Cardio-ankle Vascular Index Values Research Articles

PP.20.34

Objective: Vascular stiffness is considered to be a reliable marker of cardiovascular risk. Gold standard method of the arterial stiffness assessment – applanation tonometry - is technically complicated, observer-related; measurements are blood pressure (BP) dependent, thus, novel techniques are now under discussion, the cardio-ankle vascular index (CAVI) in particular. Application of accepted cut-off value of 9,0 can lead to misestimation of age-related differences. The aim of our study was to estimate cut-off values for CAVI in different age-groups of Russian population. Design and method: 1336 apparently healthy participants aged 25–65 years were randomly selected from Saint-Petersburg inhabitants (a sample form ESSE-RF study). All participants signed informed consent and filled in the questionnaire regarding risk factors, concomitant diseases and therapy. Fasting lipids, glucose (Abbott Architect 8000 (USA)) and BP measurement were performed. From whole cohort a group of healthy subjects (288) without CVD, dyslipidemia, hypertension and diabetes mellitus was selected. CAVI was measured by VaSera VS-1500 (Fukuda, Japan). Results: In our sample 175 of patients (13%) had CAVI value higher than accepted cut-off 9,0. Calculated regression equation CAVI = 5,29 + age*0,047 we transformed to CAVI = 6,70 + 0,047*age for including of 13% of pathological cases (87% percentile) in every age group. The cut-off values of CAVI for different age groups in healthy subjects in total population-based sample were calculated (Table 1).Conclusions: Application of CAVI cut-off values according to age groups may promote to more precise detection of subclinical vascular damage – to prevent underestimation in younger age and overestimation in older age groups.

Comparison of arteriosclerotic indicators in patients with ischemic stroke: ankle-brachial index, brachial-ankle pulse wave velocity and cardio-ankle vascular index.

The ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are surrogate markers of arteriosclerosis. However, their roles in patients with acute ischemic stroke remain unclear. From October 2003 to September 2011, we enrolled patients with arteriosclerotic ischemic stroke (AIS) exhibiting large infarcts attributed to large-artery atherosclerosis (LAA) or deep subcortical infarcts (mainly lacunar infarcts) attributed to small-artery disease (SAD). Outpatients without a history of stroke served as controls (CTL). We divided the study period into two terms and assessed patients using two different oscillometric devices (Form PWV/ABI, Omron Colin; and VaSera VS-1500, Fukuda Denshi) in each term. One-way analysis of variance and age- and sex-adjusted analysis of covariance were used to compare the three groups. We analyzed 842 patients. The ABI was significantly lower in the LAA (n = 102) group than in the SAD (n = 280) and CTL (n = 460) groups. The baPWV was significantly higher in the LAA and SAD groups than in the CTL group. The CAVI gradually increased in the order of CTL, SAD and LAA. The cutoff values of baPWV and CAVI for detection of AIS were 18.3 m s(-1) (odds ratio (OR): 6.09, 95% confidence interval (CI): 3.97-9.62, P < 0.01) and 9.5 (OR: 1.44, 95% CI: 1.24-1.70, P < 0.001), respectively. Among the three indicators, a lower ABI indicated advanced atherosclerosis associated with LAA, and an increased baPWV more closely indicated AIS. An increased CAVI may indicate the degree of vessel stiffness due to arteriosclerosis.

Fragmented QRS may predict increased arterial stiffness in asymptomatic hypertensive patients.

Detection of increased arterial stiffness could prevent patients from being mistakenly classified as being at a low or a moderate risk, when they actually are at a high risk. The main aim of present study was to investigate the relation between fragmented QRS (fQRS) on ECG and the cardio-ankle vascular index (CAVI), which is a novel parameter of arterial stiffness in asymptomatic hypertensive patients. Seventy-five asymptomatic hypertensive patients with fQRS and 75 age-matched and sex-matched control individuals without fQRS were enrolled. Patients with fQRS had higher CAVI values compared with those without fQRS (8.6 ± 1.4 vs. 7.9 ± 1.3, P=0.01). In univariate analyses, there was a significant association between increased CAVI and age (P<0.001) and fQRS (P=0.003). Multivariate binary logistic regression analyses showed fQRS (95% confidence interval: 0.122-0.675, P=0.004) and age (95% confidence interval: 1.022-1.105, P=0.002) as the independent determinants of increased CAVI. The sensitivity and specificity of fQRS for predicting abnormal CAVI were 55 and 76%, respectively. The presence of fQRS on ECG may provide important predictive information on arterial stiffness in asymptomatic hypertensive patients.

