Skip to main content

Advertisement

SpringerLink
Log in

Added value of arterial stiffness index for the 10-year atherosclerotic cardiovascular disease risk determination in a middle-aged population-based study

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objective

Atherosclerotic cardiovascular disease (ASCVD) is considered the leading cause of mortality worldwide. Arterial stiffness, measured by arterial stiffness index (ASI), could be a main predictor in target damage of organs. Uncertainty remains regarding the contribution of ASI to estimated ASCVD risk. This study investigates the added value of ASI in ASCVD risk determination using the general UK Biobank middle-aged population.

Methods

Among 100,598 participants from the UK Biobank population, ASI was assessed and associations between ASCVD risk were stratified by sex and estimated using multiple linear and logistic regressions adjusted for heart rate, physical activity, alcohol status, smocking pack years, BMI categories and CKD.

Results

Males presented higher ASCVD risk than females (8.58% vs. 2.82%, p < 0.001) and higher ASI levels (9.50 m/s vs. 7.00 m/s, p < 0.001). The Youden index was determined at 9.70 m/s in males (p < 0.001) and 10.46 m/s in females (p < 0.001). Among females, participants with ASI > 10.46 m/s showed higher ASCVD risk than others (3.64% vs. 2.56%, p < 0.001), similar results were observed for males (9.92% vs. 7.21%, p < 0.001). In males, ASI showed significant added value information when including overall covariates (AUC = 0.695 vs. AUC = 0.663, p < 0.001). Similar results were observed in females (AUC = 0.693 vs. AUC = 0.687, p = 0.001). In both genders, for the association between ASI and ASCVD risk, nonlinear relationships were observed with higher accuracies than linear models.

Conclusion

Further studies should investigate ASCVD risk stratification management depending on ASI measurement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. Volgman AS, Palaniappan LS, Aggarwal NT et al (2018) Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation 138:e1–e34. https://doi.org/10.1161/CIR.0000000000000580

    Article  PubMed  Google Scholar 

  2. Benjamin EJ, Blaha MJ, Chiuve SE et al (2017) Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 135:e146–e603. https://doi.org/10.1161/CIR.0000000000000485

    Article  PubMed  PubMed Central  Google Scholar 

  3. Goff DC, Lloyd-Jones DM, Bennett G et al (2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2935–2959. https://doi.org/10.1016/j.jacc.2013.11.005

    Article  PubMed  Google Scholar 

  4. Wang H, Wu X, Gu Y et al (2021) Relationship of noninvasive assessment of arterial stiffness with 10-year atherosclerotic cardiovascular disease (ASCVD) risk in a general middle-age and elderly population. Int J Gen Med 14:6379–6387. https://doi.org/10.2147/IJGM.S330142

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vallée A (2023) Association between social isolation and loneliness with estimated atherosclerotic cardiovascular disease risk in a UK Biobank population-based study. Int J Environ Res Public Health 20:2869. https://doi.org/10.3390/ijerph20042869

    Article  PubMed  PubMed Central  Google Scholar 

  6. Leoncini G, Ratto E, Viazzi F et al (2006) Increased ambulatory arterial stiffness index is associated with target organ damage in primary hypertension. Hypertens Dallas Tex 1979 48:397–403. https://doi.org/10.1161/01.HYP.0000236599.91051.1e

    Article  CAS  Google Scholar 

  7. Duprez DA, Cohn JN (2007) Arterial stiffness as a risk factor for coronary atherosclerosis. Curr Atheroscler Rep 9:139–144. https://doi.org/10.1007/s11883-007-0010-y

    Article  PubMed  Google Scholar 

  8. Dregan A (2018) Arterial stiffness association with chronic inflammatory disorders in the UK Biobank study. Heart 104:1257–1262. https://doi.org/10.1136/heartjnl-2017-312610

