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Aim: Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease, although it has yet to be established whether CKD is an independent risk factor for arterial stiffness in community residents. The purpose of this study was to determine the correlation between the cardio-ankle vascular index (CAVI) and estimated glomerular filtration rate (eGFR) in the general population. Methods: We studied 881 consecutively enrolled subjects undergoing health checkups. CAVI was calculated automatically from the pulse volume record, blood pressure and the vascular length from the heart to the ankle. CKD was evaluated by the eGFR. . It has been reported that microalbuminuria is a strong determinant of ischemic heart disease and death, independent of age, sex, hypertension, diabetes mellitus, renal function and the plasma lipid profile 6) . As a consequence, mild renal dysfunction has recently attracted increased attention, with a reduction in the estimated glomerular filtration rate (eGFR) being regarded as a useful index of kidney damage and also an effective strategy for detecting patients with CKD 7). Recently, an atherosclerotic index, the cardioankle vascular index (CAVI), has been developed that involves measuring pulse wave velocity (PWV) and blood pressure (BP). CAVI is adjusted for BP based on the stiffness parameter and is expressed as arterial stiffness independent of BP 8, 9) . We have reported previously that CAVI showed a weaker correlation IntroductionChronic kidney disease (CKD) is a worldwide public health problem 1) . Cardiovascular disease (CVD) is associated frequently with CKD, a relationship that is important given that individuals with CKD are more likely to die of CVD than to develop kidney failure 2) . Numerous studies have established that CKD is a major risk factor for CVD, not only in populations at high risk for CVD, but also in the general

Background:The brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are used to evaluate arterial distensibility. The purpose of this study was to elucidate the acute and chronic effects of smoking on arterial stiffness as measured by baPWV and CAVI. Methods and Results:Ten male smokers were studied to evaluate the acute effect of smoking on arterial stiffness. To elucidate the chronic effect of smoking on arterial stiffness, 160 male active smokers were analyzed. CAVI and baPWV were calculated by measuring the pulse volume record, blood pressure (BP), and vascular length from heart to ankle. CAVI and baPWV were measured using a VaSera VS-1000. In the acute study, baPWV and CAVI increased immediately after smoking 1 cigarette. In the chronic study, baPWV and CAVI significantly correlated with mean BP (MBP) and the Brinkman index. In multiple regression analysis, baPWV independently correlated with MBP, and CAVI independently correlated with the Brinkman index, but not with MBP. Receiver-operating characteristics (ROC) curves of baPWV and CAVI to predict Brinkman index ≥500 demonstrated that the area under the ROC curve of CAVI was higher than that of baPWV. Conclusions:Smoking causes a significant increase in arterial stiffness as measured by baPWV and CAVI. CAVI correlated with the Brinkman index, which suggests that CAVI is a useful index of the degree of arterial stiffness caused by smoking. (Circ J 2011; 75: 698 - 702)

The purpose of this study was to evaluate the validity of brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) as measures of arterial stiffness in hemodialysis (HD) patients. We studied 160 consecutively enrolled HD patients (mean age: 59±13 years; 91 male patients). We measured baPWV and CAVI using a VaSera VS-1000, maximum intima-media thickness (max IMT) of the carotid artery by ultrasonography and blood renal and lipid parameters. As a control, baPWV and CAVI were also measured in age-and gender-matched healthy volunteers. Both baPWV and CAVI were significantly higher in HD patients than in controls (baPWV: 1698 ± 355 vs. 1454 ± 263 cm s À1 , Po0.0001; CAVI: 9.3 ± 1.4 vs. 8.9 ± 1.2, Po0.01). BaPWV correlated positively with age (r ¼0.549, Po0.0001), systolic blood pressure (SBP) (r¼0.510, Po0.0001), diastolic blood pressure (r ¼0.203, Po0.0001), pulse pressure (PP) (r ¼0.499, Po0.0001), Kt V À1 (r ¼0.221, Po0.01), Brinkman index (r ¼0.186, Po0.05) and max IMT (r ¼0.285, Po0.001). CAVI also correlated positively with age (r ¼0.562, Po0.0001), SBP (r ¼0.395, Po0.0001), PP (r ¼0.490, Po0.0001), Kt V À1 (r ¼0.216, Po0.01), Brinkman index (r ¼0.238, Po0.01) and max IMT (r ¼0.280, Po0.001). Multiple regression analysis demonstrated baPWV and CAVI correlated independently with age and SBP. Receiver operating characteristics (ROC) curve analysis demonstrated that baPWV and CAVI had similar power to predict increases in max IMT. We also measured baPWV and CAVI immediately before and after HD, and showed CAVI was influenced by changes in water volume. Both baPWV and CAVI are therefore useful indices of arterial stiffness in HD patients.

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