title: Cross-sectional relations of arterial stiffness, pressure pulsatility, wave reflection, and arterial calcification.
abstract: OBJECTIVE
  Arterial hemodynamics and vascular calcification are associated with increased risk for cardiovascular disease, but their inter-relations remain unclear. We sought to examine the associations of arterial stiffness, pressure pulsatility, and wave reflection with arterial calcification in individuals free of prevalent cardiovascular disease.
  
  
  RESULTS
  Framingham Heart Study Third Generation and Offspring Cohort participants free of cardiovascular disease underwent applanation tonometry to measure arterial stiffness, pressure pulsatility, and wave reflection, including carotid-femoral pulse wave velocity, central pulse pressure, forward wave amplitude, and augmentation index. Participants in each cohort (n=1905, 45±6 years and n=1015, 65±9 years, respectively) underwent multidetector computed tomography to assess the presence and quantity of thoracic aortic calcification, abdominal aortic calcification, and coronary artery calcification. In multivariable-adjusted models, both higher carotid-femoral pulse wave velocity and central pulse pressure were associated with greater thoracic aortic calcification and abdominal aortic calcification, whereas higher augmentation index was associated with abdominal aortic calcification. Among the tonometry measures, carotid-femoral pulse wave velocity was the strongest correlate of all calcification measures in multivariable-adjusted models (odds ratio per SD for thoracic aortic calcification, 2.69 [95% confidence interval, 2.17-3.35]; abdominal aortic calcification, 1.47 [95% confidence interval, 1.26-1.73]; and coronary artery calcification, 1.48 [95% confidence interval, 1.28-1.72]; all P<0.001, respectively). We observed stronger relations of carotid-femoral pulse wave velocity, central pulse pressure, and forward wave amplitude with nearly all continuous calcification measures in the younger Third Generation Cohort as compared with the Offspring Cohort.
  
  
  CONCLUSIONS
  In community-dwelling individuals without prevalent cardiovascular disease, abnormal central arterial hemodynamics were positively associated with vascular calcification and were observed at younger ages than previously recognized. The mechanisms of these associations may be bidirectional and deserve further study.
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.). ctsao1@bidmc.harvard.edu.
authors.forename: Connie W
authors.initials: CW
authors.lastname: Tsao
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Karol M
authors.initials: KM
authors.lastname: Pencina
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.); Departments of Biostatistics (K.M.P., J.M.M.) and Epidemiology (E.J.B.), School of Public Health, and Department of Medicine, Sections of Cardiology and Preventative Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); The Framingham Heart Study, MA (C.W.T., E.J.B., D.L., R.S.V., C.J.O.); Division of Intramural Research, NHLBI, Bethesda, MD (C.W.T., C.J.O.); Division of Cardiology, Department of Medicine (C.J.O.) and Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001012:Aorta, Abdominal / Q000502:physiology; D001013:Aorta, Thoracic / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D002339:Carotid Arteries / Q000502:physiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005263:Femoral Artery / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology*; D063177:Pulse Wave Analysis; D061205:Vascular Calcification / Q000503:physiopathology*; D059289:Vascular Stiffness / Q000502:physiology*
keywords: hemodynamics; vascular calcification; vascular stiffness