Key result
Higher load-dependent carotid stiffness linked to ~21% higher CVD risk per 100 mm Hg.
Why the study?
It is unknown how load-dependent stiffening from higher blood pressure versus structural stiffening of the vessel wall contribute to incident cardiovascular disease events.
Does higher load-dependent carotid artery stiffness predict incident cardiovascular disease events and hypertension in adults without baseline CVD?
Cohort (n=5,873)
Yes
Does higher load-dependent carotid artery stiffness predict incident cardiovascular disease events and hypertension in adults without baseline CVD?
Hazard Ratio: 1.21 (95% CI 1.09–1.34)
p-value: p=<0.001
Differentiating components of arterial stiffness reveals that load-dependent stiffening, rather than structural stiffening, drives the association between arterial stiffness and future cardiovascular events.
May refine CVD risk stratification; leaves open whether load-dependent stiffness is modifiable or causal.
Background: Elastic arteries stiffen via 2 main mechanisms: (1) load-dependent stiffening from higher blood pressure and (2) structural stiffening due to changes in the vessel wall. It is unknown how these different mechanisms contribute to incident cardiovascular disease (CVD) events. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6814 men and women without CVD at enrollment, from 6 communities in the United States. MESA participants with B-mode carotid ultrasound and brachial blood pressure at baseline Exam in (2000–2002) and CVD surveillance (mean follow-up 14.3 years through 2018) were included (n=5873). Peterson’s elastic modulus was calculated to represent total arterial stiffness. Structural stiffness was calculated by adjusting Peterson’s elastic modulus to a standard blood pressure of 120/80 mm Hg with participant-specific models. Load-dependent stiffness was the difference between total and structural stiffness. Results: In Cox models adjusted for traditional risk factors, load-dependent stiffness was significantly associated with higher incidence of CVD events (hazard ratio/100 mm Hg, 1.21 [95% CI, 1.09–1.34] P <0.001) events while higher structural stiffness was not (hazard ratio, 1.03 [95% CI, 0.99–1.07] P =0.10). Analysis of participants who were normotensive (blood pressure <130/80, no antihypertensives) at baseline exam (n=2122) found higher load-dependent stiffness was also associated with significantly higher incidence of hypertension (hazard ratio, 1.53 [95% CI, 1.35–1.75] P <0.001) while higher structural stiffness was not (hazard ratio, 1.03 [95% CI, 0.99–1.07] P =0.16). Conclusions: These results provide valuable new insights into mechanisms underlying the association between arterial stiffness and CVD. Load-dependent stiffness was significantly associated with CVD events but structural stiffness was not.
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Pewowaruk et al. (2022) conducted a cohort in Without known cardiovascular disease at baseline (n=5,873). Higher load-dependent carotid artery stiffness vs. Lower load-dependent stiffness was evaluated on Incident cardiovascular disease (CVD) events (HR 1.21 per 100 mm Hg, 95% CI 1.09-1.34, p=<0.001). Higher load-dependent carotid artery stiffness was significantly associated with a higher incidence of CVD events (HR 1.21 per 100 mm Hg), whereas structural stiffness was not.
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