Age-dependent association of pulse wave velocity with coronary artery disease and myocardial aging in high-risk patients

Liu

Journal of Hypertension

et al. 2023

Background: The brachial-ankle pulse-wave velocity (baPWV) is regarded as the gold standard in the evaluation of arterial stiffness. Its prognostic significance for major adverse cardiovascular events (MACE) has been demonstrated. However, the factors influencing the association between baPWV and MACE risk have not been determined. In this study, we investigated the association of baPWV and MACE risk and whether it is affected by the risk factors for different cardiovascular diseases (CVDs).Methods: This was a prospective cohort study that initially enrolled 6850 participants from 12 communities in Beijing. The participants were divided into three subgroups according to their baPWV values. The primary outcome was the first occurrence of MACE, defined as hospitalization from cardiovascular diseases, first occurrence of a nonfatal myocardial infarction, or nonfatal stroke. Cox proportional hazards regression and restricted cubic spline analyses were used to examine the association between baPWV and MACE. The effect of CVD risk factors on the relationship between baPWV and MACE was explored in subgroup analyses. Results:The final study population consisted of 5719 participants. During a median follow-up of 34.73 months, MACE occurred in 169 participants. The restricted cubic spline analysis indicated a positive linear relationship between baPWV and MACE risk. After adjustment for cardiovascular risk factors, the hazard ratio (HR) for MACE risk per SD increase in baPWV was 1.272 [95% confidence interval (CI): 1.149-1.407, P < 0.001], and the HR for MACE in the high-baPWV vs. the low-baPWV group was 1.965 (95% CI: 1.296-2.979, P ¼ 0.001). Adding baPWV to the conventional cardiovascular risk factors significantly improved the model's prediction performance and the net reclassification (NRI) [NRI: 0.379 (95% CI: 0.072-0.710), P ¼ 0.025] in MACE discrimination. However, in the subgroup analysis, two CVD risk factors, stable coronary heart disease and hypertension, showed significant interaction effects (P interaction both < 0.05). This result indicated that the effect of CVD risk factors must be taken into account when assessing the relationship between baPWV and MACE.Conclusion: baPWV is a potential marker to improve the identification of MACE risk in the general population. A positive linear correlation was firstly determined between baPWV and MACE risk, but it may not be valid in participants with stable coronary heart disease and hypertension.

Section: Discussionmentioning

confidence: 96%

The association between brachial-ankle pulse-wave velocity and adverse cardiovascular events in 5719 community participants a prospective cohort study

Liu

Journal of Hypertension

et al. 2023

Journal of Hypertension

“…Arterial stiffness (carotid-femoral pulse wave velocity, cfPWV) and PWRs were measured using validated devices as previously described (Complior, Artech-Medical, Paris, France; Sphygmocor, AtCor, Sydney, Australia) [4,24]. In brief, blood pressure (BP) measurements were obtained from each patient 1 min apart using oscillometry with an automated BP device (Omron; Omron HealthCare Inc, Lake Forest, Illinois, USA) and then cfPWV was measured in the supine position.…”

Section: Vascular and Blood Pressure Measurementsmentioning

confidence: 99%

Prediction of long-term outcomes by arterial stiffness and pressure wave reflections in patients with acute stroke: the Athens Stroke Registry

