title: Relation of Central Arterial Stiffness to Incident Heart Failure in the Community.
abstract: BACKGROUND
  Arterial stiffness, pressure pulsatility, and wave reflection are associated with cardiovascular disease. Left ventricular function is coupled to proximal aortic properties, but the association of central aortic stiffness and hemodynamics with incident clinical heart failure (HF) is not well described.
  
  
  RESULTS
  Framingham Study participants without clinical HF (n=2539, mean age 64 years, 56% women) underwent applanation tonometry to measure carotid-femoral pulse wave velocity (CFPWV), central pulse pressure, forward wave amplitude, and augmentation index. CFPWV was inverse-transformed to reduce heteroscedasticity and multiplied by -1 to restore effect direction (iCFPWV). Over 10.1 (range 0.04-12.9) years, 170 HF events developed. In multivariable-adjusted analyses, iCFPWV was associated with incident HF in a continuous, graded fashion (hazards ratio [HR] per SD unit [SDU] 1.29, 95% confidence interval [CI] 1.02-1.64, P=0.037). iCFPWV was associated with HF with reduced ejection fraction (HR=1.69/SDU, 95% CI 1.19-2.42, P=0.0037) in age- and sex-adjusted models, which was attenuated in multivariable-adjusted models (P=0.065). Central pulse pressure and forward wave amplitude were associated with HF in age- and sex-adjusted models (per SDU, HR=1.20, 95% CI 1.06-1.37, P=0.006, and HR=1.15, 95% CI 1.01-1.31, P=0.036, respectively), but not in multivariable-adjusted models (both P≥0.28). Augmentation index was not associated with HF risk (P≥0.19 in all models).
  
  
  CONCLUSIONS
  In our prospective investigation of a large community-based sample of middle-aged to elderly individuals, greater aortic stiffness (reflected by higher iCFPWV) was associated with increased risk of HF. Future studies may investigate the impact of modifying aortic stiffness in reducing the community burden of HF.
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.W.T.) Framingham Heart Study, Framingham, MA (C.W.T., A.L., M.G.L., D.L., E.J.B., R.S.V.).
authors.forename: Connie W
authors.initials: CW
authors.lastname: Tsao
authors.affiliation: Department of Mathematics and Statistics, Boston University, Boston, MA (A.L., M.G.L.) Framingham Heart Study, Framingham, MA (C.W.T., A.L., M.G.L., D.L., E.J.B., R.S.V.).
authors.forename: Asya
authors.initials: A
authors.lastname: Lyass
authors.affiliation: Department of Mathematics and Statistics, Boston University, Boston, MA (A.L., M.G.L.) Framingham Heart Study, Framingham, MA (C.W.T., A.L., M.G.L., D.L., E.J.B., R.S.V.).
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.affiliation: National Heart, Lung and Blood Institute, Bethesda, MD (D.L.) Framingham Heart Study, Framingham, MA (C.W.T., A.L., M.G.L., D.L., E.J.B., R.S.V.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.affiliation: Department of Medicine, Sections of Cardiology, Boston University School of Medicine, Boston, MA (N.M.H., J.A.V., E.J.B., R.S.V.).
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.affiliation: Department of Medicine, Sections of Cardiology, Boston University School of Medicine, Boston, MA (N.M.H., J.A.V., E.J.B., R.S.V.).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vita
authors.affiliation: Department of Medicine, Sections of Cardiology, Boston University School of Medicine, Boston, MA (N.M.H., J.A.V., E.J.B., R.S.V.) Preventative Medicine, Boston University School of Medicine, Boston, MA (E.J.B., R.S.V.) Framingham Heart Study, Framingham, MA (C.W.T., A.L., M.G.L., D.L., E.J.B., R.S.V.).
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, Sections of Cardiology, Boston University School of Medicine, Boston, MA (N.M.H., J.A.V., E.J.B., R.S.V.) Preventative Medicine, Boston University School of Medicine, Boston, MA (E.J.B., R.S.V.) Framingham Heart Study, Framingham, MA (C.W.T., A.L., M.G.L., D.L., E.J.B., R.S.V.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008365:Manometry; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011673:Pulsatile Flow; D063177:Pulse Wave Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D059289:Vascular Stiffness; D016277:Ventricular Function, Left
keywords: aortic stiffness; epidemiology; heart failure; pressure pulsatility