Brachial-Ankle Pulse Wave Velocity: Myths, Misconceptions, and Realities

Sugawara, Jun; Tanaka, Hirofumi

doi:10.1159/000430771

Cited by 182 publications

(67 citation statements)

References 33 publications

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“…On the other hand, several questions and concerns regarding measurement of baPWV have also been raised. 35 The present study clearly demonstrated the applicability of baPWV as a predictor of future cardiovascular events, even when the subjects included in the analysis were limited to those with intermediate CVD risk. Thus, we propose that baPWV is applicable for CVD risk assessment in routine clinical practice, even in subjects with intermediate CVD risk.…”

Section: Discussionsupporting

confidence: 58%

Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease

Ohkuma¹,

Ninomiya²,

et al. 2017

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A rterial stiffness is well-recognized as an important predictor of development of cardiovascular disease (CVD), 1,2 and meta-analyses of prospective cohort studies have revealed that increase in the carotid-femoral pulse wave velocity (cfPWV) is associated with an increase in the risk of development of CVD. 3,4 However, the cfPWV is measured by tonometry or Doppler, which requires specialized training and exposure of the inguinal region. 5,6Abstract-An individual participant data meta-analysis was conducted in the data of 14 673 Japanese participants without a history of cardiovascular disease (CVD) to examine the association of the brachial-ankle pulse wave velocity (baPWV) with the risk of development of CVD. During the average 6.4-year follow-up period, 687 participants died and 735 developed cardiovascular events. A higher baPWV was significantly associated with a higher risk of CVD, even after adjustments for conventional risk factors (P for trend <0.001). When the baPWV values were classified into quintiles, the multivariableadjusted hazard ratio for CVD increased significantly as the baPWV quintile increased. The hazard ratio in the subjects with baPWV values in quintile 5 versus that in those with the values in quintile 1 was 3.50 (2.14-5.74; P<0.001). Correspondence to Hirofumi Tomiyama, Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Tokyo, Japan. E-mail tomiyama@ tokyo-med.ac.jp In the early 2000s, a simple device for measurement of the brachial-ankle pulse wave velocity (baPWV) was launched for clinical use. Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease An Individual Participant Data Meta-Analysis7 baPWV is automatically measured using a separate cuff for each of the 4 limbs by an oscillometric method. baPWV may be more easily applied in clinical practice than the cfPWV because of the simplicity and ease of its measurement.7,8 baPWV has been reported to be closely correlated with the directly measured aortic PWV and cfPWV. 9 A recent meta-analysis using summary data from the literature has demonstrated that higher levels of baPWV were associated with an increased risk of development of CVD.10 However, most of the studies included in the meta-analyses were conducted in patients with a high CVD risk (patients with CVD or end-stage renal disease), and thus, the usefulness of baPWV to assess the risk of development of CVD in subjects with a low to intermediate CVD risk as assessed using the Framingham risk score (FRS) had not been clearly elucidated. Furthermore, these studies did not determine the predictive ability for CVD over that of the traditional risk factors. Therefore, we conducted a meta-analysis using individual participant data (IPD) from prospective cohort studies to clarify whether baPWV could be used as an independent marker to predict the risk of development of CVD in subjects without preexisting CVD. Methods Study PopulationJ-BAVEL (Japan Brachial-Ankle Pulse Wave Velocity Individual Participant Data Meta-Analysis of Pros...

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Section: Discussionsupporting

confidence: 58%

Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease

Ohkuma¹,

Ninomiya²,

et al. 2017

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“…Because arterial stiffening is one of the earliest detectable changes in vascular structure and function that lead to clinically apparent and overt vascular diseases, a chase for the easy, precise, reliable, and optimum measurement of arterial stiffness has been intensified [1][2][3] . As a result, a number of techniques and devices have been developed to capture…”

Section: Arterial Stiffness Methodologiesmentioning

confidence: 99%

Various Indices of Arterial Stiffness: Are They Closely Related or Distinctly Different?

Tanaka¹

2017

Pulse

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Arterial stiffness is an independent risk factor for cardiovascular disease. There are a number of techniques and devices that have been developed and utilized to capture the information pertaining to the elasticity of the blood vessel. Almost all the available indices of arterial stiffness are known to increase with advancing age and are elevated in the presence of hypertension and coronary heart disease. It is not known how closely these different measures of arterial stiffness are related to each other. Available evidence indicates that arterial stiffness indices that share a homogeneous methodology appear to demonstrate good correlations. However, there are no significant associations between some measures. These overall results may be surprising considering that all the indices are supposed to reflect the same property of the arterial wall (i.e., arterial elasticity). Interestingly, no or weak correlations between indices of vascular function are not confined only to arterial stiffness and can be extended to endothelial function and vascular reactivity measures. © 2017 S. Karger AG, Basel Arterial Stiffness MethodologiesArterial stiffness is being recognized as an effective prognostic marker as well as a therapeutic target. Because arterial stiffening is one of the earliest detectable changes in vascular structure and function that lead to clinically apparent and overt vascular diseases, a chase for the easy, precise, reliable, and optimum measurement of arterial stiffness has been intensified [1][2][3] . As a result, a number of techniques and devices have been developed to capture

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“…Thus, baPWV has the potential to become a global measure of arterial stiffness. As yet, baPWV has never been fully accepted worldwide due to perceived theoretical and methodological issues [29]. To bridge the gap and further confirm the clinical usefulness of baPWV, the following two issues should be adequately addressed.…”

Section: Conclusion and Future Issuesmentioning

confidence: 99%

Brachial-Ankle Pulse Wave Velocity: Background, Method, and Clinical Evidence

Munakata

2015

Pulse

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Background: The populations of many developed countries are becoming progressively older. In aged societies, assessment of total vascular risk is critically important, because old age is usually associated with multiple risks. In this regard, pulse wave velocity (PWV) could be a global cardiovascular marker, since it increases with advancing age, high blood pressure, hyperglycaemia, and other traditional risks, summating cardiovascular risks. Carotid-femoral PWV has been widely applied in Western countries and has been used as a gold-standard PWV measure. However, this measure has never been implemented by general practitioners in Japan, possibly because of methodological difficulties. The life expectancy of Japanese people is now the highest in the world, and the establishment of an adequate total vascular risk measure is an urgent need. Against this background, brachial-ankle PWV was developed at the beginning of this century. Summary: Measurement of this parameter is easy, and its reproducibility is good. Moreover, the generality of the methodology is guaranteed. Brachial-ankle PWV has been reported to consistently increase with most traditional cardiovascular risk factors except dyslipidaemia. A meta-analysis of cohort studies including various levels of risk has shown that a 1 m/s increase in brachial-ankle PWV is associated with a 12% increase in the risk of cardiovascular events. Moreover, simultaneous evaluation of the ankle-brachial index could allow further risk stratification of high-risk individuals, who are common in aged societies. This unique feature is indispensable for the management of aged populations, who usually are exposed to multiple risks and have polyvascular diseases. This evidence, however, is chiefly derived from East Asian countries. The collection of data from Caucasian populations, therefore, remains a task for the future. Key Message: Brachial-ankle PWV has the potential to become a measure of arterial stiffness worldwide.

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Brachial-Ankle Pulse Wave Velocity: Myths, Misconceptions, and Realities

Cited by 182 publications

References 33 publications

Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease

Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease

Various Indices of Arterial Stiffness: Are They Closely Related or Distinctly Different?

Brachial-Ankle Pulse Wave Velocity: Background, Method, and Clinical Evidence

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