Interrelations Between Arterial Stiffness, Target Organ Damage, and Cardiovascular Disease Outcomes

Background Excess transmission of pressure pulsatility caused by increased arterial stiffness may incur microcirculatory damage in end organs (target organ damage [TOD] ) and, in turn, elevate risk for cardiovascular disease ( CVD ) events. Methods and Results We related arterial stiffness measures...

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Published in:Journal of the American Heart Association Vol. 8; no. 14; p. e012141
Main Authors: Vasan, Ramachandran S., Short, Meghan I., Niiranen, Teemu J., Xanthakis, Vanessa, DeCarli, Charles, Cheng, Susan, Seshadri, Sudha, Mitchell, Gary F.
Format: Journal Article
Language:English
Published: England John Wiley and Sons Inc 16.07.2019
Wiley
Subjects:
Adult
Aged
Albuminuria - epidemiology
Angina Pectoris - epidemiology
Angina, Unstable - epidemiology
Arterial Pressure - physiology
arterial stiffness
cardiovascular disease
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - mortality
Carotid-Femoral Pulse Wave Velocity
Cohort Studies
Echocardiography
epidemiology
Female
Heart Failure - epidemiology
Humans
Hypertrophy, Left Ventricular - diagnostic imaging
Hypertrophy, Left Ventricular - epidemiology
Incidence
Intermittent Claudication - epidemiology
Ischemic Attack, Transient - epidemiology
Longitudinal Studies
Male
Manometry
Middle Aged
Myocardial Infarction - epidemiology
Myocardial Infarction - mortality
Original Research
Prospective Studies
pulse wave velocity
Stroke - epidemiology
target organ damage
Vascular Stiffness - physiology
arterial stiffness
cardiovascular disease
epidemiology
pulse wave velocity
target organ damage
ISSN:2047-9980, 2047-9980
Online Access:Get full text
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Summary:Background Excess transmission of pressure pulsatility caused by increased arterial stiffness may incur microcirculatory damage in end organs (target organ damage [TOD] ) and, in turn, elevate risk for cardiovascular disease ( CVD ) events. Methods and Results We related arterial stiffness measures (carotid-femoral pulse wave velocity, mean arterial pressure, central pulse pressure) to the prevalence and incidence of TOD (defined as albuminuria and/or echocardiographic left ventricular hypertrophy) in up to 6203 Framingham Study participants (mean age 50±15 years, 54% women). We then related presence of TOD to incident CVD in multivariable Cox regression models without and with adjustment for arterial stiffness measures. Cross-sectionally, greater arterial stiffness was associated with a higher prevalence of TOD (adjusted odds ratios ranging from 1.23 to 1.54 per SD increment in arterial stiffness measure, P<0.01). Prospectively, increased carotid-femoral pulse wave velocity was associated with incident albuminuria (odds ratio per SD 1.28, 95% CI, 1.02-1.61; P<0.05), whereas higher mean arterial pressure and central pulse pressure were associated with incident left ventricular hypertrophy (odds ratio per SD 1.37 and 1.45, respectively; P<0.01). On follow-up, 297 of 5803 participants experienced a first CVD event. Presence of TOD was associated with a 33% greater hazard of incident CVD (95% CI , 0-77%; P<0.05), which was attenuated upon adjustment for baseline arterial stiffness measures by 5-21%. Conclusions Elevated arterial stiffness is associated with presence of TOD and may partially mediate the relations of TOD with incident CVD . Our observations in a large community-based sample suggest that mitigating arterial stiffness may lower the burden of TOD and, in turn, clinical CVD .
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ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.119.012141