Hypertension：脉搏波速度与轻度认知障碍患者痴呆风险增加有关

CYW

Abstract

To investigate the association between pulse wave velocity, intima-media thickness, carotid artery diameter, carotid plaques, and conversion from mild cognitive impairment to dementia. Three hundred and seventy-five elderly ambulatory subjects with mild cognitive impairment were followed yearly to examine potential conversion to dementia. Vascular function was assessed by carotid-femoral pulse wave velocity. Vascular structure was evaluated by intima-media thickness, carotid artery diameter, and carotid plaques using an ultrasonographic assessment of carotid arteries. One hundred and five patients (28%) converted to dementia during a mean follow-up period of 4.5 years. Higher pulse wave velocity was associated with greater risk of conversion to dementia (1-SD increase of pulse wave velocity: hazard ratio, 1.33; 95% CI, 1.04–1.71; P=0.02) independently of age, sex, educational level, systolic blood pressure, cardiovascular diseases, body mass index, calcium channel blockers intake, Mini–Mental State Examination at baseline, and apoE ε4 status. Intima-media thickness, carotid plaques, and carotid artery diameter did not predict conversion to dementia (1-SD increase of intima-media thickness: hazard ratio, 0.93; 95% CI, 0.73–1.18; P=0.55; presence of carotid plaques: hazard ratio, 1.08; 95% CI, 0.62–1.87; P=0.79; 1-SD increase of carotid artery diameter: hazard ratio, 1.08; 95% CI, 0.89–1.31; P=0.44). Pulse wave velocity was associated with conversion to dementia, whereas intima-media thickness, carotid plaques, or carotid artery diameter were not after controlling for age and other confounding factors. Arterial stiffness could identify mild cognitive impairment patients at higher risk of dementia and may be a therapeutic target to delay or prevent the onset of dementia.

心血管权威杂志Hypertension上发表了一篇研究文章，该研究旨在调查脉搏波速度、内膜中层厚度、颈动脉直径、颈动脉斑块与轻度认知障碍转变为痴呆之间的关联。

研究人员每年随访了377名患有轻度认知障碍的老年门诊受试者，以评估了转变为痴呆的可能性，并通过颈动脉-股动脉脉搏波速度评估血管功能，使用颈动脉的超声评估了内膜中层厚度、颈动脉直径和颈动脉斑块等血管结构。

在平均4.5年的随访期间，105名（28％）患者发展成痴呆症。较高的脉搏波速度与罹患痴呆的风险增加有关（脉搏波速度增加1个SD的风险比为1.33; 95％CI为1.04-1.71; P=0.02），并且与年龄、性别、文化程度、收缩压、心血管疾病、体重指数、钙通道阻滞剂摄入量，基线迷你精神状态评估和apoEε4状态无关。内膜中层厚度、颈动脉斑块和颈动脉直径不能预测痴呆发展（内膜中层厚度增加1个SD的风险比为0.93; 95％CI为0.73-1.18; P=0.55;存在颈动脉斑块的风险比为1.08; 95％CI为0.62-1.87; P=0.79;颈动脉直径每增加1个SD的风险比为1.08; 95％CI为0.89-1.31; P=0.44）。脉搏波速度与发展为痴呆有关，而内膜-中膜厚度、颈动脉斑块或颈动脉直径在控制年龄和其他混杂因素后与发展为痴呆无关。

由此可见，动脉硬度可以识别痴呆风险较高的轻度认知障碍患者，并且可能是延迟或预防痴呆发展的治疗目标。