Cardio-ankle vascular index is associated with cardiovascular target organ damage and vascular structure and function in patients with diabetes or metabolic syndrome, LOD-DIABETES study: a case series report

Abstract

Background: The cardio ankle vascular index (CAVI) is a new index of the overall stiffness of the artery from the origin of the aorta to the ankle. This index can estimate the risk of atherosclerosis. We aimed to find the relationship between CAVI and target organ damage (TOD), vascular structure and function, and cardiovascular risk factors in Caucasian patients with type 2 diabetes mellitus or metabolic syndrome.

Methods: We included 110 subjects from the LOD-Diabetes study, whose mean age was 61 ± 11 years, and 37.3% were women. Measurements of CAVI, brachial ankle pulse wave velocity (ba-PWV), and ankle brachial index (ABI) were taken using the VaSera device. Cardiovascular risk factors, renal function by creatinine, glomerular filtration rate, and albumin creatinine index were also obtained, as well as cardiac TOD with ECG and vascular TOD and carotid intima media thickness (IMT), carotid femoral PWV (cf-PWV), and the central and peripheral augmentation index (CAIx and PAIx). The Framingham-D'Agostino scale was used to measure cardiovascular risk.

Results: Mean CAVI was 8.7 ± 1.3. More than half (54%) of the participants showed one or more TOD (10% cardiac, 13% renal; 48% vascular), and 13% had ba-PWV ≥ 17.5 m/s. Patients with any TOD had the highest CAVI values: 1.15 (CI 95% 0.70 to 1.61, p < 0.001) and 1.14 (CI 95% 0.68 to 1.60, p < 0.001) when vascular TOD was presented, and 1.30 (CI 95% 0.51 to 2.10, p = 0.002) for the cardiac TOD. The CAVI values had a positive correlation with HbA1c and systolic and diastolic blood pressure, and a negative correlation with waist circumference and body mass index. The positive correlations of CAVI with IMT (β = 0.29; p < 0.01), cf-PWV (β = 0.83; p < 0.01), ba-PWV (β = 2.12; p < 0.01), CAIx (β = 3.42; p < 0.01), and PAIx (β = 5.05; p = 0.04) remained after adjustment for cardiovascular risk, body mass index, and antihypertensive, lipid-lowering, and antidiabetic drugs.

Conclusions: The results of this study suggest that the CAVI is positively associated with IMT, cf-PWV, ba-PWV, CAIx, and PAIx, regardless of cardiovascular risk and the drug treatment used. Patients with cardiovascular TOD have higher values of CAVI.

Trial registration: Clinical Trials.gov Identifier: NCT01065155.

Figure 1

Mean ± SD values of CAVI in patients with and without target organ damage. a: Represents the mean values of CAVI ± SD between patients with any TOD and those without TOD (CAVI = 9.22 ± 1.1; vs. CAVI = 8.07 ± 1.3, p < 0.01); with vascular TOD and without it (CAVI = 9.29 ± 1.1; vs. CAVI = 8.15 ± 1.3, p = p < 0.01); with cardiac TOD and without it (CAVI = 9.86 ± 1.0; vs. CAVI = 8.56 ± 1.3, p = 0.002); and with renal TOD and without it (CAVI = 9.11 ± 1.1; vs. CAVI = 8.63 ± 1.3, p = 0.206). b: Represents the mean values of CAVI ± SD between patients with any TOD and those without TOD with different parameters: intima-media thickness (CAVI = 9.28 ± 1.08; vs. CAVI = 8.40 ± 1.33, p < 0.01) ; carotid femoral pulse wave velocity (CAVI = 9.58 ± 1.12; vs. CAVI = 8.35 ± 1.22, p < 0.01); brachial ankle pulse wave velocity (CAVI = 10.53 ± 1.08; vs. CAVI = 8.41 ± 1.11, p < 0.01) and Ankle-brachial index (CAVI = 8.77 ± 1.99; vs. CAVI = 8.69 ± 1.29, (p > 0.05). c: Represents the mean values of CAVI ± SD between patients with renal TOD and those without TOD with different parameters: glomerular filtration rate (CAVI = 9.26 ± 0.77; vs. CAVI = 8.66 ± 1.33, p > 0.05); creatinine (CAVI = 9.15 ± 1.24; vs. CAVI = 8.65 ± 1.32, p > 0.05); albumin creatinine ratio (CAVI = 9.14 ± 0.93; vs. CAVI = 8.68 ± 1.33, p > 0.05).