Key result
Higher digital PAT ratio is linked to lower incident stroke risk but not composite CVD.
Why the study?
Novel noninvasive measures of vascular function are emerging as subclinical markers for CVD, but their associations with first-onset major CVD events needed evaluation.
Does digital peripheral arterial tonometry (PAT) ratio predict incident composite CVD events and stroke in a community-based population?
Cohort (n=3,865)
No
Does digital peripheral arterial tonometry (PAT) ratio predict incident composite CVD events and stroke in a community-based population?
Hazard Ratio: 0.95 (95% CI 0.84–1.08)
p-value: p=0.43
Digital PAT ratio may serve as a novel noninvasive marker for incident stroke risk in the general community, though it does not significantly predict broader composite CVD events.
No association with composite CVD events warrants caution against broader use; leaves open PAT ratio as hypothesis-generating stroke marker in observational cohorts.
Background and Purpose: Novel noninvasive measures of vascular function are emerging as subclinical markers for cardiovascular disease (CVD) and may be useful to predict CVD events. The purpose of our prospective study was to assess associations between digital peripheral arterial tonometry (PAT) measures and first-onset major CVD events in a sample of FHS (Framingham Heart Study) participants. Methods: Using a fingertip PAT device, we assessed pulse amplitude in Framingham Offspring and Third Generation participants (n=3865; mean age, 55±14 years; 52% women) at baseline and in 30-second intervals for 4 minutes during reactive hyperemia. The PAT ratio (relative hyperemia index) was calculated as the post-to-pre occlusion pulse signal ratio in the occluded arm, relative to the same ratio in the control (nonoccluded) arm, and corrected for baseline vascular tone. Baseline pulse amplitude and PAT ratio during hyperemia are measures of pressure pulsatility and microvascular function in the finger, respectively. We used Cox proportional hazards regression to relate PAT measures in the fingertip to incident CVD events. Results: During follow-up (median, 9.2 years; range, 0.04–10.0 years), 270 participants (7%) experienced new-onset CVD events (n=270). In multivariable models adjusted for cardiovascular risk factors, baseline pulse amplitude (hazard ratio [HR] per 1 SD, 1.04 [95% CI, 0.90–1.21]; P=0.57) and PAT ratio (HR, 0.95 [95% CI, 0.84–1.08]; P=0.43) were not significantly related to incident composite CVD events, including myocardial infarction or heart failure. However, higher PAT ratio (HR, 0.76 [95% CI, 0.61–0.94]; P=0.013), but not baseline pulse amplitude (HR, 1.15 [95% CI, 0.89–1.49]; P=0.29), was related to lower risk for incident stroke. In a sensitivity analysis by stroke subtype, higher PAT ratio was related to lower risk of incident ischemic stroke events (HR, 0.68 [95% CI, 0.53–0.86]; P=0.001). Conclusions: Novel digital PAT measures may represent a marker of stroke risk in the community.
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Cooper et al. (2021) conducted a cohort in Community-dwelling adults without prevalent cardiovascular disease (n=3,865). Digital peripheral arterial tonometry (PAT) ratio vs. Lower PAT ratio (reference group) was evaluated on Incident composite CVD events (fatal or nonfatal myocardial infarction, unstable angina, heart failure, and stroke) (HR 0.95, 95% CI 0.84-1.08, p=0.43). Higher digital PAT ratio was not significantly associated with composite CVD events (HR 0.95), but was associated with a 24% lower risk of incident stroke (HR 0.76, 95% CI 0.61-0.94, p=0.013).
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