Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness

Vlachopoulos, Charalambos; Aznaouridis, Konstantinos; Stefanadis, Christodoulos

doi:10.1016/j.jacc.2009.10.061

Cited by 3,456 publications

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“…This association is in line with previous, smaller observations 8, 29. Both reported a higher risk (6.15% versus 1.6% risk per year) of developing CVD per SD increase in aortic PWV.…”

Section: Discussionsupporting

confidence: 92%

“…In aortic PWV studies, MI was often included in the definition of outcome variables such as overall CVD events or CHD, but not investigated as an individual outcome as has been done in this study. These previous studies show an association between aortic PWV and CHD,8, 31, 32, 33 as is shown here as well. Our results are consistent with previous PP studies that reported associations with both incident MI3 and CHD34 after adjustment for traditional CVD risk factors in a hypertensive and community‐based cohort, respectively.…”

Section: Discussionsupporting

confidence: 92%

“…PP is strongly related to adverse outcomes such as coronary heart disease (CHD), and cardiovascular events in hypertensive patients,3 elderly,4 and the general population 5. Several studies have observed carotid‐femoral (aortic) PWV, which is considered the criterion standard of arterial stiffness, to be strongly related to risk factors such as atherosclerosis,6 hypertension,7 metabolic syndrome,7 diabetes mellitus,7 and future cardiovascular disease (CVD) events,8 including CHD, stroke,8 and all‐cause mortality 8. Arterial stiffness index (ASI) is a convenient and noninvasive method to measure arterial stiffness by using infrared light (photoplethysmography) to record the volume waveform of the blood in the finger.…”

Section: Introductionmentioning

confidence: 99%

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Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Said

Eppinga

Lipšic

et al. 2018

JAHA

153

122

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BackgroundVascular aging results in stiffer arteries and may have a role in the development of cardiovascular disease (CVD). Arterial stiffness index (ASI), measured by finger photoplethysmography, and pulse pressure (PP) are 2 independent vascular aging indices. We investigated whether ASI or PP predict new‐onset CVD and mortality in a large community‐based population.Methods and ResultsWe studied 169 613 UK Biobank participants (mean age 56.8 years; 45.8% males) who underwent ASI measurement and blood pressure measurement for PP calculation. Mean±SD ASI was 9.30±3.1 m/s and mean±SD PP was 50.98±13.2 mm Hg. During a median disease follow‐up of 2.8 years (interquartile range 1.4–4.0), 18 190 participants developed CVD, of which 1587 myocardial infarction (MI), 4326 coronary heart disease, 1192 heart failure, and 1319 stroke. During a median mortality follow‐up of 6.1 years (interquartile range 5.8–6.3), 3678 participants died, of which 1180 of CVD. Higher ASI was associated with increased risk of overall CVD (unadjusted hazard ratio 1.27; 95% confidence interval [CI], 1.25–1.28), myocardial infarction (1.38; 95% CI, 1.32–1.44), coronary heart disease (1.31; 95% CI, 1.27–1.34), and heart failure (1.31; 95% CI 1.24–1.37). ASI also predicted mortality (all‐cause, CVD, other). Higher PP was associated with overall CVD (1.57; 95% CI, 1.55–1.59), myocardial infarction (1.48; 95% CI, 1.42–1.54), coronary heart disease (1.47; 95% CI, 1.43–1.50), heart failure (1.47; 95% CI, 1.40–1.55), and CVD mortality (1.47; 95% CI, 1.40–1.55). PP improved risk reclassification of CVD in a non–laboratory‐based Framingham Risk Score by 5.4%, ASI by 2.3%.Conclusions ASI and PP are independent predictors of CVD and mortality outcomes. Although both improved risk prediction for new‐onset disease, PP appears to have a larger clinical value than ASI.

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“…This association is in line with previous, smaller observations 8, 29. Both reported a higher risk (6.15% versus 1.6% risk per year) of developing CVD per SD increase in aortic PWV.…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Said

Eppinga

Lipšic

et al. 2018

JAHA

153

122

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“…This increases systolic blood pressure and arterial pulse pressure (the difference between systolic and diastolic blood pressure), as well as the ‘pulsatility’ of blood flow, which is transmitted to the microvasculature of vulnerable high‐flow organs such as the brain and kidney, causing end‐organ damage and other pathophysiological effects (Lakatta & Levy, 2003; Mitchell et al ., 2010; Mitchell, 2014). Here, we show that 8 weeks of NMN supplementation reverses the age‐associated increase in two functional indices of aortic stiffness: aPWV, the gold standard clinical measure of large elastic artery stiffness (Mitchell et al ., 2010; Vlachopoulos et al ., 2010), and the elastic modulus, an in vitro measure of the intrinsic mechanical properties of arteries (Humphrey, 2002; Akhtar et al ., 2011; Fleenor et al ., 2012b) (Fig. 3A,B).…”

