title: Cardio-Ankle Vascular Index is Independently Associated with Future Cardiovascular Events in Outpatients with Metabolic Disorders.
abstract: OBJECTIVE
  We investigated whether cardio-ankle vascular index (CAVI), an arterial stiffness marker, independently predicts future cardiovascular events in subjects with metabolic disorders.
  
  
  METHODS
  1562 outpatients underwent CAVI between April 2004 and March 2006 at Toho University, Sakura Medical Center in Chiba, Japan. Patients who already had cardiovascular events at baseline, patients with low ankle brachial index (＜0.9), and patients with atrial fibrillation were excluded. After exclusion, 1080 subjects with metabolic disorders including diabetes mellitus, hypertension and dyslipidemia were screened and followed prospectively.
  
  
  RESULTS
  Eventually, 1003 subjects (92.9% of 1,080 subjects) followed until March 2012 (follow-up duration 6.7±1.6 years) were analyzed. During the observation period, 90 subjects had new-onset myocardial infarction or angina pectoris confirmed by angiography. All subjects were stratified into quartiles by baseline CAVI (Q1: CAVI ≤8.27, Q2: CAVI 8.28-9.19, Q3: CAVI 9.20-10.08, Q4: CAVI ≥10.09). Age, male ratio and future cardiovascular events increased as CAVI quartile became higher. In Cox proportional hazards regression analysis, the factors independently associated with higher risk of future cardiovascular events were every 1.0 increment of CAVI [hazard ratio (HR) 1.126, p= 0.039], male gender (HR 2.276, p=0.001), smoking (HR 1.846, p=0.007), diabetes mellitus (HR 1.702,p=0.020), and hypertension (HR 1.682, p=0.023).
  
  
  CONCLUSIONS
  In individuals with metabolic disorders, CAVI was a predictor of future cardiovascular events, independent of traditional coronary risk factors. CAVI is a potentially valuable tool to identify persons likely to benefit from more intensive therapeutic approaches.
authors.affiliation: Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Sato
authors.forename: Daiji
authors.initials: D
authors.lastname: Nagayama
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Saiki
authors.forename: Rena
authors.initials: R
authors.lastname: Watanabe
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Haruki
authors.initials: H
authors.lastname: Imamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Ban
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kawana
authors.forename: Ayako
authors.initials: A
authors.lastname: Nagumo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohira
authors.forename: Kei
authors.initials: K
authors.lastname: Endo
authors.forename: Takumi
authors.initials: T
authors.lastname: Kurosu
authors.forename: Takanobu
authors.initials: T
authors.lastname: Tomaru
authors.forename: Kohji
authors.initials: K
authors.lastname: Shirai
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tatsuno
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications; D000842:Ankle / Q000098:blood supply; D055109:Ankle Brachial Index; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis; D001794:Blood Pressure; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology; D003920:Diabetes Mellitus / Q000503:physiopathology; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008659:Metabolic Diseases / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D012307:Risk Factors; D059289:Vascular Stiffness
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human