    Article  PubMed  Google Scholar 

  9. Fernandes VRS, Polak JF, Cheng S et al (2008) Arterial stiffness is associated with regional ventricular systolic and diastolic dysfunction: the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol 28:194–201. https://doi.org/10.1161/ATVBAHA.107.156950

    Article  CAS  PubMed  Google Scholar 

  10. Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605. https://doi.org/10.1093/eurheartj/ehl254

    Article  PubMed  Google Scholar 

  11. Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55:1318–1327. https://doi.org/10.1016/j.jacc.2009.10.061

    Article  PubMed  Google Scholar 

  12. Bonarjee VVS (2018) Arterial stiffness: a prognostic marker in coronary heart disease. Available methods and clinical application. Front Cardiovasc Med 5:64. https://doi.org/10.3389/fcvm.2018.00064

    Article  PubMed  PubMed Central  Google Scholar 

  13. Said MA, Eppinga RN, Lipsic E et al (2018) Relationship of arterial stiffness index and pulse pressure with cardiovascular disease and mortality. J Am Heart Assoc 7:e007621. https://doi.org/10.1161/JAHA.117.007621

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Alty SR, Angarita-Jaimes N, Millasseau SC, Chowienczyk PJ (2007) Predicting arterial stiffness from the digital volume pulse waveform. IEEE Trans Biomed Eng 54:2268–2275. https://doi.org/10.1109/tbme.2007.897805

    Article  PubMed  Google Scholar 

  15. Badji A, Cohen-Adad J, Girouard H (2022) Relationship between arterial stiffness index, pulse pressure, and magnetic resonance imaging markers of white matter integrity: a UK Biobank study. Front Aging Neurosci 14:856782. https://doi.org/10.3389/fnagi.2022.856782

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wang M, Huang J, Wu T, Qi L (2022) Arterial stiffness, genetic risk, and type 2 diabetes: a prospective cohort study. Diabetes Care 45:957–964. https://doi.org/10.2337/dc21-1921

    Article  CAS  PubMed  Google Scholar 

  17. Gao L, Lu D, Xia G, Zhang H (2021) The relationship between arterial stiffness index and coronary heart disease and its severity. BMC Cardiovasc Disord 21:527. https://doi.org/10.1186/s12872-021-02350-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lai KY, Kumari S, Gallacher J et al (2022) Associations of residential walkability and greenness with arterial stiffness in the UK Biobank. Environ Int 158:106960. https://doi.org/10.1016/j.envint.2021.106960

    Article  PubMed  Google Scholar 

  19. Zekavat SM, Aragam K, Emdin C et al (2019) Genetic association of finger photoplethysmography-derived arterial stiffness index with blood pressure and coronary artery disease. Arterioscler Thromb Vasc Biol 39:1253–1261. https://doi.org/10.1161/ATVBAHA.119.312626

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ben-Shlomo Y, Spears M, Boustred C et al (2014) Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 63:636–646. https://doi.org/10.1016/j.jacc.2013.09.063

    Article  PubMed  Google Scholar 

  21. Vallée A (2022) Association between lipids and arterial stiffness for primary cardiovascular prevention in a general middle-aged European population. Front Cardiovasc Med 9:899841. https://doi.org/10.3389/fcvm.2022.899841

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Vallée A (2022) Arterial stiffness nomogram identification by cluster analysis: a new approach of vascular phenotype modeling. J Clin Hypertens. https://doi.org/10.1111/jch.14571

    Article  Google Scholar 

  23. Dregan A, Rayner L, Davis KAS et al (2020) Associations between depression, arterial stiffness, and metabolic syndrome among adults in the UK biobank population study: a mediation analysis. JAMA Psychiat 77:598–606. https://doi.org/10.1001/jamapsychiatry.2019.4712

    Article  Google Scholar 

  24. Raisi-Estabragh Z, Biasiolli L, Cooper J et al (2021) Poor bone quality is associated with greater arterial stiffness: insights from the UK Biobank. J Bone Miner Res Off J Am Soc Bone Miner Res 36:90–99. https://doi.org/10.1002/jbmr.4164

