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Suwannasom P, Thonghong T, Leemasawat K, Nantsupawat T, Prasertwitayakij N, Pairoj C, Wongcharoen W, Phrommintikul A. Predictive value of Systematic Coronary Risk Evaluation 2-Diabetes risk model and arterial stiffness for cardiovascular events in the Asian population with type 2 diabetes mellitus. J Diabetes Investig 2024; 15:1266-1275. [PMID: 38747805 PMCID: PMC11363117 DOI: 10.1111/jdi.14231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/09/2024] [Accepted: 04/30/2024] [Indexed: 08/31/2024] Open
Abstract
AIMS/INTRODUCTION Individuals with diabetes are at high risk of developing cardiovascular events. The present study investigated the predictive value of the cardio-ankle vascular index (CAVI) when added to the Systematic Coronary Risk Evaluation 2-Diabetes (SCORE2-Diabetes) risk algorithm to predict cardiovascular events in the Asian population. MATERIALS AND METHODS The SCORE2-Diabetes risk was assessed in 1,502 patients with diabetes, aged 40-69 years. Then, we further stratified each 10-year risk category with a CAVI value of 9.0. The primary outcomes (composite of all causes of death, myocardial infarction, stroke and hospitalization for heart failure) were assessed over 5 years. RESULTS The mean age of the population was 59.8 ± 6.4 years. The proportion of 10-year risk according to the SCORE2-Diabetes risk of low, moderate, high and very high risk identified at 7.2, 30.0, 27.2 and 35.6%, respectively. The mean CAVI value was 8.4 ± 1.4, and approximately 35.4% of the patients had CAVI ≥9.0. The SCORE2-Diabetes risk algorithm independently predicted the primary outcomes in patients with diabetes (hazard ratio 1.18, 95% confidence interval [CI] 1.13-1.22), whereas CAVI did not (hazard ratio 1.03, 95% CI 0.89-1.18). The C-index for the primary outcomes of the SCORE2-Diabetes risk algorithm alone was 0.72 (95% CI 0.67-0.77). The combination of SCORE2-Diabetes and CAVI, both in the continuous value and risk groups, did not improve discrimination (C-index 0.72, 95% CI 0.67-0.77 and 0.68, 95% CI 0.64-0.74, respectively). CONCLUSIONS Adding the CAVI to the SCORE2-Diabetes risk algorithm did not improve individual risk stratification in patients with diabetes.
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Affiliation(s)
- Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Tasalak Thonghong
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Krit Leemasawat
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Teerapat Nantsupawat
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Narawudt Prasertwitayakij
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Chutamas Pairoj
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
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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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Hou X, Zhang N, Chen S, Guo L, Yu Y, Wei Z, Liu J, Wu S, Tian F. Association of life's essential 8 and risk of fragility fractures: A large cohort study. J Orthop Res 2024; 42:798-805. [PMID: 37804221 DOI: 10.1002/jor.25708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/29/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
Cardiovascular health (CVH) score is not only associated with cardiovascular diseases, but also some disorders in other systems. This study aims to investigate the association between CVH score and the risk of fragility fractures. The analysis enrolled 89,464 participants at baseline in Kailuan study initiated in 2006-2007. All participants were then followed up every 2 years and the incidence of fragility fractures was recorded annually. A total CVH score was classified as low (0-49 points), moderate (50-79 points), and ideal (80-100 points). The primary outcome was incident fragility fractures before December 31, 2021. Kaplan-Meier was used to estimate cumulative incidence. Multivariable adjusted Cox proportional hazards regression models and time-dependent Cox hazards regression models were used to estimate fragility fracture hazard ratios (aHR) and 95% confidence intervals (95% CI). After 13.98 ± 2.84 years of follow-up, a total of 1534 cases of fragility fractures were identified, with an incidence density of 1.23 per 1000 person-years. Compared with the low CVH group, the risk of fragility fractures was significantly lower in moderate (aHR = 0.78, 95% CI: 0.66-0.92) and ideal CVH groups (aHR = 0.65, 95% CI: 0.51-0.83), particularly in the age <60 group (aHR = 0.72, 95% CI: 0.59-0.88; aHR= 0.55, 95% CI: 0.41-0.73, respectively). Time-dependent Cox hazards regression models, sensitivity analysis, and death competition model confirmed the reliability of these findings. The ideal CVH score is associated with a decreased risk of fragility fractures. With the increase of CVH score, the risk of fragility fracture decreases.
