Serial assessment of arterial stiffness by cardio-ankle vascular index for prediction of future cardiovascular events in patients with coronary artery disease

Abstract

Purpose: Arterial stiffness is a significant predictor of cardiovascular disease (CVD), which is modified by medications for atherosclerotic risk factors and life-style changes. Cardio-ankle vascular index (CAVI) provides noninvasive, objective information on arterial stiffness, independent of blood pressure. This study aimed to investigate changes in CAVI after management of atherosclerotic risk factors and their impact on future CVD outcome in patients with coronary artery disease (CAD). Methods: The study consisted of 211 CAD patients (65±10 years, 118 men) with impaired CAVI. CAVI examination was repeated 6 months later. Impaired CAVI was defined as > the mean plus 1 SD of the age- and gender-specific normal CAVI values, according to the results in 5,188 healthy subjects. All patients were followed for more than 1 year or until the occurrence of CVD event. Results: Of the 211 patients, CAVI improved 6 months later in 106 (50%) patients, but remained high in 105 (50%) patients. During follow-up (2.9±1.0 years), CVD events occurred in 28 (13%) patients. Persistently impaired CAVI was an independent predictor of future CVD events (p=0.003), independent of baseline CAVI. The CVD outcome was worse in patients with persistently impaired CAVI than in those with improved CAVI (p<0.001) (Figure). Patients with normalized CAVI after treatment (n=22) had only 1 CVD event. ![Figure][1] Kaplan-Meier curves for CVD events Conclusions: This study demonstrated for the first time that persistent impairment of arterial stiffness was an independent risk factor of future CVD events. Serial measurement of CAVI provides important prognostic information on patients with CAD in clinical practice. [1]: pending:yes