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Tavolinejad H, Erten O, Maynard H, Chirinos JA. Prognostic Value of Cardio-Ankle Vascular Index for Cardiovascular and Kidney Outcomes: Systematic Review and Meta-Analysis. JACC. ADVANCES 2024; 3:101019. [PMID: 39130005 PMCID: PMC11312768 DOI: 10.1016/j.jacadv.2024.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/17/2024] [Accepted: 04/18/2024] [Indexed: 08/13/2024]
Abstract
Background Arterial stiffness causes cardiovascular disease and target-organ damage. Carotid-femoral pulse wave velocity is regarded as a standard arterial stiffness metric. However, the prognostic value of cardio-ankle vascular index (CAVI), which is mathematically corrected for blood pressure, remains understudied. Objectives The purpose of this study was to determine the association of CAVI with cardiovascular and kidney outcomes. Methods PubMed, Scopus, and Web of Science were searched until May 6, 2023, for longitudinal studies reporting the association of CAVI with mortality, cardiovascular events (CVEs) (including death, acute coronary syndromes, stroke, coronary revascularization, heart failure hospitalization), and kidney function decline (incidence/progression of chronic kidney disease, glomerular filtration rate decline). Random-effects meta-analysis was performed. Studies were assessed with the "Quality in Prognostic Studies" tool. Results Systematic review identified 32 studies (105,845 participants; follow-up range: 12-148 months). Variable cutoffs were reported for CAVI. The risk of CVEs was higher for high vs normal CAVI (HR: 1.46 [95% CI: 1.22-1.75]; P < 0.001; I2 = 41%), and per SD/unit CAVI increase (HR: 1.30 [95% CI: 1.20-1.41]; P < 0.001; I2 = 0%). Among studies including participants without baseline cardiovascular disease (primary prevention), higher CAVI was associated with first-time CVEs (high vs normal: HR: 1.60 [95% CI: 1.15-2.21]; P = 0.005; I2 = 65%; HR per SD/unit increase: 1.28 [95% CI: 1.12-1.47]; P < 0.001; I2 = 18%). There was no association between CAVI and mortality (HR = 1.31 [0.92-1.87]; P = 0.130; I2 = 53%). CAVI was associated with kidney function decline (high vs normal: HR = 1.30 [1.18-1.43]; P < 0.001; I2 = 38%; HR per SD/unit increase: 1.12 [95% CI: 1.07-1.18]; P < 0.001; I2 = 0%). Conclusions Higher CAVI is associated with incident CVEs, and this association is present in the primary prevention setting. Elevated CAVI is associated with kidney function decline.
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Affiliation(s)
- Hamed Tavolinejad
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ozgun Erten
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hannah Maynard
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Julio A. Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Mulè’ G, Sinatra N, Vario MG, Vadala’ M, Cottone S. The Renal Dangers of an Increased Cardio-Ankle Vascular Index. Am J Hypertens 2020; 33:993-995. [PMID: 32629473 DOI: 10.1093/ajh/hpaa110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Giuseppe Mulè’
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Nicola Sinatra
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Maria Giovanna Vario
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Maria Vadala’
- Dipartimento di Biomedicina sperimentale e Neuroscienze cliniche, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento PROMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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Association of Kidney Function Tests with a Cardio-Ankle Vascular Index in Community-Dwelling Individuals with a Normal or Mildly Decreased Estimated Glomerular Filtration Rate. ACTA ACUST UNITED AC 2019; 55:medicina55100657. [PMID: 31569560 PMCID: PMC6843344 DOI: 10.3390/medicina55100657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022]
Abstract
Background and objectives: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD). Previous studies reported controversial results about the independence of CKD as a risk factor for atherosclerosis. In this study, we tried to determine whether the estimated glomerular filtration rate (eGFR) and other renal function tests are independent factors associated with arterial stiffness in community-dwelling individuals with a normal (≥90) or slightly decreased eGFR (60-90). Materials and Methods: Data of 164 community individuals were analyzed, and demographic information, related disease history, atherosclerosis risk factors, certain laboratory tests, the estimated eGFR, and urine albumin creatinine ratio (UACR) were recorded for each individual. Results: The age, systolic blood pressure (SBP), hypertension (HTN), and cardio-ankle vascular index (CAVI) significantly differed between individuals with a normal and those with a slightly decreased eGFR. Blood urea nitrogen (BUN), glycated hemoglobin (HBA1c), and the eGFR significantly differed between the high- and low-CAVI groups and were also significantly correlated with the CAVI. The relationship between the eGFR and CAVI was shown to be independent of other atherosclerosis risk factors in a multiple linear regression model. Conclusions: We concluded that evaluations of the eGFR, HTN, body-mass index, and SBP can be used in a model for arterial stiffness risk assessments for community-dwelling individuals with a normal or slightly decreased eGFR.
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Zhang C, Zhong Y, Tian H. Increased cardio-ankle vascular index is independently associated with chronic kidney disease: A cross-sectional study in Chinese patients with type 2 diabetes mellitus. J Diabetes Complications 2019; 33:623-627. [PMID: 31255433 DOI: 10.1016/j.jdiacomp.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023]
Abstract
AIMS This cross-sectional study aimed to investigate the association between arterial stiffness and chronic kidney disease (CKD) in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS This study included 1025 patients with T2DM (796 men, 229 women). The cardio-ankle vascular index (CAVI) served as an index to evaluate arterial stiffness. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 and/or urinary albumin-creatine ratio ≥ 30 mg/g. Increased CAVI was defined as a value ≥9. RESULTS The mean CAVI was 8.4 ± 1.2. Among the patients, 314 (40%) had increased CAVI and 229 (22.3%) had CKD. Blood pressure, HbA1c levels, total cholesterol, low-density lipoprotein cholesterol, uric acid and CAVI were higher among patients with CKD than among those without CKD. Patients with increased CAVI were at a 1.82-fold (95% CI, 1.20-2.75; P < 0.001) higher prevalence of CKD after adjusting for other variables. The odds ratio for CKD was 2.69 (95% CI, 1.12-6.47; P = 0.027) in women and 1.62 (95% CI, 1.01-2.61; P = 0.045) in men. CONCLUSION Increased CAVI was independently associated with CKD in patients with T2DM. Further longitudinal studies with large sample sizes are warranted to investigate the effect of CAVI on CKD in patients with T2DM.