Section: Discussionmentioning

confidence: 99%

Nicotinamide mononucleotide supplementation reverses vascular dysfunction and oxidative stress with aging in mice

et al. 2016

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SummaryWe tested the hypothesis that supplementation of nicotinamide mononucleotide (NMN), a key NAD + intermediate, increases arterial SIRT1 activity and reverses age‐associated arterial dysfunction and oxidative stress. Old control mice (OC) had impaired carotid artery endothelium‐dependent dilation (EDD) (60 ± 5% vs. 84 ± 2%), a measure of endothelial function, and nitric oxide (NO)‐mediated EDD (37 ± 4% vs. 66 ± 6%), compared with young mice (YC). This age‐associated impairment in EDD was restored in OC by the superoxide (O2−) scavenger TEMPOL (82 ± 7%). OC also had increased aortic pulse wave velocity (aPWV, 464 ± 31 cm s−1 vs. 337 ± 3 cm s−1) and elastic modulus (EM, 6407 ± 876 kPa vs. 3119 ± 471 kPa), measures of large elastic artery stiffness, compared with YC. OC had greater aortic O2− production (2.0 ± 0.1 vs. 1.0 ± 0.1 AU), nitrotyrosine abundance (a marker of oxidative stress), and collagen‐I, and reduced elastin and vascular SIRT1 activity, measured by the acetylation status of the p65 subunit of NFκB, compared with YC. Supplementation with NMN in old mice restored EDD (86 ± 2%) and NO‐mediated EDD (61 ± 5%), reduced aPWV (359 ± 14 cm s−1) and EM (3694 ± 315 kPa), normalized O2− production (0.9 ± 0.1 AU), decreased nitrotyrosine, reversed collagen‐I, increased elastin, and restored vascular SIRT1 activity. Acute NMN incubation in isolated aortas increased NAD + threefold and manganese superoxide dismutase (MnSOD) by 50%. NMN supplementation may represent a novel therapy to restore SIRT1 activity and reverse age‐related arterial dysfunction by decreasing oxidative stress.

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“…Elevated aortic stiffness is an independent predictor of cardiovascular events and all‐cause mortality in healthy1 and diseased2, 3 populations. The mechanisms responsible for increased central artery stiffness, measured most commonly as carotid‐femoral pulse wave velocity (cf‐PWV),4 are not fully understood and complex.…”

Section: Introductionmentioning

confidence: 99%

Evidence for Pressure‐Independent Sympathetic Modulation of Central Pulse Wave Velocity

Nardone

Incognito

Millar

2018

JAHA

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BackgroundWhether the sympathetic nervous system can directly alter central aortic stiffness remains controversial, mainly because of the difficulty in experimentally augmenting peripheral vasoconstrictor activity without changing blood pressure.Methods and ResultsTo address this limitation, we utilized low‐level cardiopulmonary baroreflex loading and unloading shown previously to alter sympathetic outflow without evoking parallel hemodynamic modulation. Blood pressure and carotid‐femoral aortic pulse wave velocity (cf‐PWV) were measured in 32 healthy participants (24±2 years; women: n=15) before and during 12‐minute applications of low‐level lower body negative pressure; −7 mm Hg) and lower body positive pressure; +7 mm Hg), applied in a random order. Fibular nerve microneurography was used to collect muscle sympathetic nerve activity (MSNA) in a subset (n=8) to confirm peripheral sympathetic responses. During lower body negative pressure, heart rate, blood pressure, stroke volume, cardiac output, and total peripheral resistance were not statistically different (all P>0.05); MSNA burst frequency (+15%; P=0.007), total MSNA (+44%; P=0.006), and cf‐PWV (∆+0.3±0.2 m/s; P<0.001) increased. In total, 28 (88%) of participants observed an increase in cf‐PWV greater than the baseline typical error of measurement. During lower body positive pressure, heart rate, stroke volume, cardiac output, and total peripheral resistance were not statistically different (all P>0.05), though blood pressure increased (P<0.05) and pulse pressure decreased (P=0.01); MSNA burst frequency (−4%; P=0.37), total MSNA (−7%; P=0.89), and cf‐PWV (∆0.0±0.2 m/s; P=0.68) were not statistically different.ConclusionsThese findings provide evidence that acute elevations in peripheral sympathetic activity can increase central aortic PWV in young participants independent of a change in distending or pulsatile blood pressure or heart rate.

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Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness

Abstract: Aortic stiffness expressed as aortic PWV is a strong predictor of future CV events and all-cause mortality. The predictive ability of arterial stiffness is higher in subjects with a higher baseline CV risk.

Cited by 3,456 publications

References 47 publications

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Nicotinamide mononucleotide supplementation reverses vascular dysfunction and oxidative stress with aging in mice

Evidence for Pressure‐Independent Sympathetic Modulation of Central Pulse Wave Velocity

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