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Associations between echocardiographic arterial compliance and incident cardiovascular disease in blacks: the ARIC
Melissa C Caughey1, Laura R Loehr2, Susan Cheng3
1Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina at Chapel Hill; Chapel Hill, North Carolina; caughey@med.unc.edu.
Insights
The aortic velocity time integral to pulse pressure ratio (VTI/PP) is a stronger predictor of cardiovascular disease (CVD) events in Black adults than pulse pressure alone. This echocardiographic measure offers valuable insights into arterial health and CVD risk.
Area of Science:
- Cardiovascular Medicine
- Echocardiography
- Public Health
Background:
- Systemic arterial compliance, often assessed using echocardiographic stroke volume to pulse pressure ratios, lacks extensive study in Black populations.
- Few studies have examined echocardiographic arterial compliance and its direct association with specific cardiovascular disease (CVD) outcomes.
Purpose of the Study:
- To evaluate the association between echocardiographic arterial compliance, measured by the VTI/PP ratio, and incident CVD outcomes in Black adults.
- To compare the predictive power of VTI/PP with pulse pressure for CVD events.
Main Methods:
- Analysis of 1,887 Black adults from the Atherosclerosis Risk in Communities study, free of prevalent CVD.
- Echocardiographic assessment of arterial compliance using the aortic velocity time integral to brachial pulse pressure ratio (VTI/PP).
- Cox regression modeling to assess associations between VTI/PP, pulse pressure quartiles, and subsequent CVD events (stroke, coronary events, heart failure) over 13 years.
Main Results:
- The VTI/PP ratio demonstrated significant associations with composite CVD (HR=2.3), coronary disease (HR=2.1), heart failure (HR=2.5), and stroke (HR=2.7) when comparing the lowest to highest quartiles.
- Pulse pressure also predicted CVD outcomes, but with weaker associations (composite CVD HR=1.7, coronary heart disease HR=1.6, heart failure HR=1.8, stroke HR=2.3).
Conclusions:
- The VTI/PP ratio is a more potent predictor of both composite and individual cardiovascular disease outcomes in Black individuals compared to pulse pressure alone.
- This echocardiographic-derived measure of arterial compliance offers enhanced prognostic value for cardiovascular risk assessment in this population.
Background:
Systemic arterial compliance is sometimes derived by echocardiographic stroke volume to pulse pressure ratios. Few studies have assessed echocardiographic arterial compliance in blacks or its associations with explicit, rather than composite, cardiovascular disease (CVD) outcomes.
Methods:
We analyzed a subset (n = 1,887) of blacks (mean age = 59 ± 6 years; 65% women) in the Atherosclerosis Risk in Communities study who were free of prevalent CVD and were imaged by echocardiography in 1993-1995. Arterial compliance was calculated by the aortic velocity time integral and brachial pulse pressure ratio (VTI/PP). Associations between VTI/PP and subsequent CVD (defined as first incident stroke, coronary event, or heart failure) were modeled by Cox regression after controlling for demographics, anthropometry, and cardiac risk factors. For comparison, CVD hazard ratios were also calculated for pulse pressure quartiles.
Results:
Over a mean follow-up of 13 ± 4 years, 237 subjects (12%) developed coronary disease, 322 (16%) developed heart failure, and 180 (9%) experienced a stroke. Hazard ratios contrasting lowest with highest quartiles of VTI/PP were 2.3 (95% confidence interval (CI) = 1.7-3.1) for composite CVD, 2.1 (95% CI = 1.3-3.2) for coronary disease, 2.5 (95% CI = 1.7-3.6) for heart failure, and 2.7 (95% CI = 1.6-4.5) for stroke. Hazard ratios contrasting widest with narrowest pulse pressure quartiles were 1.7 (95% CI = 1.3-2.2) for composite CVD, 1.6 (95% CI = 1.0-2.4) for coronary heart disease, 1.8 (95% CI = 1.2-2.6) for heart failure, and 2.3 (95% CI = 1.3-3.9) for stroke.
Conclusions:
In blacks, the VTI/PP ratio has stronger associations with both composite and individual CVD outcomes than does pulse pressure.