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Affiliation(s)
- Xiaoli Hou
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Nan Zhang
- Department of Orthopedics, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Lu Guo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yaohui Yu
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Zhihao Wei
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Jiayin Liu
- Second Hospital of Tangshan, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Faming Tian
- School of Public Health, North China University of Science and Technology, Tangshan, China
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Massy ZA, Lambert O, Metzger M, Sedki M, Chaubet A, Breuil B, Jaafar A, Tack I, Nguyen-Khoa T, Alves M, Siwy J, Mischak H, Verbeke F, Glorieux G, Herpe YE, Schanstra JP, Stengel B, Klein J. Machine Learning-Based Urine Peptidome Analysis to Predict and Understand Mechanisms of Progression to Kidney Failure. Kidney Int Rep 2023; 8:544-555. [PMID: 36938091 PMCID: PMC10014385 DOI: 10.1016/j.ekir.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The identification of patients with chronic kidney disease (CKD) at risk of progressing to kidney failure (KF) is important for clinical decision-making. In this study we assesed whether urinary peptidome (UP) analysis may help classify patients with CKD and improve KF risk prediction. Methods The UP was analyzed using capillary electrophoresis coupled to mass spectrometry in a case-cohort sample of 1000 patients with CKD stage G3 to G5 from the French CKD-Renal Epidemiology and Information Network (REIN) cohort. We used unsupervised and supervised machine learning to classify patients into homogenous UP clusters and to predict 3-year KF risk with UP, respectively. The predictive performance of UP was compared with the KF risk equation (KFRE), and evaluated in an external cohort of 326 patients. Results More than 1000 peptides classified patients into 3 clusters with different CKD severities and etiologies at baseline. Peptides with the highest discriminative power for clustering were fragments of proteins involved in inflammation and fibrosis, highlighting those derived from α-1-antitrypsin, a major acute phase protein with anti-inflammatory and antiapoptotic properties, as the most significant. We then identified a set of 90 urinary peptides that predicted KF with a c-index of 0.83 (95% confidence interval [CI]: 0.81-0.85) in the case-cohort and 0.89 (0.83-0.94) in the external cohort, which were close to that estimated with the KFRE (0.85 [0.83-0.87]). Combination of UP with KFRE variables did not further improve prediction. Conclusion This study shows the potential of UP analysis to uncover new pathophysiological CKD progression pathways and to predict KF risk with a performance equal to that of the KFRE.
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Affiliation(s)
- Ziad A. Massy
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, CHU Ambroise Paré, APHP, Boulogne Billancourt Cedex, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
| | - Mohammed Sedki
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Methodology Pole, Villejuif, France
| | - Adeline Chaubet
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Acil Jaafar
- Department of Clinical Physiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Ivan Tack
- Department of Clinical Physiology, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Thao Nguyen-Khoa
- Laboratory of Biochemistry, HU Necker-Enfants Malades, AP-HP Centre Université de Paris, Paris, France
- INSERM U1151, Institut Necker-Enfants Malades, Université de Paris Cité, Paris, France
| | - Melinda Alves
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany
| | | | - Francis Verbeke
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Yves-Edouard Herpe
- Biobanque de Picardie, Biological Resource Center of the Amiens University Hospital, 1 rondpoint du Pr Christian Cabrol, Amiens Cedex, France
| | - Joost P. Schanstra
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Versailles-Saint Quentin, Inserm UMRS 1018, Clinical Epidemiology Team, Villejuif, France
- Department of Nephrology, CHU Ambroise Paré, APHP, Boulogne Billancourt Cedex, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale, Institute of Cardiovascular and Metabolic Disease, UMRS 1297, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
- Correspondence: Julie Klein, Institute of Metabolic and Cardiovascular disease, 1 avenue Jean-Poulhès, 31432 Toulouse Cedex 4, France.
