TY - JOUR
T1 - Relation of central arterial stiffness to incident heart failure in the community
AU - Tsao, Connie W.
AU - Lyass, Asya
AU - Larson, Martin G.
AU - Levy, Daniel
AU - Hamburg, Naomi M.
AU - Vita, Joseph A.
AU - Benjamin, Emelia J.
AU - Mitchell, Gary F.
AU - Vasan, Ramachandran S.
N1 - Publisher Copyright:
© 2015 The Authors.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Background-Arterial stiffness, pressure pulsatility, and wave reflection are associated with cardiovascular disease. Left ventricular function is coupled to proximal aortic properties, but the association of central aortic stiffness and hemodynamics with incident clinical heart failure (HF) is not well described. Methods and Results-Framingham Study participants without clinical HF (n=2539, mean age 64 years, 56% women) underwent applanation tonometry to measure carotid-femoral pulse wave velocity (CFPWV), central pulse pressure, forward wave amplitude, and augmentation index. CFPWV was inverse-transformed to reduce heteroscedasticity and multiplied by -1 to restore effect direction (iCFPWV). Over 10.1 (range 0.04-12.9) years, 170 HF events developed. In multivariable-adjusted analyses, iCFPWV was associated with incident HF in a continuous, graded fashion (hazards ratio [HR] per SD unit [SDU] 1.29, 95% confidence interval [CI] 1.02-1.64, P=0.037). iCFPWV was associated with HF with reduced ejection fraction (HR=1.69/SDU, 95% CI 1.19-2.42, P=0.0037) in age- and sex-adjusted models, which was attenuated in multivariable-adjusted models (P=0.065). Central pulse pressure and forward wave amplitude were associated with HF in age- and sex-adjusted models (per SDU, HR=1.20, 95% CI 1.06- 1.37, P=0.006, and HR=1.15, 95% CI 1.01-1.31, P=0.036, respectively), but not in multivariable-adjusted models (both P=0.28). Augmentation index was not associated with HF risk (P ≥ 0.19 in all models). Conclusions-In our prospective investigation of a large community-based sample of middle-aged to elderly individuals, greater aortic stiffness (reflected by higher iCFPWV) was associated with increased risk of HF. Future studies may investigate the impact of modifying aortic stiffness in reducing the community burden of HF.
AB - Background-Arterial stiffness, pressure pulsatility, and wave reflection are associated with cardiovascular disease. Left ventricular function is coupled to proximal aortic properties, but the association of central aortic stiffness and hemodynamics with incident clinical heart failure (HF) is not well described. Methods and Results-Framingham Study participants without clinical HF (n=2539, mean age 64 years, 56% women) underwent applanation tonometry to measure carotid-femoral pulse wave velocity (CFPWV), central pulse pressure, forward wave amplitude, and augmentation index. CFPWV was inverse-transformed to reduce heteroscedasticity and multiplied by -1 to restore effect direction (iCFPWV). Over 10.1 (range 0.04-12.9) years, 170 HF events developed. In multivariable-adjusted analyses, iCFPWV was associated with incident HF in a continuous, graded fashion (hazards ratio [HR] per SD unit [SDU] 1.29, 95% confidence interval [CI] 1.02-1.64, P=0.037). iCFPWV was associated with HF with reduced ejection fraction (HR=1.69/SDU, 95% CI 1.19-2.42, P=0.0037) in age- and sex-adjusted models, which was attenuated in multivariable-adjusted models (P=0.065). Central pulse pressure and forward wave amplitude were associated with HF in age- and sex-adjusted models (per SDU, HR=1.20, 95% CI 1.06- 1.37, P=0.006, and HR=1.15, 95% CI 1.01-1.31, P=0.036, respectively), but not in multivariable-adjusted models (both P=0.28). Augmentation index was not associated with HF risk (P ≥ 0.19 in all models). Conclusions-In our prospective investigation of a large community-based sample of middle-aged to elderly individuals, greater aortic stiffness (reflected by higher iCFPWV) was associated with increased risk of HF. Future studies may investigate the impact of modifying aortic stiffness in reducing the community burden of HF.
KW - Aortic stiffness
KW - Epidemiology
KW - Heart failure
KW - Pressure pulsatility
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U2 - 10.1161/JAHA.115.002189
DO - 10.1161/JAHA.115.002189
M3 - Article
C2 - 26597152
AN - SCOPUS:85006184555
SN - 2047-9980
VL - 4
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e002189
ER -