Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease

Abstract

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...

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

“…In the present study, we found that abnormal ABI was a strong predictor of MACE independent of biomarkers, whereas baPWV was not an independent predictor for the entire group and also for the patients with normal ABI. baPWV has been reported to be correlated with the direct measure of aortic PWV and carotid‐femoral PWV, which has been shown to be a strong predictor of mortality in ESKD patients . However, because of technical issues such as measurement protocols and reproducibility, the use of baPWV for the accurate risk prediction of ESKD patients is still discussed .…”

“…Accumulating evidence suggests that arterial stiffness and ankle‐brachial index (ABI) are well correlated with atherosclerotic burden and are strong predictors of MACE . Among the various indices of arterial stiffness, brachial‐ankle (ba) pulse wave velocity (PWV) is an established tool for the noninvasive assessment of arterial stiffness in clinical practice . However, measurements of baPWV can be influenced by the presence of PAD and hemodynamic condition after hemodialysis (HD) session .…”

Endothelial Dysfunction, Increased Arterial Stiffness, and Cardiovascular Risk Prediction in Patients With Coronary Artery Disease: FMD‐J (Flow‐Mediated Dilation Japan) Study A

“…These findings suggest that measurement of baPWV in patients with CAD might be clinically useful for identifying individuals who have increased arterial stiffness and who are at high risk for recurrent cardiovascular events. A literature‐based meta‐analysis, in which more than half of the study participants were very high‐risk patients, such as those with end‐stage renal disease or ASCVD, and a recent individual participant data meta‐analysis investigating the association of baPWV with the risk of development of ASCVD in subjects without a history of ASCVD, have demonstrated that elevated baPWV is associated with increased risk of cardiovascular events independent of conventional risk factors 15, 16. Taken together, the findings of our study support the broad applicability of baPWV for risk stratification in general clinical settings regardless of cardiovascular risk.…”

“…Therefore, vascular function tests could be used not only as markers of atherosclerosis but also as prognostic markers of cardiovascular events 11. Recent meta‐analyses have shown that flow‐mediated vasodilation (FMD), an index of endothelial function, and brachial–ankle pulse wave velocity (baPWV), an index of arterial stiffness, are significant predictors of cardiovascular events independent of conventional cardiovascular risk factors 12, 13, 14, 15, 16. However, there have only been a few studies in which the predictive values of FMD, baPWV, and a combination of FMD and baPWV in patients with established CAD were investigated.…”

Peripheral arterial stiffness as a surrogate of central hemodynamics: A new era for cardiovascular risk estimation?

“…Importantly, it was noted that an increase in baPWV of 1 m/s resulted in a 12%, 13%, and 6% risk increase for any CV event, CV mortality and all‐cause mortality . A more recent meta‐analysis of 14 673 patients free of CV disease found that a 1 SD increase in baPWV was independently associated with a 1.19‐fold risk increase of a CV event . On the contrary, changes in aortic PWV with aerobic exercise were associated with the changes in baPWV …”