Clinical Impact of Blood Testosterone Concentration on Cardio-Ankle Vascular Index in Female Patients With Type 2 Diabetes Mellitus

New Horizons of Arterial Stiffness Developed Using Cardio-Ankle Vascular Index (CAVI)

Arterial stiffness is recognized mainly as an indicator of arteriosclerosis and a predictor of cardiovascular events. Cardio-ankle vascular index (CAVI), which reflects arterial stiffness from the origin of the aorta to the ankle, was developed in 2004. An important feature of this index is the independency from blood pressure at the time of measurement. A large volume of clinical evidence obtained using CAVI has been reported. CAVI is high in patients with various atherosclerotic diseases including coronary artery disease and chronic kidney disease. Most coronary risk factors increase CAVI and their improvement reduces CAVI. Many prospective studies have investigated the association between CAVI and future cardiovascular disease (CVD), and proposed CAVI of 9 as the optimal cut-off value for predicting CVD. Research also shows that CAVI reflects afterload and left ventricular diastolic dysfunction in patients with heart failure. Furthermore, relatively acute changes in CAVI are observed under various pathophysiological conditions including mental stress, septic shock and congestive heart failure, and in pharmacological studies. CAVI seems to reflect not only structural stiffness but also functional stiffness involved in acute vascular functions. In 2016, Spronck and colleagues proposed a variant index CAVI₀, and claimed that CAVI₀ was truly independent of blood pressure while CAVI was not. This argument was settled, and the independence of CAVI from blood pressure was reaffirmed. In this review, we summarize the recently accumulated evidence of CAVI, focusing on the proposed cut-off values for CVD events, and suggest the development of new horizons of vascular function index using CAVI.

Correlation Between the Cardio-Ankle Vascular Index and Renal Resistive Index in Patients With Essential Hypertension

Background

Renal resistive index (RRI) is a parameter determined by Doppler sonography that reflects renal hemodynamics. Significant relationships connecting increases in the RRI with cardiovascular risk factors and the incidence of cardiovascular disease in hypertensive patients have been reported. This cross-sectional study aimed to clarify the relationship between cardio-ankle vascular index (CAVI), a novel marker of arterial stiffness, and the RRI in patients with essential hypertension with the goal of primary prevention of cardiovascular disease.

Methods

The study included 245 patients undergoing treatment for essential hypertension (95 men and 150 women; mean age ± standard deviation, 65 ± 13 years) with no history of cardiovascular disease. The CAVI and RRI were measured using commercial devices, and their relationships to various clinical parameters were examined.

Results

A significant positive correlation was observed between the CAVI and RRI (r = 0.43, P < 0.001). Multiple regression analyses revealed a value of β of 0.28 (P < 0.001) when CAVI was evaluated as the independent and RRI as the dependent variable. Receiver-operating characteristic curve analysis indicated that the CAVI cutoff point for high RRI (> 0.70) was 9.0 with area under the curve of 0.700 (P < 0.001).

Conclusion

The results from this study indicate that the CAVI varies directly with measures of renal vascular hemodynamics (RRI) in patients with essential hypertension. These findings identified a cardiovascular risk value of the CAVI from the perspective of renal hemodynamics as 9.0 in this patient population.