Higher Cardio-ankle Vascular Index Research Articles

Increasing age associated with elevated cardio–ankle vascular index scores in patients with type 2 diabetes mellitus

The study investigated the relationship between arterial stiffness calculated using the cardio-ankle vascular index (CAVI), diagnosis of type 2 diabetes mellitus and type 2 diabetes-related cardiovascular complications, in patients with type 2 diabetes mellitus (type 2 diabetes) and nondiabetic patients. A retrospective cross-sectional study was conducted in patients with type 2 diabetes and age-matched nondiabetic patients. CAVI was measured using an automatic vascular screening system. Parameters associated with type 2 diabetes and cardiovascular complications were also measured. A total of 51 patients with type 2 diabetes and 59 nondiabetic patients were enrolled in the study. Significantly higher CAVI scores were observed in patients with type 2 diabetes compared with nondiabetic patients (mean ± SD: 9.55 ± 1.13 versus 8.54 ± 0.94, respectively). Multivariate linear regression analyses demonstrated that age was the only significant factor influencing the CAVI score, in patients with type 2 diabetes. Patients with type 2 diabetes had an increased risk of arterial stiffness, based on the CAVI score, compared with nondiabetic patients; this, in turn, could increase their risk of developing other cardiovascular complications.

Abstract TP216: Cardio-Ankle Vascular Index (CAVI) Is A Novel Parameter To Predict Aortic Arch Plaque Causing Atherothrombotic Stroke

Aortic arch plaque is an important cause of atherothrombotic stroke. The cardio-ankle vascular index (CAVI) has been reported as a novel parameter for aortic stiffness, and high CAVI implies progression of carotid and coronary arteriosclerosis. However, it remains to be determined whether CAVI is associated with arch plaques. We performed CAVI and transesophageal echocardiography in 290 subjects (197 males, 65 ± 12 years), including 29 patients with the history of atherothrombotic stroke. We defined arch plaque as wall thickness ≥ 4 mm and the presence of ulceration or mobile plaque in aortic arch. CAVI showed a good correlation with age, systolic blood pressure, fibrinogen, von Willebrand factor, carotid plaque score and arch wall thickness. CAVI was higher in subjects with following risk factors than in those without; hypertension, diabetes mellitus, and dyslipidemia. CAVI was higher in subjects with ulceration or mobile plaques than in those without. CAVI was higher in subjects with atherothrombotic stroke than in those without (10.5 vs. 8.6, P<0.001). The subjects with CAVI ≥ 9 had higher risk for atherothrombotic stroke compared with those with CAVI < 9 in univariate logistic regression analysis (odds ratio 5.07, 95% confidence interval 2.16-11.91). Multivariate logistic regression analysis revealed that CAVI was an independent risk factor for atherothrombotic stroke. In conclusion, CAVI is a novel parameter predicting aortic arch plaques, which cause atherothrombotic stroke.

Association of Inflammatory Gene Polymorphisms and Conventional Risk Factors With Arterial Stiffness by Age

BackgroundInflammatory gene polymorphisms are potentially associated with atherosclerosis risk, but their age-related effects are unclear. To investigate the age-related effects of inflammatory gene polymorphisms on arterial stiffness, we conducted cross-sectional and 5-year follow-up studies using the cardio-ankle vascular index (CAVI) as a surrogate marker of arterial stiffness.MethodsWe recruited 1850 adults aged 34 to 69 years from the Japanese general population. Inflammatory gene polymorphisms were selected from NF-kB1, CD14, IL-6, IL-10, MCP-1, ICAM-1, and TNF-α. Associations of CAVI with genetic and conventional risk factors were estimated by sex and age group (34–49, 50–59, and 60–69 years) using a general linear model. The association with 5-year change in CAVI was examined longitudinally.ResultsGlucose intolerance was associated with high CAVI among women in all age groups, while hypertension was associated with high CAVI among participants in all age groups, except younger women. Mean CAVI for the CD14 CC genotype was lower than those for the TT and CT genotypes (P for trend = 0.005), while the CD14 polymorphism was associated with CAVI only among men aged 34 to 49 years (P = 0.006). No association of the other 6 polymorphisms with CAVI was observed. No association with 5-year change in CAVI was apparent.ConclusionsInflammatory gene polymorphisms were not associated with arterial stiffness. To confirm these results, further large-scale prospective studies are warranted.

