Association of cardio-ankle vascular index with cardiovascular risk factors and cardiovascular events in metabolic syndrome patients

Abstract

Objectives: We aimed to investigate the association between arterial stiffness assessed as cardio-ankle vascular index (CAVI) and cardiovascular (CV) risk factors and CV events in the middle-aged metabolic syndrome (MS) patients.

Materials and methods: A follow-up study was carried out in 2106 middle-aged (53.83±6.17 years old, 62% women) MS subjects without overt atherosclerotic disease. Patients were initially recruited in 2009-2011 as participants of the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program and followed up for 3.8±1.7 years for CV events. Thorough cardiometabolic risk assessment was carried out at inclusion.

Results: Subjects with higher CAVI had worse lipid and glucose metabolism profile: elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), decreased high-density lipoprotein cholesterol (HDL-C), higher fasting and oral glucose tolerance test (OGTT) glucose levels (all P<0.001), and lower fasting insulin (P=0.021). Greater age (P<0.001), heart rate (P=0.016), and mean arterial pressure (P<0.001) were also associated with higher CAVI. Over the follow-up period, 93 (4.4%) patients developed a cardiovascular event: 55 (2.6%) patients had myocardial infarction and 38 (1.8%) suffered a cerebrovascular event. Fatal CV events comprised 6.5% (n=6) of all CV events. CAVI was statistically significantly associated with occurrence of myocardial infarction (P=0.027) and total cardiovascular events (P=0.045), but not cerebrovascular events (P=0.65). However, this association was dependent on age and gender.

Conclusions: In the middle-aged MS patients, higher CAVI was associated with altered lipid and glucose metabolism, older age, greater heart rate and mean arterial pressure, and worse cardiovascular outcome.

Keywords: Arterial stiffness; Cardiovascular risk; Metabolic syndrome.