Journal of agricultural medicine and community health (농촌의학ㆍ지역보건)

Korean Society for Rural Medicine and Community Health (한국농촌의학지역보건학회)
권호 표지
DOI QR코드

DOI QR Code

Cross-Sectional Relations of Arterial Stiffness and Inflammatory Markers in Korean Adults Aged 50 Years and Older

지역사회 거주 50세 이상 성인의 동맥경직도와 염증반응인자와의 관련성

  • Ryu, So-Yeon (Department of Preventive Medicine, Chosun University Medical School) ;
  • Shin, Min-Ho (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Lee, Young-Hoon (Department of Preventive Medicine, Wonkwang University College of Medicine) ;
  • Rhee, Jung-Ae (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Choi, Jin-Su (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Park, Kyeong-Soo (Department of Preventive Medicine, Seonam University College of Medicine) ;
  • Nam, Hae-Sung (Department of Preventive Medicine, Chungnam National University Medical School) ;
  • Jeong, Seul-Ki (Department of Neurology, Chonbuk National University Medical School) ;
  • Kweon, Sun-Seog (Department of Preventive Medicine, Chonnam National University Medical School)
  • 류소연 (조선대학교 의과대학 예방의학교실) ;
  • 신민호 (전남대학교 의과대학 예방의학교실) ;
  • 이영훈 (원광대학교 의과대학 예방의학교실) ;
  • 이정애 (전남대학교 의과대학 예방의학교실) ;
  • 최진수 (전남대학교 의과대학 예방의학교실) ;
  • 박경수 (서남대학교 의과대학 예방의학교실) ;
  • 남해성 (충남대학교 의학전문대학원 예방의학교실) ;
  • 정슬기 (전북대학교 의학전문대학원 신경과학교실) ;
  • 권순석 (전남대학교 의과대학 예방의학교실)
  • Received : 2011.05.03
  • Accepted : 2011.06.17
  • Published : 2011.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: The aim of this study is to determine arterial stiffness levels as measured by brachial-ankle pulse wave velocity (baPWV) and to identify the association between arterial stiffness and inflammatory markers, in healthy adults over 50 years old. Methods: The study population consisted of 4617 persons over the age of 50 years who participated in the baseline survey of the Dong-gu Study, which was conducted in 2007 and 2008. Arterial stiffness was measured using baPWV. A multiple regression analysis was performed to assess the relationship between conventional cardiovascular risk factors and inflammatory markers, including white blood cell (WBC) counts, high-sensitive C-reactive protein (hs-CRP), and gamma glutamyltransferase (GGT). Results: After adjustment for conventional cardiovascular risk factors including sex, age, smoking status, body mass index, systolic blood pressure, fasting glucose, hypertension or diabetic medication, total cholesterol, triglycerides, uric acid, and alanine aminotransferase, baPWV was significantly associated with WBC counts (${\beta}$=0.158, p<0.0001), hs-CRP (${\beta}$=0.244, p=0.026), and GGT (${\beta}$=0.003, p<0.0001). Conclusion: This study shows that arterial stiffness correlates with inflammatory markers. Arterial stiffness may be used as a composite risk factor to identify persons with higher risk for cardiovascular disease. Additionally, arterial stiffness may be a marker for future cardiovascular disease and a target for prevention.

