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. 2024 Jun 4;3(7):101019.
doi: 10.1016/j.jacadv.2024.101019. eCollection 2024 Jul.

Prognostic Value of Cardio-Ankle Vascular Index for Cardiovascular and Kidney Outcomes: Systematic Review and Meta-Analysis

Hamed Tavolinejad  1   2 , Ozgun Erten  1   2 , Hannah Maynard  1   2 , Julio A Chirinos  1   2
Affiliations

Prognostic Value of Cardio-Ankle Vascular Index for Cardiovascular and Kidney Outcomes: Systematic Review and Meta-Analysis

Hamed Tavolinejad et al. JACC Adv. .

Abstract

Background: Arterial stiffness causes cardiovascular disease and target-organ damage. Carotid-femoral pulse wave velocity is regarded as a standard arterial stiffness metric. However, the prognostic value of cardio-ankle vascular index (CAVI), which is mathematically corrected for blood pressure, remains understudied.

Objectives: The purpose of this study was to determine the association of CAVI with cardiovascular and kidney outcomes.

Methods: PubMed, Scopus, and Web of Science were searched until May 6, 2023, for longitudinal studies reporting the association of CAVI with mortality, cardiovascular events (CVEs) (including death, acute coronary syndromes, stroke, coronary revascularization, heart failure hospitalization), and kidney function decline (incidence/progression of chronic kidney disease, glomerular filtration rate decline). Random-effects meta-analysis was performed. Studies were assessed with the "Quality in Prognostic Studies" tool.

Results: Systematic review identified 32 studies (105,845 participants; follow-up range: 12-148 months). Variable cutoffs were reported for CAVI. The risk of CVEs was higher for high vs normal CAVI (HR: 1.46 [95% CI: 1.22-1.75]; P < 0.001; I2 = 41%), and per SD/unit CAVI increase (HR: 1.30 [95% CI: 1.20-1.41]; P < 0.001; I2 = 0%). Among studies including participants without baseline cardiovascular disease (primary prevention), higher CAVI was associated with first-time CVEs (high vs normal: HR: 1.60 [95% CI: 1.15-2.21]; P = 0.005; I2 = 65%; HR per SD/unit increase: 1.28 [95% CI: 1.12-1.47]; P < 0.001; I2 = 18%). There was no association between CAVI and mortality (HR = 1.31 [0.92-1.87]; P = 0.130; I2 = 53%). CAVI was associated with kidney function decline (high vs normal: HR = 1.30 [1.18-1.43]; P < 0.001; I2 = 38%; HR per SD/unit increase: 1.12 [95% CI: 1.07-1.18]; P < 0.001; I2 = 0%).

Conclusions: Higher CAVI is associated with incident CVEs, and this association is present in the primary prevention setting. Elevated CAVI is associated with kidney function decline.

Keywords: CAVI; cardio-ankle vascular index; cardiovascular; mortality; vascular stiffness.

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Conflict of interest statement

Dr Chirinos is supported by 10.13039/100000002National Institutes of Health grants R01-HL 121510, U01-TR003734, 3U01TR003734-01W1, U01-HL160277, R33-HL-146390, R01-HL153646, K24-AG070459, R01-AG058969, R01-HL104106, P01-HL094307, R03-HL146874, R56-HL136730, R01 HL155599, R01 HL157264, R01HL155, and 1R01HL153646-01. Dr Chirinos has served as a consultant for Bayer, Sanifit, Fukuda-Denshi, Bristol-Myers Squibb, Johnson & Johnson, Edwards Lifesciences, Merck, NGM Biopharmaceuticals, and the Galway-Mayo Institute of Technology; has received research grants to the University of Pennsylvania from 10.13039/100000002National Institutes of Health, Fukuda-Denshi, 10.13039/100002491Bristol-Myers Squibb, Microsoft, and Abbott; has been named as inventor in a University of Pennsylvania patent for the use of inorganic nitrates/nitrites for the treatment of heart failure with preserved ejection fraction (HFpEF) and on patent applications for the use of plasma and urine protein biomarkers in HFpEF; has received payments for editorial roles from the American Heart Association, the American College of Cardiology, and Wiley; and has received research device loans from AtCor Medical, Fukuda-Denshi, Uscom, NDD Medical Technologies, Microsoft, and MicroVision Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
The PRISMA Flow Diagram PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest Plots for Cardiovascular Events HR of incident cardiovascular events (CVEs) in (A) unadjusted models of high vs normal CAVI, (B) unadjusted models of per SD/unit increase of CAVI, (C) multivariable adjusted models of high vs normal CAVI, (D) multivariable adjusted models of per SD/unit increase of CAVI. (E) Multivariable adjusted ORs of high vs normal CAVI. CAVI = cardio-ankle vascular index.
Figure 3
Figure 3
Forest Plots for All-Cause Death HR of all-cause death for high vs normal CAVI in (A) unadjusted models, and (B) multivariable adjusted models. Abbreviation as in Figure 2.
Figure 4
Figure 4
Forest Plots for Cardiovascular Death HR of cardiovascular (CV) death for high vs normal CAVI in (A) unadjusted models, and (B) multivariable adjusted models. (C) Unadjusted OR of CV death. Abbreviation as in Figure 2.
Figure 5
Figure 5
Forest Plots for Kidney Function Decline Risk of renal function decline in (A) unadjusted models, (B) multivariable adjusted models. (C) Adjusted OR of renal function decline. Abbreviation as in Figure 2.
Central Illustration
Central Illustration
Prognostic Value of Cardio-Ankle Vascular Index for Cardiovascular and Kidney Outcomes: Systematic Review and Meta-Analysis CAVI = cardio-ankle vascular index.
See this image and copyright information in PMC

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