Zhongguo quanke yixue (May 2023)
Effects of Cardiovascular Risk Factors on the Progression of Carotid Intima-media Thickening
Abstract
Background As an alternative indicator of atherosclerosis, the prevention of carotid intima-media thickening is conductive to the primary prevention of atherosclerosis, but contributions of cardiovascular risk factors to carotid intima-media thickening are not clear. Objective To identity the controllable risk factors of carotid intima-media thickening, and to perform a dominance analysis of these factors in terms of percentage of contribution in people without major diseases, so as to provide a reference for the determination of key issues related to early prevention and control of cardiovascular diseases. Methods A total of 738 residents were recruited from Liuzhou, Guangxi Zhuang Autonomous Region from 2019 to 2021. By use of a questionnaire survey and a physical examination, participant information was collected, including demographics, biomarkers in fasting whole blood and urine samples, carotid intima-media thickness (CIMT) and internal diameter of the common carotid artery measured by color Doppler ultrasonography. The aforementioned information was compared between residents with normal CIMT (CIMT <1 mm, n=693) and those with thickened CIMT (CIMT≥1 mm, n=45) . Logistic regression model with adaptive Lasso was established with thickened CIMT as dependent variable to screen its potentially associated factors, then the identified ones were further analyzed using multivariate logistic regression, and the percentage of contribution of each identified associated factor to thickened CIMT was estimated using dominance analysis. Moreover, potential factors associated with naturally logarithmized CIMT were screened using Adaptive Lasso linear regression, then the identified ones were further analyzed using multiple linear regression, and the percentage of contribution of identified associated factors to CIMT was estimated and ranked in descending order. Results There was statistically significant difference in gender, age, ethnicity, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , smoking status, common carotid artery diameter, total cholesterol (TC) , urinary microalbumin creatinine ratio (ACR) , lipoprotein A (LPA) , vascular cell adhesion factor 1, apolipoprotein A/ Apolipoprotein B (ApoA/ApoB) , C-reactive protein (CRP) , urinary microalbumin (ALB) and physical activity level (PHYMET) (P<0.05) . Eleven factors potentially associated with thickened CIMT were identified by adaptive Lasso-logit regression analysis, including internal diameter of the common carotid artery, SBP, TC, overweight/obesity, ACR, physical activity level, CRP, LPA, renal function, VCAM-1, and ApoA/ApoB ratio. And 12 factors potentially associated with CIMT were identified by adaptive Lasso linear regression analysis, i.e., internal diameter of the common carotid artery, SBP, TC, physical activity level, ACR, smoking, alcohol consumption, CRP, LPA, ApoA/ApoB ratio, fasting plasma glucose, and family history of diabetes mellitus. Multivariate Logistic regression analysis revealed that risk factors for thickened CIMT were elevated SBP〔OR=1.032, 95%CI (1.013, 1.050) 〕, TC〔OR=1.558, 95%CI (1.049, 2.315) 〕, decreased physical activity level〔OR=2.226, 95%CI (1.289, 3.844) 〕, and elevated CRP〔OR=1.462, 95%CI (1.043, 2.050) 〕, and the percentage of contribution to thickened CIMT of them ranked from high to low was elevated SBP (63.7%) , elevated CRP (16.1%) , elevated TC (12.4%) and decreased physical activity level (7.8%) . Multiple linear regression analysis showed that SBP (β=0.017, P<0.001) , current smoking (β=0.076, P=0.021) , TC (β=0.020, P=0.021) , and physical activity level (β=0.022, P=0.034) were influential factors for CIMT (P<0.05) , and the percentage of contribution to thickened CIMT of them ranked descendingly was SBP (68.7%) , current smoking (19.9%) , TC (8.8%) , and physical activity level (2.6%) . Conclusion In our study, elevated SBP, TC, and CRP as well as reduced physical activity level were risk factors of CIMT thickening, and the percentage of contribution of them ranked from high to low was elevated SBP, elevated CRP, elevated TC, reduced physical activity level. The CIMT was significantly correlated with SBP, current smoking, TC and physical activity level, and the percentage of contribution of them ranked descendingly was SBP, current smoking, TC, physical activity level. Therefore, targeted measures for early control and prevention of cardiovascular diseases should keep in line with the controllable influencing factors and their contribution levels.
Keywords
