title: Arterial stiffness and cardiovascular events: the Framingham Heart Study.
abstract: BACKGROUND
  Various measures of arterial stiffness and wave reflection have been proposed as cardiovascular risk markers. Prior studies have not assessed relations of a comprehensive panel of stiffness measures to prognosis in the community.
  
  
  RESULTS
  We used proportional hazards models to analyze first-onset major cardiovascular disease events (myocardial infarction, unstable angina, heart failure, or stroke) in relation to arterial stiffness (pulse wave velocity [PWV]), wave reflection (augmentation index, carotid-brachial pressure amplification), and central pulse pressure in 2232 participants (mean age, 63 years; 58% women) in the Framingham Heart Study. During median follow-up of 7.8 (range, 0.2 to 8.9) years, 151 of 2232 participants (6.8%) experienced an event. In multivariable models adjusted for age, sex, systolic blood pressure, use of antihypertensive therapy, total and high-density lipoprotein cholesterol concentrations, smoking, and presence of diabetes mellitus, higher aortic PWV was associated with a 48% increase in cardiovascular disease risk (95% confidence interval, 1.16 to 1.91 per SD; P=0.002). After PWV was added to a standard risk factor model, integrated discrimination improvement was 0.7% (95% confidence interval, 0.05% to 1.3%; P<0.05). In contrast, augmentation index, central pulse pressure, and pulse pressure amplification were not related to cardiovascular disease outcomes in multivariable models.
  
  
  CONCLUSIONS
  Higher aortic stiffness assessed by PWV is associated with increased risk for a first cardiovascular event. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of cardiovascular disease risk in the community.
authors.affiliation: Cardiovascular Engineering, Inc, 1 Edgewater Dr, Suite 201A, Norwood, MA 02062, USA. GaryFMitchell@mindspring.com
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vita
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology*; D001011:Aorta / Q000503:physiopathology*; D015415:Biomarkers; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000502:physiology; D002339:Carotid Arteries / Q000502:physiology; D015331:Cohort Studies; D004548:Elasticity / Q000502:physiology*; D005260:Female; D005263:Femoral Artery / Q000502:physiology; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*
chemical_list: D015415:Biomarkers