Non-hemodynamic predictors of arterial stiffness after 17 years of follow-up: the Malmö Diet and Cancer study

Abstract

Background: Arterial stiffness plays a fundamental role in the development of hypertension and is a risk factor for both cardiovascular disease and mortality. The stiffening that occurs with increasing age has, in numerous cross-sectional studies, been shown to be associated with several cardiovascular risk factors. This observational study aims to characterize the predictive and cross-sectional markers focusing on the non-hemodynamic component of arterial stiffness.

Method: In all, 2679 men and women from Malmö, Sweden, were examined at baseline during 1991-1994, and again at follow-up during 2007-2012 (mean age 72 years, 38% men). Follow-up examination included measurement of arterial stiffness by carotid-femoral pulse wave velocity (c-fPWV), after a mean period of 17 years. The associations between c-fPWV and risk markers were calculated with multiple linear regression.

Results: The results indicated that for both sexes, waist circumference (β = 0.17, P < 0.001), fasting glucose (β = 0.13, P < 0.001), Homeostatic Model Assessment - Insulin Resistance (β = 0.10, P < 0.001), triglycerides (β = 0.10, P < 0.001), and high-density lipoprotein cholesterol (β = -0.08, P < 0.001) were all predictors of cfPWV adjusted for mean arterial pressure and heart rate, as well as for classical cardiovascular risk factors and drug treatment. There were no associations between baseline or follow-up low-density lipoprotein cholesterol, smoking, or eGFR and c-fPWV.

Conclusion: The non-hemodynamic cluster of risk markers and predictors of arterial stiffness in a middle-aged population includes abdominal obesity, hyperglycemia, and dyslipidemia, but not smoking and low-density lipoprotein cholesterol. This pattern existed in both sexes.

FIGURE 1

Flow diagram of nonparticipation. (^∗) For some individuals, data were missing both from baseline and follow-up investigation, therefore presented in both categories.

FIGURE 2

Box-plot of c-fPWV in different age groups, organized by sex. Boxes contain 50% of observations bars contain the remainder. Horizontal lines indicate median value; circles and asterisk indicate outliers and extreme outliers, respectively. c-fPWV, carotid–femoral pulse wave velocity.

FIGURE 3

Mean and 95% confidence interval of c-fPWV in different decentiles of fasting glucose, HOMA-IR and HbA_1c. c-fPWV, carotid–femoral pulse wave velocity; HOMA-IR, Homeostatic Model Assessment – Insulin Resistance.

FIGURE 4

Mean and 95% confidence interval of c-fPWV in different diabetes status. c-fPWV, carotid–femoral pulse wave velocity.