Increased cardio-ankle vascular index in hyperlipidemic patients without diabetes or hypertension.

The cardio-ankle vascular index (CAVI) is a sensitive non-invasive marker of arterial stiffness and atherosclerosis. The aim of this work was to compare the CAVI values in patients with dyslipidemia (without diabetes mellitus and hypertension) and healthy controls. A Total 248 subjects with dyslipidemia (104 men, 144 women), 55.0 (95% CI 30-70) years of age with combined hyperlipidemia or primary hypercholesterolemia and 537 healthy controls (244 men, 293 women) 40.0 (95% CI 26-62) years of age were included in this study. Fasting blood samples were collected to measure the serum total cholesterol, triglyceride, HDL-cholesterol and apolipoprotein A1 and B levels. The LDL cholesterol level was also calculated, and the CAVI was measured using the VaSera(®) 1500 system. The CAVI values were significantly higher in the dyslipidemic patients (8.08, 95% CI 6.00-10.05) than in the controls (7.11, 95% CI 5.77-9.05; p < 0.01). In addition, the CAVI values were elevated in both subgroups of patients with hypercholesterolemia (7.95, 95% CI 5.85-6.90; p < 0.01) and combined hyperlipidemia (8.30, 95% CI 6.60-10.15; p < 0.01) in comparison with those observed in the controls. After adopting the propensity score method in order to balance the confounding factors (age, gender, body mass index) and adjust the analysis for diastolic blood pressure, the CAVI values in the dyslipidemic patients remained significantly high (7.78, 95% CI 5.80-9.69) compared to that observed in the controls (7.31, 95% CI 5.44-9.35; p < 0.001). However, the CAVI values did not differ significantly between the controls and both subgroups of dyslipidemic patients(primary hypercholesterolemia, combined hyperlipidemia). The present findings demonstrated that dyslipidemia increases the CAVI values in comparison to that seen in healthy subjects.

Association between the Postprandial Glucose Levels and Arterial Stiffness Measured According to the Cardio-ankle Vascular Index in Non-diabetic Subjects.

Although a relationship between post-challenge hyperglycemia and arterial stiffness has been reported, the relationship between the postprandial glucose levels and cardio-ankle vascular index (CAVI) in non-diabetic subjects is not clear. This study thus evaluated the association between the postprandial glucose levels after a composite meal and the degree of arterial stiffness measured according to CAVI in non-diabetic subjects. The subjects included 1,291 individuals (655 men and 636 women; mean age, 48.6 years; range, 23-85 years) who underwent medical examinations, including blood tests and CAVI assessments, between October 2005 and April 2012. The 1-hour postprandial glucose levels were determined after a 600-kcal traditional Japanese meal. The CAVI values were significantly higher in the subjects with higher 1-hour postprandial glucose levels (≥140 mg/dL in men; ≥158 mg/dL in women). A simple regression analysis indicated that the CAVI values were significantly correlated with the 1-hour postprandial glucose levels in men (r=0.286, p<0.0001) and women (r=0.228, p<0.0001). After adjusting for age, BMI, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, 1-hour postprandial glucose, homeostatis model assessment of insulin resistance, estimated glemerular filtration rate, and high sensitive C-reactive protein, stepwise multiple regression analysis demonstrated that the 1-hour postprandial glucose level was an independent predictor associated with the CAVI in men (p=0.003) and older women 50 years of age or older (p=0.003). This study demonstrated that the 1-hour postprandial glucose levels are associated with increased CAVI values in non-diabetic men and older women 50 years of age or older.

Association of Metabolic Syndrome with the Cardioankle Vascular Index in Asymptomatic Korean Population.

