Reflection Magnitude, a Measure of Arterial Stiffness, Predicts Incident Heart Failure in Men But Not Women: Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

BackgroundArterial stiffness is a risk factor for heart failure (HF) and is higher in women. Our objective was to investigate sex differences between arterial stiffness and incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA) population. Methods and ResultsApplanation tonometry from 5959 participants (52.8% women) was used to calculate augmentation index (AIx), pulse pressure amplification (PPA), and reflection magnitude (RM). Sex-specific risk of HF was assessed with the use of a competing-risk regression model. Women had higher AIx (P < .00001), higher RM (P = .023), and lower PPA (P < .00001) indicating greater arterial stiffness in women. However, increasing RM quartile independently predicted HF in men (adjusted hazard ratios and 95% confidence intervals: Q2: 2.05 [1.06–3.96; P = .033]; Q3: 2.49 [1.30–4.73; P = .006]; Q4: 3.26 [1.75–6.08; P = .0002]) but not in women (Q2: 1.04 [0.54–1.98; P = .91]; Q3: 1.30 [0.71–2.37; P = .4]; Q4: 0.79 [0.4–1.55; P = .49]). ConclusionWomen demonstrate greater arterial stiffness than men. Despite this, arterial stiffness, as measured by RM, predicts incident HF in men but not in women. RM represents a novel risk factor for HF in men but not in women. Further investigation of risk factors for HF in women is warranted. ConclusionArterial stiffness, measured by RM, predicts incident HF in men but not in women in this MESA cohort.