title: Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study.
abstract: BACKGROUND
  Arterial stiffness has been associated with the risk of cardiovascular disease in selected groups of patients. We evaluated whether arterial stiffness is a predictor of coronary heart disease and stroke in a population-based study among apparently healthy subjects.
  
  
  RESULTS
  The present study included 2835 subjects participating in the third examination phase of the Rotterdam Study. Arterial stiffness was measured as aortic pulse wave velocity and carotid distensibility. Cox proportional hazards regression analysis was performed to compute hazard ratios. During follow-up, 101 subjects developed coronary heart disease (mean follow-up period, 4.1 years), and 63 subjects developed a stroke (mean follow-up period, 3.2 years). The risk of cardiovascular disease increased with increasing aortic pulse wave velocity index. Hazard ratios and corresponding 95% CIs of coronary heart disease for subjects in the second and third tertiles of the aortic pulse wave velocity index compared with subjects in the reference category were 1.72 (0.91 to 3.24) and 2.45 (1.29 to 4.66), respectively, after adjustment for age, gender, mean arterial pressure, and heart rate. Corresponding estimates for stroke were 1.22 (0.55 to 2.70) and 2.28 (1.05 to 4.96). Estimates decreased only slightly after adjustment for cardiovascular risk factors, carotid intima-media thickness, the ankle-arm index, and pulse pressure. The aortic pulse wave velocity index provided additional predictive value above cardiovascular risk factors, measures of atherosclerosis, and pulse pressure. Carotid distensibility as measured in this study was not independently associated with cardiovascular disease.
  
  
  CONCLUSIONS
  Aortic pulse wave velocity is an independent predictor of coronary heart disease and stroke in apparently healthy subjects.
authors.affiliation: Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Francesco U S
authors.initials: FU
authors.lastname: Mattace-Raso
authors.forename: Tischa J M
authors.initials: TJ
authors.lastname: van der Cammen
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Nicole M
authors.initials: NM
authors.lastname: van Popele
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bos
authors.forename: Maarten A D H
authors.initials: MA
authors.lastname: Schalekamp
authors.forename: Roland
authors.initials: R
authors.lastname: Asmar
authors.forename: Robert S
authors.initials: RS
authors.lastname: Reneman
authors.forename: Arnold P G
authors.initials: AP
authors.lastname: Hoeks
authors.forename: Monique M B
authors.initials: MM
authors.lastname: Breteler
authors.forename: Jacqueline C M
authors.initials: JC
authors.lastname: Witteman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000502:physiology; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D011674:Pulse; D012044:Regression Analysis; D012306:Risk; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014655:Vascular Resistance