Samara¹,

Vemmou

Kyrkou

et al. 2022

Self Cite

Background and purpose: Stroke patients' management might be improved by addressing the role of aortic stiffness (carotid-femoral pulse wave velocity: cfPWV) and pressure wave reflections (PWRs, augmentation index: AIx) in their pathogenesis and outcome. We tested the hypothesis that cfPWV and AIx, separately and combined, predict long-term outcomes [all-cause mortality, incidence of cardiovascular events, stroke recurrence and disability defined by modified Ranking Scale (mRS) !3] in patients with acute stroke, using data from the 'Athens Stroke Registry'.Methods: Data from 552 patients (70% men, age: 66.1 AE 10.4 years, 13.4% deaths from any cause, 21.2% cardiovascular events, 14.1% stroke recurrences and 20.1% poor mRS, mean follow-up 68.4 AE 41.4 months) were analyzed. Results:The main findings were that: high aortic stiffness (cfPWV > 13 m/s) alone is an independent predictor of allcause mortality and cardiovascular (CV) events, but not of stroke recurrence and poor functional outcome; evaluated separately from aortic stiffness, neither low nor high PWRs have any prognostic value; even after multiple adjustments, patients with both high aortic stiffness (cfPWV > 13 m/s) and low PWRs (Aix < 22%) have almost two-fold higher hazard ratio, not only for all-cause mortality and CV events but also for stroke recurrence and poor functional outcome. Conclusions:The present study provides evidence about the role of aortic stiffness, PWRs and their combined incremental value in the long-term survival, morbidity, and functional disability after acute stroke.

Journal of Cardiovascular Medicine

“…In patients with a high risk for cardiovascular disease, an age-dependent association between arteriosclerosis with coronary artery disease (CAD) and diastolic dysfunction has been shown. 3 Arteriosclerosis is the basis of cardiocerebrovascular diseases, and its presence is not only predictive of the occurrence and development of cardiocerebrovascular disease but also useful in evaluating their severity and predicting prognosis. 4,5 Therefore, the identification of risk factors related to early arteriosclerosis is important for the development of strategies to not only treat but also prevent cardiocerebrovascular diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Arteriosclerosis is a sign of vascular aging. In patients with a high risk for cardiovascular disease, an age-dependent association between arteriosclerosis with coronary artery disease (CAD) and diastolic dysfunction has been shown 3 . Arteriosclerosis is the basis of cardiocerebrovascular diseases, and its presence is not only predictive of the occurrence and development of cardiocerebrovascular disease but also useful in evaluating their severity and predicting prognosis 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Positive association between alkaline phosphatase and arteriosclerosis: a cross-sectional study

Zhou,

Chen,

Bai

et al. 2023

Aims Serum alkaline phosphatase (ALP) is known to be associated with cardiovascular events and cerebral arteriosclerosis. However, the link between ALP and early arteriosclerosis remains unclear. This study investigated the relationship between ALP and early arteriosclerosis assessed by brachial–ankle pulse wave velocity (Ba-PWV). Methods This retrospective analysis included 5011 participants who underwent health examinations, including ALP and Ba-PWV measurement, at the Second Hospital of Hebei Medical University from 2012 to 2017. Regression analysis, smoothing function analysis in the generalized additive model (GAM), threshold effect analysis, and subgroup analyses were performed. Results Multivariate regression analysis identified a significantly positive association between serum ALP and arteriosclerosis [odds ratio (OR) = 1.008, 95% confidence interval (CI) 1.004–1.011, P < 0.001]. Smoothing function analysis indicated a two-stage association between ALP and arteriosclerosis. Furthermore, threshold effect analysis determined an inflection point at 135 U/l, below which the relationship was linearly positive and above which the risk of arteriosclerosis did not increase prominently with increasing ALP (OR = 1.009, 95% CI: 1.005–1.013, P < 0.001; OR = 0.976, 95% CI: 0.952–1.002, P = 0.068). However, ALP was not associated with arteriosclerosis only in participants with diabetes (OR = 0.996, 95% CI: 0.979–1.014, P = 0.690). A positive association between Ba-PWV and arteriosclerosis was observed for both the arteriosclerosis and nonarteriosclerosis groups (β = 9.10, 95% CI: 4.67–13.54, P < 0.001; β = 8.02, 95% CI: 5.67–10.37, P < 0.001). Conclusion In this study, the serum ALP level was positively associated with early arteriosclerosis, with a saturation effect beyond ALP = 135 U/l. However, the positive association between ALP and arteriosclerosis was unclear in adults with diabetes.