Association of Segment‐Specific Pulse Wave Velocity With Vascular Calcification: The ARIC (Atherosclerosis Risk in Communities) Study

Q: What are the key findings of this study?

Carotid-femoral pulse wave velocity (highest vs lowest quartile) was independently associated with high coronary artery calcium and descending aorta calcification.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Vascular calcification and arterial stiffness in older adults (n=1351). Intervention: Segment-specific pulse wave velocity (carotid-femoral PWV highest quartile [1415.5-6155 cm/s]) vs. Lowest quartile of carotid-femoral PWV (353-1011.5 cm/s). Primary outcome: High coronary artery calcium score (≥75th percentile of Agatston score) (OR 1.84, 95% CI 1.24-2.74, p=<0.05).

Q: What does this research mean for the field?

Higher pulse wave velocity, particularly carotid-femoral pulse wave velocity, is independently associated with high coronary artery calcium and descending aorta calcification in older adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the associations between segment-specific pulse wave velocity measures and multiterritory vascular calcification, and to test whether arterial stiffness improves calcification discrimination beyond traditional risk factors.

Kentaro Ejiri; Ning Ding; Esther Kim; Yasuyuki Honda; Miguel Cainzos‐Achirica; Hirofumi Tanaka; Candace M. Howard; Kenneth R. Butler; Timothy M. Hughes; Jeremy Van’t Hof; Michelle L. Meyer; Michael J. Blaha; Kunihiro Matsushita

doi:10.1161/jaha.123.031778

January 12, 2024Journal of the American Heart AssociationOpen Access

Association of Segment‐Specific Pulse Wave Velocity With Vascular Calcification: The ARIC (Atherosclerosis Risk in Communities) Study

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Key result

Higher carotid-femoral pulse wave velocity linked to ~84% higher odds of severe coronary calcification.

OR 1.84
95% CI 1.24-2.74
P<0.05
n=1,351

Figures

Why the study?

The association between pulse wave velocity and vascular calcification across different vascular beds had not been fully investigated.

Are segment-specific pulse wave velocity measures associated with and able to improve discrimination of multiterritory vascular calcification (coronary artery calcium and extracoronary calcification) beyond traditional risk factors in older adults?

Key Points

To evaluate the associations between segment-specific pulse wave velocity measures and multiterritory vascular calcification, and to test whether arterial stiffness improves calcification discrimination beyond traditional risk factors.
Cross-sectional analysis of 1351 older adults (mean age, 79.2 years [SD, 4.1]; 39% men, 19% Black) from the ARIC study.
Measured 6 segment-specific pulse wave velocities (heart-carotid, heart-femoral, carotid-femoral, heart-ankle, brachial-ankle, and femoral-ankle).
Evaluated high calcium scores (≥75th percentile of Agatston score) across 6 vascular territories: coronary arteries, aortic valve ring, aortic valve, mitral valve, ascending aorta, and descending aorta using multivariable logistic regression.
Quartiles of carotid-femoral, heart-femoral, heart-ankle, and brachial-ankle pulse wave velocity were significantly associated with coronary artery calcium (adjusted OR for quartile 4 vs 1 of carotid-femoral PWV, 1.84 [95% CI, 1.24–2.74]).
Pulse wave velocities were most strongly linked to descending aorta calcification (adjusted OR for quartile 4 vs 1 of carotid-femoral PWV, 3.99 [95% CI, 2.61–6.17]), whereas femoral-ankle PWV demonstrated an inverse association.
Adding carotid-femoral PWV improved the C statistic for descending aorta calcification by 0.021 (95% CI, 0.005–0.037) and showed borderline improvement for coronary artery calcium (ΔC statistic, 0.008 [95% CI, −0.001 to 0.018]; P=0.07).

Study Design

Type

Cohort (n=1,351)

Multicenter

Yes

Structured PICO

Are segment-specific pulse wave velocity measures associated with and able to improve discrimination of multiterritory vascular calcification (coronary artery calcium and extracoronary calcification) beyond traditional risk factors in older adults?

P

Population

1,351 older Black and White adults (mean age 79.2 years, 61% female) from 4 US communities in the ARIC study, free of prior myocardial infarction or coronary revascularization, who underwent segment-specific pulse wave velocity and cardiac-gated CT calcium assessment.

