baPWV Quartiles Research Articles

409 USE OF ANKLE-BRACHIAL BLOOD PRESSURE INDEX AND PULSE WAVE VELOCITY IN THE PREDICTION OF MORTALITY IN ELDERLY CHINESE

Objectives: We investigated the usefulness of combining ankle-brachial blood pressure index (ABI) with pulse wave velocity (baPWV) in the prediction of mortality in elderly Chinese. Methods: The subjects of our prospective observational study were older persons (≥60 years) living in a suburb town of Shanghai. In addition to the measurement of ABI and baPWV using an Omron device, we also measured conventional cardiovascular risk factors at baseline, and collected vital information during follow-up. Results: At baseline, the study participants (n = 3161, 1391 men [44.0%]) had a mean age of 69 years (±7 [SD]), and included 1897 (60.0%) hypertensive and 291 (9.2%) diabetic patients. During a mean follow-up of 4 years, the number of all-cause and cardiovascular deaths was 205 and 95, respectively. Subjects with an ABI of ≤0.9 (n = 84 [2.7%]), compared to those with an ABI greater than 0.9, had a significantly (P < 0.0001) higher incidence rate (per 1000 person-years) of total (73.4 vs. 15.0) and cardiovascular mortality (43.3 vs. 5.9). After exclusion of 84 subjects with an ABI of ≤0.9, we performed analysis on baPWV, and found that subjects in the top quartile of baPWV (>20 m/s), compared to rest 3 quartiles, had a significantly (P < 0.01) higher incidence rate of total (28.2 vs. 10.9) and cardiovascular mortality (15.5 vs. 3.9). However, after adjustment for sex, age and conventional cardiovascular risk factors, only the association between ABI and total mortality remained significant (P = 0.009). Conclusions: In conclusion, in elderly Chinese, ABI but not baPWV is independently predictive of total mortality.

Relationship between Brachial-ankle Pulse Wave Velocity and Cardiovascular Risk Factors: A Multi-ethnic Study

The objective of the present multi-ethnic study was to explore whether an association exists between brachial-ankle pulse wave velocity (baPWV) and cardiovascular risk factors in China. Two hundred sixty-four adult subjects (152 subjects were of Han nationality, 70 subjects were from Uygur, 19 subjects were from Kazakh, 15 subjects were from Hui, and 8 subjects were of other nationalities.) aged 30-82 years were enrolled in the present study. The subjects' anthropometric, baPWV and laboratory measurements were recorded. Age (p=0.000), systolic blood pressure (p=0.000), diastolic blood pressure (p=0.002), fasting blood glucose (p=0.000), and hemoglobin (p=0.019) differed significantly among the subjects in the baPWV quartile. Spearman correlation analyses indicated that baPWV was significantly and positively associated with age (r=0.584, p=0.000), systolic blood pressure (r=0.396, p=0.000), diastolic blood pressure (r=0.217, p=0.000), and fasting blood glucose (r=0.231, p=0.000). baPWV was significantly and negatively associated with erythrocyte number (r=-0.181, p=0.003) and hemoglobin (r=-0.192, p=0.002) levels. Multiple regression analyses suggested that age (β=0.573, p=0.000), systolic blood pressure (β=0.181, p=0.003), triglycerides (β=0.160, p=0.008), and cholesterol (β=0.132, p=0.020) were independently associated with baPWV. Age, SBP, triglycerides, and cholesterol levels are independently and positively associated with baPWV.

Metabolic syndrome is associated with change in subclinical arterial stiffness - A community-based Taichung Community Health Study

BackgroundThe aim of this study was to evaluate the effect of MetS on arterial stiffness in a longitudinal study.MethodsBrachial-ankle pulse wave velocity (baPWV), a measurement interpreted as arterial stiffness, was measured in 1518 community-dwelling persons at baseline and re-examined within a mean follow-up period of 3 years. Multivariate linear regression with generalized estimating equations (GEE) were used to examine the longitudinal relationship between MetS and its individual components and baPWV, while multivariate logistic regression with GEE was used to examine the longitudinal relationship between MetS and its individual components and the high risk group with arterial stiffness.ResultsSubjects with MetS showed significantly greater baPWV at the end point than those without MetS, after adjusting for age, gender, education, hypertension medication and mean arterial pressure (MAP). MetS was associated with the top quartile of baPWV (the high-risk group of arterial stiffness, adjusted odds ratio [95% confidence interval] 1.52 [1.21-1.90]), and a significant linear trend of risk for the number of components of MetS was found (p for trend < 0.05). In further considering the individual MetS component, elevated blood pressure and fasting glucose significantly predicted a high risk of arterial stiffness (adjusted OR [95% CI] 3.72 [2.81-4.93] and 1.35 [1.08-1.68], respectively).ConclusionsMetS affects the subject's progression to arterial stiffness. Arterial stiffness increased as the number of MetS components increased. Management of MetS is important for preventing the progression to advanced arterial stiffness.

