Associations between echocardiographic arterial compliance and incident cardiovascular disease in blacks: the ARIC study.
BACKGROUND
Systemic arterial compliance is sometimes derived by echocardiographic stroke volume to pulse pressure ratios. Few studies have assessed echocardiographic arterial compliance in blacks or its associations with explicit, rather than composite, cardiovascular disease (CVD) outcomes.


METHODS
We analyzed a subset (n = 1,887) of blacks (mean age = 59 ± 6 years; 65% women) in the Atherosclerosis Risk in Communities study who were free of prevalent CVD and were imaged by echocardiography in 1993-1995. Arterial compliance was calculated by the aortic velocity time integral and brachial pulse pressure ratio (VTI/PP). Associations between VTI/PP and subsequent CVD (defined as first incident stroke, coronary event, or heart failure) were modeled by Cox regression after controlling for demographics, anthropometry, and cardiac risk factors. For comparison, CVD hazard ratios were also calculated for pulse pressure quartiles.


RESULTS
Over a mean follow-up of 13 ± 4 years, 237 subjects (12%) developed coronary disease, 322 (16%) developed heart failure, and 180 (9%) experienced a stroke. Hazard ratios contrasting lowest with highest quartiles of VTI/PP were 2.3 (95% confidence interval (CI) = 1.7-3.1) for composite CVD, 2.1 (95% CI = 1.3-3.2) for coronary disease, 2.5 (95% CI = 1.7-3.6) for heart failure, and 2.7 (95% CI = 1.6-4.5) for stroke. Hazard ratios contrasting widest with narrowest pulse pressure quartiles were 1.7 (95% CI = 1.3-2.2) for composite CVD, 1.6 (95% CI = 1.0-2.4) for coronary heart disease, 1.8 (95% CI = 1.2-2.6) for heart failure, and 2.3 (95% CI = 1.3-3.9) for stroke.


CONCLUSIONS
In blacks, the VTI/PP ratio has stronger associations with both composite and individual CVD outcomes than does pulse pressure.
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina at Chapel Hill; Chapel Hill, North Carolina; caughey@med.unc.edu.
Melissa C
MC
Caughey
Department of Epidemiology, University of North Carolina at Chapel Hill; Chapel Hill, North Carolina;
Laura R
LR
Loehr
Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
Susan
S
Cheng
Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
Scott D
SD
Solomon
Department of Epidemiology, University of North Carolina at Chapel Hill; Chapel Hill, North Carolina;
Christy
C
Avery
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
Alan L
AL
Hinderliter
D001741:Black or African American; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D003187:Compliance; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D059289:Vascular Stiffness
arterial compliance; blood pressure; cardiovascular disease; echocardiography; hypertension.