Collectively, these results indicate that cfPWV and baPWV are indices of arterial stiffness that exhibit similar extent of associations with cardiovascular disease risk factors and clinical events.
A rterial stiffness is well-recognized as an important predictor of development of cardiovascular disease (CVD), 1,2 and meta-analyses of prospective cohort studies have revealed that increase in the carotid-femoral pulse wave velocity (cfPWV) is associated with an increase in the risk of development of CVD. 3,4 However, the cfPWV is measured by tonometry or Doppler, which requires specialized training and exposure of the inguinal region.
5,6Abstract-An individual participant data meta-analysis was conducted in the data of 14 673 Japanese participants without a history of cardiovascular disease (CVD) to examine the association of the brachial-ankle pulse wave velocity (baPWV) with the risk of development of CVD. During the average 6.4-year follow-up period, 687 participants died and 735 developed cardiovascular events. A higher baPWV was significantly associated with a higher risk of CVD, even after adjustments for conventional risk factors (P for trend <0.001). When the baPWV values were classified into quintiles, the multivariableadjusted hazard ratio for CVD increased significantly as the baPWV quintile increased. The hazard ratio in the subjects with baPWV values in quintile 5 versus that in those with the values in quintile 1 was 3.50 (2.14-5.74; P<0.001). Correspondence to Hirofumi Tomiyama, Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Tokyo, Japan. E-mail tomiyama@ tokyo-med.ac.jp In the early 2000s, a simple device for measurement of the brachial-ankle pulse wave velocity (baPWV) was launched for clinical use.
Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease An Individual Participant Data Meta-Analysis7 baPWV is automatically measured using a separate cuff for each of the 4 limbs by an oscillometric method. baPWV may be more easily applied in clinical practice than the cfPWV because of the simplicity and ease of its measurement.7,8 baPWV has been reported to be closely correlated with the directly measured aortic PWV and cfPWV. 9 A recent meta-analysis using summary data from the literature has demonstrated that higher levels of baPWV were associated with an increased risk of development of CVD.10 However, most of the studies included in the meta-analyses were conducted in patients with a high CVD risk (patients with CVD or end-stage renal disease), and thus, the usefulness of baPWV to assess the risk of development of CVD in subjects with a low to intermediate CVD risk as assessed using the Framingham risk score (FRS) had not been clearly elucidated. Furthermore, these studies did not determine the predictive ability for CVD over that of the traditional risk factors. Therefore, we conducted a meta-analysis using individual participant data (IPD) from prospective cohort studies to clarify whether baPWV could be used as an independent marker to predict the risk of development of CVD in subjects without preexisting CVD.
Methods
Study PopulationJ-BAVEL (Japan Brachial-Ankle Pulse Wave Velocity Individual Participant Data Meta-Analysis of Pros...
Although the brachial ankle PWV does not agree with the carotid femoral PWV, this parameter may yet become a new, useful measure for arterial stiffness. Further longitudinal studies are necessary to confirm the clinical significance of the brachial ankle PWV.
Arterial stiffness is a vascular measure that has been reported to predict cardiovascular events. It is important to measure arterial stiffness in order to determine current vascular status and treatment strategy. Brachial-ankle pulse wave velocity (baPWV) is a unique measure of systemic arterial stiffness that is measured by brachial and tibial arterial wave analyses. Measurement of baPWV is easy and is reproducible. For more than a decade, this measure has been used broadly in East Asian countries. Meta-analysis of cohort studies conducted in the general population with hypertension, diabetes, or end-stage renal disease, and other high-risk individuals have shown that a 1 m/s increase in baPWV is associated with 12% increase in the risk of cardiovascular events. Thus, the Japanese Circulation Society has proposed that a baPWV of 1800 cm/s is a threshold for high-risk category. For baPWV to be clinically applicable, we must confirm that circulation of the lower limbs are normal by examining brachial ankle blood pressure index. In cases of peripheral arterial disease, the reliability of baPWV measurement is attenuated. To further confirm the clinical usefulness of this measure, we need to examine the hypothesis that baPWV-guided therapy could improve prognosis in high-risk patients.
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