Centre for Cardiovascular Research, Innovation and Development, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Wales, United Kingdom (K.S., B.J.M., C.J.A.P.).
National Cardiovascular Research Network, Wales, United Kingdom (K.S., B.J.M. , C.J.A.P.).
Hypertension. 2024 Dec;81(12):e185-e196. doi: 10.1161/HYPERTENSIONAHA.124.23392. Epub 2024 Oct 7.
The aortic-femoral arterial stiffness gradient, calculated as the ratio of lower-limb pulse-wave velocity (PWV) to central (aortic) PWV, is a promising tool for assessing cardiovascular disease (CVD) risk, but whether it predicts incident CVD is unknown.
We examined the association of the aortic-femoral arterial stiffness gradient measures carotid-femoral stiffness gradient (femoral-ankle PWV divided by carotid-femoral PWV) and the heart-femoral stiffness gradient (femoral-ankle PWV divided by heart-femoral PWV), as well as PWV, with incident CVD (coronary disease, stroke, and heart failure) and all-cause mortality among 3109 participants of the Atherosclerosis Risk in Communities Study cohort (age, 75±5 years; carotid-femoral PWV, 11.5±3.0 m/s), free of CVD. Cox regression was used to estimate hazard ratios (HR) and 95% CIs.
Over a median 7.4-year follow-up, there were 322 cases of incident CVD and 410 deaths. In fully adjusted models, only top quartiles of carotid-femoral stiffness gradient (quartile 4: HR, 1.43 [95% CI, 1.03-1.97]; and quartile 3: HR, 1.49 [95% CI, 1.08-2.05]) and heart-femoral stiffness gradient (quartile 4: HR, 1.77 [95% CI, 1.27-2.48]; and quartile 3: HR, 1.41 [95% CI, 1.00-2.00]) were significantly associated with a greater risk of incident CVD. Only high aortic stiffness in combination with low lower-limb stiffness was significantly associated with incident CVD (HR, 1.46 [95% CI, 1.06-2.02]) compared with the referent low aortic stiffness and high lower-limb stiffness. No PWVs were significantly associated with incident CVD. No exposures were associated with all-cause mortality.
The aortic-femoral arterial stiffness gradient may enhance CVD risk assessment in older adults in whom the predictive capacity of traditional risk factors and PWV are attenuated.
股动脉脉搏波速度（PWV）与中心（主动脉）PWV 的比值计算出的主动脉-股动脉僵硬度梯度，是评估心血管疾病（CVD）风险的一种很有前途的工具，但它是否可以预测 CVD 的发生尚不清楚。
我们研究了股-踝脉搏波速度（踝-颈 PWV 除以股-颈 PWV）和心-股脉搏波速度（踝-股 PWV 除以心-股 PWV）的股动脉僵硬度梯度指标以及 PWV 与 3109 名社区动脉粥样硬化风险研究队列参与者（年龄 75±5 岁；股-颈 PWV，11.5±3.0 m/s）中 CVD（冠心病、中风和心力衰竭）和全因死亡率的相关性。Cox 回归用于估计危险比（HR）和 95%置信区间。
在中位 7.4 年的随访期间，发生了 322 例 CVD 事件和 410 例死亡。在完全调整的模型中，只有股-颈僵硬度梯度的前四分位数（四分位 4：HR，1.43[95%CI，1.03-1.97]；四分位 3：HR，1.49[95%CI，1.08-2.05]）和心-股僵硬度梯度（四分位 4：HR，1.77[95%CI，1.27-2.48]；四分位 3：HR，1.41[95%CI，1.00-2.00]）与 CVD 发病风险增加显著相关。只有主动脉僵硬度高合并下肢僵硬度低与 CVD 发病风险显著相关（HR，1.46[95%CI，1.06-2.02]），而与参照的低主动脉僵硬度和高下肢僵硬度相比。没有脉搏波速度与 CVD 发病显著相关。没有暴露与全因死亡率相关。
在传统危险因素和 PWV 预测能力减弱的老年人群中，主动脉-股动脉僵硬度梯度可能增强 CVD 风险评估。
