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Multicenter Study
. 2024 May:103:105107.
doi: 10.1016/j.ebiom.2024.105107. Epub 2024 Apr 17.

Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study

Magnus Bäck  1 , Jirar Topouchian  2 , Carlos Labat  3 , Sylvie Gautier  4 , Jacques Blacher  2 , Marcin Cwynar  5 , Alejandro de la Sierra  6 , Denes Pall  7 , Kevin Duarte  4 , Francesco Fantin  8 , Katalin Farkas  9 , Luis Garcia-Ortiz  10 , Zoya Hakobyan  11 , Piotr Jankowski  12 , Ana Jelakovic  13 , Marina Kotsani  4 , Alexandra Konradi  14 , Oksana Mikhailova  15 , Iveta Mintale  16 , Oscar Plunde  17 , Rafael Ramos  18 , Anatoly Rogoza  15 , Yuriy Sirenko  19 , Nebojsa Tasic  20 , Iurii Rudyk  21 , Saule Urazalina  22 , Peter Wohlfahrt  23 , Parounak Zelveian  11 , Roland Asmar  24 , Athanase Benetos  25
Affiliations
Multicenter Study

Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study

Magnus Bäck et al. EBioMedicine. 2024 May.

Abstract

Background: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression.

Methods: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years.

Findings: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI.

Interpretation: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments.

Funding: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.

Keywords: Arterial stiffness; Cardio-ankle vascular index; Cardiovascular morbimortality; Risk factor.

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Conflict of interest statement

Declaration of interests AdlS reports support from Sanofi and Viatris. JB reports support from AstraZeneca, Bayer, Elkendi, Hikma, Leurquin, Omron, Organon, Sanofi, and Vivactis. AK reports honoraria for lecturing from Servier, KRKA, and Novartis, and travel support from Servier. PW reports support from Ministry of Health of the Czech Republic, grant nr. NV 19-09-00125, National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, Project No. LX22NPO5104)–Funded by the European Union–Next Generation EU, Servier, and ProMED. The remaining authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Kaplan Meier plots for cumulative (a) cardiovascular morbimortality and (b) all-cause mortality according to the CAVI stratum at baseline. Red: CAVI > 9, blue: CAVI 8–9, and green: CAVI < 8.
Fig. 2
Fig. 2
Hazard ratios for cardiovascular (CV) morbimortality and all-cause mortality per 1 arbitrary unit (AU) CAVI increase from a fully adjusted (Model 2) Cox analysis in the whole population and in age-stratified subgroups.
See this image and copyright information in PMC

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