Sex-specific associations of brachial–ankle pulse wave velocity with adverse cardiac remodeling and long-term cardiovascular outcome

Abstract

Background: It remains unclear whether the cardiovascular consequences of arterial stiffness differ by sex. This study aimed to investigate the sex-specific association of brachialankle pulse wave velocity (baPWV) with adverse cardiac remodeling and cardiovascular outcome. Method:We studied 11 767 patients (57.6% men) with cardiovascular risk factors, whose baPWV was measured. The primary endpoint was composite cardiovascular events. Restricted cubic spline (RCS) analyses were performed to delineate the association of baPWV with echocardiography parameters and risks of cardiovascular events.Results: RCS curves showed that structural/functional echocardiography parameters gradually worsened with increasing baPWV more prominently in women than in men. The prevalence of left ventricular hypertrophy and diastolic dysfunction increases with baPWV increase more steeply in women (P-for-interaction by sex <0.001). During the median follow-up of 3.64 years (interquartile interval, 1.56-5.38 years), 350 cardiovascular events (3.0%) and 155 deaths (1.3%) occurred. Cumulative cardiovascular events and deaths were significantly higher in patients with elevated baPWV in both sexes (P < 0.001). Cox analyses showed that the increase in baPWV was associated with the higher risks of cardiovascular events and deaths more strongly in women [cardiovascular events: men, adjusted hazard ratio 1.10, 95% confidence interval (1.08-1.13), P < 0.001; women, adjusted hazard ratio 1.18, 95% confidence interval (1.13-1.24), P < 0.001 by 100 cm/s increase in baPWV; P-for-interaction by sex ¼ 0.022]. Conclusion:The detrimental effects of baPWV on adverse cardiac remodeling and cardiovascular outcome were stronger in women than in men. The prognostic information provided by baPWV may be particularly crucial for women.

The sex difference in the association of enhanced brachial–ankle pulse wave velocity and adverse cardiac remodeling: the possible background mechanism

“…In unadjusted comparisons, the prevalence of nondipping and reverse dipping increased in parallel with the decline in eGFR. In multivariate-adjusted logistic regression analysis, as compared with the referent quartile 4 of patients with the highest eGFR, the odds ratio (OR) for reverse dipping was 0.959 in quartile 3, 1.385 in quartile 2 and 1.685 in the quartile 1 [1]. A similar association was observed between the decreasing levels of eGFR and increasing likelihood for a nondipper with reverse-dipper BP pattern in 24-h ABPM.…”

“…A similar association was observed between the decreasing levels of eGFR and increasing likelihood for a nondipper with reverse-dipper BP pattern in 24-h ABPM. Using again patients with the highest eGFR as a reference category (quartile 4), the OR for nondipping with reverse dipping was 1.130, 1.345, and 1.422 for quartiles 3, 2 and 1 of eGFR, respectively [1]. In both occasions, there was a significant linear trend across quartiles, indicating that eGFR was an independent determinant of circadian BP variation in this large cohort of patients with preserved kidney function.…”

“…We read with great interest the article by Kwak et al [1]. In the article, the authors have showed the detrimental effects of brachial–ankle pulse wave velocity (baPWV) on adverse cardiac remodeling and cardiovascular outcome were stronger in women than in men.…”

Sex differences in the association between visceral adipose tissue and atherosclerosis in type 2 diabetes patients with normal bodyweight: A study in a Chinese population

“…Recently, the sex‐specific association of baPWV with adverse cardiac remodeling and the cardiovascular outcome was shown in a large population of 11,767 patients. The detrimental effects of baPWV on adverse cardiac remodeling and cardiovascular outcomes were stronger in women than in men 35 . Unfortunately, in our present study, the data of history of menopause were incomplete, so statistical analyses could not be carried out due to large missing values.…”

Sex differences in pressure and flow waveform physiology across the life course

“…In a meta-analysis to determine if brachial-ankle PWV predicted CVD events (6.4 years follow up), sex differences were not reported [118]. However, a recent single site analysis of 11 767 patients (42% women) found that increased brachial-ankle PWV was more strongly associated with a higher risk of CVD events and death in women compared with men, after 3.6 years median follow up [119].…”