Association of the Cardioankle Vascular Index and Ankle-Brachial Index with Carotid Artery Intima Media Thickness in Hemodialysis Patients

The objectives of the present study are (1) to compare the cardioankle vascular index (CAVI), ankle-brachial index (ABI), and carotid artery intima-media thickness (CA-IMT) between HD patients with and without type 2 diabetes (T2D) or prevalence of cardiovascular (CV) disease and (2) also to evaluate the relationship of these indices with CA-IMT in these patients according to ABI levels. This study consisted of 132 HD patients with T2D and the same number of patients without T2D. The patients with diabetes or prevalence of CV disease had significantly higher CA-IMT and lower ABI values than those without diabetes or prevalence of CV disease, respectively. Although diabetic patients had higher CAVI than those without diabetes, CAVI did not differ between patients with or without prevalence of CV disease. In univariate analysis, CA-IMT was more strongly correlated with ABI than CAVI. However, the opposite was true in patients with an ABI value of more than 0.95. Both indices were significantly correlated with CA-IMT although ABI was a powerful determinant than CAVI. It appears that both indices are associated with CA-IMT in HD patients, especially with an ABI value of more than 0.95.

Arterial Stiffness Using Cardio-Ankle Vascular Index Reflects Cerebral Small Vessel Disease in Healthy Young and Middle Aged Subjects

The cardio-ankle vascular index (CAVI) reflects overall arterial stiffness from the aorta to the ankle, independent of blood pressure. Cerebral small vessel diseases (SVDs), including white matter lesions (WML), silent lacunar infarction (SLI) and cerebral microbleeds (CMB), are considered to increase the risk of stroke and cognitive impairment further. We aimed to investigate the association of cerebral SVD with CAVI in asymptomatic young and middle-aged subjects. Asymptomatic Korean individuals aged 30 to 59 years old without neurologic disease who had CAVI and brain magnetic resonance imaging (MRI) were evaluated retrospectively. Among 484 subjects, cerebral SVDs (advanced WML, SLI and CMB) were found in 20 (4.1%). Subjects with SVDs tended to be older and to have higher systolic blood pressure (SBP) and higher CAVI. From multivariate regression analysis, including pulse pressure (PP) or SBP, CAVI showed a significant association with SVD [adjusted OR (95% CI): 1.889 (1.094-3.263), p= 0.002 and 1.793 (1.020-3.153), p= 0.043, for PP and SBP, respectively]. When CAVI was assessed by quartiles, the highest quartile of CAVI (CAVI >7.65) showed a significant association with SVD, after adjustment for PP [adjusted OR (95% CI): 2.766 (1.115-6.866), p= 0.028]. In young and middle-aged subjects, cerebral SVD was significantly associated with arterial stiffness measured by CAVI after adjusting for PP or SBP.

Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis

Cerebral microbleeds (CMBs) are recognized as a manifestation of arteriolosclerosis in cerebral small vessels. However, little is known regarding whether stroke patients with CMBs often have systemic atherosclerosis. The aim of the present study was to elucidate this issue using the cardio-ankle vascular index (CAVI), a new index of systemic atherosclerosis, in acute ischemic stroke patients. We prospectively studied 105 patients (71 males, median age=70.0 years) with acute ischemic stroke. All of the patients were examined using T2*-weighted gradient echo magnetic resonance imaging (MRI) to look for and assess the CMBs and using fluid-attenuated inversion recovery to evaluate white matter hyperintensity (WMH). We assigned the patients into CMB and non-CMB groups and compared the clinical characteristics of these groups. The factors associated with CMBs were investigated using multivariate logistic regression analysis. T2*-weighted gradient echo MRI revealed CMBs in 47 patients (44.8%) and no CMBs in 58 patients (55.2%). The CAVI was significantly higher in the CMBs group (10.5 vs. 8.6, P<0.001). In the multivariate logistic regression analysis, CAVI per one point increase (odds ratio (OR), 1.50; 95% confidence interval (CI), 1.12-2.00; P=0.006), advanced WMH (OR, 4.78; 95% CI, 1.55-14.74; P=0.006) and impaired kidney function (OR, 3.31; 95% CI, 1.16-9.81; P=0.031) were independent factors associated with the presence of CMBs. A high CAVI was independently associated with CMBs in patients with acute ischemic stroke. Our results indicated that ischemic stroke patients with CMBs may have cerebral arteriolosclerosis as well as systemic atherosclerosis.