Aim. Metabolic syndrome is characterized by a cluster of atherosclerotic cardiovascular risk factors. The cardioankle vascular index (CAVI) reflects arterial stiffness and may be used as an indicator of atherosclerotic cardiovascular disease. In this study, we investigated the association of CAVI with metabolic syndrome. Methods. A total of 1,144 adults were included in this study. We measured CAVIs and examined blood samples to identify metabolic syndrome according to WHO Asia Pacific criteria and NCEP-ATPIII criteria. AST, ALT, r-GTP, BUN, creatinine, high sensitivity C-reactive protein, and uric acid were also measured. Results. CAVI values were significantly higher in subjects with metabolic syndrome than those without metabolic syndrome and increased according to the number of metabolic syndrome components present. Subjects with high fasting blood sugar levels or high blood pressure showed high CAVI values. Multiple regression analysis showed that age, sex, diastolic blood pressure, and uric acid were independent predictors of CAVI. Conclusion. Subjects with metabolic syndrome had high CAVIs, which indicated arterial stiffness, and were closely associated with an increase in the number of metabolic risk factors. The individual risk factors for metabolic syndrome have the synergistic effect of elevating arterial stiffness in asymptomatic Korean population.

The cardio-ankle vascular index and ankle-brachial index in young russians.

A noninvasive approach to assess atherosclerosis in young people is of great concern. The cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) reflect the arterial conditions, although the CAVI has not fully been studied in Russian populations. This study aimed to determine the CAVI and ABI in young Russians, to compare these findings with those in their Japanese peers and to investigate the lifestyle correlates and genetic associations with the CAVI and ABI in the Russians. In addition to several atherosclerotic parameters and self-reported lifestyle factors, the CAVI and ABI levels were measured in 114 Russians (mean 21 years). Four gene polymorphisms, including cholesteryl ester transfer protein (CETP) Taq1B polymorphism, were typed in some of the subjects. The Russians exhibited significantly higher CAVI levels compared to their Japanese counterparts (5.87 vs. 5.36; p＜0.05), while the ABI levels were similar between the two populations. In the Russians, the ABI was significantly correlated with the mean blood pressure (r=-0.26) and heart rate (r=-0.43), while the CAVI did not show such correlations. No significant associations existed between lifestyle-related factors and the CAVI or ABI levels. A lower ABI level was found in carriers with the T-allele of CETP Taq1B in the Russians. The reference CAVI value can be specified for individual ethnic populations. Our findings suggest that Russians may develop atherosclerosis-related conditions at a younger age compared to Japanese subjects, although this must be verified in additional studies. The possible association between CETP polymorphisms and the ABI deserves further investigation.

Effects of Add-on Therapy Consisting of a Selective Mineralocorticoid Receptor Blocker on Arterial Stiffness in Patients with Uncontrolled Hypertension.

Aldosterone plays an important role in the pathogenesis of atherosclerosis; however, the significance of mineralocorticoid receptor blockade for atherosclerosis has not been fully elucidated. In this study, the effect of add-on eplerenone on the degree of arterial stiffness was examined in patients with uncontrolled hypertension. Forty-seven uncontrolled hypertensive patients who had previously been treated with anti-hypertensive drugs were examined retrospectively. Thirty-two patients received add-on therapy consisting of eplerenone (Group E) and 15 patients received add-on therapy with a Calcium channel blocker (CCB) or an increased dose of CCB (Group C) in addition to their baseline medications. Both the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were significantly decreased at two and 12 months in Group C. In contrast, neither the SBP nor DBP values were significantly changed at two months and eventually decreased at 12 months in Group E. The degree of arterial stiffness, as evaluated according to the cardio-ankle vascular index (CAVI), did not improve at either two or 12 months in Group C, whereas the CAVI values improved as early as at two months and the improvement was sustained at 12 months in Group E. The extent of change in the CAVI was not associated with the level of changes in the SBP or DBP values in Group E. Treatment with eplerenone added to the patient's baseline medications improves the degree of arterial stiffness as early as at two months after the beginning of treatment, independent of the blood pressure-lowering actions of these drugs in patients with uncontrolled hypertension.

The state of the vascular wall in adult population of Tomsk in the framework of the project ESSAY RF

The article presents the results of study of arterial stiffness, ankle-brachial index and pulse pressure in adult population of Tomsk in the framework of the project ESSAY RF (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). 1379 men and women of 24-64 y.o. were studied by using volumetric sphygmography (VaSera VS-1500, Fukuda Denshi, Japan).The optimal values of CAVI (cardio-ankle vascular index), as a marker of arterial stiffness, were considered in group of relatively healthy persons in russian population. CAVI values in whole studied population were analyzed in comparison with data of other researchers and in association with CVD and CVD risk factors.

