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Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study

Bäck M 1 , Topouchian J 2 , Labat C 3 , Gautier S 4 , Blacher J 2 , Cwynar M 5 Show all authors , de la Sierra A 6 , Pall D 7 , Duarte K 4 , Fantin F 8 , Farkas K 9 , Garcia-Ortiz L 10 , Hakobyan Z 11 , Jankowski P 12 , Jelakovic A 13 , Kotsani M 4 , Konradi A 14 , Mikhailova O 15 , Mintale I 16 , Plunde O 17 , Ramos R 18 , Rogoza A 15 , Sirenko Y 19 , Tasic N 20 , Rudyk I 21 , Urazalina S 22 , Wohlfahrt P 23 , Zelveian P 11 , Asmar R 24 , Benetos A 25

Affiliations 

  • 1 Department of Medicine Solna, Karolinska Institutet and Department of Cardiology Karolinska University Hospital, Stockholm, Sweden; Inserm U1116, Nancy, France; Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France. Electronic address: Magnus.Back@ki.se
  • 2 Paris-Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel Dieu, Paris, France
  • 3 Inserm U1116, Nancy, France
  • 4 Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France
  • 5 Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
  • 6 Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
  • 7 Department of Medical Clinical Pharmacology, University of Debrecen, Hungary
  • 8 Department of Medicine, Section of Geriatric Medicine, University of Verona, Italy
  • 9 Cardiometabolic Centre, Dept. of Angiology, Szent Imre University Teaching Hospital, Budapest, Hungary
  • 10 Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL), Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
  • 11 Institute of Cardiology, Centre of Preventive Cardiology, Yerevan, Armenia
  • 12 Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
  • 13 Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre, Zagreb, Croatia
  • 14 Almazov Federal Medical Research Centre, St-Petersburg, Russia
  • 15 FSBI "Chazov National Medical Research Centre of Cardiology" of the Ministery of Health of the Russian Federation, Moscow, Russia
  • 16 P. Stradins University Hospital, Cardiology Centre, Riga, Latvia
  • 17 Department of Medicine Solna, Karolinska Institutet and Department of Cardiology Karolinska University Hospital, Stockholm, Sweden
  • 18 Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Department of Medical Sciences, University of Girona, Primary Care Services, Biomedical Research Institute, Institut Català de la Salut, Girona, Spain
  • 19 Institute of Cardiology, Kiev, Ukraine
  • 20 Medical Faculty, University of Belgrade and Cardiovascular Institute, Dedinje, Belgrade, Serbia
  • 21 Government Institution, L.T. Malaya Therapy Institute of the National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine
  • 22 Scientific and Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
  • 23 Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  • 24 Foundation-Medical Research Institutes, Paris, France
  • 25 Inserm U1116, Nancy, France; Université de Lorraine, CHRU Nancy, University Hospital of Nancy, France
EBioMedicine, 2024 May;103:105107.
PMID: 38632024 DOI: 10.1016/j.ebiom.2024.105107

Abstract

BACKGROUND: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression.

METHODS: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years.

FINDINGS: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI.

INTERPRETATION: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments.

FUNDING: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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