Abstract
Objectives: Arterial stiffness is widely accepted as an important predictor of cardiovascular disease (CVD) development. While obesity is generally associated with increased CVD risk, there is evidence that overweight patients with existing CVD may have better clinical outcomes than their lean counterparts. Our study sought to observe any potential association between brachial–ankle pulse wave velocity (BAPWV), a marker of arterial stiffness related to CVD risk, and Body Mass Index (BMI), a crude and widely used measure of obesity. Methods: Adult individuals (n = 857) assessed for routine CV risk were included and grouped according to their BMI (<25 kg/m2: normal; 25–30 kg/m2: overweight, ≥30 kg/m2: obese). Their anthropometric parameters, brachial cuff pressures, and BAPWV were measured. Results: Brachial pressure was significantly higher as BMI increased. BAPWV showed a positive linear association with systolic (r = 0.66, p < 0.01), mean (r = 0.60, p < 0.01), diastolic (r = 0.51, p < 0.01), and pulse (r = 0.53, p < 0.01) pressures. However, a linear relationship between BMI and BAPWV was only apparent in males aged <50 years (p = 0.01) and in females aged ≥50 years (p < 0.01). In individuals with similar brachial systolic pressure, BAPWV was higher in normal-weight subjects compared to overweight–obese ones. Conclusions: This conflicting finding is attributed to an overestimation of the degree of arterial stiffness as a measure of CVD risk in individuals with a less ‘healthy’ BMI. This suggests that BMI may not the appropriate obesity indicator to assess CV risk. Our finding emphasizes the importance of establishing a non-linear relationship between CVD risk, age, and BMI, taking into account apparent sex differences, to predict future CV events. While this finding may suggest a lower degree of stiffness in large arteries of overweight–obese subjects compared to their normal-weight counterparts, the potential implications for individuals with higher BMI need be explored further.
Highlights
Arterial stiffness is widely accepted as an important predictor of cardiovascular disease (CVD) development [1,2] and is usually considered as an index of vascular aging quantifiable by the measurement of pulse wave velocity (PWV)
A systematic analysis of the Global Burden of Disease 2013 Study [29] showed that the percentage of individuals with Body Mass Index (BMI) ≥ 25 increased from 28.8% in 1980 to 36.9% in 2013
A systematic analysis of the Global Burden of Disease 2013 Study [29] showed that the percentage of individuals with BMI ≥ 25 increased from 28.8% in 1980 to 36.9% in 2013 for men and from 29.8% to 38.0% for women
Summary
Arterial stiffness is widely accepted as an important predictor of cardiovascular disease (CVD) development [1,2] and is usually considered as an index of vascular aging quantifiable by the measurement of pulse wave velocity (PWV). BAPWV has been shown to be closely correlated with the directly measured aortic and carotid–femoral PWV [5] This measurement can be performed using an automatic cuff for each of the four limbs by an oscillometric method [6]. Another method of assessing vascular stiffness is the ankle–brachial index (ABI), that is the ratio of the ankle systolic blood pressure (BP) to the brachial systolic BP. ABI has been reported to have an inverse relationship with the presence of CV risk factors [7] While both indexes are shown to be markers of arterial stiffness, there are conflicting reports on how well each one predicts CV risk in the presence of different diseases [8,9]. An alternative to PWV is the cardio–ankle vascular index (CAVI) [11]; this index is not BP-dependent and may reflect the stiffness of a section of an artery
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