The Relationship Between Arterial Stiffness and Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease and some studies have documented its link with cardiovascular risk factors. This study aimed to investigate the association between arterial stiffness and NAFLD. Among 1,442 health check-up subjects (955 men, 487 women), we examined the association between brachial-ankle pulse wave velocity (baPWV) as a measurement of arterial stiffness and the presence of NAFLD based on abdominal sonographic findings. Multivariate linear and logistic regression analyses were conducted to examine the independent association between baPWV and the presence of NAFLD in gender-specific manners. In multivariate regression analysis, NAFLD was found to be independently associated with baPWV in both men and women. Moreover, in multivariate logistic regression analysis, a graded independent relation was found between higher levels of baPWV and the prevalence risk of NAFLD. Odds ratios (95% CI) for the highest vs. the lowest quartile of baPWV were 1.85 (range, 1.13-2.62) in men and 3.32 (1.45-7.62) in women after adjusting for age, smoking status, regular exercise, body mass index, blood pressure, fasting plasma glucose, triglyceride, HDL-cholesterol, hypertension and diabetes. Arterial stiffness was independently associated with the prevalence risk for NAFLD regardless of classical CVD risk factors.

Albuminuria is strongly associated with arterial stiffness, especially in diabetic or hypertensive subjects—A population-based study (Taichung Community Health Study, TCHS)

ObjectiveAlbuminuria is recognized as a marker of vascular dysfunction. Brachial–ankle pulse wave velocity (baPWV) reflects the stiffness of central and peripheral muscular arteries. Limited information is available for the association between albuminuria and arterial stiffness in Chinese. We aimed to assess the association between albuminuria and arterial stiffness in a middle-aged population-based study. MethodsA total of 2180 subjects aged 40 years and over were recruited in 2004 in Taiwan. Albuminuria was defined as urinary albumin-to-creatinine ratio (ACR)≥30mg/g creatinine. BaPWV was divided by quartile. Multiple logistic and linear regression analyses were used to evaluate the relationship between baPWV and albuminuria. ResultsAfter adjusting for age, body mass index, mean arterial pressure, fasting glucose, triglycerides, total cholesterol, chronic kidney disease, smoking, alcohol drinking, and physical activity status, multiple logistic regression analyses revealed baPWV groups were significantly associated with albuminuria. Compared to the lowest baPWV quartile, the adjusted odds ratio of having albuminuria for baPWV quartile II, III, and IV were 1.12(0.63–2.02), 2.04(1.15–3.60), and 2.45(1.29–4.65). The significant increase in odds ratios for albuminuria in progressive baPWV quartiles reveals a dose–response effect (p<0.001). Among diabetic, hypertensive, and macroalbuminuria subjects, these relationships were stronger than in subjects without diabetes, hypertension, and microalbuminuria. Moreover, multiple linear regression analyses showed that baPWV was significantly associated with urinary ACR after adjusting for potential confounders. ConclusionAlbuminuria was strongly related to arterial stiffness among Chinese middle-aged adults. These relationships were enhanced in subjects with hypertension, diabetes, or macroalbuminuria.

Association between arterial stiffness and cerebrovascular resistance in the elderly

Arterial stiffness is an established cardiovascular risk factor influencing haemodynamic properties in the microcirculation. We tested the hypothesis that increased arterial stiffness is associated with an increase in cerebrovascular resistance in the elderly. Brachial-ankle pulse wave velocity (baPWV), using arterial tonometry, and anterior cerebral blood flow (aCBF), using extracranial ultrasound, were measured in 26 participants (67-92 years). Non-parametric statistics examined relationships between age, blood pressure, baPWV, cerebrovascular resistance (CVRi) and aCBF. Bivariate analysis suggested that baPWV was the only vascular characteristic associated with CVRi (r(s)=0.59; P=0.002). CVRi was strongly correlated with aCBF (r(s)=-0.89; P<0.001). Furthermore, compared with participants in the lower three quartiles of baPWV (LO), those in the upper quartile (HI) had elevated CVRi (median (interquartile range); HI: 0.240 (0.143) mm Hg ml(-1) min(-1); LO: 0.197 (0.072) mm Hg ml(-1) min(-1); P=0.02), and tended to have lower aCBF (HI: 394 (155) ml min(-1); LO: 459 (154) ml min(-1); P=0.09). This study found a positive correlation between baPWV and CVRi in the elderly, suggesting that haemodynamic characteristics associated with arterial aging influence cerebral circulation.

