End Point–Based Threshold for the Ambulatory Arterial Stiffness Index

Q: What are the key findings of this study?

Each 1-SD increment in the ambulatory arterial stiffness index was associated with a 13% increased risk of the composite cardiovascular end point, establishing AASI ≥0.50 as a risk-carrying threshold.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: General population (n=12558). Intervention: Ambulatory arterial stiffness index (AASI) vs. Lower ambulatory arterial stiffness index (AASI). Primary outcome: Composite cardiovascular end point (cardiovascular mortality, nonfatal cardiac end points, heart failure, and stroke) (HR 1.13, 95% CI 1.07-1.18).

Q: What does this research mean for the field?

AASI levels exceeding 0.50 indicate a 14% increased risk of all-cause deaths and a 13% increased risk of cardiovascular events in the general population. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Yi-Bang Cheng; De-Wei An; D. Zhang; Yu-ling YU; Jesús D. Melgarejo; José Boggia; D Martens; Tine W. Hansen; K. Asayama; Takayoshi Ohkubo; Katarzyna Stolarz‐Skrzypek; Qi-Fang Huang; Sofia Malyutina; Edoardo Casiglia; Lars Lind; Gladys E. Maestre; Ji-Guang Wang; Masahiro Kikuya; Jianguo Lin; Eamon Dolan; Edgardo Sandoya; Marek Rajzer; T Nawrot; Krzysztof Narkiewicz; Wen-Yi Yang; Peter Verhamme; Jan Filipovský; Graciani Auxiliadora; José R. Banegas; Y L Li; Jan A. Staessen; B. Mujaj; F.F. Wei; QH Guo; YY Kang; Y. Li; Huang Jf; CS Sheng; Y. Wang; D. Zhang; W. Zhang; C. Liu; F.F. Wei; J. Seidlerová; Marie Tichá; Hans Ibsen; J. Jeppesen; C. Torp-Pedersen; E. O’Brien; Valérie Tikhonoff; M. Satoh; Y. Tatsumi; Tomohisa Murakami; M. Tsubota-Utsugi; Takuo Hirose; K. Nomura; H. Metoki; Atsushi Hozawa; Y. Imai; N. Gilis-Malinowska; A. Łebek-Szatańska; Marcin Cwynar; Jerzy Gąsowski; Tomasz Grodzicki; Wojciech Lubaszewski; Agnieszka Olszanecka; Barbara Wizner; Wiktoria Wojciechowska; Jolanta Życzkowska; V. Cabanas; F.F. Caballero; E. López-García; P. Guallar; Fernando Rodríguez‐Artalejo; E. Pello; G. Simonova; M. Voevoda; Kristina Björklund‐Bodegârd; Björn Zethelius; M. Bianchi; Carlos Schettini; Emma Schwedt; Hugo Senra

doi:10.1161/hypertensionaha.125.25442

January 8, 2026Hypertension

End Point–Based Threshold for the Ambulatory Arterial Stiffness Index

View Full Paper

Ask AI

Bookmark

Share

Key result

Higher ambulatory arterial stiffness index linked to ~13% higher cardiovascular risk per SD.

HR 1.13
95% CI 1.07-1.18
n=12,558

Figures

Why the study?

Although AASI is increasingly used in research and practice, its prognostic accuracy in the general population needed consolidation and an end point-based risk threshold had not been derived.

Does the ambulatory arterial stiffness index (AASI) predict mortality and cardiovascular endpoints in the general population?

Key Points

To establish the prognostic value of the ambulatory arterial stiffness index (AASI) in the general population and identify a clinically meaningful, end point–based risk threshold.
Conducted an individual-participant meta-analysis of 12 558 individuals across 14 population studies (48.8% women; mean age, 59.3 years) with a median follow-up of 10.7 years.
Calculated AASI by regressing 24-hour diastolic on systolic blood pressure from ambulatory monitoring.
Used Cox regression in a discovery sample (n=8189) and replication sample (n=4369) to identify AASI risk thresholds tied to total mortality and cardiovascular events.
Over 10.7 years, 3027 all-cause deaths and 2183 cardiovascular end points occurred, with multivariable-adjusted HRs per 1-SD AASI increment of 1.08 (95% CI, 1.04–1.13) and 1.13 (95% CI, 1.07–1.18), respectively.
In the discovery cohort, the risk-carrying threshold converged to 0.50, with HRs (≥0.50 vs <0.50) of 1.14 (95% CI, 1.04–1.26) for all-cause death and 1.13 (95% CI, 1.01–1.26) for cardiovascular end points.
In the replication cohort (n=4369), an AASI ≥0.50 yielded HRs of 1.13 (95% CI, 1.01–1.26) for all-cause mortality and 1.19 (95% CI, 1.04–1.35) for cardiovascular events.

