Introduction
Vascular health indicators,
including structural lumen stenosis and functional disorder, reflect the
long-term cumulative effects of traditional and unidentified
cardiovascular (CV) risk factors before and after clinical vascular
events, and can be regarded as an alternative end point index for target
organ damage and risk prediction1. Several markers
have been considered as the reflection of vascular health, among them
endothelial function, arterial stiffness and carotid atherosclerosis are
the most common indicators1. Endothelial dysfunction
may represent the effect of traditional CV risk factors on vascular
health2. Arterial stiffness is increasingly recognized
as a surrogate end point for cardiovascular disease (CVD) and as a risk
factor for clinical hypertension3,
4. Carotid ultrasound measurement
of intima-media thickness (IMT) along with carotid plaque are emerging
as the focus of carotid artery ultrasound imaging for CV risk
prediction5. Currently, studies on assessing vascular
health use only one or more of these indicators6-8.
Beijing Vascular Health Stratification (BVHS)was put forward to assess
vascular health including all stages of vascular disease progression,
from endothelial function to arteriosclerosis to vascular
stenosis9. BVHS is a risk prediction tool using
subclinical vascular measures such as endothelial function, arterial
stiffness, carotid atherosclerotic plaques and artery stenosis by
non-invasive detections. Furthermore, traditional risk factors are not
included in BVHS, but are used as adjusted confounding factors to
analyze the independent predictive role of BVHS.
All the markers are graded as artery functional injury or structural
disease or both. Our previous retrospective study found that the BVHS
was a comprehensive risk assessment system and was independent of
traditional CV risk factors10. However, the previous
study did not develop a strict study design and follow-up plan.
Therefore, this study was designed as a prospective cohort study to
verify the previous research results and further explore the clinical
value of BVHS for the prediction of major adverse cardiovascular events
(MACEs).