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. 2022 Feb 21;118(3):904-912.
doi: 10.1093/cvr/cvab087.

Non-invasive peripheral vascular function, incident cardiovascular disease, and mortality in the general population

Renate B Schnabel  1   2 , Christina Magnussen  1   2 , Andreas Schulz  3 , Francisco M Ojeda  1 , Volker H Schmitt  4   5 , Natalie Arnold  1 , Christoph R Sinning  1   2 , Manfred E Beutel  6 , Irene Schmidtmann  7 , Norbert Pfeiffer  8 , Anja Leuschner  4 , Karl J Lackner  9 , Tommaso Gori  4   5 , Emelia J Benjamin  10   11   12 , Harald Binder  7 , Philipp S Wild  3   5   13 , Stefan Blankenberg  1   2 , Thomas Münzel  4   5 ; Gutenberg Health Study investigators
Affiliations

Non-invasive peripheral vascular function, incident cardiovascular disease, and mortality in the general population

Renate B Schnabel et al. Cardiovasc Res. .

Abstract

Aims: Evidence suggests that peripheral vascular function is related to cardiovascular disease (CVD) and mortality. We evaluated the associations of non-invasive measures of flow-mediated dilatation and peripheral arterial tonometry with incident CVD and mortality.

Methods and results: In a post-hoc analysis of the community-based Gutenberg Health Study, median age 55 years (25th/75th percentile 46/65) and 49.5% women, we measured brachial artery flow-mediated dilatation (N=12 599) and fingertip peripheral arterial tonometry (N=11 125). After a follow-up of up to 11.7 years, we observed 595 incident CVD events, 106 cardiac deaths, and 860 deaths in total. Survival curves showed decreased event-free survival with higher mean brachial artery diameter and baseline pulse amplitude and better survival with higher mean flow-mediated dilatation and peripheral arterial tonometry ratio (all Plog rank <0.05). In multivariable-adjusted Cox regression analyses only baseline pulse amplitude was inversely related to mortality [hazard ratio (HR) per standard deviation increase, 0.86, 95% confidence interval (95% CI), 0.79-0.94; P=0.0009]. After exclusion of individuals with prevalent CVD the association was no longer statistically significant in multivariable-adjusted models (HR 0.91, 95% CI 0.81-1.02; P=0.11). None of the vascular variables substantially increased the C-index of a model comprising clinical risk factors.

Conclusions: In our cohort, non-invasive measures of peripheral vascular structure and function did not reveal clinically relevant associations with incident CVD or mortality. Whether determination of pulse amplitude by peripheral arterial tonometry improves clinical decision-making in primary prevention needs to be demonstrated.

Keywords: Cohort; Epidemiology; Flow-mediated dilatation; Mortality; Non-invasive vascular function; Peripheral arterial tonometry.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Survival curves stratified by median vascular function measures for baseline brachial artery diameter, FMD, ln baseline pulse amplitude, and PAT ratio for incident CVD (N=595) and total mortality (N=860). P-values are for the log rank test. FMD, flow-mediated dilatation; PAT, peripheral arterial tonometry.
Figure 2
Figure 2
Vascular function measures in relation to incident CVD in multivariable-adjusted Cox regression analyses. Provided are HRs per SD increase in vascular function measure and 95% CI. Age- and sex-adjusted and CVRFs-adjusted models are presented. The latter include age, sex, current smoking, body mass index, systolic blood pressure, heart rate, hypertension treatment, diabetes, LDL/HDL cholesterol, lipid treatment, and prevalent CVD. FMD stands for flow-mediated dilatation, PAT for peripheral arterial tonometry.
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