title: Resistive and pulsatile arterial hemodynamics and cardiovascular events: the Multiethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Arterial blood pressure is dependent on interactions between the heart and arteries. Resistive and pulsatile components of arterial load can be assessed by systemic vascular resistance (SVR, a microvascular property) and the ratio of stroke volume to pulse pressure (a surrogate of total arterial compliance, TAC), respectively. The relationship between arterial function and cardiovascular events in populations without cardiovascular disease is unknown.
  
  
  RESULTS
  We studied 4806 adults enrolled in the Multi-Ethnic Study of Atherosclerosis who were free of clinical cardiovascular disease at baseline. SVR and stroke volume/pulse pressure (SV/PP) were derived by sphygmomanometry and magnetic resonance imaging. The relationship between these measures of arterial function and incident cardiovascular events was assessed using Cox regression. With a mean follow-up of 7.5 years, cardiovascular events occurred in 358 participants (7.4%). There was no relationship between SVR and subsequent cardiovascular events. However, increased stroke volume/pulse pressure was associated with reduced event rate in unadjusted (hazard ratio=0.67, 95% CI=0.58 to 0.77, P<0.001) and analyses that adjusted for multiple confounders (HR=0.75; 95% CI=0.62 to 0.90; P<0.001).
  
  
  CONCLUSIONS
  Greater total arterial compliance, manifest by higher stroke volume/pulse pressure is associated with a reduced incidence of subsequent CVE. In contrast, SVR was not independently associated with CVE in subjects free of overt cardiovascular disease at baseline. These findings support the concept that alternations in the large conduit vessels, rather than changes in microvascular resistance, are primarily related to incident cardiovascular disease.
authors.affiliation: Division of Cardiovascular Medicine, Ohio State University Heart and Vascular Center, Columbus, OH (S.M.L.).
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lilly
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN (D.J.).
authors.forename: David
authors.initials: D
authors.lastname: Jacobs
authors.affiliation: Radiology and Imaging Sciences, National Institute of Health Clinical Center, Bethesda, MD (D.A.B.).
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Cardiovascular Division, University of Minnesota, MN (D.D.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Duprez
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA (P.Z., J.C.).
authors.forename: Payman
authors.initials: P
authors.lastname: Zamani
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA (P.Z., J.C.).
authors.forename: Julio
authors.initials: J
authors.lastname: Chirinos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D001158:Arteries / Q000503:physiopathology*; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D003187:Compliance; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011673:Pulsatile Flow; D012307:Risk Factors; D019722:Sphygmomanometers; D013318:Stroke Volume; D013997:Time Factors; D014655:Vascular Resistance; D059289:Vascular Stiffness
keywords: arterial compliance; microvascular; pulsatile hemodynamics; resistance