118 Brachial-Ankle Pulse Wave Velocity Predicts the Development of Cardiovascular Disease in a General Japanese Population

Abstract

Objective Elevated blood pressure (BP) response to the cold pressor test (CPT) is associated with increased risk of hypertension and cardiovascular diseases. However, it is still unclear whether BP response to CPT is a stable and reproducible trait over time. Design and methodsWe repeated the CPT among 568 Han Chinese 4.5 years after the initial study. The same CPT protocol was applied in the initial and repeated studies. BP was measured prior to and at 0, 1, 2, and 4 minutes after the participants immersed their hand in ice water (3 °C to 5 °C) for 1 minute using a standard mercury sphygmomanometer. ResultsAbsolute BP levels and BP responses during the CPT in the initial and repeated studies were highly correlated. For example, the correlation coeffi cients were 0.67, 0.73, 0.71, and 0.72 for absolute systolic BP (SBP) levels at 0, 1, 2, and 4 minutes after ice water immersion (all P Ͻ 0.0001). The correlation coeffi cients for SBP responses were 0.41 at 0 minute, 0.37 at 1 minute, 0.42 for maximum responses, and 0.39 for the area-under-the-curve during CPT (all P Ͻ 0.0001). ConclusionsThese data indicate that BP response to CPT is a long-term reproducible and stable characteristic in general population.Objective We examined the relationship between brachial-ankle pulse wave velocity and the development of cardiovascular disease in prospective study of a general Japanese population. Design and MethodsA total of 2,916 community-dwelling Japanese individuals without history of cardiovascular disease aged Ն 40 years were followed up for an average of 7.1 years, and the relationship between brachial-ankle pulse wave velocity and the development of cardiovascular disease was estimated using the Cox proportional hazards model. To compare the accuracy of the risk assessment for future cardiovascular events between the models adjusted for known cardiovascular risk factors with and without brachial-ankle pulse wave velocity, receiver operating characteristic curves for the model were plotted. ResultsDuring the follow-up period, 126 subjects experienced cardiovascular events. Age-and sex-adjusted cumulative incidence rates of cardiovascular disease increased linearly with elevating brachial-ankle pulse wave velocity levels (p for trend Ͻ 0.001). After adjusting for potential confounding factors, every 20% increment in brachial-ankle pulse wave velocity was associated with a 1.30-fold (95% confi dential interval, 1.10-1.53) greater cardiovascular risk. The area under the receiver operating characteristic curve was signifi cantly increased when brachial-ankle pulse wave velocity was incorporated into a model with known cardiovascular risk factors (0.776 vs. 0.761, p ϭ 0.01). ConclusionsOur fi ndings suggest that brachial-ankle pulse wave velocity is a signifi cant predictive factor for cardiovascular disease in the general Japanese population and that information on brachial-ankle pulse wave velocity substantially improves cardiovascular risk assessment beyond a model based on potential risk factors in general practice.