Age-related progression of arterial stiffness and its elevated positive association with blood pressure in healthy people

Objective: Arterial stiffness occurs as a consequence of age and arteriosclerosis, but the mechanics of the progression of arterial stiffness along with age is not fully explored. We aim to investigate the age-related progression of arterial stiffness through the examination of 4659 healthy subjects aged from 20 to 75. Methods: The cardio-ankle vascular index (CAVI) was used as a marker of arterial stiffness. Piecewise linear regression model was utilized to analyze the association between different stages of age and arterial stiffness. The mean CAVI values of age groups were calculated to fit the linear regression and curvilinear regression models. We also constructed multiple regression models to examine the interactions of blood pressure and age on CAVI. Result: The regression coefficients (β) of piecewise linear regression of each age group (<35, 35–44, 45–59, >59) were 0.07062, 0.03133, 0.03840 and 0.07272 for men, and 0.03342, 0.02025, 0.04826 and 0.10604 for women, respectively. The highest R square came from curvilinear regression for men (R2 = 0.9220), and piecewise linear regression for women (R2 = 0.9454). The interactions between each type of blood pressure and age were significant (all P < 0.001). Conclusion: There were various increased trends between different stages of age. Age-related progression of arterial stiffness could be better explained by a growth curve, rather than a straight line. In addition, blood pressure has an increasingly positive association with CAVI values as age increases.

Serum osteoprotegerin is associated with arterial stiffness assessed according to the cardio-ankle vascular index in hypertensive patients.

Arterial stiffness is recognized to be an independent risk factor for cardiovascular morbidity and mortality. Recent studies have found that osteoprotegerin (OPG) is associated with increased pulse wave velocity and may reflect endothelial dysfunction. The aim of this study was to evaluate the relationship between the serum OPG level and arterial stiffness in hypertensive patients using the cardio-ankle vascular index (CAVI). Fasting blood samples were obtained from 115 hypertensive patients and 52 healthy participants. The CAVI value was derived using the waveform device (CAVI-VaSera VS-1000). The serum OPG levels were measured using a commercially available enzyme-linked immunosorbent assay. A CAVI value of ≥9 defined the high arterial stiffness group. Sixty-five hypertensive patients (56.5%) were included in the high arterial stiffness group. Diabetes (p=0.032), smoking (p=0.044), age (p < 0.001), systolic blood pressure (p=0.001), diastolic blood pressure (p=0.024), pulse pressure (p=0.046) and the creatinine (p=0.013) and serum OPG (p < 0.001) levels were higher in the high arterial stiffness group than in the low arterial stiffness group, while the glomerular filtration rate (p=0.003) was lower in the high arterial stiffness group than in the low arterial stiffness group among the hypertensive patients. The results of the Spearman's rank correlation coefficient test also indicated a strong positive correlation between the OPG and CAVI values (r=0.484, p < 0.001) in the hypertensive patients. In addition, a multivariate logistic regression analysis showed that age (odds ratio: 1.162, 95% confidence interval (CI): 1.070-1.263, p < 0.001), diastolic blood pressure (odds ratio: 1.109, 95% CI: 1.033-1.190, p=0.004), and serum OPG level (odds ratio: 1.275, 95% CI: 1.030-1.580, p=0.026) were independent predictors of arterial stiffness in hypertensive patients. The serum OPG level is positively associated with arterial stiffness in hypertensive patients.

