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Updated: Jun 28, 2025
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the
Magnus Bäck1, Jirar Topouchian2, Carlos Labat3
1Department of Medicine Solna, Karolinska Institutet and Department of Cardiology Karolinska University Hospital, Stockholm, Sweden; Inserm U1116, Nancy, France; Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France.
Insights
The cardio-ankle vascular index (CAVI) predicts cardiovascular events and mortality, especially in older adults. Managing arterial stiffness through treatments may reduce risks and improve outcomes.
Area of Science:
- Cardiovascular Health
- Vascular Biology
- Biomedical Engineering
Background:
- Arterial stiffness, measured by cardio-ankle vascular index (CAVI), is linked to cardiovascular risk factors.
- The predictive capability of CAVI for cardiovascular events requires further investigation.
Purpose of the Study:
- To assess the association between CAVI and cardiovascular morbimortality and all-cause mortality.
- To identify determinants of CAVI progression.
Main Methods:
- Prospective longitudinal study (TRIPLE-A-Stiffness) with over 2000 participants aged ≥40 years.
- Follow-up of 1250 subjects for a median of 3.82 years across 32 European centers.
- Cox regression and ROC analyses to evaluate CAVI's predictive value and identify progression determinants.
Main Results:
- Higher CAVI levels correlated with increased cardiovascular morbimortality and all-cause mortality, particularly in individuals ≥60 years.
- Optimal CAVI thresholds for predicting cardiovascular events were identified (9.25 for ≥60 years, 8.30 for <60 years).
- Age, mean arterial blood pressure, and treatments (anti-diabetic, lipid-lowering) independently predicted CAVI progression.
Conclusions:
- CAVI provides additional prognostic value for cardiovascular outcomes, especially in older adults (≥60 years), beyond traditional risk factors.
- CAVI progression may be a modifiable risk factor, suggesting potential benefits from targeted treatments.
Background:
The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression.
Methods:
TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years.
Findings:
Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI.
Interpretation:
The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments.
Funding:
International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.
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