In Addition to Insulin Resistance and Obesity, Brachial-Ankle Pulse Wave Velocity is Strongly Associated with Metabolic Syndrome in Chinese - A Population-Based Study (Taichung Community Health Study, TCHS)

To investigate the association between arterial stiffness (present with brachial-ankle pulse wave velocity (baPWV)) and metabolic syndrome (MetS) in a population-based study of middle-aged Chinese. MetS was defined using the AHA/NHLBI criteria. A total of 1,018 subjects aged 40 years and over were recruited in 2004. Homeostasis model assessment was applied to estimate the degree of insulin resistance (HOMA-IR). The baPWV was divided into four groups by quartiles. The prevalence of MetS and its individual components increased by the increase in baPWV quartiles. After adjusting for age, BMI, HOMA-IR, smoking, alcohol drinking, betel nut chewing, and physical activity status, multiple logistic regression revealed that baPWV groups were significantly associated with MetS. Compared with the lowest baPWV quartile, the adjusted odds ratio of having MetS in baPWV quartile II, III, IV was 2.10 (1.034.28), 4.48 (2.169.26), 10.4 (4.5324.0) in men, and 4.20 (1.4712.0), 14.6 (5.2240.6), 16.3 (5.4848.2) in women, respectively. The prevalence of MetS increased with the increase of age, HOMA-IR, and BMI groups. The optimal cut-off values of baPWV for MetS were 1,539 cm/sec in men and 1,482 cm/sec in women, respectively. In addition to insulin resistance and obesity, baPWV was strongly related to MetS in middle-aged Taiwan Chinese. The cut-off value of baPWV for cardiovascular disease differed between genders.

Aortic Stiffness Is an Independent Determinant of B-Type Natriuretic Peptide in Patients with Coronary Artery Disease

Previous studies demonstrated that the B-type natriuretic peptide (BNP) level is high in some patients with coronary artery disease (CAD) despite a preserved left ventricular function, although the mechanism underlying this increase in patients with CAD has not been fully elucidated. Because aortic stiffness is greater in patients with CAD and increases with CAD severity, there is a possibility that an increased aortic stiffness in turn increases the elevation of the BNP level in patients with CAD. In this study, we measured BNP level and brachial-ankle pulse wave velocity (baPWV) in 134 patients with CAD, and evaluated the relationship between BNP and baPWV. The patients were classified on the basis of the quartiles of BNP level to identify the characteristics of patients with a high BNP level. baPWV was significantly greater in patients classified into the highest quartile of BNP level than in those classified into the other quartiles. Multivariate analysis demonstrated that baPWV and left ventricular ejection fraction independently correlated with BNP level. Logistic regression analysis demonstrated that the odds ratio for the highest quartile of BNP level increased with baPWV quartile. This association remained significant after adjustment for systolic and diastolic function. In conclusion, increased aortic stiffness possibly underlies the increase in the BNP level in patients with CAD.

Impact of Brachial-Ankle Pulse Wave Velocity and Ankle-Brachial Blood Pressure Index on Mortality in Hemodialysis Patients

Pulse wave velocity (PWV) and ankle-brachial blood pressure index (ABPI) are markers for atherosclerosis, and each predicts mortality in patients undergoing hemodialysis. However, there have been no studies in the past that compared head-to-head the clinical validity of these 2 parameters. Compared with conventional aortic PWV, brachial-ankle PWV (baPWV) is considered simple and thereby easily applicable to clinical use. To clarify the relationship between baPWV and ABPI and assess their prognostic values, we analyzed 785 hemodialysis patients with a mean age of 60.2 +/- 12.5 (SD) years for whom ABPI and baPWV at baseline had been measured simultaneously and who were followed up for 33.8 +/- 10.8 months. Of 785 patients, 131 deaths were recorded. In Kaplan-Meier analysis, all-cause mortality was progressively and significantly greater from the lowest quartile of baPWV onward (log-rank test, 41.8; P < 0.001). However, in Cox proportional hazards analysis, the impact of baPWV was insignificant when ABPI was included as a covariate. ABPI maintained strong predictive power in this model. When patients who had advanced peripheral arterial occlusive disease (ABPI < 0.9) were excluded from analysis, patients with the highest quartile of baPWV had significantly increased hazard ratios of all-cause (hazard ratio, 4.08; 95% confidence interval, 1.46 to 11.43; P < 0.007) and cardiovascular (hazard ratio, 7.03; 95% confidence interval, 1.49 to 33.08; P < 0.014) mortality. The predictive power of baPWV in this population was independent from other covariates associated with atherosclerotic disorders. In a head-to-head comparison, ABPI, but not baPWV, showed strong power in predicting the mortality of hemodialysis patients. However, baPWV was useful to pick a high-risk population in patients with ABPI greater than 0.9. Thus, screening hemodialysis patients by means of baPWV and ABPI provides complementary information in identifying a high-risk population.