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Components of hemodynamic load and cardiovascular events: the Framingham Heart Study

Leroy L Cooper1, Jian Rong1, Emelia J Benjamin1

  • 1From Cardiovascular Engineering Inc, Norwood, MA (L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Boston University and NHLBI's Framingham Study, Framingham, MA (J.R., E.J.B., M.G.L., D.L.); Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, MA (E.J.B., R.S.V.); Department of Mathematics and Statistics, Boston University, Boston, MA (M.G.L., R.S.V.); Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Evans Department of Medicine (J.A.V., N.M.H., R.S.V.), Whitaker Cardiovascular Institute (J.A.V., N.M.H., R.S.V.), Boston University School of Medicine, Boston, MA.

Circulation
|November 23, 2014
PubMed

Insights

Forward pressure wave amplitude, a measure of aortic stiffness, is linked to higher cardiovascular disease (CVD) risk. Mean arterial pressure and wave reflection were not associated with increased CVD risk in this study.

Area of Science:

  • Cardiovascular Physiology
  • Hemodynamics
  • Epidemiology

Background:

  • Elevated blood pressure is a primary modifiable risk factor for cardiovascular disease (CVD) and premature death.
  • The blood pressure waveform has distinct hemodynamic components that may independently contribute to adverse outcomes.
  • Pressure-flow measures have not been extensively studied in large, community-based populations.

Purpose of the Study:

  • To investigate the association between hemodynamic components of the blood pressure waveform and incident CVD.
  • To examine the independent contributions of forward pressure wave amplitude, mean arterial pressure, and global wave reflection to CVD risk.

Main Methods:

  • Utilized wave separation analysis and echocardiography in 2492 participants from the Framingham Heart Study.
  • Employed proportional hazards models to assess the association of CVD events with hemodynamic parameters.
  • Adjusted for multiple cardiovascular risk factors, including age, sex, BMI, cholesterol, smoking, diabetes, and antihypertensive therapy.

Main Results:

  • Forward pressure wave amplitude was significantly associated with incident CVD (HR, 1.40; P=0.0003) after multivariable adjustment.
  • Mean arterial pressure (HR, 1.10; P=0.25) and global wave reflection (HR, 0.93; P=0.58) were not significantly associated with incident CVD.
  • Forward pressure wave amplitude remained a significant correlate of CVD events even after including systolic blood pressure and pulse wave velocity in the model (HR, 1.33; P=0.02).

Conclusions:

  • Increased forward pressure wave amplitude, reflecting proximal aortic geometry and stiffness, is associated with a higher risk of incident CVD.
  • Mean arterial pressure and relative wave reflection, indicators of resistance vessel function, were not associated with increased CVD risk in this cohort.
Abstract

Keywords:
cardiovascular diseaseshemodynamicspulsatile flow

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