Relationship Between Arterial Stiffness and Subclinical Aortic Atherosclerosis

Background—Noninvasive measures of arterial compliance may be useful for the detection of subclinical atherosclerosis. Methods and Results—Measures of calf and thigh arterial compliance (MaxV50) were recorded in 267 subjects who also underwent MRI of the distal aorta to quantify distal aorta atherosclerosis. The average of calf and thigh MaxV50 was strongly predictive of extent of aortic atherosclerosis and risk of being in the top quartile of aortic atherosclerosis after adjustment for the Framingham Coronary Risk Score (FCRS) or the combination of the FCRS and C-reactive protein (P<0.0001). The areas under the receiver operating curves predicting the top quartile of gender-specific aortic atherosclerosis were 0.57, 0.60, and 0.75 for models containing the FCRS, the FCRS and C-reactive protein, and the FCRS, C-reactive protein, and the average of calf and thigh MaxV50. Conclusions—Lower-extremity arterial compliance may identify subjects with extensive subclinical atherosclerosis. Further studies examining the potential value of arterial stiffness as a screening tool to guide initiation of more aggressive preventive interventions are warranted.

[1]  C Yuan,et al.  Comparison of carotid vessel wall area measurements using three different contrast-weighted black blood MR imaging techniques. , 2001, Magnetic resonance imaging.

[2]  K. Matthews,et al.  Carotid atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured after menopause. , 1998, Stroke.

[3]  A. Wierzbicki,et al.  A Comparison of Algorithms for Initiation of Lipid Lowering Therapy in Primary Prevention of Coronary Heart Disease , 2000, Journal of Cardiovascular Risk.

[4]  S. Thompson,et al.  Production of C-reactive protein and risk of coronary events in stable and unstable angina , 1997, The Lancet.

[5]  W. Hundley,et al.  Cardiac cycle-dependent changes in aortic area and distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance. , 2001, Journal of the American College of Cardiology.

[6]  Y Nakayama,et al.  Pulsatility of ascending aortic pressure waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. , 2000, Circulation.

[7]  René M. Botnar,et al.  Age and Sex Distribution of Subclinical Aortic Atherosclerosis: A Magnetic Resonance Imaging Examination of the Framingham Heart Study , 2002, Arteriosclerosis, thrombosis, and vascular biology.

[8]  A. Hofman,et al.  Association Between Arterial Stiffness and Atherosclerosis: The Rotterdam Study , 2001, Stroke.

[9]  S M Grundy,et al.  Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. , 2001, Circulation.

[10]  A. Gotto,et al.  Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. , 1998, JAMA.

[11]  D. E. Grobbee,et al.  J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis , 1994, The Lancet.

[12]  S. Yusuf.  MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary , 2002 .

[13]  AndrewJ. S. Coats.  MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trial , 2002, The Lancet.

[14]  F. Epstein,et al.  Is imaging at intermediate doses necessary during dobutamine stress magnetic resonance imaging? , 2001, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[15]  P Ducimetière,et al.  Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study. , 1999, Stroke.

[16]  M. Bond,et al.  Anatomic correlates of aortic pulse wave velocity and carotid artery elasticity during atherosclerosis progression and regression in monkeys. , 1991, Circulation.

[17]  L. Kuller,et al.  The importance of pulsatile components of hypertension in predicting carotid stenosis in older adults , 1997, Journal of hypertension.

[18]  R J Glynn,et al.  Increased pulse pressure and risk of heart failure in the elderly. , 1999, JAMA.

[19]  Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking. A preliminary report from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. , 1990, JAMA.

[20]  David M Herrington,et al.  Arterial compliance adds to conventional risk factors for prediction of angiographic coronary artery disease. , 2003, American heart journal.

[21]  R H Fagard,et al.  Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. , 1999, Archives of internal medicine.

[22]  H. Krumholz,et al.  Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program. , 2001, The American journal of cardiology.

[23]  D. Sloane,et al.  An Introduction to Categorical Data Analysis , 1996 .

[24]  V. Fuster,et al.  In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography. , 2000, Circulation.

[25]  L A Moyé,et al.  Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and Ventricular Enlargement. , 1997, Circulation.

[26]  W. Hundley,et al.  Automated analysis of phase-contrast magnetic resonance images in the assessment of endothelium-dependent flow-mediated dilation. , 2003, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[27]  R J Glynn,et al.  Pulse pressure and mortality in older people. , 2000, Archives of internal medicine.

[28]  W J Rogers,et al.  Age-associated changes in regional aortic pulse wave velocity. , 2001, Journal of the American College of Cardiology.

[29]  V. Fuster,et al.  Effects of Lipid-Lowering by Simvastatin on Human Atherosclerotic Lesions: A Longitudinal Study by High-Resolution, Noninvasive Magnetic Resonance Imaging , 2001, Circulation.

[30]  S Collatina,et al.  Systolic and pulse blood pressures (but not diastolic blood pressure and serum cholesterol) are associated with alterations in carotid intima–media thickness in the moderately hypercholesterolaemic hypertensive patients of the Plaque Hypertension Lipid Lowering Italian Study , 2001, Journal of hypertension.

[31]  Chun Yuan,et al.  Accuracy and uniqueness of three in vivo measurements of atherosclerotic carotid plaque morphology with black blood MRI , 2003, Magnetic resonance in medicine.

[32]  M. Safar.  Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. , 1994, Hypertension.

[33]  H. Krumholz,et al.  Pulse pressure and risk for myocardial infarction and heart failure in the elderly. , 2000, Journal of the American College of Cardiology.

[34]  P. Ridker,et al.  Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. , 1998, Circulation.

[35]  M. Pfeffer,et al.  Cardiovascular Risk Assessment Using Pulse Pressure in the First National Health and Nutrition Examination Survey (NHANES I) , 2001, Hypertension.

[36]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.

[37]  T. Lüscher,et al.  Statins enhance postischemic hyperemia in the skin circulation of hypercholesterolemic patients: a monitoring test of endothelial dysfunction for clinical practice? , 2003, Journal of the American College of Cardiology.