Association of Inter-Arm Systolic Blood Pressure Difference with Coronary Atherosclerotic Disease Burden Using Calcium Scoring
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: There are no sufficient data on the correlation between inter-arm blood pressure (BP) difference and coronary atherosclerosisfound using coronary artery calcium score (CACS). We aimed to investigate if the increased difference in inter-arm BP is independently associated with severity of CACS. Materials and Methods: Patients who had ≥3 cardiovascular risk factors or an intermediate Framingham Risk Score (FRS; ≥10) were enrolled. Inter-arm BP difference was defined as the absolute difference in BP in both arms. Quantitative CACS was measuredby using coronary computed tomography angiography with the scoring system. Results: A total of 261 patients were included in this study. Age (r=0.256, p<0.001), serum creatinine (r=0.139, p=0.030), mean of right arm systolic BP (SBP; r=0.172, p=0.005), mean of left arm SBP (r=0.190, p=0.002), inter-arm SBP difference (r=0.152, p=0.014), and the FRS (r=0.278, p<0.001) showed significant correlation with CACS. The increased inter-arm SBP difference (≥6 mm Hg) was significantly associated with CACS ≥300 [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.12–4.22; p=0.022]. In multivariableanalysis, the inter-arm SBP difference ≥6 mm Hg was also significantly associated with CACS ≥300 after adjusting for clinical risk factors (OR 2.34, 95 % CI 1.06–5.19; p=0.036). Conclusion: An increased inter-arm SBP difference (≥6 mm Hg) is associated with coronary atherosclerotic disease burden using CACS, and provides additional information for predicting severe coronary calcification, compared to models based on traditional risk factors.
Abstract
Purpose: There are no sufficient data on the correlation between inter-arm blood pressure (BP) difference and coronary atherosclerosisfound using coronary artery calcium score (CACS). We aimed to investigate if the increased difference in inter-arm BP is independently associated with severity of CACS. Materials and Methods: Patients who had ≥3 cardiovascular risk factors or an intermediate Framingham Risk Score (FRS; ≥10) were enrolled. Inter-arm BP difference was defined as the absolute difference in BP in both arms. Quantitative CACS was measuredby using coronary computed tomography angiography with the scoring system. Results: A total of 261 patients were included in this study. Age (r=0.256, p<0.001), serum creatinine (r=0.139, p=0.030), mean of right arm systolic BP (SBP; r=0.172, p=0.005), mean of left arm SBP (r=0.190, p=0.002), inter-arm SBP difference (r=0.152, p=0.014), and the FRS (r=0.278, p<0.001) showed significant correlation with CACS. The increased inter-arm SBP difference (≥6 mm Hg) was significantly associated with CACS ≥300 [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.12–4.22; p=0.022]. In multivariableanalysis, the inter-arm SBP difference ≥6 mm Hg was also significantly associated with CACS ≥300 after adjusting for clinical risk factors (OR 2.34, 95 % CI 1.06–5.19; p=0.036). Conclusion: An increased inter-arm SBP difference (≥6 mm Hg) is associated with coronary atherosclerotic disease burden using CACS, and provides additional information for predicting severe coronary calcification, compared to models based on traditional risk factors.
참고문헌 (23)
- Smith SC Jr, "AHA conference proceedings. Prevention conference V: beyond secondary prevention:identifying the high-risk patient for primary prevention: executive summary. American Heart Association", Circulation, 101, pp.111~116 (2000)
- Greenland P, "Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests", Circulation, 104, pp.1863~1867 (2001)
- Greenland P, "2010 ACCF", AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation, J Am Coll Cardiol, pp.2010, 56[DOI]
- Budoff MJ, "Long-term prognosis associated with coronary calcification:observations from a registry of 25,253 patients", J Am Coll Cardiol, 49, pp.1860~1870 (2007)
- Madhavan MV, "Coronary artery calcification: pathogenesis and prognostic implications", J Am Coll Cardiol, 63, pp.1703~1714 (2014)
- Agarwal R, "Prognostic significance of between-arm blood pressure differences", Hypertension, 51, pp.657~662 (2008)
- Cao K, "Association of an inter-arm systolic blood pressure difference with all-cause and cardiovascular mortality: an updated meta-analysis of cohort studies", Int J Cardiol, 189, pp.211~219 (2015)
- Clark CE, "Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis", Lancet, 379, pp.905~914 (2012)
- Clark CE, "The difference in blood pressure readings between arms and survival: primary care cohort study", BMJ, 344, pp.e1327~ (2012)
- Su HM, "Association of interarm systolic blood pressure difference with atherosclerosis and left ventricular hypertrophy", PLoS One, 7, pp.e41173~ (2012)
- Johansson JK, "Interarm blood pressure difference and target organ damage in the general population", J Hypertens, 32, pp.260~266 (2014)
- Wilson PW, "Prediction of coronary heart disease using risk factor categories", Circulation, 97, pp.1837~1847 (1998)
- Ann SH, "Reproducibility of coronary artery calcium measurements using 0.8-mmthickness 256-slice coronary CT", Jpn J Radiol, 32, pp.677~684 (2014)
- Agatston AS, "Quantification of coronary artery calcium using ultrafast computed tomography", J Am Coll Cardiol, 15, pp.827~832 (1990)
- Tanaka Y, "The inter-arm difference in systolic blood pressure is a novel risk marker for subclinical atherosclerosis in patients with type 2diabetes", Hypertens Res, 37, pp.548~552 (2014)
- Baumann F, "Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics", Internist (Berl), 54, pp.535~542 (2013)
- Weinberg I, "The systolic blood pressure difference between arms and cardiovascular disease in the Framingham Heart Study", Am J Med, 127, pp.209~215 (2014)
- van der Hoeven NV, "Simultaneous compared with sequential blood pressure measurement results in smaller inter-arm blood pressure differences", J Clin Hypertens (Greenwich), 15, pp.839~844 (2013)
- Schulman-Marcus J, "Prognostic utility of coronary artery calcium scoring in active smokers: a 15-year follow-up study", Int J Cardiol, 177, pp.581~583 (2014)
- Goff DC Jr, "2013 ACC", AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology, Circulation, pp.2014, 129(25 Suppl 2)[DOI]
- Perk J, "European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)", Eur Heart J, 33, pp.1635~1701 (2012)
- Nakanishi R, "The relationship between coronary artery calcium score and the long-term mortality among patients with minimal or absent coronary artery risk factors", Int J Cardiol, 185, pp.275~281 (2015)
- Okwuosa TM, "Distribution of coronary artery calcium scores by Framingham 10-year risk strata in the MESA (Multi-Ethnic Study of Atherosclerosis)potential implications for coronary risk assessment", J Am Coll Cardiol, 57, pp.1838~1845 (2011)