The present study was conducted to evaluate the validity and reproducibility of noninvasive brachial-ankle pulse wave velocity (baPWV) measurements and to examine the alteration of baPWV in patients with coronary artery disease (CAD). Simultaneous recordings of baPWV by a simple, noninvasive method and aortic pulse wave velosity (PWV) using a catheter tip with pressure manometer were performed in 41 patients with CAD, vasospastic angina, or cardiomyopathy. In 32 subjects (15 controls and 17 patients with CAD), baPWV was recorded independently by two observers in a random manner. In 55 subjects (14 controls and 41 patients with CAD), baPWV was recorded twice by a single observer on different days. baPWV were compared among 172 patients with CAD (aged 62 +/- 8 years); 655 age-matched patients without CAD but with hypertension, diabetes mellitus, or dyslipidemia; and 595 age-matched healthy subjects without these risk factors. baPWV correlated well with aortic PWV (r=0.87, p<0.01). Pearson's correlation coefficients of interobserver and intraobserver reproducibility were r=0.98 and r=0.87, respectively. The corresponding coefficients of variation were 8.4% and 10.0%. baPWV were significantly higher in CAD patients than in non-CAD patients with risk factors, for both genders (p<0.01). In addition, baPWV were higher in non-CAD patients with risk factors than in healthy subjects without risk factors. Thus, the validity and reproducibility of baPWV measurements are considerably high, and this method seems to be an acceptable marker reflecting vascular damages. baPWV measured by this simple, noninvasive method is suitable for screening vascular damages in a large population.

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The measurement of brachial-ankle pulse wave velocity (baPWV) is simple and applicable for general population studies. The present study was conducted to evaluate the applicability of baPWV for screening cardio-

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Abstract-Arterial stiffness is recognized as a marker of arterial damage and an indicator of cardiovascular risk. This observational study was conducted to examine the synergistic effect of raised blood pressure (RBP; Ն130/85 mm Hg) and raised plasma glucose (RPG; Ն110 mg/dL) even at levels below those conventionally used to define hypertension and diabetes on the rate of increase of the pulse wave velocity (PWV) over a 3-year period in 2080 Japanese men (age 42Ϯ9 years). First, the subjects were classified into 4 groups based on the presence at the first examination of RBP, RPG, both abnormalities, or neither abnormality. The estimated annual rate of increase of the PWV was higher in subjects with both the abnormalities than in those with either abnormality alone or neither of the 2 abnormalities. Second, the subjects were also classified based on the evolutional status of these abnormalities during the study period; persistence of both of the abnormalities synergistically accelerated the rate of increase of the PWV (68. A rterial stiffness is recognized as a marker of arteriosclerotic arterial damage 1,2 and has been shown to be a predictor of future cardiovascular events. 3,4 Hypertension and diabetes mellitus are major atherogenic factors, they frequently coexist, and when they coexist, they additively increase the risk of life-threatening cardiovascular events. 5 Some cross-sectional studies have demonstrated an increase of arterial stiffness in subjects with either hypertension or glucose intolerance, 6,7 and increased arterial stiffness is associated with an increased risk of cardiovascular events, both in subjects with hypertension and in those with diabetes mellitus or glucose intolerance. 3,4 Recent studies have demonstrated that values even below those defining the presence of hypertension and diabetes mellitus [raised blood pressure (RBP): Ն130/85 mm Hg and raised plasma glucose (RPG): Ն110 mg/dL] are also predictors of future cardiovascular events. 8,9 However, no studies until now have evaluated the effects of RBP, RPG, and the coexistence of both disorders on the rate of progression of arterial stiffening.In this observational cohort study of Japanese men, we succeeded in recording the brachial-ankle pulse wave velocity (PWV) twice in 2 examinations conducted at an interval of 3 years. Then, we examined whether the presence of RBP alone, RPG alone, and the coexistence of both at the first examination in this study predicted an acceleration of the rate of increase of the brachial-ankle PWV and whether the persistence of either or both disorders during the study period additionally affected the rate of increase of the brachial-ankle PWV. Methods Design and SubjectsThis observational study was performed on the Japanese male employees of a single large construction company. The routine annual health checkup included evaluation of the atherosclerotic risk factors (body mass index [BMI], serum levels of triglycerides [TG], high-density lipoprotein cholesterol [HDL], total cholesterol [TC], fasting plasm...