Cardio‐ankle vascular index as a predictor of major adverse cardiovascular events in metabolic syndrome patients

Abstract

Background: Arterial stiffness, as reflected in the cardio-ankle vascular index (CAVI), is a risk factor for major adverse cardiovascular events (MACEs).Hypothesis: Combining CAVI and metabolic syndrome (MetS) may enhance prediction of MACEs in a general adult population.Methods: A total of 3807 employees of the Electricity Generating Authority of Thailand were enrolled in a longitudinal health study during 2007-2008. Baseline characteristics were collected and CAVI determined. Subjects with previous coronary artery disease or stroke were excluded from analysis. MetS was defined using the modified NCEP-ATP III for Asians. The primary study endpoint was occurrence of a MACE (myocardial infarction, stroke, or cardiovascular death).Results: MetS was present in 39.2% at study baseline. The prevalence of CAVI > 9 was higher in subjects with MetS compared to those without (33.7% vs. 28.5%, P = 0.001). During the 12.4 ± 0.6 years follow-up, 227 participants developed MACEs and 350 died. MetS was more common in patients who developed a MACE (8.2% vs. 5.0%, p < 0.001) than was non-MetS, but it was not a significant risk after adjusting covariables. Participants with CAVI > 9 had greater risk for MACEs 1.34 (95% CI: 1.01, 1.79) relative to those with CAVI < 9. Participants with both MetS and CAVI > 9 had the worst outcomes, with the highest frequency of MACEs, among the four groups. Conclusion: Arterial stiffness assessed by CAVI may enhance prediction of futureMACEs, adding to the null predictive power of MetS. This index can be used to motivate MetS patients to modify their life-styles for prevention.

Arterial Stiffness Assessment by Pulse Wave Velocity in Patients with Metabolic Syndrome and Its Components: Is It a Useful Tool in Clinical Practice?

“…In a large European multicentre study, a significant impact of MS on PWV was confirmed, although heterogeneous effects of MS components on AS parameters [ 89 ]. In a prospective study involving 3807 subjects, it was documented that patients with MS and AS assessed by the cardio–ankle vascular index (CAVI) have the worst prognosis, with the highest percentages of major adverse cardiovascular events such as myocardial infarction, stroke, or cardiovascular death compared to patients without MS or MS with normal range of CAVI index [ 90 ]. AS, defined by CAVI, has been reported to be a predictor of cardiovascular events, independent of conventional risk factors for atherosclerosis [ 91 ].…”

Cardio-Ankle Vascular Index as an Arterial Stiffness Marker Improves the Prediction of Cardiovascular Events in Patients without Cardiovascular Diseases

“…Second, the study population included only Asian individuals. Although several studies on non-Asian populations have been reported [12,14], the generalizability of our data to other races/ethnicities remains uncertain. Third, we failed to estimate the cutoff value of CAVI for each event because of the small number of events.…”

“…Several studies have shown that CAVI is associated with the incidence of cardiovascular events in patients with known CVD [5][6][7][8][9] and without CVD [10][11][12][13][14][15][16]. However, evidence on the incremental value of CAVI over a clinical risk score for predicting cardiovascular events has been limited.…”

“…CAVI can be obtained automatically by wrapping pressure cuffs around the upper and lower legs and is less dependent on blood pressure. Previous studies have reported the association between a greater CAVI and a high incidence of cardiovascular events in patients with diabetes mellitus, obesity, and several CVD risk factors [5][6][7][8][9][10][11][12][13][14][15][16].…”

Aging of the Arterial System

“…Cardiovascular disease is the leading cause of death worldwide. Several risk factors have been identified and, among these, increased arterial stiffness has gained attention due to its correlation with many cardiovascular endpoints [ 1 ]. Studies reported the determinants of arterial stiffness [ 2 ], which contributes to the stiffening of the wall artery.…”