High Cardio-Ankle Vascular Index in Patients Who Have Coronary Spastic Angina

要 旨：過去にcoronary spastic angina(CSA)とcardio-ankle vascular index(CAVI)との関連についての報告はない。そこで今回2009年に心臓カテーテル検査で冠攣縮誘発試験を行った41例を冠攣縮陽性群と陰性群の2郡に群別し，その関連を検討した。評価項目は年齢・性別・喫煙・血圧・脂質代謝(T-Cho，TG，HDL，LDL，LDL/HDL比)・糖代謝(HbA1C)・ABI・CAVIとした。2群間で有意差が得られたのはCAVIのみであった(陽性群8.78±0.21，陰性群7.73±0.26，P=0.004)。血管内皮障害がCSAを惹起し，CAVIを上昇させたと考えられた。

Evaluation of Arteriosclerotic Vascular Disease with a New Noble Stiffness Indicator, Cardio-Ankle Vascular Index (CAVI)

Arterial stiffness is a well-known predictor of arteriosclerotic vascular disease. One index of arterial stiffness was the pulse wave velocity (PWV). But, it is known that PWV depends on the blood pressure at measuring time. Cardio-ankle vascular index (CAVI) is derived from stiffness parameter beta, and reflects the stiffness of the artery from the origin of the aorta to the ankle as a whole. Conspicuous feature is independency from the blood pressure at measuring time. An administration of alfa-1 blocker, doxazosin decreased CAVI transiently. Prostacyclin analogue, beraprost also decreased CAVI. These results suggest that CAVI might reflect the smooth muscle cell contracture. CAVI showed high value with aging, and in patients with cerebral infarction, coronary stenosis, and chronic hemodialysis, suggesting that CAVI is reflecting systemic vascular arteriosclerosis. As for the risks of coronary artery disease, CAVI showed high value in hypertension, diabetes mellitus, dyslipidemia, smoking and metabolic syndrome. Improvement of those risk factors reduced CAVI. CAVI seems to be a useful indicator for the management of the risk factors. Arterial inflammatory diseases also showed high CAVI value. Furthermore, various associations between CAVI and cardiac functions such as left ventricular diastolic function were reported. Above results suggested that CAVI reflect the degrees of arteriosclerosis and of ages, and also reflect the contracture of arterial smooth muscle cells. CAVI might be useful to investigate a new insight of vascular function.

Association between arterial stiffness and pulmonary function in hypertensive patients

Arterial stiffness, assessed by cardio-ankle vascular index (CAVI), is clinically used to assess arteriosclerosis. Recently, pulmonary age, as determined by pulmonary function test, has been proposed by the Japanese Respiratory Society as a diagnostic measure for chronic obstructive pulmonary disease (COPD). This study aims to examine the association between CAVI and pulmonary function and to elucidate the correlation between vascular stiffness and pulmonary age in hypertensive patients. We enrolled a total of 45 hypertensive patients (70±9 years) who had been taking antihypertensive medications for at least 1 year. Pulmonary function was measured by the percentage of predicted forced vital capacity (FVC) and the ratio of forced expiratory volume in 1 s (FEV(1)) to FVC (FEV(1)/FVC ratio). Pulmonary age was determined by the equation proposed by the Japanese Respiratory Society. CAVI was measured at the same clinic visit. In the simple correlation analysis CAVI correlated with the FEV(1)/FVC ratio (r=-0.399, P=0.007) and pulmonary age (r=0.559, P<0.001). Multiple linear regression analysis revealed that CAVI was independently associated with FEV(1)/FVC ratio (β=-0.418, P=0.014) and pulmonary age (β=0.514, P=0.002). In addition, CAVI was significantly higher in patients with increased pulmonary age (9.4±1.4) than in those with normal pulmonary age (8.4±0.9) (P=0.011). The present study indicates that an increased CAVI is independently associated with reduced pulmonary function and increased pulmonary age. Hypertensive patients with high CAVI may need to be monitored for the progression of COPD.

