Methods of arterial stiffness calculation and cardiovascular disease events: the multiethnic study of atherosclerosis

Abstract

Background: A wide variety of different formulae have been used to calculate local arterial stiffness with little external validation in relationship to cardiovascular events. We compared the associations of several arterial stiffness calculations in a large, multiethnic cohort.

Methods: The multi-ethnic study of atherosclerosis (MESA) is a longitudinal study of 6814 adults without clinical cardiovascular disease (CVD) at enrollment. MESA participants with CVD surveillance through year 2018 and carotid ultrasound ( n = 5873) or aorta MRI ( n = 3175) at the baseline exam (2000-2002) were included. We analyzed 21 different calculations of local arterial stiffness. Cross-sectional and longitudinal statistical analyses were performed in addition to Cox hazard modeling for associations with CVD events (myocardial infarction, resuscitated cardiac arrest, stroke, adjudicated angina, and cardiovascular death).

Results: Carotid artery stiffness calculations had variable correlations with each other ( r = 0.56-0.99); aortic stiffness measures were similar ( r = 0.66-0.99). Nevertheless, for CVD events, the hazard ratio (HR) per standard deviation change were similar for all carotid stiffness calculations with HRs in the range of 1.00-1.10 (equivalence P < 0.001). For the aorta, aortic distensibility coefficient had a stronger association with CVD events (HR 1.18 [1.02-1.37]) compared to aorta Peterson's elastic modulus (HR 0.98 [0.89-1.07]) and aorta pulse wave velocity (HR 1.00 [0.90-1.11]). HRs between all other aortic stiffness calculations were equivalent ( P < 0.01).

Conclusion: Different methods of calculating local arterial stiffness largely gave equivalent results, indicating that the variety of different arterial stiffness calculations in use do not cause inconsistent findings.

Figure 1:

A-B. Correlations of baseline values of different arterial stiffness parameters. C. Pearson correlation coefficients for the baseline associations of arterial stiffness parameters with baseline CVD risk factors. Coefficients are presented per increment PEM, PWV, and YEM and per SD decrement DC and CC. Abbreviations: c – carotid, Ao – aorta, PEM – Peterson’s elastic modulus, PWV – pulse wave velocity, YEM – Young’s elastic modulus, DC – distensibility coefficient, CC – compliance coefficient, cIMT – carotid intima-media thickness, cDd – carotid diastolic diameter, Ao Ad – aorta diastolic area, SBP – systolic blood pressure, DBP – diastolic blood pressure, PP – pulse pressure, MBP – mean blood pressure, HR – heart rate, BMI – body mass index, FBG – fasting blood glucose, non HDL-C – non HDL Cholesterol.

Figure 2:

A-B. Correlations of longitudinal changes in carotid artery stiffness parameters. C. Coefficients from general linear model for the longitudinal change in carotid artery stiffness. Coefficients are presented per SD increment PEM, PWV, and YEM and per SD decrement DC and CC. Abbreviations: c – carotid, PEM – Peterson’s elastic modulus, PWV – pulse wave velocity, YEM – Young’s elastic modulus, DC – distensibility coefficient, CC – compliance coefficient, SBP – systolic blood pressure, HR – heart rate, BMI – body mass index, FBG – fasting blood glucose, non HDL-C – non HDL Cholesterol, HS – High school.

Figure 3:

Longitudinal changes in A. carotid Peterson’s elastic modulus (PEM) and B. carotid distensibility coefficient (DC) are plotted versus percentile baseline cPEM for groups 0–5, 5–10, etc. Note that percentiles of baseline PEM and DC are the same and PEM is the inverse of DC. For reading clarity along the x axis, only every other percentile cutoff is labeled.

Figure 4:

Hazard ratios and 95% confidence intervals from Cox models for different arterial stiffness calculations and A. all CVD events, B. stroke events, and C. coronary heart disease events. Ratios calculated SD increment in PEM, PWV, and YEM and per SD decrement in DC and CC. Models adjusted for: Age, sex, race/ethnicity, education level, body mass index, diabetes mellitus status, smoking status, systolic blood pressure non HDL cholesterol, antihypertensive medication usage, lipid lowering medication usage Abbreviations: CVD – Cardiovascular disease, c – carotid, Ao – aorta, PEM – Peterson’s elastic modulus, PWV – pulse wave velocity, YEM – Young’s elastic modulus, DC – distensibility coefficient, CC – compliance coefficient