E

Exposure

Segment-specific pulse wave velocity (PWV) measures assessed noninvasively via VP-1000plus (Omron Healthcare): carotid-femoral (cfPWV), heart-carotid (hcPWV), heart-femoral (hfPWV), heart-ankle (haPWV), brachial-ankle (baPWV), and femoral-ankle (faPWV), comparing highest quartile vs lowest quartile

C

Comparator

Lowest quartile of each respective segment-specific pulse wave velocity measure (e.g., cfPWV Quartile 1: 353-1011.5 cm/s)

O

Outcome

High coronary artery calcium (CAC) and extracoronary calcification (ECC: descending aorta, ascending aorta, aortic valve ring, aortic valve, mitral valve), defined as ≥75th percentile of Agatston score on noncontrast electrocardiogram-gated CTsurrogate

Main Result

Odds Ratio: 1.84 (95% CI 1.24–2.74)

Absolute Event Rate: 36.1% vs 20.8%

p-value: p=<0.05

Segment-specific pulse wave velocity, especially carotid-femoral PWV, is independently associated with and modestly improves discrimination of coronary artery and descending aorta calcification beyond traditional risk factors in older adults.

Limitations

Included only older Black and White participants, limiting extrapolation to other age ranges or racial/ethnic groups
Elapsed time between PWV measurement and CT scan was >1 year in some participants
CT images were acquired from the pulmonary artery bifurcation to the apex of the heart, omitting the aortic arch, abdominal aorta, and leg arteries
Uncertain transportability of findings to PWV measures evaluated by different measurement systems
Possibility of residual confounding due to unmeasured or unknown confounders
Study included only older Black and White participants, limiting generalizability to other age ranges or racial/ethnic groups
CT scan range (pulmonary artery bifurcation to heart apex) did not include aortic arch, abdominal aorta, or leg arteries
Uncertain transportability to PWV evaluated by different measurement systems
Potential residual confounding from unmeasured or unknown confounders

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Implication

Carotid-femoral PWV may aid calcification risk assessment in older adults; hypothesis-generating and should not yet change practice.

Abstract

BACKGROUND: Pulse wave velocity (PWV) is a noninvasive measure of arterial stiffness and predictor of cardiovascular disease. However, the association between PWV and vascular calcification across different vascular beds has not been fully investigated. This study aimed to quantify the association between PWV and multiterritory calcification and to explore whether PWV can identify individuals with vascular calcification beyond traditional risk factors. METHODS AND RESULTS: Among 1351 older adults (mean age, 79.2 years [SD, 4.1]) from the ARIC (Atherosclerosis Risk in Communities) study, we measured segment-specific PWVs: heart-carotid, heart-femoral, carotid-femoral, heart-ankle, brachial-ankle, and femoral-ankle. Dependent variables were high calcium score (≥75th percentile of Agatston score) across different vascular beds: coronary arteries, aortic valve ring, aortic valve, mitral valve, ascending aorta, and descending aorta. Quartiles of carotid-femoral, heart-femoral, heart-ankle, and brachial-ankle PWV were significantly associated with coronary artery calcium (eg, adjusted odds ratio [OR] for the highest versus lowest quartile of carotid-femoral PWV, 1.84 [95% CI, 1.24-2.74]). Overall, PWVs were most strongly associated with descending aorta calcification, with significant results for carotid-femoral, heart-femoral, heart-ankle, and brachial-ankle PWV (eg, adjusted OR for the highest versus lowest quartile of carotid-femoral PWV, 3.99 [95% CI, 2.61-6.17]). In contrast, femoral-ankle PWV was inversely associated with descending aorta calcification. Some PWVs improved the discrimination of coronary artery calcium and descending aorta calcification beyond traditional risk factors. CONCLUSIONS: The associations of PWV with vascular calcification varied substantially across segments, with descending aorta calcification most closely linked to PWVs. Our study suggests that some PWVs, especially carotid-femoral PWV, are helpful to identify individuals with coronary artery calcium and descending aorta calcification.

Discussion

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Cite This Study

Ejiri et al. (2024) conducted a cohort in Vascular calcification and arterial stiffness in older adults (n=1,351). Segment-specific pulse wave velocity (carotid-femoral PWV highest quartile [1415.5-6155 cm/s]) vs. Lowest quartile of carotid-femoral PWV (353-1011.5 cm/s) was evaluated on High coronary artery calcium score (≥75th percentile of Agatston score) (OR 1.84, 95% CI 1.24-2.74, p=<0.05). Carotid-femoral pulse wave velocity (highest vs lowest quartile) was independently associated with high coronary artery calcium and descending aorta calcification.

synapsesocial.com/papers/6a7da6310631e052c4b87116 https://doi.org/10.1161/jaha.123.031778

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Association of Segment‐Specific Pulse Wave Velocity With Vascular Calcification: The ARIC (Atherosclerosis Risk in Communities) Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of Segment‐Specific Pulse Wave Velocity With Vascular Calcification: The ARIC (Atherosclerosis Risk in Communities) Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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