Diabetic Peripheral Neuropathy Is Associated With Increased Arterial Stiffness Without Changes in Carotid Intima–Media Thickness in Type 2 Diabetes

OBJECTIVEThis study was conducted to investigate the association of diabetic peripheral neuropathy (DPN) with both arterial stiffness and intima–media thickness (IMT).RESEARCH DESIGN AND METHODSWe conducted a cross-sectional analysis of 731 subjects with type 2 diabetes. DPN was diagnosed on the basis of neuropathic symptoms, insensitivity to a 10-g monofilament, abnormal pin-prick sensation, and abnormal current perception threshold. Arterial stiffness was assessed by cardio-ankle vascular index (CAVI), and IMT was assessed by B-mode ultrasonography.RESULTSPatients with DPN had higher CAVI than those without DPN in multivariate-adjusted models, whereas no differences in IMT were observed between patients with and without DPN after adjustment for age and sex. In the multivariate analysis, CAVI was a significant determinant of DPN (odds ratio 1.36 [95% CI 1.13–1.65], P = 0.001).CONCLUSIONSDPN is significantly associated with arterial stiffness without carotid intimal changes in patients with type 2 diabetes.

Association of Cardio-Ankle Vascular Index with Cardiovascular Disease Risk Factors and Coronary Heart Disease among Japanese Urban Workers and their Families

Purpose: Recently the cardio-ankle vascular index (CAVI) has been developed to represent the extent of arteriosclerosis in the artery from the aortic valve to the ankle. The aim of the study is to examine the association of CAVI scores with the established cardiovascular disease (CVD) risk factors and coronary heart disease (CHD). Methods: Subjects were 9,881 men and 12,033 women of company employees and their families between 20 and 70 years of age and over who participated in CVD screening in Japan. The screening included measurements of CAVI, electrocardiogram, blood pressure, lipids, serum glucose, hemoglobin A1c, height, weight, and questions on smoking and drinking status. Persons having CHD were defined as those having history of CHD and/or having abnormal Q wave and/or ischemic change in ECG. After converting CAVI scores to binary variables (normal or abnormally high CAVI scores), logistic regression analysis was conducted. Results: After adjusting for age, significant odds ratios (ORs) of abnormally high CAVI scores among men were found with diabetes mellitus (10.02, p<0.001), hypertension (8.37, p<0.001), triglycerides (2.76, p<0.001, for 150-199mg/dL and 2.85, p<0.001, for ≥200mg/dL, as reference:<150mg/dL), high density lipoprotein cholesterol (0.19, p<0.001, for 40-59mg/dL and 0.20, p<0.001 for ≥60mg/dL, as reference: <40mg/dL), body mass index (2.04, p<0.001, for <20, 2.31, p<0.001, for 28-29.9 and 3.37, p<0.001, for ≥30 as reference:20-22.9), and ex-smokers (1.20, p<0.01, as reference: non-smokers). Almost identical results were found among women, except a significant OR with current smokers (2.25, p<0.001). The significant association between CHD and abnormally high CAVI scores was found: OR=3.87, p<0.001 for men and 1.45, p<0.01 for women after adjusting for CVD risk factors. Conclusions: Our results confirmed that CAVI scores are a reliable indicator of arteriosclerosis reflecting the extent of arterial stiffness and atherosclerosis in the major artery between the aortic valve and the ankle.