GW25-e0055 Comparative study of cardio-ankle vascular index between Chinese and Japanese healthy subjects

Arterial stiffness is an independent predictor for vascular diseases. Cardio-ankle vascular index (CAVI) is a new index of arterial stiffness. However, there was little research about the CAVI value between different countries. The aim of the present study was to compare CAVI between Chinese and

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

Arterial stiffness is a significant predictor of cardiovascular disease (CVD), the risk of 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 the impact of these changes on future CVD outcomes in patients with coronary artery disease (CAD). 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 greater than the mean plus 1 s.d. of the age- and gender-specific normal CAVI values, according to results obtained in 5188 healthy subjects. All patients were followed for > 1 year or until the occurrence of a CVD event. Of the 211 patients, CAVI improved in 106 (50%) patients after 6 months, 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 = 0.01), independent of baseline CAVI. CVD outcomes were worse in patients with persistently impaired CAVI than in those with improved CAVI (P < 0.001). Among patients with a normalized CAVI after treatment (n = 22) only one suffered a CVD event. This study was the first to demonstrate that persistent impairment of arterial stiffness was an independent risk factor of future CVD events. Serial measurements of CAVI provide important prognostic information regarding patients with CAD in clinical practice.

Arterial Stiffness and Impaired Renal Function in Patients With and Without Diabetes Mellitus

Abstract Background and aims: Cardio-Ankle Vascular Index (CAVI) was developed as an index of arterial stiffness independently of blood pressure and other markers of early atherosclerosis. The aim of the study was to assess the correlations between CAVI and renal disease in type 2 diabetic patients compared with those without diabetes. Material and methods: We evaluated anthropometric, biochemical and vascular parameters (through CAVI) in 133 patients with and 80 without type 2 diabetes mellitus (T2DM) mean aged 59.34 ± 11.94 years. Results: We found that 52.04 % of subjects with T2DM and 22.22 % of patients without T2DM had pathological arterial stiffness. Mean CAVI value was significantly higher in T2DM (p = 0.04), positively correlated with age and negatively with glomerular filtration rate. The prevalence of chronic kidney disease in patients with pathological vascular stiffness was 5.28 times higher in T2DM compared with the control group. Conclusion: The prevalence of pathological vascular stiffness, mean CAVI and prevalence of chronic kidney disease (CKD) were also higher in patients with T2DM than in the control group. Arterial stiffness plays an important role in renal impairment both in normoglycemic subjects and patients with T2DM, so preventive measures to optimize lifestyle and treatment must target the decrease of CAVI

Comparative study of cardio-ankle vascular index between Chinese and Japanese healthy subjects

Objectives: Arterial stiffness is an independent predictor for vascular diseases. Cardio-ankle vascular index (CAVI) is a new index of arterial stiffness. However, there was little research about the CAVI value between different countries. The aim of the present study was to compare CAVI between Chinese and Japanese subjects and to assess related factors.Methods: 2519 healthy persons [1245 Chinese (M/F, 524/721) and 1274 Japanese (M/F, 534/740)] from the Department of Physical Examination were enrolled into our study. CAVI was recorded using a VaseraVS-1000 vascular screening system.Results: CAVI was increasing with aging in all subjects. CAVI was significantly lower in Chinese compared with Japanese both in male and female. There was difference in lipid metabolism between these two groups. Multivariate analysis showed that age, systolic blood pressure (SBP), fasting plasma glucose (FPG), plasma creatinine (Cr) were significant independent associating factors of CAVI in Chinese persons (β = 0.548, p < 0.001; β = 0.129, p = 0.001; β = 0.105, p = 0.006; and β = 0.100, p = 0.012, respectively), whereas age, SBP, high-density lipoprotein cholesterol (HDL-C), Cr, body mass index (BMI), FPG were significant independent associating factors of CAVI in Japanese subjects (β = 0.669, p < 0.001; β = 0.198, p < 0.001; β = −0.079, p < 0.001; β = 0.090, p < 0.001; β = −0.124, p < 0.001; β = 0.055, p=0.009; respectively).Conclusions: CAVI was increasing with aging in both Chinese and Japanese subjects. CAVI was significantly lower in Chinese than in Japanese subjects. Age, SBP, FPG and creatinine were independently associated with CAVI in both Chinese and Japanese subjects.

