Digital Peripheral Arterial Tonometry and Cardiovascular Disease Events: The Framingham Heart Study

Leroy L. Cooper, Na Wang, Alexa S. Beiser, José Rafael Romero, Hugo J. Aparicio, Vasileios Arsenios Lioutas, Emelia J. Benjamin, Martin G. Larson, Ramachandran S. Vasan, Gary F. Mitchell, Sudha Seshadri, Naomi M. Hamburg

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background and Purpose: Novel noninvasive measures of vascular function are emerging as subclinical markers for cardiovascular disease (CVD) and may be useful to predict CVD events. The purpose of our prospective study was to assess associations between digital peripheral arterial tonometry (PAT) measures and first-onset major CVD events in a sample of FHS (Framingham Heart Study) participants. Methods: Using a fingertip PAT device, we assessed pulse amplitude in Framingham Offspring and Third Generation participants (n=3865; mean age, 55±14 years; 52% women) at baseline and in 30-second intervals for 4 minutes during reactive hyperemia. The PAT ratio (relative hyperemia index) was calculated as the post-to-pre occlusion pulse signal ratio in the occluded arm, relative to the same ratio in the control (nonoccluded) arm, and corrected for baseline vascular tone. Baseline pulse amplitude and PAT ratio during hyperemia are measures of pressure pulsatility and microvascular function in the finger, respectively. We used Cox proportional hazards regression to relate PAT measures in the fingertip to incident CVD events. Results: During follow-up (median, 9.2 years; range, 0.04-10.0 years), 270 participants (7%) experienced new-onset CVD events (n=270). In multivariable models adjusted for cardiovascular risk factors, baseline pulse amplitude (hazard ratio [HR] per 1 SD, 1.04 [95% CI, 0.90-1.21]; P=0.57) and PAT ratio (HR, 0.95 [95% CI, 0.84-1.08]; P=0.43) were not significantly related to incident composite CVD events, including myocardial infarction or heart failure. However, higher PAT ratio (HR, 0.76 [95% CI, 0.61-0.94]; P=0.013), but not baseline pulse amplitude (HR, 1.15 [95% CI, 0.89-1.49]; P=0.29), was related to lower risk for incident stroke. In a sensitivity analysis by stroke subtype, higher PAT ratio was related to lower risk of incident ischemic stroke events (HR, 0.68 [95% CI, 0.53-0.86]; P=0.001). Conclusions: Novel digital PAT measures may represent a marker of stroke risk in the community.

Original languageEnglish (US)
Pages (from-to)2866-2873
Number of pages8
Issue number9
StatePublished - Sep 1 2021


  • epidemiology
  • hyperemia
  • ischemic stroke
  • myocardial infarction
  • risk factors

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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