Low insulin level is associated with aortic stiffness

Recent studies have demonstrated that hyperinsulinemia is a risk factor for cardiovascular disease. The aim of this study was to evaluate the relationship between serum insulin level and the cardio-ankle vascular index (CAVI), which was developed as a marker of arterial stiffness. We performed a cross-sectional study of 260 consecutive and nondiabetic subjects with clinical suspicion of coronary heart disease. We measured CAVI in all subjects. A standard 75-g oral glucose tolerance test was performed, and plasma glucose and serum insulin levels were measured in venous blood collected at 0, 30, 60 and 120 min after the test. Statistical analyses were conducted for four subgroups according to the insulin area under the concentration time curve (InsAUC). Mean CAVI and InsAUC were 8.7 and 109.5 μIUml(-1)h(-1), respectively. Unadjusted analysis demonstrated that the InsAUC quartiles were significantly associated with CAVI (P<0.0001), and the lowest InsAUC quartile (P=0.001) had a lower glucose AUC. Analysis of covariance demonstrated that the lowest InsAUC quartile had the highest CAVI, and, after adjusting for several coronary risk factors, the highest InsAUC quartile had a higher CAVI than the second and third InsAUC quartiles (P<0.0001). In conclusion, the lowest InsAUC quartile was related to CAVI, although the lowest InsAUC quartile maintained glucose homeostasis in this study population. Both hyperinsulinemia and low insulin level are independently associated with CAVI.

Effects of Metabolic Syndrome on Cardio-Ankle Vascular Index in Middle-Aged and Elderly Chinese

Metabolic syndrome is characterized by multiple risk factors and is associated with increased risk of diabetes and cardiovascular disease. The rapid change in the lifestyle and food habits of Chinese people has resulted in metabolic syndrome becoming one of the most widespread health challenges in China. Recently, the cardio-ankle vascular index (CAVI) was developed as a new parameter reflecting arterial stiffness and providing an index of vascular status. The purpose of this study was to investigate the effect of metabolic syndrome on CAVI. A total of 222 Chinese subjects aged 50-92 years participated in this study. We measured CAVI and examined blood samples to define metabolic syndrome according to the International Diabetes Federation criteria. CAVI in the subjects with abnormal waist circumference was significantly higher than that obtained in the normal subjects (P < 0.01). In the abnormal high-density lipoprotein cholesterol (HDL-C) group, CAVI was significantly increased (P < 0.01) compared to the normal HDL-C group. CAVI showed a positive correlation with waist circumference and increased significantly with the number of metabolic syndrome components. In conclusion, subjects with metabolic syndrome have a high CAVI that indicated arterial stiffness and is closely associated with an increase in the number of metabolic syndrome risk factors. Elevated abdominal obesity and low HDL-C are the main players affecting arterial stiffness in the middle-aged and elderly Chinese. These findings suggest that interaction of the individual components of metabolic syndrome plays a role in the relationship between metabolic syndrome and arterial stiffness.

INTERNATIONAL STUDY OF THE CARDIO ANKLE VASCULAR INDEX (CAVI) AS THE USEFUL PARAMETER TO EVALUATE THE ATHEROSCLEROSIS IN RUSSIA, CHINA, E.U., AND JAPAN: PP.19.230

Cardio Ankle Vascular Index (CAVI) is the parameter for the quantitative diagnosis of the atherosclerosis in the patients with hypertension. CAVI is simulating the stiffness parameter beta by the information of the pulse wave velocity, so CAVI is the stable parameter not influenced by the condition of the patients. In this paper, international cooperative study of CAVI was performed. Among the advanced countries, largest people in Russia died with cardiovascular events, and smallest people died with cardiovascular events in Japan. For the evaluation of the atherosclerosis, the relationship between the CAVI and aging was compared. Slope of the regression line between CAVI and Aging in a Japanese healthy person is smaller compared with Russian, suggesting that the Russian people showed rapid progress of atherosclerosis. In European Union (EU), the importance of obesity was increased more and more. Among E.U., worst group of obesity is Marta and Russia, and Czech, Lithuania, Belgium were in the second group. Thus, we evaluated the atherosclerosis in Czech, which exist in the center of E.U., as the typical example. In the analysis of an arteriosclerosis risk, it has become clear that existence of hypertension, diabetes and IHD had contributed to increase of CAVI. China has a long culture of food in the history. In this study, we had investigated the atherosclerosis in the people in the Jilin University, Changchun, China, and compared the data with Japanese people. CAVI in Chinese people showed increased value according to the Aging compared with Japanese. The smoker showed high CAVI. Surprisingly, the drinking did not have the effect in CAVI. Chinese who did not take meat showed larger value of CAVI. Chinese who did not take the fruit showed high CAVI. Unfortunately, criteria of obesity and metabolic syndrome are different, so that comparison is a little bit difficult. Development of atherosclerosis research may be desired for the peoples in the every countries health in future.

