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. 2021 Nov;44(11):1628-1635.
doi: 10.1002/clc.23735. Epub 2021 Sep 29.

Cardio-ankle vascular index as a predictor of major adverse cardiovascular events in metabolic syndrome patients

Thosaphol Limpijankit  1 , Prin Vathesatogkit  1 , Dujrudee Matchariyakul  2 , Teerapat Yingchoncharoen  1 , Sukanya Siriyotha  3 , Ammarin Thakkinstian  3 , Piyamitr Sritara  1
Affiliations

Cardio-ankle vascular index as a predictor of major adverse cardiovascular events in metabolic syndrome patients

Thosaphol Limpijankit et al. Clin Cardiol. 2021 Nov.

Abstract

Background: Arterial stiffness, as reflected in the cardio-ankle vascular index (CAVI), is a risk factor for major adverse cardiovascular events (MACEs).

Hypothesis: Combining CAVI and metabolic syndrome (MetS) may enhance prediction of MACEs in a general adult population.

Methods: A total of 3807 employees of the Electricity Generating Authority of Thailand were enrolled in a longitudinal health study during 2007-2008. Baseline characteristics were collected and CAVI determined. Subjects with previous coronary artery disease or stroke were excluded from analysis. MetS was defined using the modified NCEP-ATP III for Asians. The primary study endpoint was occurrence of a MACE (myocardial infarction, stroke, or cardiovascular death).

Results: MetS was present in 39.2% at study baseline. The prevalence of CAVI > 9 was higher in subjects with MetS compared to those without (33.7% vs. 28.5%, P = 0.001). During the 12.4 ± 0.6 years follow-up, 227 participants developed MACEs and 350 died. MetS was more common in patients who developed a MACE (8.2% vs. 5.0%, p < 0.001) than was non-MetS, but it was not a significant risk after adjusting covariables. Participants with CAVI > 9 had greater risk for MACEs 1.34 (95% CI: 1.01, 1.79) relative to those with CAVI < 9. Participants with both MetS and CAVI > 9 had the worst outcomes, with the highest frequency of MACEs, among the four groups.

Conclusion: Arterial stiffness assessed by CAVI may enhance prediction of future MACEs, adding to the null predictive power of MetS. This index can be used to motivate MetS patients to modify their life-styles for prevention.

Keywords: arterial stiffness; cardio-ankle vascular index (CAVI); major adverse cardiovascular events; metabolic syndrome.

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Conflict of interest statement

None of the authors reported any conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Schematic illustration of cardio‐ ankle vascular index (CAVI) measurement. ECG, electrocardiogram; haPWV, heart ankle pulse wave velocity; Ps, systolic blood pressure; Pd, diastolic blood pressure; DP, Ps–Pd; ρ, blood density; tba, time between rise in brachial pulse wave and rise in ankle pulse wave; tb, time between closing sound of aortic valve and notch in brachial pulse wave; t'b, time between opening sound of aortic valve and rise in brachial pulse wave; a and b, scale conversion constants. Source: Modified from Shirai et al.
FIGURE 2
FIGURE 2
Flow of selection of patients in analysis
FIGURE 3
FIGURE 3
Probability of major adverse cardiovascular events (MACEs) among 3630 subjects grouped by MetS and CAVI status
See this image and copyright information in PMC

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