3.3 TOTAL ARTERIAL ELASTANCE IS MORE STRONGLY ASSOCIATED WITH CARDIOVASCULAR DISEASE THAN CAROTID-FEMORAL PULSE WAVE VELOCITY

Abstract

Background. Arterial stiffness is associated with an increased risk of cardiovascular disease (CVD) and carotid-femoral pulse wave velocity (cfPWV) is considered as the ‘gold standard’ measurement method. However cfPWV does not assess the stiffness of the proximal aorta and its sensitivity at higher levels of arterial stiffness, such as in the elderly, has been questioned. We compared associations between CVD and cfPWV and total arterial elastance (TAE) in a cohort of elderly individuals. Methods. 961 individuals (69±6yrs; 76% male) underwent echocardiography (Philips iE33), cerebral MRI, cfPWV (Pulse Trace) and central blood pressure (Pulsecor) measurements. Central pulse pressure and stroke volume were used to calculate TAE. Coronary heart disease (CHD) was defined as a coronary event or revascularisation identified by medical record review, and adjudicated by an independent committee. Cerebrovascular disease was defined as those with infarcts (2+) on MRI or adjudicated history of stroke. Associations are presented as odds ratios (OR) [95% confidence intervals] by logistic regression. Results. A modest correlation was observed between cfPWV and TAE (spearman’s rho = 0.14). Associations with CVD were stronger for TAE than cfPWV and subdividing participants based on cfPWV had little effect on associations (Table). All participants n=961 PWV < 12 ms−1 n = 643 PWV ≥ 12 ms−1 n = 318 OR [95%CI] P OR [95%CI] P OR [95%CI] P CHD cfPWV 1.05 [1.01,1.09] 0.03 1.06 [0.93,1.21] 0.4 1.05 [0.97,1.10] 0.2 TAE 2.15 [1.34–3.45] 0.002 2.11 [1.14, 3.91] 0.02 2.00 [0.93,4.30] 0.07 Cerebro-vascular disease cfPWV 1.04 [0.99,1.08] 0.1 0.99 [0.88,1.12] 0.9 1.01 [0.93,1.10] 0.8 TAE 1.40 [0.86–2.26] 0.2 1.54 [0.85,2.80] 0.2 1.12 [0.49,2.59] 0.8 Table.Association of cfPWV and TAE with CHD and cerebrovascular disease (adjusted for age, sex and ethnicity). Individuals were also subdivided into two groups based on their cfPWV. Conclusions. cfPWV is less strongly associated with CHD and cerebrovascular disease than TAE and may have more limited prognostic value in elderly individuals.