50세 이상 건강한 성인을 대상으로 baPWV로 측정한 동맥경직도 수준과 염증인자와 동맥경직도와의 관련성을 파악하기 위하여 본 연구를 수행하였다. 2007년과 2008년에 수행된 광주광역시 동구연구(Dong-gu Study)의 기반조사에 참여한 50세 이상 주민 4617명을 대상으로 하였으며, 다중회귀분석을 시행하여 전통적인 심뇌혈관질환 위험요인을 통제한 상태에서 baPWV와 CRP, GGT와 WBC 등의 염증반응인자와의 관련성을 알아보았다. 평균 baPWV는 남자 $17.0{\pm}4.0\;m/s$, 여자 $16.2{\pm}3.6\;m/s$로 남, 여 간에 통계적으로 유의한 차이가 있었고, 연령이 증가할수록 baPWV는 통계적으로 유의하게 증가하는 경향을 보였다. 성, 연령, 흡연상태, 체질량지수, 수축기혈압, 공복혈당, 고혈압 또는 당뇨병의 투약 여부, 혈청 지질, 요산과 ALT 등의 전통적인 심뇌혈관질환 위험요인을 통제한 상태에서 WBC (${\beta}$=0.158, p<0.0001), hs-CRP(${\beta}$=0.244, p=0.026)와 GGT (${\beta}$=0.003, p<0.0001)는 baPWV와 통계적으로 유의하게 독립적인 관련성이 있음을 알 수 있었다. 결론적으로 baPWV로 측정한 동맥경직도 지표는 염증반응인자와 관련이 있음을 알 수 있었다. baPWV 등의 동맥경직도 측정 지표는 동맥 기능의 초기변화를 반영하고 일반적으로 알려져 있는 심혈관질환 위험요인과 유의한 상관관계를 가지고 있어, 이를 이용하여 심혈관질환의 위험을 예측하는데 활용할 수 있을 것으로 생각된다.

