Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study
Bäck M. Topouchian J. Labat C. Gautier S. Blacher J. Cwynar M. de la Sierra A. Pall D. Duarte K. Fantin F. Farkas K. Garcia-Ortiz L. Hakobyan Z. Jankowski P. Jelakovic A. Kotsani M. Konradi A. Mikhailova O. Mintale I. Plunde O. Ramos R. Rogoza A. Sirenko Y. Tasic N. Rudyk I. Urazalina S. Wohlfahrt P. Zelveian P. Asmar R. Benetos A.
May 2024Elsevier B.V.
eBioMedicine
2024#103
Background: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression. Methods: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81–4.69) years. Findings: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03–1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10–1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542–0.654) and 8.30 (c-index 0.565; 0.512–0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI. Interpretation: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments. Funding: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.
Arterial stiffness , Cardio-ankle vascular index , Cardiovascular morbimortality , Risk factor
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Department of Medicine Solna, Karolinska Institutet and Department of Cardiology Karolinska University Hospital, Stockholm, Sweden
Inserm U1116, Nancy, France
Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France
Paris-Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel Dieu, Paris, France
Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
Department of Medical Clinical Pharmacology, University of Debrecen, Hungary
Department of Medicine, Section of Geriatric Medicine, University of Verona, Italy
Cardiometabolic Centre, Dept. of Angiology, Szent Imre University Teaching Hospital, Budapest, Hungary
Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
Institute of Cardiology, Centre of Preventive Cardiology, Yerevan, Armenia
Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre, Zagreb, Croatia
Almazov Federal Medical Research Centre, St-Petersburg, Russian Federation
FSBI “Chazov National Medical Research Centre of Cardiology” of the Ministery of Health of the Russian Federation, Moscow, Russian Federation
P. Stradins University Hospital, Cardiology Centre, Riga, Latvia
Institut Universitari dInvestigació en Atenció Primària Jordi Gol, Department of Medical Sciences, University of Girona, Primary Care Services, Biomedical Research Institute, Institut Català de la Salut, Girona, Spain
Institute of Cardiology, Kiev, Ukraine
Medical Faculty, University of Belgrade and Cardiovascular Institute, Dedinje, Belgrade, Serbia
Government Institution, L.T. Malaya Therapy Institute of the National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine
Scientific and Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Foundation-Medical Research Institutes, Paris, France
Department of Medicine Solna
Inserm U1116
Université de Lorraine
Paris-Descartes University
Department of Internal Medicine and Gerontology
Department of Internal Medicine
Department of Medical Clinical Pharmacology
Department of Medicine
Cardiometabolic Centre
Primary Care Research Unit of Salamanca (APISAL)
Institute of Cardiology
Department of Internal Medicine and Geriatric Cardiology
Department of Nephrology
Almazov Federal Medical Research Centre
FSBI “Chazov National Medical Research Centre of Cardiology” of the Ministery of Health of the Russian Federation
P. Stradins University Hospital
Institut Universitari dInvestigació en Atenció Primària Jordi Gol
Institute of Cardiology
Medical Faculty
Government Institution
Scientific and Research Institute of Cardiology and Internal Diseases
Department of Preventive Cardiology
Foundation-Medical Research Institutes
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