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Affiliation(s)
- Chenghui Zhang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yajun Zhong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.
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Maliha G, Townsend RR. A study of the VaSera arterial stiffness device in US patients. J Clin Hypertens (Greenwich) 2017; 19:661-668. [PMID: 28440017 DOI: 10.1111/jch.12967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 12/20/2022]
Abstract
The cardio-ankle vascular index (CAVI) represents a promising index of arterial stiffness. However, neither the CAVI measure nor its measurement device, the VaSera, have undergone general testing in a North American clinical setting. To begin the process of collecting normal values in the United States, we studied 20 male and 28 female volunteers without reported cardiovascular or renal disease and no history of smoking. Their CAVIs, ankle-brachial indices (ABIs), and four-limb blood pressures were measured in three positions: supine, 7° Trendelenburg, and 7° reverse Trendelenburg. In addition, the ABI function was validated against an established ABI measurement technique. Position was found to affect CAVI and other hemodynamic parameters, indicating that CAVI is not robust to slight positional variations. No differences were found in the blood pressure between arms or legs (interbrachial or interankle), supporting recent findings from meta-analyses and studies but contradicting other work. This study represents an early step in bringing the VaSera device and its CAVI measurement into clinical practice.
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Affiliation(s)
- George Maliha
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kusunose K, Sato M, Yamada H, Saijo Y, Bando M, Hirata Y, Nishio S, Hayashi S, Sata M. Prognostic Implications of Non-Invasive Vascular Function Tests in High-Risk Atherosclerosis Patients. Circ J 2016; 80:1034-40. [PMID: 26936237 DOI: 10.1253/circj.cj-15-1356] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to assess the role of clinically available vascular function tests as predictors of cardiovascular events and decline in kidney function. METHODS AND RESULTS One hundred and fourteen patients who had at least 2 cardiovascular risk factors were recruited for vascular function assessment including ankle-brachial blood pressure index (ABI), brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI) and flow-mediated vasodilatation (%FMD). During a median period of 51 months, 35 patients reached the primary endpoint (29 cardiovascular events and 6 cardiac deaths), and 30 patients reached the secondary endpoint (decline in kidney function: defined as a 5% per year decline of estimated glomerular filtration rate). In sequential Cox models, a model on the basis of the Framingham risk score, hemoglobin, and high-sensitivity C-reactive protein (chi-squared, 16.6) was improved by the ABI (chi-squared: 21.5; P=0.047). The baPWV (hazard ratio: 1.42 per 1 SD increase; P=0.025) and the CAVI (hazard ratio: 1.52 per 1 SD increase; P=0.040) were associated with the secondary endpoint. The %FMD was only slightly associated with the primary and secondary endpoints. CONCLUSIONS Both ABI and baPWV are significantly associated with future cardiovascular events in high-risk patients with cardiovascular disease. The predictive capabilities of these parameters are greater than that of other parameters in this cohort.
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Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
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Shirai K, Saiki A, Nagayama D, Tatsuno I, Shimizu K, Takahashi M. The Role of Monitoring Arterial Stiffness with Cardio-Ankle Vascular Index in the Control of Lifestyle-Related Diseases. Pulse (Basel) 2015; 3:118-33. [PMID: 26587461 DOI: 10.1159/000431235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Arteriosclerosis is a major contributor to cardiovascular diseases. One of the difficulties in controlling those diseases is the lack of a suitable indicator of arteriosclerosis or arterial injury in routine clinical practice. Arterial stiffness was supposed to be one of the monitoring indexes of arteriosclerosis. Cardio-ankle vascular index (CAVI) is reflecting the stiffness of the arterial tree from the origin of the aorta to the ankle, and one of the features of CAVI is independency from blood pressure at a measuring time. When doxazosin, an α1-adrenergic blocker, was administered, CAVI decreased, indicating that arterial stiffness is composed of both organic stiffness and functional stiffness, which reflects the contraction of arterial smooth muscle. CAVI shows a high value with aging and in many arteriosclerotic diseases, and is also high in persons possessing main coronary risk factors such as diabetes mellitus, metabolic syndrome, hypertension and smoking. Furthermore, when the most of those risk factors were controlled by proper methods, CAVI improved. Furthermore, the co-relationship between CAVI and heart function was demonstrated during treatment of heart failure. This paper reviews the principle and rationale of CAVI, and discusses the meaning of monitoring CAVI in following up so-called lifestyle-related diseases and cardiac dysfunction in routine clinical practice.
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Affiliation(s)
- Kohji Shirai
- Department of Vascular Function, Chiba, Japan ; Seijinkai Mihama Hospital, Chiba, Japan
| | | | | | | | - Kazuhiro Shimizu
- Cardiovascular Center, Sakura Hospital, School of Medicine, Toho University, Chiba, Japan
| | - Mao Takahashi
- Cardiovascular Center, Sakura Hospital, School of Medicine, Toho University, Chiba, Japan
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