysis confirmed that PWV ratio (R² = 0.0667, <i>p &lt;</i> .001), as well as carotid radial (R² = 0.0341, <i>p &lt;</i> .001) and carotid femoral PWV (R² = 0.1752, <i>p &lt;</i> .001) is affected by mean arterial blood pressure. <b>Conclusions:</b> Age, abdominal obesity, blood pressure, triglycerides, glucose, kidney function parameters and menopause all are associated with PWV ratio. More importance to women with high cardiovascular risk should be given whilst screening and stratifying further progression of the disease.

**研究目的：** 本研究旨在评估50~65岁无显性心血管疾病，但合并高血压、肥胖、糖尿病、高胆固醇血症等心血管高危因素女性的脉搏波速度（pulse wave velocity, PWV）比值的临床与实验室决定因素。

**材料与方法：** 本研究对纳入全国性一级预防项目的1170名女性的临床数据进行分析。基于临床资料、实验室检测值与合并症分组，采用单因素及多因素线性回归分析确定独立危险因素。采用平压张力测量技术（applanation tonometry technique）结合SphygmoCor设备评估动脉僵硬度；通过中心-股动脉脉搏波速度（cfPWV）与颈-桡动脉脉搏波速度（crPWV）的比值计算得到PWV比值。

**结果：** 多因素logistic回归分析显示，年龄（优势比（odds ratio, OR）=1.109，*P*<0.001）、腰围（OR=1.021，*P*=0.001）与平均动脉压（OR=1.031，*P*<0.001）为PWV比值的独立临床决定因素；独立实验室决定因素则包括尿白蛋白肌酐比（OR=1.189，*P*=0.010）、甘油三酯（OR=1.161，*P*=0.034）、血糖（OR=1.28，*P*=0.001）与估算肾小球滤过率（estimated glomerular filtration rate, eGFR）（OR=0.998，*P*=0.007）。合并症组中，糖尿病（OR=1.811，*P*=0.029）、高血压（OR=2.784，*P*=0.042）与绝经状态（OR=1.054，*P*=0.018）为独立影响因素。本分析证实，PWV比值（决定系数（coefficient of determination, *R*²）=0.0667，*P*<0.001）、颈-桡动脉PWV（*R*²=0.0341，*P*<0.001）与颈-股动脉PWV（*R*²=0.1752，*P*<0.001）均受平均动脉压的影响。

**结论：** 年龄、腹型肥胖、血压水平、甘油三酯、血糖、肾功能指标与绝经状态均与PWV比值显著相关。针对此类心血管高危女性，在临床筛查与疾病进展分层管理中应予以更高优先级的关注。