Relationship Between Arterial Stiffness and Subclinical Aortic Atherosclerosis

Herrington, David M.; Brown, W. Virgil; Mosca, Lori; Davis, Warren W.; Eggleston, Barry; Hundley, W. Gregory; Raines, Jeffrey K.

doi:10.1161/01.cir.0000136582.33493.cc

Cited by 64 publications

(34 citation statements)

References 43 publications

(23 reference statements)

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“…Mounting evidence show that sleep apnoea enhances endothelial dysfunction and arterial stiffness, the key factors in the development of atherosclerosis [10][11][12][24][25][26]. The prevalence of sleep apnoea in our PAD patients is higher than in any other previously reported population with manifestations of atherosclerosis, with earlier studies showing 30-58% prevalence of OSA in coronary artery disease and 30-80% prevalence in arterial hypertension [3,4,8].…”

Section: Discussionsupporting

confidence: 40%

Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease

et al. 2012

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Patients needing surgery for peripheral arterial disease (PAD) represent a severe form of atherosclerosis with an overall 5-yr mortality of 30% after revascularisation. The aetiology for poor post-operative clinical outcome in these high-risk patients is not fully established. Obstructive sleep apnoea (OSA) is associated with atherosclerosis and is an independent risk factor for fatal and nonfatal cardiac events. Here, we determine the prevalence of undiagnosed OSA in a homogenous group of PAD patients undergoing subinguinal surgical revascularisation.82 consecutive patients (mean age 67¡9 yrs, 52 males) with sinus rhythm and without congestive heart failure or previously diagnosed OSA were enrolled for pre-operative polysomnography and echocardiography.OSA was present in 70 (85%) patients (95% CI 75-93%), of whom 24 (34%) had severe OSA. OSA was mostly asymptomatic, and age-and sex-adjusted multivariate regression analysis showed no relation to obesity, metabolic syndrome or any manifestation of atherosclerosis, other than PAD. Left ventricular ejection fraction (p50.002) and high-density lipoprotein/total cholesterol ratio (p50.03) were the only independent predictors for the severity of OSA.Thus, prevalence of OSA is unexpectedly high in patients with PAD and is not related to classical risk factors of sleep apnoea.

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Section: Discussionsupporting

confidence: 40%

Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease

et al. 2012

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“…Herrington et al 22 demonstrated that a measure of lower extremity arterial stiffness was associated with aortic atherosclerotic burden quantified by MRI. In a study of Ͼ3000 elderly subjects aged 60 to 101 years, aPWV was related to the extent of atherosclerotic plaque in the aorta and the carotid artery.…”

Section: Discussionmentioning

confidence: 99%

Aortic Pulse Wave Velocity Is Associated With the Presence and Quantity of Coronary Artery Calcium

et al. 2006

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We investigated the relationship of aortic pulse wave velocity (aPWV), a measure of central arterial stiffness, with the presence and quantity of coronary artery calcium (CAC) in a community-based sample of adults without prior history of heart attack or stroke (n=401, mean age 59.8 years, 53% men). ECG-gated waveforms of the right carotid and right femoral artery were obtained by applanation tonometry, and aPWV was calculated using established methods. CAC was measured noninvasively by electron beam computed tomography, and CAC score was calculated. aPWV was significantly correlated with log(CAC +1; r=0.41; P<0.0001) and pulse pressure (r=0.47; P<0.0001). Multivariable logistic and linear regression models were used to identify independent predictors of the presence and quantity of CAC, respectively. In multivariable logistic regression analyses, aPWV was associated with the presence of CAC (P=0.011) after adjustment for age, male sex, total cholesterol, high-density lipoprotein cholesterol, diabetes, history of smoking, systolic blood pressure, body mass index, and use of hypertension and statin medications. In multivariable linear regression analyses, aPWV was significantly associated with log(CAC +1) after adjustment for the covariates enumerated above (P<0.0001). aPWV remained significantly associated with both the presence and quantity of CAC even after the additional adjustment for diastolic blood pressure. We conclude that aPWV is related to subclinical coronary atherosclerosis independent of conventional risk factors (including indices of blood pressure) and may be a biomarker of cardiovascular risk in asymptomatic individuals.

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“…[35][36][37][38][39] The progressive deterioration of conduit vessel function may be the common pathway of multiple risk factors that lead to similar clinical end points (ie, left ventricular hypertrophy, myocardial infarction, congestive heart failure, atherosclerosis, and death). 40,41 Patients with wide PP may be predisposed to acute postoperative renal dysfunction because of occult abnormal vascular *Among the 2381 patients in the derivation cohort, 47 patients were excluded with missing values for at least 1 of the predictors in the model, including the covariates. The Hosmer-Lemeshow goodness-of-fit 2 test statistic was 5.5 (Pϭ0.599).…”

Section: Pp Hypertensionmentioning

confidence: 99%

“…44,45 In addition, pulsatile stress in central arteries may contribute to plaque rupture by a mechanical fatiguing effect. 40 PP, necessarily increased in patients with isolated systolic hypertension, can be singled out as a greater predictor of risk for stroke, heart failure, coronary artery disease, and renal failure than diastolic blood pressure. 3,46,47 This study showed a significant and progressive increase in the risk of renal composite above a PP threshold of 40 mm Hg.…”

Section: Pp Hypertensionmentioning

confidence: 99%

Risk Index for Perioperative Renal Dysfunction/Failure

et al. 2007

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Background— An acute renal event after coronary bypass graft surgery is associated with high mortality and substantial additive cost. Methods and Results— This prospective and descriptive study of 4801 patients having coronary bypass graft surgery with cardiopulmonary bypass from November 1996 to June 2000 at 70 centers in 16 countries established associations between predictor variables and postoperative renal composite (renal dysfunction and/or renal failure) from a cohort of 2381 patients and developed a risk index assessed in a validation cohort of 2420 patients. Postoperative renal composite occurred in 231 patients (4.8%). Independent and significant risk factors were age >75 years (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.23 to 3.37; P =0.006), preoperative congestive heart failure (OR, 2.38; CI, 1.55 to 3.64; P <0.001), prior myocardial infarction (OR, 1.75; CI, 1.08 to 2.83; P =0.023), preexisting renal disease (OR, 3.71; CI, 2.41 to 5.70; P <0.001), intraoperative multiple inotrope use (OR, 2.75; CI, 1.75 to 4.31; P <0.001), intraoperative intra-aortic balloon pump insertion (OR, 4.41; CI, 2.21 to 8.80; P <0.001), cardiopulmonary bypass >2 hours (OR, 1.78; CI, 1.15 to 2.74; P =0.01), and preoperative pulse pressure such that for every additional 20–mm Hg increment in pulse pressure >40 mm Hg, there was an OR of 1.49 (CI, 1.17 to 1.89; P =0.001). Patients with pulse pressure hypertension >80 mm Hg were 3 times more likely to die a renal-related death compared with those without (3.7% versus 1.1%). Conclusions— Beside established risk factors, pulse pressure is independently and significantly associated with increased renal composite.

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Relationship Between Arterial Stiffness and Subclinical Aortic Atherosclerosis

Cited by 64 publications

References 43 publications

Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease

Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease

Aortic Pulse Wave Velocity Is Associated With the Presence and Quantity of Coronary Artery Calcium

Risk Index for Perioperative Renal Dysfunction/Failure

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