Gómez-Marcos Manuel Ángel, Recio-Rodríguez José Ignacio, Patino-Alonso María Carmen, Agudo-Conde Cristina, Gómez-Sánchez Leticia, Gomez-Sanchez Marta, Rodríguez-Sanchez Emiliano, Maderuelo-Fernandez Jose Angel, García-Ortiz Luís
Cardiovasc Diabetol. 2015 Jan 16;14:7. doi: 10.1186/s12933-014-0167-y.
The cardio ankle vascular index (CAVI) is a new index of the overall stiffness of the artery from the origin of the aorta to the ankle. This index can estimate the risk of atherosclerosis. We aimed to find the relationship between CAVI and target organ damage (TOD), vascular structure and function, and cardiovascular risk factors in Caucasian patients with type 2 diabetes mellitus or metabolic syndrome.
We included 110 subjects from the LOD-Diabetes study, whose mean age was 61 ± 11 years, and 37.3% were women. Measurements of CAVI, brachial ankle pulse wave velocity (ba-PWV), and ankle brachial index (ABI) were taken using the VaSera device. Cardiovascular risk factors, renal function by creatinine, glomerular filtration rate, and albumin creatinine index were also obtained, as well as cardiac TOD with ECG and vascular TOD and carotid intima media thickness (IMT), carotid femoral PWV (cf-PWV), and the central and peripheral augmentation index (CAIx and PAIx). The Framingham-D'Agostino scale was used to measure cardiovascular risk.
Mean CAVI was 8.7 ± 1.3. More than half (54%) of the participants showed one or more TOD (10% cardiac, 13% renal; 48% vascular), and 13% had ba-PWV ≥ 17.5 m/s. Patients with any TOD had the highest CAVI values: 1.15 (CI 95% 0.70 to 1.61, p < 0.001) and 1.14 (CI 95% 0.68 to 1.60, p < 0.001) when vascular TOD was presented, and 1.30 (CI 95% 0.51 to 2.10, p = 0.002) for the cardiac TOD. The CAVI values had a positive correlation with HbA1c and systolic and diastolic blood pressure, and a negative correlation with waist circumference and body mass index. The positive correlations of CAVI with IMT (β = 0.29; p < 0.01), cf-PWV (β = 0.83; p < 0.01), ba-PWV (β = 2.12; p < 0.01), CAIx (β = 3.42; p < 0.01), and PAIx (β = 5.05; p = 0.04) remained after adjustment for cardiovascular risk, body mass index, and antihypertensive, lipid-lowering, and antidiabetic drugs.
The results of this study suggest that the CAVI is positively associated with IMT, cf-PWV, ba-PWV, CAIx, and PAIx, regardless of cardiovascular risk and the drug treatment used. Patients with cardiovascular TOD have higher values of CAVI.
Clinical Trials.gov Identifier: NCT01065155.
心踝血管指数（CAVI）是一种反映从主动脉起始部至踝部动脉整体僵硬度的新指标。该指数可用于评估动脉粥样硬化风险。我们旨在探究白种人2型糖尿病或代谢综合征患者中CAVI与靶器官损害（TOD）、血管结构和功能以及心血管危险因素之间的关系。
我们纳入了来自LOD - 糖尿病研究的110名受试者，其平均年龄为61±11岁，女性占37.3%。使用VaSera设备测量CAVI、肱踝脉搏波速度（ba - PWV）和踝臂指数（ABI）。同时获取心血管危险因素、通过肌酐评估的肾功能、肾小球滤过率和白蛋白肌酐指数，以及通过心电图评估的心脏TOD、血管TOD、颈动脉内膜中层厚度（IMT）、颈股脉搏波速度（cf - PWV）以及中心和外周增强指数（CAIx和PAIx）。采用弗明汉 - 达戈斯蒂诺量表评估心血管风险。
平均CAVI为8.7±1.3。超过半数（54%）的参与者存在一项或多项TOD（10%为心脏相关，13%为肾脏相关；48%为血管相关），13%的患者ba - PWV≥17.5 m/s。存在任何TOD的患者CAVI值最高：出现血管TOD时为1.15（95%可信区间0.70至1.61，p<0.001）和1.14（95%可信区间0.68至1.60，p<0.001），出现心脏TOD时为1.30（95%可信区间0.51至2.10，p = 0.002）。CAVI值与糖化血红蛋白、收缩压和舒张压呈正相关，与腰围和体重指数呈负相关。在对心血管风险、体重指数以及抗高血压、降脂和抗糖尿病药物进行校正后，CAVI与IMT（β = 0.29；p<0.01）、cf - PWV（β = 0.83；p<0.01）、ba - PWV（β = 2.12；p<0.01）、CAIx（β = 3.42；p<0.01）和PAIx（β = 5.05；p = 0.04）仍呈正相关。
本研究结果表明，无论心血管风险和所使用的药物治疗如何，CAVI均与IMT、cf - PWV、ba - PWV、CAIx和PAIx呈正相关。存在心血管TOD的患者CAVI值更高。
ClinicalTrials.gov标识符：NCT01065155。
