부산대학교 도서관

Background:The prognostic utility of long-term cumulative blood pressure (BP) in young adults for premature cardiovascular disease (CVD) and mortality is uncertain.Methods:We investigated 3014 CARDIA participants aged 33-45 years(y) at Y15 (2000-2001), who attended 6 visits from Y0. Cox proportional hazard models were used to obtain relative hazards (HR) and 95% confidence intervals (CI) for cumulative (Y0 to Y15), single-occasion (Y15), and BP change (15y) measures and incident heart failure (HF), stroke, coronary heart disease (CHD), CVD, and mortality events. Models were adjusted for risk factors and time-varying BP medication use. C-statistics, category-free net reclassification index (NRI), and integrated discrimination improvement (IDI) were computedResults:Mean age at Y15 was 40.2?3.6y, 44.1% were men, and 44.1% were African-American. Over a median of 16y, subjects developed 144 CVD, 156 death, 54 stroke, 25 HF, and 81 CHD events. In Cox models (per SD increment)(table), cumulative systolic BP (SBP) was associated with HF (HR=2.42 95% CI [1.74-3.37]), stroke (HR=1.83 95% CI [1.39-2.41]), CHD (HR=1.48 95% CI [1.17-1.87]), CVD (HR=1.76 95% CI[1.49-2.09]), and mortality (HR=1.29 95% CI [1.09-1.54]). Cumulative DBP, Y15 SBP, and SBP change were similarly associated with adverse outcomes; albeit with lower magnitudes of association. For CVD, C-statistic for Y15 SBP was (0.70) in the base model and in incremental models adding SBP change or Cumulative SBP was (0.71 and 0.74), respectively. For CVD, using Y15 SBP as reference, NRI and IDI respectively for cumulative SBP was (0.39,standard error (SE) 0.08) and (0.02 SE 0.007) while NRI for SBP change was (0.22,SE 0.08) and IDI was non-significant.Conclusions:Cumulative BP across early adulthood was associated with incident HF, CHD, stroke, CVD, and mortality in middle age and provided incremental predictive value and improved risk reclassification when compared to a single-occasion or longitudinal BP change.