title: Aortic-Brachial Arterial Stiffness Gradient and Cardiovascular Risk in the Community: The Framingham Heart Study.
abstract: A recent study reported that the aortic-brachial arterial stiffness gradient, defined as carotid-radial/carotid-femoral pulse wave velocity (PWV ratio), predicts all-cause mortality better than carotid-femoral pulse wave velocity (CFPWV) alone in dialysis patients. However, the prognostic significance of PWV ratio for cardiovascular disease (CVD) in the community remains unclear. Accordingly, we assessed the correlates and prognostic value of the PWV ratio in 2114 Framingham Heart Study participants (60±10 years; 56% women) free of overt CVD. Mean PWV ratio decreased from 1.36±0.19 in participants aged <40 years to 0.73±0.21 in those aged ≥80 years. In multivariable linear regression, older age, male sex, higher body mass index, diabetes mellitus, lower high-density lipoprotein cholesterol, higher mean arterial pressure, and higher heart rate were associated with lower PWV ratio (P<0.001 for all). During a median follow-up of 12.6 years, 248 first CVD events occurred. In Cox regression models adjusted for standard CVD risk factors, 1-SD changes in CFPWV (hazard ratio, 1.33; 95% confidence interval, 1.10-1.61) and PWV ratio (hazard ratio, 1.32; 95% confidence interval, 1.09-1.59) were associated with similar CVD risks. Models that included conventional CVD risk factors plus CFPWV or PWV ratio gave the same C statistics (C=0.783). Although PWV ratio has been reported to provide incremental predictive value over CFPWV in dialysis patients, we could not replicate these findings in our community-based sample. Our findings suggest that the prognostic significance of PWV ratio may vary based on baseline CVD risk, and CFPWV should remain the criterion standard for assessing vascular stiffness in the community.
authors.affiliation: From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.). teemu.niiranen@thl.fi.
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Niiranen
authors.affiliation: From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.affiliation: From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.affiliation: From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.affiliation: From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.affiliation: From the National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA (T.J.N., M.G.L., E.J.B., R.S.V.); Center for Clinical Translational Epidemiology and Comparative Effectiveness Research (B.K., R.S.V.), Section of Preventive Medicine, Department of Medicine (B.K., E.J.B., R.S.V.), Department of Biostatistics (M.G.L.), Evans Department of Medicine and Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), Section of Cardiology, Department of Medicine (N.M.H., E.J.B., R.S.V.), Section of Vascular Biology, Department of Medicine (N.M.H.), and Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA; and Cardiovascular Engineering, Inc., Norwood, MA (G.F.M.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000046:Academic Medical Centers; D017677:Age Distribution; D000368:Aged; D055109:Ankle Brachial Index; D001900:Boston; D001916:Brachial Artery / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D002339:Carotid Arteries / Q000503:physiopathology*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D063177:Pulse Wave Analysis / Q000009:adverse effects*; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D059289:Vascular Stiffness / Q000502:physiology*
keywords: blood pressure; cardiovascular diseases; epidemiology; hypertension; risk factors; vascular stiffness