CARDIO-ANKLE VASCULAR INDEX (CAVI) AND ARTERIAL STIFFNESS ASSESSMENT AT MEDICAL PREVENTION DEPARTMENTS AND UNITS

Aim. To study the clinical potential and feasibility of the assessment of cardio-ankle vascular index (CAVI) at medical prevention departments and units.Material and methods. The study included 66 patients (13 men and 53 women; mean age 52,26±11,2 years) with very low to very high total cardiovascular risk (CVR) levels and SCORE index 0–25% (mean SCORE index 3,18±4,34%), who underwent volume sphygmography and automatic CAVI measurement.Results. There was a moderately strong, statistically significant correlation between CAVI and age; CAVI and systolic blood pressure (SBP); and CAVI and SCORE. While higher CAVI values were observed among non-smokers and patients with arterial hypertension, these differences were not statistically significant.Conclusion. As a method for arterial stiffness assessment, CAVI measurement is easy to perform, does not require any special preparation, and can be used at medical prevention departments and units as a part of a more detailed preventive examination. A moderately strong, statistically significant correlation was observed between CAVI and SCORE, as well as between CAVI and such SCORE components as age and SBP. However, further research is needed in order to clarify the possibility of CAVI inclusion in prognostic models.

Recovery of Flow-Mediated Vasodilatation after Repetitive Measurements Is Involved in Early Vascular Impairment: Comparison with Indices of Vascular Tone

In repetitive measurements of flow-mediated dilatation (FMD), the duration of the interval between measurements remains controversial. In this pilot study, we conducted three sequential measurements of low–flow-mediated constriction (L-FMC), FMD and flow-mediated total dilation (FMTD; L-FMC+ FMD) at baseline and intervals of 15 and 60 min in 30 healthy males. FMD15, L-FMC15, and FMTD15 were significantly lower than the respective first measurements, but all indices showed full recovery at 60 min in all subjects. The baseline diameter was slightly increased at 15 min and restored at 60 min, but the maximum diameter, and the baseline and reactive flow velocity unchanged. We examined the relationship between recovery rate of FMTD at 15 min (FMTD-R) and cardio-ankle vascular index (CAVI). Univariate analysis showed moderate correlation between FMTD-R, and CAVI and L-FMC0. Patients were divided according to FMTD-R value; the low-FMTD-R group [below the median value (−26.2%)] included a significantly higher proportion of smokers and higher CAVI values than the high-FMTD-R group. The reproducibility of FMTD and FMTD-R was evaluated in another group of 25 healthy subjects. The range of variation across measurements was 1.1% for FMTD and 4.6% for FMTD-R; with intraclass correlation coefficients of 0.93 and 0.95, respectively. The present study demonstrated blunted recovery of FMD within 15 min, suggesting the need for selection of a more adequate interval between measurements to avoid underestimation of FMD in subsequent measurements. The findings demonstrated the reproducibility of FMTD-R and FMTD measurements, and that FMTD-R might be involved in arterial stiffness and early vascular impairment in the healthy subjects.

Abstract 19214: Inverse Relationships of Cardio-Ankle Vascular Index and Body Mass Index in Children

Objective: The epidemic of childhood obesity, with early onset of adult-type diseases like diabetes and hypertension, is creating a national health crisis. Cardio-ankle vascular index (CAVI), a non-invasive measure of vascular function, reflects the stiffness of arteries independently of changes in blood pressure (BP). There are currently no CAVI scores available for children. We hypothesized that CAVI, by providing an objective measure of vascular health, may help identify children at increased risk for cardiovascular disease. Methods: Study subjects were 292 Non- Hispanic White, Non- Hispanic Black, or Hispanic children 10-18 years old, normal weight (BMI85th percentile for age). CAVI values were measured using the VaSera VS-1500N device. Results: CAVI was measured in 292 children, with 133 males and 159 females, including 89 Black, 100 White and 103 Hispanic children. After controlling for age, sex, and body weight, normal weight Black males had a higher CAVI score in comparison to Hispanic males and White males (5.53±0.15 vs. 5.13±0.15 vs. 5.02±0.15, p=0.04). In univariate analyses, mean BP showed a positive correlation with BMI (r=0.4, p&lt;0.001). Interestingly, BMI had a negative effect on the CAVI score (r= -0.335, p&lt;0.0001). In multivariate analysis, raw BMI and average CAVI scores were significant predictors of the other (R2=0.34, p&lt;0.001, R2=0.21,p&lt;0.001 respectively). No correlation occurred between the CAVI and resting BP values, confirming that CAVI scores were independent of concurrent BP values. Conclusions: Significant differences in vascular function exist among ethnic groups. Obese children had lower CAVI scores, suggestive of possible vascular adaptation to obesity in early life. CAVI may be useful measure in long-term intervention studies using diet and exercise, and may be a cost-effective, non-invasive method for examining vascular health in children.