    Article  Google Scholar 

  25. Sudlow C, Gallacher J, Allen N et al (2015) UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med 12:e1001779. https://doi.org/10.1371/journal.pmed.1001779

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bycroft C, Freeman C, Petkova D et al (2018) The UK Biobank resource with deep phenotyping and genomic data. Nature 562:203–209. https://doi.org/10.1038/s41586-018-0579-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Vallée A (2022) Arterial stiffness determinants for primary cardiovascular prevention among healthy participants. J Clin Med 11:2512. https://doi.org/10.3390/jcm11092512

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mozaffarian D, Benjamin EJ, Go AS et al (2015) Heart disease and stroke statistics-2015 update: a report from the American Heart Association. Circulation 131:e29-322. https://doi.org/10.1161/CIR.0000000000000152

    Article  PubMed  Google Scholar 

  29. Yadlowsky S, Hayward RA, Sussman JB et al (2018) Clinical implications of revised pooled cohort equations for estimating atherosclerotic cardiovascular disease risk. Ann Intern Med 169:20–29. https://doi.org/10.7326/M17-3011

    Article  PubMed  Google Scholar 

  30. Nonterah EA, Boateng D, Crowther NJ et al (2022) Carotid atherosclerosis, microalbuminuria, and estimated 10-year atherosclerotic cardiovascular disease risk in Sub-Saharan Africa. JAMA Netw Open 5:e227559. https://doi.org/10.1001/jamanetworkopen.2022.7559

    Article  PubMed  PubMed Central  Google Scholar 

  31. Woodman RJ, Kingwell BA, Beilin LJ et al (2005) Assessment of central and peripheral arterial stiffness: studies indicating the need to use a combination of techniques. Am J Hypertens 18:249–260. https://doi.org/10.1016/j.amjhyper.2004.08.038

    Article  PubMed  Google Scholar 

  32. Sollinger D, Mohaupt MG, Wilhelm A et al (2006) Arterial stiffness assessed by digital volume pulse correlates with comorbidity in patients with ESRD. Am J Kidney Dis Off J Natl Kidney Found 48:456–463. https://doi.org/10.1053/j.ajkd.2006.05.014

    Article  Google Scholar 

  33. Millasseau SC, Kelly RP, Ritter JM, Chowienczyk PJ (2002) Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Clin Sci Lond Engl 1979 103:371–377. https://doi.org/10.1042/cs1030371

    Article  CAS  Google Scholar 

  34. Vallée A (2022) Association between serum uric acid and arterial stiffness in a large-aged 40–70 years old population. J Clin Hypertens. https://doi.org/10.1111/jch.14527

    Article  Google Scholar 

  35. UK Biobank (2011) Arterial pulse-wave velocity, https://biobank.ndph.ox.ac.uk/ukb/ukb/docs/Pulsewave.pdf

  36. Collaboration ERF, Sarwar N, Gao P et al (2010) Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet Lond Engl 375:2215–2222. https://doi.org/10.1016/S0140-6736(10)60484-9

    Article  CAS  Google Scholar 

  37. UK Biobank (2019) Biomarker assay quality procedures: approaches used to minimise systematic and random errors (and the wider epidemiological implications). https://biobank.ctsu.ox.ac.uk/crystal/crystal/docs/biomarker_issues.pdf. Accessed Jan 2023

  38. Vallée A (2023) Association between cannabis use and blood pressure levels according to comorbidities and socioeconomic status. Sci Rep. Feb 5;13(1):2069. https://doi.org/10.1038/s41598-022-22841-6

  39. Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB

    Article  PubMed  Google Scholar 

  40. Bradbury KE, Guo W, Cairns BJ et al (2017) Association between physical activity and body fat percentage, with adjustment for BMI: a large cross-sectional analysis of UK Biobank. BMJ Open 7:e011843. https://doi.org/10.1136/bmjopen-2016-011843