Study Design

Type

Meta-Analysis (n=12,558)

Multicenter

Yes

Structured PICO

Does the ambulatory arterial stiffness index (AASI) predict mortality and cardiovascular endpoints in the general population?

P

Population

12,558 individuals aged ≥30 years from 14 population studies across Asia, Europe, and South America, followed for a median of 10.7 years to determine the prognostic accuracy of the ambulatory arterial stiffness index.

E

Exposure

Ambulatory arterial stiffness index (AASI) measurement, specifically analyzing 1-SD increments and a high-risk threshold of ≥0.50 mm Hg/mm Hg.

C

Comparator

Lower ambulatory arterial stiffness index (AASI) levels.

O

Outcome

Coprimary end points of total mortality and a composite cardiovascular end point (cardiovascular mortality combined with nonfatal cardiac end points, heart failure, and stroke) at median 10.7 years follow-up.composite

Main Result

Hazard Ratio: 1.13 (95% CI 1.07–1.18)

Limitations

Pathophysiological mechanisms underlying AASI need further clarification
Reproducibility of AASI questioned in previous reports
Black populations were not represented in the current analysis
Pathophysiological mechanisms underlying AASI and its association with adverse health outcomes need further clarification
Reproducibility of AASI has been questioned
Lack of representation of Black populations

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

An end point-based AASI threshold of 0.50 mm Hg/mm Hg improves cardiovascular risk stratification beyond traditional risk factors in the general population.

Abstract

BACKGROUND: The ambulatory arterial stiffness index (AASI) is increasingly used in clinical research and practice. This individual-participant meta-analysis aims to consolidate the prognostic accuracy of AASI in the general population and to derive an end point–based AASI risk threshold. METHODS: In 12 558 individuals enrolled in 14 population studies (48.8% women; mean age, 59.3 years), AASI was derived by regressing 24-hour diastolic on systolic blood pressure (mm Hg/mm Hg). Using Cox regression, the risk-carrying AASI threshold was established by examining stepwise increasing AASI levels and by determining the AASI level, yielding a 10-year risk similar to an office systolic pressure of 140 mm Hg. RESULTS: Over 10.7 years (median), 3027 all-cause deaths and 2183 cardiovascular end points occurred. In all participants, multivariable-adjusted hazard ratios expressing the all-cause deaths and cardiovascular end point risk per 1-SD AASI increment were 1.08 (95% CI, 1.04–1.13) and 1.13 (95% CI, 1.07–1.18). In a randomly defined subset of 8189 individuals, the risk-carrying AASI thresholds converged to 0.50 with hazard ratios (≥0.50 versus <0.50) of 1.14 (95% CI, 1.04–1.26) for all-cause deaths and 1.13 (95% CI, 1.01–1.26) for cardiovascular end point. In the replication sample (n=4369), these hazard ratios were 1.13 (95% CI, 1.01–1.26) and 1.19 (95% CI, 1.04–1.35). AASI continuous or per threshold significantly improved model performance. Analyses of secondary end points and subgroups stratified by sex, age, hypertension status and treatment, history of cardiovascular disease, and nocturnal dipping were confirmatory. CONCLUSIONS: Over and beyond traditional risk factors, AASI improves risk stratification. Exceeding the risk-carrying 0.50 AASI threshold necessitates increased vigilance in managing risk factors before irreversible cardiovascular complications occur.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Cheng et al. (2026) conducted a meta-analysis in General population (n=12,558). Ambulatory arterial stiffness index (AASI) vs. Lower ambulatory arterial stiffness index (AASI) was evaluated on Composite cardiovascular end point (cardiovascular mortality, nonfatal cardiac end points, heart failure, and stroke) (HR 1.13, 95% CI 1.07-1.18). Each 1-SD increment in the ambulatory arterial stiffness index was associated with a 13% increased risk of the composite cardiovascular end point, establishing AASI ≥0.50 as a risk-carrying threshold.

synapsesocial.com/papers/696321c091e05aa366cb7fc8 https://doi.org/10.1161/hypertensionaha.125.25442

View Full Paper

Ask AI

Bookmark

Share

End Point–Based Threshold for the Ambulatory Arterial Stiffness Index

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

End Point–Based Threshold for the Ambulatory Arterial Stiffness Index

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading