关键词: 高血压, 颈动脉内膜中膜厚度, 心血管疾病, 脑血管障碍

Abstract: Background　Either carotid intima-media thickening（CIMT） or hypertension is closely related to the occurrence of cardio-cerebrovascular disease（CVD），yet large-scale studies exploring the combination of the two in relation to cardio-cerebrovascular disease are rare.Objective　To investigate the association of new-onset CVD with the combination of CIMT thickening and hypertension.Methods　In this prospective cohort study，5 440 middle-aged and elderly people（≥ 40 years old） who participated in the health examination of Kailuan Group from July 2006 to January 2017 and carotid ultrasound in 2010 were randomly selected.The content of epidemiological investigation，anthropometric indices，biochemical indices and the definition of living habits were described in the previous study of our group.Participants were grouped according to CIMT thickening and hypertension prevalence：group 1：normal CIMT（CIMT<1.0 mm） without hypertension；group 2：CIMT thickening without hypertension；group 3：normal CIMT（CIMT<1.0 mm） with hypertension；group 4：CIMT thickening with hypertension.The follow-up started since the completion of 2010 physical examination，and ended on 2017-12-31 with CVD（including stroke and myocardial infarction） as the endpoint event.The CVD cumulative incidence curves of the four groups were plotted by Kaplan-Meier method，and were compared by the Log-Rank test.Multivariate Cox regression analysis was used to explore the association of CIMT thickening and hypertension with new-onset CVD.Results　The mean follow-up period was（6.84±0.89） years.The cumulative incidence of CVD for groups 1，2，3，and 4 was 1.28%，2.96%，5.73% and 8.37%，respectively，with a statistically significant difference（χ2=96.10，P<0.001）.Multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） for new-onset CVD in groups 2，3 and 4 was 1.15（0.55，2.37），3.34（2.15，5.19） and 3.16（1.91，5.12），respectively.Sex-based analysis showed that compared to men in group 1，the HR（95%CI） for new-onset CVD in those in groups 2，3 and 4 was 1.35（0.62，2.94），3.46（2.04，5.89） and 3.29（1.84，5.90），respectively.Compared to women in group 1，the HR（95%CI） for new-onset CVD in those in groups 3，4 was 2.53（1.13，5.65） and 2.67（0.98，7.31），respectively.After eliminating the interference of antihypertensive drugs，the HR value of group 4 was significantly higher than that of group 3（P<0.05）.After excluding individuals taking lipid-lowering drugs，multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） of new-onset CVD in group 4 was 3.36（2.02，5.59）.After excluding those taking antihypertensive drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.19（1.19，5.71） compared to group 1in the multivariate Cox regression.And after excluding those taking hypoglycemic drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.59（2.06，6.25） compared to group 1showed by multivariate Cox regression analysis.Conclusion　CIMT thickening with hypertension may be strongly associated with new-onset CVD，which can provide help for clinical prevention of CVD.

Key words: Hypertension, Carotid intima-media thickness, Cardiovascular diseases, Cerebrovascular disorders