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Liu J, Su X, Nie Y, Zeng Z, Chen H. Nocturnal blood pressure rather than night-to-day blood pressure ratio is related to arterial stiffening in untreated young and middle-aged adults with non-dipper hypertension. J Clin Hypertens (Greenwich) 2022; 24:1044-1050. [PMID: 35894760 PMCID: PMC9380157 DOI: 10.1111/jch.14546] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/18/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022]
Abstract
Little is known about nocturnal blood pressure (BP) or night-to-day BP ratio, which is a more specific determinant of arterial stiffness in subjects with non-dipper hypertension? This study aims to investigate the correlation of nocturnal BP and brachial-ankle pulse wave velocity (ba PWV), an index of arterial stiffness in untreated young and middle-aged adults with non-dipper hypertension. A cross-sectional analysis of baseline parameters of the NARRAS trial was performed. Twenty-four hour ambulatory BP measurements, ba PWV and routine clinical data collection were performed in all patients. The relationship of 24-h ambulatory BP profiles, biochemical measures as well as demographic parameters and ba PWV were analyzed using Pearson's correlation and multiple stepwise regression analysis. A total of 77 patients (mean age 47.0 ± 11.7 years) with non-dipper hypertension were included. Age, height, weight and nocturnal systolic BP were related to ba PWV in Pearson's correlation analysis. In stepwise regression analysis, age (β = 10.57, 95% confidence interval (CI): 6.099-15.042, p < 0.001) and weight (β = -3.835, 95% CI: -7.658--0.013, p = 0.049) are related to ba PWV. Nocturnal systolic BP (β = 8.662, 95% CI: 2.511-14.814, p = 0.006) was the independent predictors of ba PWV, even after night-to-day systolic BP ratio or 24-h ambulatory BP profile were taken into account. Nocturnal systolic BP rather than night-to-day systolic BP ratio appears to be a more specific determinant for arterial stiffness, as assessed by ba PWV in young and middle-aged adults with non-dipper hypertension. 24-h ambulatory BP measurements are essential for cardiovascular risk evaluation.
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Affiliation(s)
- Jing Liu
- Department of HypertensionPeking University People's HospitalBeijingChina
| | - Xiaofeng Su
- Department of HypertensionPeking University People's HospitalBeijingChina
| | - Ying Nie
- Department of Internal MedicineBeijing Jiaotong University HospitalBeijingChina
| | - Zhihuan Zeng
- Department of CardiologyThe First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhouChina
| | - Hongyan Chen
- Deparment of Internal MedicineNorth China Electric Power University HospitalBeijingChina
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Budoff MJ, Alpert B, Chirinos JA, Fernhall B, Hamburg N, Kario K, Kullo I, Matsushita K, Miyoshi T, Tanaka H, Townsend R, Valensi P. Clinical Applications Measuring Arterial Stiffness: An Expert Consensus for the Application of Cardio-Ankle Vascular Index. Am J Hypertens 2022; 35:441-453. [PMID: 34791038 PMCID: PMC9088840 DOI: 10.1093/ajh/hpab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this document is to provide clinicians with guidance, using expert consensus, to help summarize evidence and offer practical recommendations. METHODS Expert Consensus Documents are intended to provide guidance for clinicians in areas in which there are no clinical practice guidelines, especially for new and evolving tests such as arterial stiffness measurements, until any formal guidelines are released. RESULTS This expert consensus document is intended as a source of information for decision-making and to guide clinician-patient discussions in various clinical scenarios. CONCLUSIONS The goal is to help clinicians and patients make a more informed decision together.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California, USA
