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Microvascular Function Contributes to the Relation Between Aortic Stiffness and Cardiovascular Events: The Framingham
Leroy L Cooper1, Joseph N Palmisano1, Emelia J Benjamin1
1From the Cardiovascular Engineering, Inc., Norwood, MA (L.L.C., G.F.M.); Cardiovascular Research Center, Lifespan Cardiovascular Institute, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Data Coordinating Center (J.N.P.), Department of Epidemiology (E.J.B., R.S.V.), and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Boston University and the National Heart, Lung, and Blood Institute's Framingham Study, MA (E.J.B., M.G.L., R.S.V.); and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Evans Department of Medicine (E.J.B., R.S.V., N.M.H.), and Whitaker Cardiovascular Institute (E.J.B., R.S.V., N.M.H.), Boston University School of Medicine, MA.
Higher aortic stiffness and lower vasodilator function predict cardiovascular disease (CVD) events. Microvascular damage mediates the link between aortic stiffness and CVD, highlighting potential therapeutic targets for preventing cardiovascular disease.
Area of Science:
- Cardiovascular Science
- Vascular Biology
- Epidemiology
Background:
- Arterial dysfunction is a key factor in cardiovascular disease (CVD) progression.
- The interplay between aortic stiffness, vasodilator function, and incident CVD requires further investigation.
Purpose of the Study:
- To examine the association between measures of arterial stiffness and vasodilator function with incident CVD.
- To investigate potential mediation by microvascular function in the relationship between aortic stiffness and CVD events.
Main Methods:
- Utilized proportional hazards models in 4547 Framingham Heart Study participants across two generations.
- Assessed carotid-femoral pulse wave velocity, hyperemic mean flow velocity, primary pressure wave amplitude, brachial diameter, and flow-mediated dilation.
- Conducted mediation analyses to explore the role of microvascular function.
Main Results:
- Increased carotid-femoral pulse wave velocity (a measure of aortic stiffness) was significantly associated with incident CVD (HR, 1.32).
- Reduced hyperemic mean flow velocity (a measure of vasodilator function) was significantly associated with incident CVD (HR, 0.84).
- Hyperemic mean flow velocity mediated 8% to 13% of the association between aortic stiffness and CVD events.
Conclusions:
- Aortic stiffness is a significant predictor of incident CVD.
- Microvascular damage and remodeling are implicated in the pathway linking aortic stiffness to CVD events.
