Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study.
Arterial stiffness may predict coronary heart disease beyond classic risk factors. In a longitudinal study, we assessed the predictive value of arterial stiffness on coronary heart disease in patients with essential hypertension and without known clinical cardiovascular disease. Aortic stiffness was determined from carotid-femoral pulse wave velocity at baseline in 1045 hypertensives. The risk assessment of coronary heart disease was made by calculating the Framingham risk score according to the categories of gender, age, blood pressure, cholesterol, diabetes, and smoking. Mean age at entry was 51 years, and mean follow-up was 5.7 years. Coronary events (fatal and nonfatal myocardial infarction, coronary revascularization, and angina pectoris) and all cardiovascular events served as outcome variables in Cox proportional-hazard regression models. Fifty-three coronary events and 97 total cardiovascular events occurred. In univariate analysis, the relative risk of follow-up coronary event or any cardiovascular event increased with increasing level of pulse wave velocity; for 1 SD, ie, 3.5 m/s, relatives risks were 1.42 (95% confidence interval [CI], 1.10 to 1.82; P<0.01) and 1.41 (95% CI, 1.17 to 1.70; P<0.001), respectively. Framingham score significantly predicted the occurrence of coronary and all cardiovascular events in this population (P<0.01 and P<0.0001, respectively). In multivariate analysis, pulse wave velocity remained significantly associated with the occurrence of coronary event after adjustment either of Framingham score (for 3.5 m/s: relative risk, 1.34; 95% CI, 1.01 to 1.79; P=0.039) or classic risk factors (for 3.5 m/s: relative risk, 1.39; 95% CI, 1.08 to 1.79; P=0.01). Parallel results were observed for all cardiovascular events. This study provides the first direct evidence in a longitudinal study that aortic stiffness is an independent predictor of primary coronary events in patients with essential hypertension.
Boutouyrie
Pierre
P
Department of Pharmacology and INSERM EMI 0107, Hôpital Européen Georges Pompidou, Paris, France.
Tropeano
Anne Isabelle
AI
Asmar
Roland
R
Gautier
Isabelle
I
Benetos
Athanase
A
Lacolley
Patrick
P
Laurent
Stéphane
S
D000465:Algorithms; D001011:Aorta / Q000503:physiopathology*; D001783:Blood Flow Velocity; D002339:Carotid Arteries / Q000503:physiopathology; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D004548:Elasticity; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011674:Pulse; D012307:Risk Factors