| | - Bruce Alpert
- Department of Medicine, University of Tennessee Medical Group, Memphis, Tennessee, USA
| | - Julio A Chirinos
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bo Fernhall
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Naomi Hamburg
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kazuomi Kario
- Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Iftikhar Kullo
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kunihiro Matsushita
- Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Toru Miyoshi
- Department of Medicine, Okayama University, Okayama, Japan
| | - Hirofumi Tanaka
- Department of Medicine, The University of Texas at Austin, Austin, Texas, USA
| | - Ray Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, Department of Medicine, Jean Verdier Hospital, AP-HP, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
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Nagayama D, Fujishiro K, Tsuda S, Watanabe Y, Yamaguchi T, Suzuki K, Saiki A, Shirai K. Enhanced prediction of renal function decline by replacing waist circumference with "A Body Shape Index (ABSI)" in diagnosing metabolic syndrome: a retrospective cohort study in Japan. Int J Obes (Lond) 2021; 46:564-573. [PMID: 34824353 PMCID: PMC8872991 DOI: 10.1038/s41366-021-01026-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022]
Abstract
Background Abdominal obesity as a risk factor for diagnosing metabolic syndrome (MetS) is conventionally evaluated using waist circumference (WC), although WC does not necessarily reflect visceral adiposity. Objective To examine whether replacing WC with “A Body Shape Index (ABSI)”, an abdominal obesity index calculated by dividing WC by an allometric regression of weight and height, in MetS diagnosis is useful for predicting renal function decline. Subjects/Methods In total, 5438 Japanese urban residents (median age 48 years) who participated in a public health screening program for 4 consecutive years were enrolled. Systemic arterial stiffness was assessed by cardio-ankle vascular index (CAVI). The predictability of the new-onset renal function decline (eGFR < 60 mL/min/1.73 m2) by replacing high WC with high ABSI (ABSI ≥ 0.080) was examined using three sets of MetS diagnostic criteria: Japanese, IDF and NCEP-ATPIII. Results In Japanese and NCEP-ATPIII criteria, MetS diagnosed using ABSI (ABSI-MetS) was associated with significantly higher age-adjusted CAVI compared to non-MetS, whereas MetS diagnosed using WC (WC-MetS) showed no association. Kaplan–Meier analysis of the rate of new-onset renal function decline over 4 years (total 8.7%) showed remarkable higher rate in subjects with ABSI-MetS than in those without (log-rank test p < 0.001), but almost no difference between subjects with and without WC-MetS (p = 0.014–0.617). In gender-specific Cox-proportional hazards analyses including age, proteinuria, and treatments of metabolic disorders as confounders, ABSI-MetS (Japanese criteria for both sexes, IDF criteria for men) contributed independently to the new-onset renal function decline. Of these, the contribution of IDF ABSI-MetS disappeared after adjustment by high CAVI in the subsequent analysis. Conclusion In this study, replacing WC with ABSI in MetS diagnostic criteria more efficiently predicted subjects at risk of renal function decline and arterial stiffening.
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Affiliation(s)
- Daiji Nagayama
- Department of Internal Medicine, Nagayama Clinic, 2-12-22, Tenjin-cho, Oyama-city, Tochigi, 3230032, Japan. .,Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, 564-1, Shimoshizu, Sakura-city, Chiba, 2850841, Japan.
