Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome

Abstract

Objectives Cardiovascular disease is a major cause of morbidity and mortality in antiphospholipid syndrome (APS). Arterial stiffness (ArS) has emerged as predictor of future cardiovascular events in the general population. We aimed to assess ArS in patients with thrombotic APS versus diabetes mellitus (DM) and healthy controls (HC), and identify predictors of increased ArS in APS. Methods ArS was evaluated by carotid-femoral Pulse Wave Velocity (cfPWV) and Augmentation Index normalized to 75 beats/min (AIx@75), using the SphygmoCor device. Participants also underwent carotid/femoral ultrasound for atherosclerotic plaques detection. We used linear regression to compare ArS measures among groups and assess ArS determinants in APS group. Results We included 110 patients with APS (70.9% female, mean age: 45.4 years), 110 DM patients and 110 HC, all age/sex matched. After adjustment for age, sex, cardiovascular risk factors and plaque presence, APS patients exhibited similar cfPWV (beta=-0.142, 95% CI: -0.514–0.230, p= 0.454) but increased AIx@75 (beta = 4.525, 1.372–7.677, p= 0.005) compared with HC, and lower cfPWV (p< 0.001) but similar AIx@75 (p= 0.193) vs DM patients. In APS group, cfPWV was independently associated with age (beta = 0.056, 0.034–0.078, p< 0.001), mean arterial pressure (MAP) (beta = 0.070, 0.043–0.097, p< 0.001), atherosclerotic femoral plaques (beta = 0.732, 0.053–1.411, p= 0.035) and anti-β2GPI IgM positivity (beta = 0.696, 0.201–1.191, p= 0.006). AIx@75 was associated with age (beta = 0.334, 0.117–0.551, p= 0.003), female sex (beta = 7.447, 2.312–12.581, p= 0.005) and MAP (beta = 0.425, 0.187–0.663, p= 0.001). Conclusion APS patients exhibit elevated AIx@75 versus HC, and similar to DM, indicating enhanced arterial stiffening in APS. Given its prognostic value, ArS evaluation may help to improve cardiovascular risk stratification in APS.