Prognostic Value of Aortic Pulse Wave Velocity as Index of Arterial Stiffness in the General Population

Abstract

Background-Few population studies addressed the prognostic significance of aortic pulse wave velocity (APWV) above and beyond other cardiovascular risk factors. Methods and Results-We studied a sex-and age-stratified random sample of 1678 Danes aged 40 to 70 years. We used Cox regression to investigate the prognostic value of APWV, office pulse pressure (PP), and 24-hour ambulatory PP while adjusting for mean arterial pressure (MAP) and other covariates. Over a median follow-up of 9.4 years, the incidence of fatal and nonfatal cardiovascular end points, cardiovascular mortality, and fatal and nonfatal coronary heart disease amounted to 154, 62, and 101 cases, respectively. We adjusted for sex, age, body mass index, MAP measured in the office (conventional PP and APWV) or by ambulatory monitoring (24-hour PP), smoking, and alcohol intake. With these adjustments, APWV maintained its prognostic significance in relation to each end point (PϽ0.05), whereas office and 24-hour PP lost their predictive value (PϾ0.19), except for office PP in relation to coronary heart disease (Pϭ0.02). For each 1-SD increment in APWV (3.4 m/s), the risk of an event increased by 16% to 20%. In sensitivity analyses, APWV still predicted all cardiovascular events after standardization to a heart rate of 60 beats per minute, after adjustment for 24-hour MAP instead of office MAP, and/or after additional adjustment for the ratio of total to HDL serum cholesterol and diabetes mellitus at baseline. Conclusions-In

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

“…Published data in the setting of rheumatologic disorders [42][43], including also a recent paper of our group [44], confirm the increased rate of early alterations of elastic properties of the arterial wall in a cohort of patients of the same ethnic origin. The single head-to-head comparison study published so far on expression of atherosclerosis markers in intestinal and rheumatological inflammatory disease, while confirming higher stiffness values in both conditions, points toward a major role of traditional risk factors [45]. Thirdly, we did not investigate the possibility that a genetic predisposition that is not only limited to IBD may be at the base of the risk of cardiovascular disease and specifically to atherosclerosis in our cohort.…”

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

“…In population-based studies, aortic PWV has been known to be a superior independent predictor of cardiovascular outcome even after adjusting the traditional cardiovascular risk factors 5,7 and elevated PP also has been known to be an independent risk factor of cardiovascular disease. [29][30][31] Haemodynamic patterns of age-related changes in BP was shown in the Framingham heart 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.…”

Increased arterial stiffness in obstructive sleep apnea: a systematic review

“…[2][3][4][5][6][7] Arterial stiffness is independently associated with cardiovascular risk [19][20][21][22][23][24]26,[28][29][30][31][75][76][77][78] and may therefore provide a potential explanation for the increased risk of cardiovascular events in OSA patients. Furthermore, a strong correlation between arterial stiffness and the development of atherosclerosis at various sites in the arteries has been noted.…”

“…25,26 It has been used extensively and has the largest amount of epidemiological evidence to support its predictive value for cardiovascular events in the general and diseased populations. 25,[28][29][30][31][32] Measurements of arterial stiffness are believed to reflect global arterial endothelial function. 33 A strong correlation between arterial stiffness and the development of atherosclerosis at various sites in the arterial tree has been noted.…”