Keywords

References

  1. Statistics Korea. 2009 Annual report on the cause death statistics. Daejeon: Statitisc Korea, 2010 (Korean)
  2. 예방의학 편찬위원회. 예방의학 서울: 계축문화사, 2011, pp291-302
  3. Jo YK, Jeon JY, Kim ES, Kekal YS, Eom YB, Im JA. Determinats of arterial stiffness in young adults. J Exp Biomed Sci 2006;12:191-196
  4. Cohn JN. Arterial compliance to stratify cardiovascular risk: more precision in therapeutic decision making. Am J Hypertens 2001;14:258S-263S https://doi.org/10.1016/S0895-7061(01)02154-9
  5. Slotwiner DJ, Devereux RB, Schwartz JE, Pickering TG, de Simone G, Ganau A, Saba PS, Roman MJ. Relation of age to left ventricular function in clinically normal adults. Am J Cardiol 1998;82(5):621-626 https://doi.org/10.1016/S0002-9149(98)00390-7
  6. Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999;33(5):1111-1117 https://doi.org/10.1161/01.HYP.33.5.1111
  7. Mortolotto LA, Blacher J, Kondo T, Takazawa K, Safar ME. Assessment of vascular aging and atherosclerosis in hypertensive subjects : second derivative of photoplethsmogram versus pulse wave velocity. Am J Hypertens 2000;13:165-171 https://doi.org/10.1016/S0895-7061(99)00192-2
  8. Tsai WC, Chen JY, Wang MC, W u HT, Chi CK, Chen YK et al. Association of risk factors with increased pulse wave velocity detected by a novel method using dual-channel photoplethysmography. Am J Hypertens 2005;18:1118-1122 https://doi.org/10.1016/j.amjhyper.2005.03.739
  9. Dart AM, Kingwell BA. Pulse pressure - a review of mechanism and clinical relevance. J Atherosclero Thromb 2006;13:101-107 https://doi.org/10.5551/jat.13.101
  10. Fujiwara Y, Chaves P, Takahashi R, Amano H, Kumagai S, Fujuta K, Yoshida H, Wang DG, Varadhan R, Uchida H, Shinkai S. Relationships between brachial-ankle pulse wave velocity and conventional atherosclerotic risk factors in community-dwelling people. Prev Med 2004;39:1135-1142 https://doi.org/10.1016/j.ypmed.2004.04.026
  11. Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, Vasan RS, Levy D. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension 2004;43:1239-1245 https://doi.org/10.1161/01.HYP.0000128420.01881.aa
  12. Tomiyama H, Yamashina A, Arai T, Hirose K, Koji Y, Chikamori T, Hori S, Yamamoto Y, Doba N, Hinohara S. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement-a survey of 12517 subjects. Atherosclerosis 2003;166:303-309 https://doi.org/10.1016/S0021-9150(02)00332-5
  13. Yasmin, McEniery CM, Wallace S, Mackenzie IS, Cockcroft JR, Wilkinson IB. C-reactive protein is associated with arterial stiffness in apparently health individuals. Arterioscler Thromb Vasc Biol 2004;24:969-974 https://doi.org/10.1161/01.ATV.zhq0504.0173
  14. Kullo IJ, Seward JB, Bailey KR, Bielak LF, Grossardt BR, Sheedy PF II, Peyser PA, Turner ST. C-reactive protein is related to arterial wave reflection and stiffness in asymptomatic subjects from the community. Am J Hypertens 2005;18:1123-1129 https://doi.org/10.1016/j.amjhyper.2005.03.730
  15. Tomiyama H, Arai T, Koji Y, Yambe M, Hirayama Y, Yamamoto Y, Yamashina A. The relationship between high-sensitive C-reactive protein and pulse wave velocity in healthy Japanese men. Atherosclerosis 2004;174:373-377 https://doi.org/10.1016/j.atherosclerosis.2004.01.032
  16. Nagano M, Nakamura M, Sato K, Tanaka F, Segawa T, Hiramori K. Association between C-reactive protein levels and pulse wave velocity: a population-based cross-sectional study in a general population. Atherosclerosis 2005;180:189-195 https://doi.org/10.1016/j.atherosclerosis.2004.11.019
  17. Mattace-Raso F, van der Cammen T, van der Meer I, Sxhalekamp M, Asmar R, Hofman A, Witteman J. C-reactive protein and arterial stiffness in older adults : the Rotterdam Study. Athersclerosis 2004;176:111-116 https://doi.org/10.1016/j.atherosclerosis.2004.04.014
  18. Saijo Y, Utsugi M, Yoshioka E, Horikawa N, Sato T, Gong Y, Kishi R. The relationship of gamma glutamyltransferase to C-reactive protein and arterial stiffness. Nutr Metab Cardiovasc Dis 2008;18:211-219 https://doi.org/10.1016/j.numecd.2006.10.002
  19. Lee MS, Park HS, Park JH, Lee JH, Choi SW, Jeong JO, Gu BJ, Kim DH, Kim J, Lee TY, Sung IW. Increased Serum Ferritin Concentration is Associated with Increased Arterial Stiffness Assessed by Pulse Wave Velocity. Korean J Lipid Atherosclerosis 2006;16:281-288(Korean)
