Abstract 10787: Carotid Artery Stiffness Mechanisms Associated With End Organ Damage and All-Cause Mortality: The Multi-Ethnic Study of Atherosclerosis (mesa)

Abstract

Introduction: Stiff arteries increase the risk of end organ damage to the brain and kidneys. Arterial stiffness can be separated into two main mechanisms: 1) load-dependent stiffening from higher blood pressure and (2) structural stiffening due to remodeling of the vessel wall. The relationship between arterial stiffness mechanisms and end organ damage risk is unknown. Hypothesis: Both stiffness mechanisms will be significantly associated with chronic kidney disease (CKD), dementia, and mortality. Methods: MESA participants with B-mode carotid ultrasound in 2000-2002 were included in this study (n=6147). Carotid pulse wave velocity (cPWV) was calculated to represent total stiffness. Structural stiffness was calculated by adjusting cPWV to a 120/80 BP with participant-specific models. Load dependent (LD) stiffness was the difference of total and structural stiffness. Associations with incident CKD, dementia defined by ICD codes, and mortality were assessed with Cox models adjusted for age, sex, race/ethnicity, education, study site, smoking, pack-years, diabetes, BMI, SBP, non-HDL-C, BP medication, and lipid medication. Results: During 14.3±4.8 years of follow-up, 773 CKD events, 535 dementia events, and 1529 deaths occurred. Total cPWV was associated with mortality (HR 1.04 [1.01-1.08], p=0.02) and dementia (HR 1.06 [1.01 - 1.12], p=0.03). Structural cPWV was significantly associated with mortality (HR 1.04 [1.00 - 1.08], p=0.04) but not CKD (HR 1.00 [0.94-1.05], p=0.86) or dementia (HR 1.06 [0.99-1.13], p=0.06). LD cPWV was associated with CKD (HR 1.38 [1.17 - 1.63], p<0.001) but not mortality (HR 1.11 [0.99-1.25], p=0.07) or dementia (HR 1.14 [0.94-1.38], p=0.19). Conclusions: Structural carotid artery stiffness was significantly associated with all-cause mortality, while LD stiffness was significantly associated with CKD. Total carotid stiffness was associated with incident dementia but LD and structural stiffness mechanisms were not.