| | - Kentaro Fujishiro
- Japan Health Promotion Foundation, 1-24-4, Ebisu, Shibuya-ku, Tokyo, 1500013, Japan
| | - Shinichi Tsuda
- Fukuda Denshi Co., Ltd., 3-39-4, Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Yasuhiro Watanabe
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, 564-1, Shimoshizu, Sakura-city, Chiba, 2850841, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, 564-1, Shimoshizu, Sakura-city, Chiba, 2850841, Japan
| | - Kenji Suzuki
- Japan Health Promotion Foundation, 1-24-4, Ebisu, Shibuya-ku, Tokyo, 1500013, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, 564-1, Shimoshizu, Sakura-city, Chiba, 2850841, Japan
| | - Kohji Shirai
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, 564-1, Shimoshizu, Sakura-city, Chiba, 2850841, Japan.,Department of Internal Medicine, Mihama Hospital, 1-1-5, Uchise, Mihama-ku, Chiba, 2610013, Japan
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Ankle-brachial index predicts renal outcomes and all-cause mortality in high cardiovascular risk population: a nationwide prospective cohort study in CORE project. Int Urol Nephrol 2021; 54:1641-1652. [PMID: 34724144 DOI: 10.1007/s11255-021-03049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low ankle-brachial index (ABI) related ischemic events are common among individuals with chronic kidney disease (CKD). It is also associated with an increased risk of rapid renal function decline. The presence of peripheral artery disease (PAD) with low ABI among patients with high cardiovascular (CV) risk increases limb loss and mortality. AIMS To estimate the association between abnormal ABI and renal endpoints and all-cause mortality. METHODS A multicenter prospective cohort study was conducted among subjects with high CV risk or established CV diseases in Thailand. The subjects were divided into 3 groups based on ABI at baseline > 1.3, 0.91-1.3, and ≤ 0.9, respectively. Primary composite outcome consisted of estimated glomerular filtration rate (eGFR) decline over 40%, eGFR less than 15 mL/min/1.73 m2, doubling of serum creatinine and initiation of dialysis. The secondary outcome was all-cause mortality. Cox regression analysis and Kaplan-Meier curve were performed. RESULTS A total of 5543 subjects (3005 men and 2538 women) were included. Cox proportional hazards model showed a significant relationship of low ABI (ABI ≤ 0.9) and primary composite outcome and all-cause mortality. Compared with the normal ABI group (ABI 0.91-1.3), subjects with low ABI at baseline significantly had 1.42-fold (95% CI 1.02-1.97) and 2.03-fold (95% CI 1.32-3.13) risk for the primary composite outcome and all-cause mortality, respectively, after adjusting for variable factors. CONCLUSION Our study suggested that PAD independently predicts the incidence of renal progression and all-cause mortality among Thai patients with high CV risk.
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Cardio-ankle vascular index with renal progression and mortality in high atherosclerosis risk: a prospective cohort study in CORE-Thailand. Clin Exp Nephrol 2021; 26:247-256. [PMID: 34643840 DOI: 10.1007/s10157-021-02149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increased arterial stiffness is linked to markers of endothelial dysfunction and vasculopathy such as albuminuria, vascular calcification, left ventricular hypertrophy and cardiovascular (CV) diseases. Studies of arterial stiffness on renal progression are limited. OBJECTIVE The study aimed to evaluate the association between high cardio-ankle vascular index (CAVI) and renal endpoint and all-cause mortality in a Thai population with high atherosclerosis risk. METHODS A multicenter prospective cohort study was conducted among subjects with high CV risk or established CV diseases in Thailand. Subjects were divided into 3 groups with mean CAVI < 8, 8-8.9, and ≥ 9, respectively. Primary composite outcome consisted of estimated glomerular filtration rate (eGFR) decline over 40%, eGFR less than 15 mL/min/1.73 m2, doubling of serum creatinine, initiation of dialysis and death related to renal causes. The secondary outcomes were all-cause mortality, CV mortality and eGFR decline. RESULTS A total of 4898 subjects (2743 men and 2155 women) were enrolled. Cox proportional hazards model showed a significant relationship of high CAVI (CAVI ≥ 9) and primary composite outcome. Subjects with high CAVI at baseline had a 1.45-fold (95% CI 1.13-1.84) significant risk for the primary composite outcome and 1.72-fold (95% CI 1.12-2.63) risk for all-cause mortality, compared with normal CAVI (CAVI < 8). After stepwise multivariate analysis, the high CAVI group was only positively associated with primary composite outcome. Kaplan-Meier curve of the primary composite outcome and all-cause mortality demonstrated the worst survival in the high CAVI group (log-rank test with P < 0.05). CONCLUSION In a Thai cohort with high atherosclerosis risk, increased arterial stiffness was a risk factor for worsening renal function, including end-stage renal disease and initiation of dialysis.