    Article  PubMed  PubMed Central  Google Scholar 

  41. O’Donnell J, Smith-Byrne K, Velardo C et al (2020) Self-reported and objectively measured physical activity in people with and without chronic heart failure: UK Biobank analysis. Open Heart 7:e001099. https://doi.org/10.1136/openhrt-2019-001099

    Article  PubMed  PubMed Central  Google Scholar 

  42. Laukkanen JA, Kurl S, Salonen JT (2002) Cardiorespiratory fitness and physical activity as risk predictors of future atherosclerotic cardiovascular diseases. Curr Atheroscler Rep 4:468–476. https://doi.org/10.1007/s11883-002-0052-0

    Article  PubMed  Google Scholar 

  43. Biddinger KJ, Emdin CA, Haas ME et al (2022) Association of habitual alcohol intake with risk of cardiovascular disease. JAMA Netw Open 5:e223849. https://doi.org/10.1001/jamanetworkopen.2022.3849

    Article  PubMed  PubMed Central  Google Scholar 

  44. Duncan MS, Greevy RA, Tindle HA et al (2022) Inclusion of smoking data in cardiovascular disease risk estimation. JAMA Cardiol 7:195–203. https://doi.org/10.1001/jamacardio.2021.4990

    Article  PubMed  Google Scholar 

  45. Henning RJ (2021) Obesity and obesity-induced inflammatory disease contribute to atherosclerosis: a review of the pathophysiology and treatment of obesity. Am J Cardiovasc Dis 11:504–529

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Mathew RO, Bangalore S, Lavelle MP et al (2017) Diagnosis and management of atherosclerotic cardiovascular disease in chronic kidney disease: a review. Kidney Int 91:797–807. https://doi.org/10.1016/j.kint.2016.09.049

    Article  PubMed  Google Scholar 

  47. Giannoglou GD, Chatzizisis YS, Zamboulis C et al (2008) Elevated heart rate and atherosclerosis: an overview of the pathogenetic mechanisms. Int J Cardiol 126:302–312. https://doi.org/10.1016/j.ijcard.2007.08.077

    Article  PubMed  Google Scholar 

  48. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  49. Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF (2021) Arterial stiffness and cardiovascular risk in hypertension. Circ Res 128:864–886. https://doi.org/10.1161/CIRCRESAHA.121.318061

    Article  CAS  PubMed  Google Scholar 

  50. Oishi Y, Miyoshi H, Mizuguchi Y et al (2011) Aortic stiffness is strikingly increased with age ≥ 50 years in clinically normal individuals and preclinical patients with cardiovascular risk factors: assessment by the new technique of 2D strain echocardiography. J Cardiol 57:354–359. https://doi.org/10.1016/j.jjcc.2010.12.003

    Article  PubMed  Google Scholar 

  51. Vallée A, Cinaud A, Protogerou A et al (2020) Arterial stiffness and coronary ischemia: new aspects and paradigms. Curr Hypertens Rep 22:5. https://doi.org/10.1007/s11906-019-1006-z

    Article  PubMed  Google Scholar 

  52. Tanaka H, Munakata M, Kawano Y et al (2009) Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness. J Hypertens 27:2022–2027. https://doi.org/10.1097/HJH.0b013e32832e94e7

    Article  CAS  PubMed  Google Scholar 

  53. Kubo T, Miyata M, Minagoe S et al (2002) A simple oscillometric technique for determining new indices of arterial distensibility. Hypertens Res Off J Jpn Soc Hypertens 25:351–358. https://doi.org/10.1291/hypres.25.351

    Article  Google Scholar 

  54. Duprez DA, Jacobs DR, Lutsey PL et al (2011) Association of small artery elasticity with incident cardiovascular disease in older adults: the multi-ethnic study of atherosclerosis. Am J Epidemiol 174:528–536. https://doi.org/10.1093/aje/kwr120

