title: Association of small artery elasticity with incident cardiovascular disease in older adults: the multi-ethnic study of atherosclerosis.
abstract: Functional biomarkers like large artery elasticity (LAE) and small artery elasticity (SAE) may predict cardiovascular disease (CVD) events beyond blood pressure. The authors examined the prognostic value of LAE and SAE for clinical CVD events among 6,235 Multi-Ethnic Study of Atherosclerosis participants who were initially aged 45-84 years and without symptomatic CVD. LAE and SAE were derived from diastolic pulse contour analysis. During a median 5.8 years of follow-up between 2000 and 2008, 454 adjudicated CVD events occurred, including 256 cases of coronary heart disease (CHD), 93 strokes, and 126 heart failures (multiple diagnoses were possible). After adjustment for age, race/ethnicity, sex, clinic, height, heart rate, body mass index, systolic and diastolic blood pressure, use of antihypertensive and cholesterol-lowering medications, smoking, total cholesterol, high density lipoprotein cholesterol, triglycerides, diabetes, and high-sensitivity C-reactive protein, the hazard ratio for any CVD per standard-deviation increase in SAE was 0.71 (95% confidence interval: 0.61, 0.83; P < 0.0001). The lowest (stiffest) SAE quartile had a hazard ratio of 2.28 (95% confidence interval: 1.55, 3.36) versus the highest (most elastic) quartile. The net reclassification index, conditional on base risk, was 0.11. SAE was significantly associated with future CHD, stroke, and heart failure. After adjustment, LAE was not significantly related to CVD. In asymptomatic participants free of overt CVD, lower SAE added prognostic information for CVD, CHD, stroke, and heart failure events.
authors.affiliation: Cardiovascular Division, Medical School, University of Minnesota, VCRC–Room 270, MMC 508, 420 Delaware Street SE, Minneapolis, MN 55455, USA. dupre007@umn.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Duprez
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Lyndia C
authors.initials: LC
authors.lastname: Brumback
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000503:physiopathology*; D050197:Atherosclerosis / Q000208:ethnology* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000503:physiopathology; D004548:Elasticity; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models