Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function?
BACKGROUND
Arterial distensibility measures, generally from pulse-wave velocity (PWV), are widely used with little knowledge of relationships to patient outcome. We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance-tested (GTT) multiethnic population samples.


RESULTS
Participants were randomly sampled from (1) a type 2 diabetes outpatient clinic and (2) primary care population registers, from which nondiabetic control subjects were given a GTT. Brachial blood pressures and Doppler-derived aortic PWV were measured. Mortality data over 10 years' follow-up were obtained. At any level of systolic blood pressure (SBP), aortic PWV was greater in subjects with diabetes than in controls. Mortality risk doubled in subjects with diabetes (hazard ratio 2.34, 95% CI 1.5 to 3.74) and in those with glucose intolerance (2.12, 95% CI 1.11 to 4.0) compared with controls. For all groups combined, age, sex, and SBP predicted mortality; the addition of PWV independently predicted all-cause and cardiovascular mortality (hazard ratio 1.08, 95% CI 1.03 to 1.14 for each 1 m/s increase) but displaced SBP. Glucose tolerance status and smoking were other independent contributors, with African-Caribbeans experiencing reduced mortality risk (hazard ratio 0.41, 95% CI 0.25 to 0.69).


CONCLUSIONS
Aortic PWV is a powerful independent predictor of mortality in both diabetes and GTT population samples. In displacing SBP as a prognostic factor, aortic PWV is probably further along the causal pathway for arterial disease and may represent a useful integrated index of vascular status and hence cardiovascular risk.
Cruickshank
Kennedy
K
Clinical Epidemiology Group, School of Epidemiology & Health Sciences, University of Manchester Medical School, Manchester, UK. clinep@man.ac.uk
Riste
Lisa
L
Anderson
Simon G
SG
Wright
John S
JS
Dunn
Graham
G
Gosling
Ray G
RG
D001011:Aorta / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D003187:Compliance; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality*; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011897:Random Allocation; D012307:Risk Factors; D015996:Survival Rate; D014463:Ultrasonography