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Meta-Analysis
. 2019 Jan;21(1):16-24.
doi: 10.1111/jch.13425. Epub 2018 Nov 19.

Cardio-ankle vascular index and cardiovascular disease: Systematic review and meta-analysis of prospective and cross-sectional studies

Kunihiro Matsushita  1 , Ning Ding  1 , Esther D Kim  1 , Matthew Budoff  2 , Julio A Chirinos  3 , Bo Fernhall  4 , Naomi M Hamburg  5 , Kazuomi Kario  6 , Toru Miyoshi  7 , Hirofumi Tanaka  8 , Raymond Townsend  3
Affiliations
Meta-Analysis

Cardio-ankle vascular index and cardiovascular disease: Systematic review and meta-analysis of prospective and cross-sectional studies

Kunihiro Matsushita et al. J Clin Hypertens (Greenwich). 2019 Jan.

Abstract

The cardio-ankle vascular index (CAVI) is a new measure of arterial stiffness that reflects the stiffness from the ascending aorta to the ankle arteries, and demonstrates little dependence on blood pressure during the evaluation. However, a comprehensive assessment of the association of CAVI with cardiovascular disease (CVD) has not been reported. We performed a systematic review to assess the association between CAVI and CVD. We searched for both prospective and cross-sectional studies using MEDLINE, Embase, and Cochrane from inception until April 11, 2017. We pooled the results using random-effects models. Among 1519 records, we identified nine prospective studies (n = 5214) and 17 cross-sectional eligible studies (n = 7309), with most enrolling high CVD risk populations in Asia. All nine prospective studies investigated composite CVD events as an outcome (498 cases including coronary events and stroke) but modeled CAVI inconsistently. The pooled adjusted hazard ratio for CVD events per 1 standard deviation increment of CAVI in four studies was 1.20 (95% CI: 1.05-1.36, P = 0.006). Of the 17 cross-sectional studies, 13 studies compared CAVI values between patients with and without CVD and all reported significantly higher values in those with CVD (pooled mean difference in CAVI values 1.28 [0.86-1.70], P < 0.001). This systematic review suggests a modest association between CAVI and incident CVD risk, and highlights the need for studies assessing CAVI as a predictor of CVD in the general population and non-Asian countries.

Keywords: all-cause mortality; arterial stiffness; cardio-ankle vascular index; cardiovascular disease; meta-analysis.

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Conflict of interest statement

KM received honorarium from Fukuda Denshi outside of the work.

Figures

Figure 1
Figure 1
Flow diagram of study selection
Figure 2
Figure 2
Hazard ratios (HR) of cardiovascular events for 1 standard deviation (SD) increment of cardio‐ankle vascular index (CAVI). The bars/diamond and their width represent the HRs and the 95% CI, respectively. *Converted from HR per 1 increment
Figure 3
Figure 3
Hazard ratios (HR) of cardiovascular events for the highest vs. the lowest category of cardio‐ankle vascular index (CAVI). Compared CAVI categories: ≥ vs <9 in Chung 2015; ≥9.9 vs <8.0 in Kato 2012; and ≥10 vs <9 in Kubota 2011
Figure 4
Figure 4
Mean difference in cardio‐ankle vascular index (CAVI) among those with and without cardiovascular disease (CVD)
See this image and copyright information in PMC

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