  20. Kim JS, Kang TS, Kim JB, Se o HS, Park S, Kim C, Ko YG, Choi D, Jang Y, Chung N. Significant association of C-reactive protein with arterial stiffness in treated non-diabetic hypertensive patients. Atherosclerosis 2007;192:401-406 https://doi.org/10.1016/j.atherosclerosis.2006.05.025
  21. Kweon SS, Shin MH, Park KS, Nam HS, Jeong SK, Ryu SY, Chung EK, Choi JS. Distribution of the ankle-brachial index and associated cardiovascular risk factors in a population of middle-aged and elderly Koreans. J Korean Med Sci 2005;20:373-378 https://doi.org/10.3346/jkms.2005.20.3.373
  22. Munakawa M, Ito N, Nunokawa T, Yoshinaga K. Utility of automated brachial arterial ankle pulse wave velocity measurements in hypertensive patients. Am J Hypertens 2003;16:653-657 https://doi.org/10.1016/S0895-7061(03)00918-X
  23. Woo J, Lynn H, Wong SYS, Hong A, Tang YN, Lau WY, et al. Correlates for a low ankle-brachial index in elderly Chinese. Atherosclerosis 2006;186:360-366 https://doi.org/10.1016/j.atherosclerosis.2005.07.022
  24. Zheng ZJ, Sharrett AR, Chambless LE, et al. Associations of ankle-brachial index with clinical coronary heart disease, stroke, and preclinical carotid and popliteal atherosclerosis: the Atherosclerosis Risk in Community (ARIC) study. Atherosclerosis 1997;131:115-125 https://doi.org/10.1016/S0021-9150(97)06089-9
  25. Bernstein EF, Fronek A. Current status of non-invasive tests in the diagnosis of peripheral arterial disease. Surg Clin North Am 1982;62:473-487 https://doi.org/10.1016/S0039-6109(16)42739-8
  26. Murabito JM, Evans JC, Larson MG, Nieto K, Levy D, Wilson PW. The ankle-brachial index in the elderly and risk of stroke, coronary disease and death : the Framingham Study. Arch Int Med 2003;163:1939-1942 https://doi.org/10.1001/archinte.163.16.1939
  27. Resnick HE, Lindsay RS, McDermott MM, et al. Relationship of high and low ankle-brachial index to all-cause and cardiovascular disease mortality : the Strong Heart Study. Circulation 2004;109:733-739 https://doi.org/10.1161/01.CIR.0000112642.63927.54
  28. Papamichael C, Lekakis JP, Stamatelopoulos KS, et al. Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease. Am J Cardiol 2000;86:615-618 https://doi.org/10.1016/S0002-9149(00)01038-9
  29. Laurent S, Cockcrofe J, Van Bortel L, Boutouyrie P, Giannattasia C, Hayoz D, et al. European network for non-invasive investigation of large arteries expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588-2605 https://doi.org/10.1093/eurheartj/ehl254
  30. Ross R. Atherosclerosis- an inflammatory disease. N Engl J Med 1999;340:115-126 https://doi.org/10.1056/NEJM199901143400207
  31. Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL. Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med 1989;320:915-924 https://doi.org/10.1056/NEJM198904063201407
  32. Pande RL, Perlstein TS, Beckman JA, Creager MA. Association of insulin resistance and inflammation with peripheral arterial disease : The National Health and Nutrition Examination Survey, 1999 to 2004. Circulation 2008;118:33-41 https://doi.org/10.1161/CIRCULATIONAHA.107.721878
  33. Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest 2006;116:1793-1801 https://doi.org/10.1172/JCI29069
  34. Teschke R, Brand A, Strohmeyer T. Induction of hepatic microsomal gamma-glutamyltransferase activity following chronic alcohol consumption. Biochem Biophys Res Commun 1977;75:718-724 https://doi.org/10.1016/0006-291X(77)91531-5
  35. Wannamethee G, Ebrahim S, Shaper AG. Gamma-glutamyltranspeptidase : determinants and association with mortality from ischemic heart disease and all causes. Am J Epidemiol 1995;142:699-708 https://doi.org/10.1093/oxfordjournals.aje.a117699
  36. Jousilahti P, Rastenyte D, Tuomilehto J. Serum gamma-glutamyltransferase, selfreported alcohol drinking, and the risk of stroke. Stroke 2000;31:1851-1855 https://doi.org/10.1161/01.STR.31.8.1851
  37. Lee DH, Blomhoff R, Jacobs Jr DR. Is serum gamma glutamyltransferase a marker of oxidative stress? Free Radic Res 2004;38:535-539 https://doi.org/10.1080/10715760410001694026
  38. Karp DR, Shimooku K, Lipsky PE. Expression of gamma-glutamyl transpeptidase protects ramos B cells from oxidationinduced cell death. J Biol Chem 2001;276;3798-3804 https://doi.org/10.1074/jbc.M008484200
  39. Paolicchi A, Dominici S, Pieri L, Maellaro E, Pompella A. Glutathione catabolism as a signaling mechanism. Biochem Pharmacol 2002;64:1027-1035 https://doi.org/10.1016/S0006-2952(02)01173-5