    Article  PubMed  PubMed Central  Google Scholar 

  55. Duprez DA (2010) Is vascular stiffness a target for therapy? Cardiovasc Drugs Ther 24:305–310. https://doi.org/10.1007/s10557-010-6250-z

    Article  PubMed  Google Scholar 

  56. Gardner AW, Parker DE (2011) Predictors of large and small artery elasticity in healthy subjects 9 to 89 years old. Am J Hypertens 24:599–605. https://doi.org/10.1038/ajh.2011.5

    Article  PubMed  Google Scholar 

  57. Cohn JN (1998) Arteries, myocardium, blood pressure and cardiovascular risk: towards a revised definition of hypertension. J Hypertens 16:2117–2124

    CAS  PubMed  Google Scholar 

  58. Brumback LC, Jacobs DR, Dermond N et al (2010) Reproducibility of arterial elasticity parameters derived from radial artery diastolic pulse contour analysis: the multi-ethnic study of atherosclerosis. Blood Press Monit 15:312–315. https://doi.org/10.1097/MBP.0b013e32833fe2a6

    Article  PubMed  PubMed Central  Google Scholar 

  59. Nigam A, Mitchell GF, Lambert J, Tardif J-C (2003) Relation between conduit vessel stiffness (assessed by tonometry) and endothelial function (assessed by flow-mediated dilatation) in patients with and without coronary heart disease. Am J Cardiol 92:395–399. https://doi.org/10.1016/s0002-9149(03)00656-8

    Article  PubMed  Google Scholar 

  60. DeLoach SS, Townsend RR (2008) Vascular stiffness: its measurement and significance for epidemiologic and outcome studies. Clin J Am Soc Nephrol CJASN 3:184–192. https://doi.org/10.2215/CJN.03340807

    Article  PubMed  Google Scholar 

  61. Richiardi L, Pizzi C, Pearce N (2013) Commentary: representativeness is usually not necessary and often should be avoided. Int J Epidemiol 42:1018–1022. https://doi.org/10.1093/ije/dyt103

    Article  PubMed  Google Scholar 

  62. Rothman KJ, Gallacher JEJ, Hatch EE (2013) Why representativeness should be avoided. Int J Epidemiol 42:1012–1014. https://doi.org/10.1093/ije/dys223

    Article  PubMed  PubMed Central  Google Scholar 

  63. Khera R, Pandey A, Ayers CR et al (2020) Performance of the pooled cohort equations to estimate atherosclerotic cardiovascular disease risk by body mass index. JAMA Netw Open 3:e2023242. https://doi.org/10.1001/jamanetworkopen.2020.23242

    Article  PubMed  PubMed Central  Google Scholar 

  64. Jerrard-Dunne P, Mahmud A, Feely J (2008) Ambulatory arterial stiffness index, pulse wave velocity and augmentation index–interchangeable or mutually exclusive measures? J Hypertens 26:529–534. https://doi.org/10.1097/HJH.0b013e3282f35265

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This research has been conducted using the UK Biobank Resource under Application Number 55917. The author thanks Polly Gobin for the English correction.

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France

    Alexandre Vallée

Authors
  1. Alexandre Vallée
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, formal analysis, writing—original draft preparation were done by A.V. The author has read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Alexandre Vallée.

Ethics declarations

Conflict of interest

The author declares no conflict of interest.

Ethics of approval statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Northwest—Haydock Research Ethics Committee (protocol code: 21/NW/0157, date of approval: 21 June 2021).

Patient consent statement

Written informed consent has been obtained from the patients.

Permission to reproduce material from other sources

Not applicable.

Clinical trial registration

Not applicable.

Institutional review board statement

Not applicable.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vallée, A. Added value of arterial stiffness index for the 10-year atherosclerotic cardiovascular disease risk determination in a middle-aged population-based study. Clin Res Cardiol 112, 1679–1689 (2023). https://doi.org/10.1007/s00392-023-02267-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-023-02267-4

Keywords

Search

Navigation