Association of Cardio-Ankle Vascular Index With Tonometric Measures and Vasodilator Function Across a Spectrum of Cardiovascular Risk Burden

BACKGROUND: Arterial stiffness and endothelial dysfunction are two important features of cardiovascular injury. Arterial stiffness can be measured by Pulse Wave Velocity (PWV) and endothelial dysfunction can be assessed with reactive hyperemia measured by flow-mediated dilation (FMD). Cardio-Ankle Vascular Index (CAVI) is a recently developed method for measuring arterial stiffness. Studies assessing CAVI's association with established tests of arterial stiffness and endothelial function are limited. METHODS: In a cross-sectional study of adults (ages 18-80) with a range of cardiovascular disease risk burden, we measured CAVI by VaSera, tonometry measures of arterial stiffness [carotid-radial PWV (CRPWV), carotid-femoral PWV (CFPWV)], and ultrasound based brachial artery measures of vasodilator function. RESULTS: We enrolled 100 participants with acceptable quality from 93 subjects for primary analysis. The mean value of CAVI measure was 7.7 ± 1.2. There was a significant association between CAVI and CFPWV (r = 0.609, P < 0.001), which remained significant after adjusting for systolic blood pressure while the association of CAVI with CRPWV was more modest. Higher Framingham Risk Score, older age, history of hypertension and diabetes were significantly associated with higher CAVI and CFPWV. There was not any association between CAVI and FMD. Higher CAVI was associated with lower reactive hyperemia, an indicator of vasodilator function in the microvasculature (r = -0.365, P < 0.001). CONCLUSION: Our findings suggest that CAVI relates to both central and peripheral artery stiffness though is not identical to tonometry measures. CAVI associates with microvascular but not conduit artery vasodilator function consistent with the interrelation of large artery stiffness with small vessel dysfunction.