Cardio-Ankle Vascular Index as a Predictor of Cognitive Impairment in Community-Dwelling Elderly People: Four-Year Follow-Up

Background/Aim: The relation between markers of generalized atherosclerosis and cognitive impairment in old age is controversial. The aim of the study was to evaluate the cardio-ankle vascular index (CAVI) as a predictor of longitudinal changes in cognitive function in older individuals. Methods: We evaluated the cognitive function in elderly people with high (AS(+)) and low (AS(–)) values of CAVI each year over 4 years. Results: The changes in the Hasegawa Dementia Scale Revised (HDS-R) and the mini-mental state examination (MMSE) at 4 years were significantly larger in the AS(+) group (AS(+) vs. AS(–) = –1.8 ± 4.4 vs. 0.3 ± 2.8 points and –1.1 ± 3.0 vs. 0.1 ± 2.3 points, p = 0.008 and 0.03, respectively). The annual changes in the HDS-R were significantly decreased from baseline at 1 year later to 4 years later in AS(+) (baseline vs. 1, 2, 3, 4 years = 26.5 vs. 25.0, 25.5, 25.7, 24.8 points, p < 0.001); in comparison, the annual changes in MMSE significantly decreased from the baseline over the 4 years in AS (+) (baseline vs. 1, 2, 3, 4 years = 26.8 vs. 26.2, 25.8, 26.4, 25.7 points, p = 0.002). Conclusion: The results of this study suggest that elderly people with a high CAVI value are at a greater risk of cognitive decline.

Cardio-ankle vascular index measures arterial wall stiffness independent of blood pressure

Although brachial-ankle pulse wave velocity (baPWV) is a non-invasive method of detecting arteriosclerosis, it is affected by changes in blood pressure (BP). Cardio-ankle vascular index (CAVI) is a new method for estimating arteriosclerosis, and it has been reported to be less influenced by BP. We investigated the influence of BP changes on CAVI and the correlation of CAVI to clinical factors and carotid arteriosclerosis. CAVI and baPWV in 35 non-diabetic and 33 diabetic subjects were measured in increased BP (after stair climbing) and rested BP (after 10 min of rest). Intima-media thickness (IMT) of carotid arteries was measured by ultrasoundsonography. We achieved the following results: CAVI did not show a significant change with a change in BP in both non-diabetic and diabetic subjects. On the contrary, baPWV was significantly influenced by BP changes. Carotid artery IMT had a significant positive correlation with CAVI and baPWV. Multiple regression analysis revealed that significant risk factors of high baPWV were age and systolic BP. On the contrary, significant risk factors of high CAVI were age and hemoglobin A1c, while systolic BP was not relevant. Our findings suggest that CAVI is independent of BP and useful as an indicator of early arteriosclerosis in diabetic subjects.

Association of acute-phase reactants with arterial stiffness in patients with type 2 diabetes mellitus

Background The relationship between chronic low-grade inflammation and atherosclerotic progress in patients with diabetes mellitus has not been confirmed. We determined whether acute-phase reactants are associated with arterial stiffness in diabetic patients. Methods Relationships of blood inflammatory markers [high-sensitivity C-reactive protein (CRP), amyloid A protein (SAA), sialic acid, fibrinogen and white blood cells (WBC)] with atherosclerosis were investigated in a cross-sectional study using 114 subjects with type 2 diabetes. The degree of atherosclerosis was evaluated by arterial stiffness measured using cardio-ankle vascular index (CAVI), a new index of arterial stiffness, which is compatible with conventional aortic pulse-wave velocity. Results CRP, SAA, sialic acid, fibrinogen and WBC showed significant correlations with CAVI. CAVI was significantly higher in the highest tertile of sialic acid, fibrinogen and WBC compared with the lowest tertile or lowest and middle tertiles. This association was independent of age, sex and smoking. By logistic regression analysis, the highest levels of these acute-phase reactants showed increased risk of high CAVI, while CRP and SAA were not associated with an increased risk in this analysis. CAVI was also significantly correlated with duration of diabetes, blood pressure and serum total cholesterol. Conclusions Acute-phase reactants, such as CRP, SAA, sialic acid, fibrinogen and WBC, are associated with arterial stiffness in patients with type 2 diabetes mellitus.