Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease

Abstract

Background-Increased arterial stiffness, determined invasively, has been shown to predict a higher risk of coronary atherosclerosis. However, invasive techniques are of limited value for screening and risk stratification in larger patient groups. Methods and Results-We prospectively enrolled 465 consecutive, symptomatic men undergoing coronary angiography for the assessment of suspected coronary artery disease. Arterial stiffness and wave reflections were quantified noninvasively using applanation tonometry of the radial artery with a validated transfer function to generate the corresponding ascending aortic pressure waveform. Augmented pressure (AP) was defined as the difference between the second and the first systolic peak, and augmentation index (AIx) was AP expressed as a percentage of the pulse pressure.In univariate analysis, a higher AIx was associated with an increased risk for coronary artery disease (OR, 4.06 for the difference between the first and the fourth quartile [1.72 to 9.57; PϽ0.01]). In multivariate analysis, after controlling for age, height, presence of hypertension, HDL cholesterol, and medications, the association with coronary artery disease risk remained significant (OR, 6.91; PϽ0.05). The results were exclusively driven by an increase in risk with premature vessel stiffening in the younger patient group (up to 60 years of age), with an unadjusted OR between AIx quartiles I and IV of 8.25 (PϽ0.01) and a multiple-adjusted OR between these quartiles of 16.81 (PϽ0.05). Conclusions-AIx and AP, noninvasively determined manifestations of arterial stiffening and increased wave reflections, are strong, independent risk markers for premature coronary artery disease.

Changes of central haemodynamic parameters during mental stress and acute bouts of static and dynamic exercise

“…indicative of cardiovascular risk in healthy subjects, 35 and in patients with coronary artery disease 36 and end-stage renal failure. 37 Chronic dynamic training is associated with lower central AS in young men 38 and coronary patients, 39 whereas chronic resistance exercise results in stiffer large arteries in both young men 40 and athletes.…”

C-reactive protein and aortic stiffness and wave reflection in middle-aged and elderly men from the community

“…[6][7][8] There is evidence suggesting that aortic pulse wave velocity (PWV) and wave reflections as assessed by augmentation index (AIx) are associated with an increased risk of cardiovascular disease in young and middle-aged men. 9 PWV and AIx have been found to be elevated in patients with active arteritis. 10 Although some studies in healthy subjects also suggest a relationship between CRP and arterial stiffness measured by PWV or arterial wave reflections measured by AIx 11,12, other studies do not.…”

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

“…[2][3][4] In population-based studies, aortic stiffness is an independent predictor of cardiovascular outcomes after adjustment for traditional cardiovascular risk factors. [4][5][6][7] Arterial stiffness has been shown to predict coronary artery disease [8][9][10][11] and cardiovascular mortality in patients with essential hypertension, 12 end-stage renal disease 13,14 and impaired glucose tolerance and diabetes mellitus (DM). 15 Although there are many measures to quantify stiffness, none of them is a gold standard, but approximations.…”