Arterial Stiffness and Cardiovascular Events: The Framingham Heart Study

Circulation. 2010 Feb 2;121(4):505-11. doi: 10.1161/CIRCULATIONAHA.109.886655. Epub 2010 Jan 18.

Abstract

Background: Various measures of arterial stiffness and wave reflection have been proposed as cardiovascular risk markers. Prior studies have not assessed relations of a comprehensive panel of stiffness measures to prognosis in the community.

Methods and results: We used proportional hazards models to analyze first-onset major cardiovascular disease events (myocardial infarction, unstable angina, heart failure, or stroke) in relation to arterial stiffness (pulse wave velocity [PWV]), wave reflection (augmentation index, carotid-brachial pressure amplification), and central pulse pressure in 2232 participants (mean age, 63 years; 58% women) in the Framingham Heart Study. During median follow-up of 7.8 (range, 0.2 to 8.9) years, 151 of 2232 participants (6.8%) experienced an event. In multivariable models adjusted for age, sex, systolic blood pressure, use of antihypertensive therapy, total and high-density lipoprotein cholesterol concentrations, smoking, and presence of diabetes mellitus, higher aortic PWV was associated with a 48% increase in cardiovascular disease risk (95% confidence interval, 1.16 to 1.91 per SD; P=0.002). After PWV was added to a standard risk factor model, integrated discrimination improvement was 0.7% (95% confidence interval, 0.05% to 1.3%; P<0.05). In contrast, augmentation index, central pulse pressure, and pulse pressure amplification were not related to cardiovascular disease outcomes in multivariable models.

Conclusions: Higher aortic stiffness assessed by PWV is associated with increased risk for a first cardiovascular event. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of cardiovascular disease risk in the community.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina, Unstable / epidemiology*
  • Aorta / physiopathology*
  • Biomarkers
  • Blood Flow Velocity / physiology
  • Blood Pressure / physiology
  • Brachial Artery / physiology
  • Carotid Arteries / physiology
  • Cohort Studies
  • Elasticity / physiology*
  • Female
  • Femoral Artery / physiology
  • Follow-Up Studies
  • Heart Failure / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Proportional Hazards Models
  • Risk Factors
  • Stroke / epidemiology*

Substances

  • Biomarkers