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Aortic-Brachial Arterial Stiffness Gradient and Cardiovascular Risk in the Community: The Framingham Heart Study
Teemu J Niiranen1, Bindu Kalesan2, Martin G Larson2
1From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.). teemu.niiranen@thl.fi.
Insights
The aortic-brachial arterial stiffness gradient (PWV ratio) did not predict cardiovascular disease (CVD) risk better than carotid-femoral pulse wave velocity (CFPWV) alone in the general community. CFPWV remains the standard for assessing vascular stiffness.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Epidemiology
Background:
- Arterial stiffness, measured by pulse wave velocity (PWV), is a marker of cardiovascular risk.
- The aortic-brachial arterial stiffness gradient (PWV ratio) showed prognostic value for mortality in dialysis patients.
- The prognostic significance of PWV ratio for cardiovascular disease (CVD) in the general community is not well-established.
Purpose of the Study:
- To assess the correlates of the PWV ratio in a community-based sample.
- To evaluate the prognostic value of the PWV ratio for incident CVD.
- To compare the predictive performance of PWV ratio versus carotid-femoral pulse wave velocity (CFPWV) for CVD risk.
Main Methods:
- 2114 Framingham Heart Study participants free of overt CVD were analyzed.
- Correlates of PWV ratio were assessed using multivariable linear regression.
- Prognostic value for CVD was evaluated using Cox regression models over a median follow-up of 12.6 years.
Main Results:
- PWV ratio decreased with increasing age.
- Older age, male sex, higher BMI, diabetes, lower HDL, higher MAP, and higher heart rate were associated with lower PWV ratio.
- Both CFPWV and PWV ratio were similarly associated with CVD risk; PWV ratio did not provide incremental value over CFPWV.
Conclusions:
- In a community-based sample, the PWV ratio did not offer incremental prognostic value for CVD beyond CFPWV.
- The prognostic significance of PWV ratio may depend on baseline CVD risk, as seen in dialysis patients versus the community.
- Carotid-femoral pulse wave velocity (CFPWV) remains the criterion standard for assessing vascular stiffness in the general population.
Abstract:
A recent study reported that the aortic-brachial arterial stiffness gradient, defined as carotid-radial/carotid-femoral pulse wave velocity (PWV ratio), predicts all-cause mortality better than carotid-femoral pulse wave velocity (CFPWV) alone in dialysis patients. However, the prognostic significance of PWV ratio for cardiovascular disease (CVD) in the community remains unclear. Accordingly, we assessed the correlates and prognostic value of the PWV ratio in 2114 Framingham Heart Study participants (60±10 years; 56% women) free of overt CVD. Mean PWV ratio decreased from 1.36±0.19 in participants aged <40 years to 0.73±0.21 in those aged ≥80 years. In multivariable linear regression, older age, male sex, higher body mass index, diabetes mellitus, lower high-density lipoprotein cholesterol, higher mean arterial pressure, and higher heart rate were associated with lower PWV ratio (P<0.001 for all). During a median follow-up of 12.6 years, 248 first CVD events occurred. In Cox regression models adjusted for standard CVD risk factors, 1-SD changes in CFPWV (hazard ratio, 1.33; 95% confidence interval, 1.10-1.61) and PWV ratio (hazard ratio, 1.32; 95% confidence interval, 1.09-1.59) were associated with similar CVD risks. Models that included conventional CVD risk factors plus CFPWV or PWV ratio gave the same C statistics (C=0.783). Although PWV ratio has been reported to provide incremental predictive value over CFPWV in dialysis patients, we could not replicate these findings in our community-based sample. Our findings suggest that the prognostic significance of PWV ratio may vary based on baseline CVD risk, and CFPWV should remain the criterion standard for assessing vascular stiffness in the community.