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Sumin AN, Shcheglova AV. Assessment of Arterial Stiffness Using the Cardio-Ankle Vascular Index – What We Know and What We Strive for. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-08-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Currently, the importance of assessing arterial stiffness as an integral indicator of cardiovascular risk, an indicator of arteriosclerosis, and a predictor of cardiovascular events has been demonstrated. The traditional indicator of arterial stiffness-pulse wave velocity-depends on the level of blood pressure, which makes it difficult to use it for dynamic assessment. The proposed new arterial stiffness index-the cardio-ankle vascular index (CAVI), does not depend on the level of blood pressure and is more convenient in practical use. CAVI has been widely used in clinical medicine for the past 15 years as an index for assessing cardiovascular diseases and risk factors, which has allowed for the expansion and deepening of research on this topic. This review focuses primarily on recent publications and new opportunities for evaluating vascular function using CAVI. The review provides information on solving methodological problems in evaluating CAVI, highlights the relationship between CAVI and future cardiovascular events, and provides cross-sectional data on the Association of CAVI with the presence of cardiovascular diseases and their risk factors. The results of studies on the effect of drug therapy and measures to control risk factors for cardiovascular diseases on CAVI are presented. While it remains unclear how much changes in CAVI over time can affect the forecast, research is currently being conducted in this direction. The use of CAVI also opens up new perspectives in the assessment of cardiovascular interactions, the study of vascular function in vasculitis and vascular injuries, as well as in geriatric medicine (concepts of premature vascular aging and excess vascular aging).
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Affiliation(s)
- A. N. Sumin
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - A. V. Shcheglova
- Research Institute for Complex Issues of Cardiovascular Diseases
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Miyoshi T, Ito H. Arterial stiffness in health and disease: The role of cardio-ankle vascular index. J Cardiol 2021; 78:493-501. [PMID: 34393004 DOI: 10.1016/j.jjcc.2021.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022]
Abstract
Arterial stiffness increases with age, as well as in various pathological states, including obesity, diabetes mellitus, smoking, and dyslipidemia, and it has important consequences for cardiovascular health. Arterial stiffness plays a central role in hemodynamic dysfunction characterized by excess pulsatility; specifically, it leads to heart failure, cerebrovascular disease, and renal failure. Among measures of arterial stiffness, carotid-femoral pulse wave velocity is considered as the reference standard; however, it has not been incorporated into routine clinical practice. Cardio-ankle vascular index (CAVI), which is a marker of arterial stiffness measured from the origin of the aorta to the ankle, was developed in 2004. CAVI is based on stiffness parameter β, which is theoretically independent of blood pressure at the time of measurement. CAVI applies stiffness parameter β to arterial segments between the heart and ankle. The measurement of CAVI is simple and well-standardized, and its reproducibility and accuracy are acceptable. Several studies have demonstrated that CAVI is high in patients with various atherosclerotic risk factors, and treatment of cardiovascular risk factors and lifestyle modifications improve CAVI. Several prospective studies have investigated the association between CAVI and future cardiovascular events in the general population and in patients with cardiovascular risk factors. A cut-off value of 9.0 is proposed for predicting patients at a high risk of cardiovascular events. From this review, it is clear that CAVI may be useful in the prevention of cardiovascular disease.
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Affiliation(s)
- Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Sato Y, Yoshihisa A, Ichijo Y, Watanabe K, Hotsuki Y, Kimishima Y, Yokokawa T, Misaka T, Sato T, Kaneshiro T, Oikawa M, Kobayashi A, Takeishi Y. Cardio-Ankle Vascular Index Predicts Post-Discharge Stroke in Patients with Heart Failure. J Atheroscler Thromb 2021; 28:766-775. [PMID: 32981919 PMCID: PMC8265923 DOI: 10.5551/jat.58727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/19/2020] [Indexed: 12/25/2022] Open
Abstract
AIM We aimed to evaluate the significance of the cardio-ankle vascular index (CAVI) to predict stroke in patients with heart failure (HF). METHODS This was a prospective observational study, which recruited clinical data from a total of 557 patients who had been hospitalized for HF and undergone CAVI. According to the receiver operating characteristic curve analysis, the accurate cut-off value of CAVI in predicting post-discharge stroke was 9.64. We divided the patients into two groups: the high-CAVI group (HF patients with CAVI ≥ 9.64, n=111, 19.9%) and the low-CAVI group (HF patients with CAVI <9.64, n=446, 80.1%). We compared the patients' characteristics and post-discharge prognosis. The primary endpoint was stroke. RESULTS The high-CAVI group was older (73.0 vs. 65.5 years old, P<0.001). Male sex (73.9% vs. 61.4%, P=0.015), coronary artery disease (47.7% vs. 36.1%, P=0.024), and diabetes mellitus (54.1% vs. 37.4%, P=0.001) were more prevalent in the high-CAVI group. In contrast, there was no difference in left ventricular ejection fraction, and prevalence of hypertension and dyslipidemia. The Kaplan-Meier analysis demonstrated that post-discharge stroke rate was higher in the high-CAVI group than in the low-CAVI group (log-rank P=0.005). In multivariate Cox proportional hazard analysis, high CAVI was found to be an independent predictor of stroke, with an adjusted hazard ratio of 3.599, compared to low CAVI. CONCLUSION CAVI independently predicts stroke in patients with HF.
