Peripheral arterial stiffness predicts cardiovascular mortality
Peripheral arterial stiffness is an independent predictor of cardiovascular mortality risk, suggests a study presented at the Asian Pacific Society of Cardiology (APSC) Congress 2018.
During a median follow-up period of 13.3 years, a total of 59 cardiovascular deaths and 219 all-cause deaths occurred among the 960 participants (mean age 62.4 years) included in the analysis. The incidence rates of cardiovascular and all-cause mortalities increased with decreasing arterial compliance and distensibility. [APSC 2018, abstract P007]
The inverse association between arterial compliance and the risk of cardiovascular mortality (hazard risk for each 1-standard-deviation decrease, 1.49; 95 percent CI, 1.02–2.20) remained significant even after adjusting for conventional cardiovascular risk factors. This inverse association also persisted across the quartiles of arterial compliance, with a significant linear tendency (p=0.015 for linear trend).
Furthermore, there was a significant, albeit modest, improvement in the performance of model prediction for the risk of cardiovascular mortality when arterial compliance was added to conventional risk prediction model (integrated discriminatory improvement, 1.8 percent; 0.2–3.5 percent; p=0.016).
“However, the associations between arterial distensibility and mortalities attenuated after full conventional cardiovascular risk factors were taken into consideration,” researchers said.
In this study, 526 women and 434 men were recruited from a prospective community-based cohort. Peripheral arterial stiffness was determined by noninvasively measuring arterial compliance and distensibility derived from the oscillometric signals of brachial arterial pressures.
Cardiovascular and all-cause mortalities were the clinical outcomes. Cardiovascular mortality referred to death from coronary heart disease, heart failure, sudden death, peripheral arterial disease and stroke.
“Prior studies have recognized aortic stiffness as an independent risk predictor for cardiovascular events. However, the relationship remains unclear between peripheral arterial stiffness and cardiovascular risk,” according to researchers.
In a separate editorial, Dr Piotr Jankowski from the Institute of Cardiology at Jagiellonian University Medical College in Poland said that arterial stiffness, together with its haemodynamic consequences, is an established predictor of cardiovascular mortality and morbidity. [Medicographia 2015;37:399-403]
“Arterial stiffness is positively associated with systolic hypertension, coronary artery disease, stroke and heart failure, which are the leading causes of mortality in the developed world,” he said.
Several concepts have been suggested by existing literature to explain such mechanism. [Jankowski P, Blacher J, Weber T. Arterial stiffness, central blood pressure and coronary heart disease. In: Safar ME, O’Rourke MF, Frohlich ED, eds. Blood Pressure and Arterial Wall Mechanics in Cardiovascular Diseases. London, UK: Springer-Verlag; 2014.]
“The first concept is the relation between arterial wall stiffness and lower diastolic and higher systolic blood pressure in the ascending aorta; [t]he second concept is that increased stiffness is a symptom of ‘disease’ of the arterial wall; [and t]he third concept is that high arterial stiffness increases the pulsatile component of blood pressure, especially central pressure, which in turn leads to the development of atherosclerosis and its complications as well as to damage of microvasculature,” Jankowski explained.