CARDIO-ANKLE VASCULAR INDEX IN PATIENTS WITH CORONARY HEART DISEASE: ROLE OF PERIPHERAL ATHEROSCLEROSIS

Aim. To study the association between cardio-ankle vascular index (CAVI) and peripheral atherosclerosis in patients with coronary heart disease (CHD). Material and methods. The study included 182 CHD patients (161 men and 21 women; mean age 58,5±7,5 years). The examination of peripheral arteries was performed using the VaSera VS-1000 device (Fukuda Denshi, Japan). Ankle-brachial index (ABI) and CAVI were calculated. All participants were divided into three groups: Group I (n=93): CAVI &lt;9,0 and ABI &gt;0,9; Group II (n=32): CAVI &lt;9,0 and ABI &lt;0,9; and Group III (n=57): CAVI &gt;0,9 and ABI &gt;0,9. Clinical parameters, coronary angiography (CAG) data, and ultrasound signs of peripheral artery atherosclerosis were compared across groups. Results. CAVI &lt;0,9, which reflected increased arterial stiffness, was observed in 31,3% of CHD patients. According to CAG results, Group I participants had a slightly higher prevalence of one-vessel pathology (32,3%) than their peers from Groups II and III (15,6% and 17,5%, respectively; p=0,07). The prevalence of three-vessel pathology was similar in all three groups (29%, 25%, and 28%; p=0,9). Atherosclerosis of three vascular basins was more prevalent in Group II (46,9%) and Group III (14%; p&lt;0,00001). In multivariate logistic regression analyses, increased CAVI was associated with age and body mass index (BMI). Conclusion. In CHD patients, high CAVI values were linked to older age and lower BMI. There was no clear association between CAVI and coro￾nary atherosclerosis severity; however, CHD patients with high CAVI and/or low ABI demonstrated a higher number of atherosclerosis-affected vascular basins.

Effects of Dividing Amlodipine Daily Doses on Trough Drug Concentrations and Blood Pressure Control Over a 24-Hour Period

BackgroundIn the treatment of hypertension, once-daily administration of long-acting antihypertensive drugs has been recommended for the improvement of treatment adherence; however, it is unclear whether dividing daily doses has the additional benefit of more ideal blood pressure (BP) control over a 24-hour period. ObjectiveThe aim of the study was to investigate whether dividing a 10-mg daily dose of amlodipine, a long-acting calcium channel blocker, is associated with increased trough plasma amlodipine concentrations, reduced arterial stiffness, and improved BP control over a 24-hour period. MethodsOutpatients with essential hypertension were included this open-label, 2-period crossover study. The patients were administered amlodipine 10 mg/d in 2 divided doses for 8 weeks. At week 4, blood was collected just before amlodipine administration for the evaluation of trough plasma amlodipine concentrations. At week 8, 24-hour, daytime, nighttime, and early morning BP, as well as arterial stiffness, were measured using ambulatory BP monitoring (ABPM) and cardio-ankle vascular index (CAVI), respectively. In the subsequent study period, amlodipine 10 mg/d was administered once daily, and the same tests were performed at the same timings as in period 1. ResultsTen patients were enrolled (7 men, 3 women; mean age, 61.0 [15.3] years). Mean 24-hour BP with twice-daily administration was not significantly lower than that with once-daily administration (129.7 [7.3]/80.1 [7.9] mm Hg vs 130.5 [11.8]/80.1 [7.9] mm Hg, respectively). Similarly, there were no significant differences in daytime, nighttime, or early morning BP between twice- and once-daily administration. In addition, the differences in trough plasma amlodipine concentrations (22.37 [7.66] ng/mL vs 20.57 [8.22] ng/mL) and CAVI values (8.2 [1.8] vs 8.5 [1.0]) were not significantly different between twice- and once-daily administration. ConclusionsAdministering amlodipine in 2 divided doses was not associated with increased trough plasma amlodipine concentrations, reduced arterial stiffness, or improved BP control over a 24-hour period in patients with essential hypertension. UMIN Clinical Trials Registry no. UMIN000003914.