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Affiliation(s)
- Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Koichiro Watanabe
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yu Hotsuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Kimishima
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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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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14
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Miyata M. Basic Research Sheds Light on the Aspect of Cardio-Ankle Vascular Index (CAVI) including Elastic and Muscular Arteries. J Atheroscler Thromb 2020; 28:588-589. [PMID: 33041314 PMCID: PMC8219537 DOI: 10.5551/jat.ed147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Masaaki Miyata
- School of Health Sciences, Faculty of Medicine, Kagoshima Universit
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Manabe S, Kataoka H, Mochizuki T, Iwadoh K, Ushio Y, Kawachi K, Watanabe K, Watanabe S, Akihisa T, Makabe S, Sato M, Iwasa N, Yoshida R, Sawara Y, Hanafusa N, Tsuchiya K, Nitta K. Maximum Carotid Intima-Media Thickness in Association with Renal Outcomes. J Atheroscler Thromb 2020; 28:491-505. [PMID: 32759541 PMCID: PMC8193787 DOI: 10.5551/jat.57752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim:
We aimed to examine the association between the maximum intima-media thickness of the carotid artery (Max IMT) and renal prognosis, considering their potential interaction with age.
Methods:
Survival analyses were performed in 112 patients with chronic kidney disease (CKD), to assess renal prognosis, with the endpoint defined as a ≥ 30% decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease.
Results:
During a median follow-up of 12.5 years, 44 participants reached the study endpoint. The major determinant of Max IMT was the maximum IMT of the internal carotid artery (Max ICA-IMT), which was the distribution ratio of 50.0% of Max IMT. Kaplan–Meier analyses showed that Max IMT ≥ 1.5 mm was significantly associated with renal prognosis when age and eGFR were matched. On multivariate Cox regression analysis, Max IMT was significantly associated with the renal outcomes and had a significant interaction with the age categories (≥ 65 years or <65 years) (
P
=0.0153 for interaction). A 1-mm increase in Max IMT was significantly associated with disease progression in the sub-cohort <65 years age-category, but not in the ≥ 65 years age-category; similarly the hazard ratio (HR) in the <65 years age-category was higher than in the ≥ 65 years age-category (HR: 2.52 vs. 0.95). Comparable results were obtained for Max ICA-IMT, Max bulb-IMT, but not for Max common carotid artery-IMT.
Conclusions:
A higher Max IMT was a significant renal prognosis factor in patients with CKD aged <65 years. Our results may provide new insights into treating CKD.
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Affiliation(s)
- Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Kazuhiro Iwadoh
- Department of Blood Purification, Tokyo Women's Medical University
| | - Yusuke Ushio
- Department of Nephrology, Tokyo Women's Medical University
| | - Keiko Kawachi
- Department of Nephrology, Tokyo Women's Medical University
| | | | - Saki Watanabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women's Medical University
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Masayo Sato
- Department of Nephrology, Tokyo Women's Medical University
| | - Naomi Iwasa
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Rie Yoshida
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Yukako Sawara
- Department of Nephrology, Tokyo Women's Medical University
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women's Medical University
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University
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