Circulation. 2002;106:2085-2090
Published online before print September 23, 2002, doi: 10.1161/01.CIR.0000033824.02722.F7
Published online before print September 23, 2002, doi: 10.1161/01.CIR.0000033824.02722.F7
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(Circulation. 2002;106:2085.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance
An Integrated Index of Vascular Function?
From the Clinical Epidemiology Group (K.C., L.R., S.G.A.) and the Biostatistics Group (G.D.), School of Epidemiology & Health Sciences, University of Manchester Medical School, Manchester, UK; Department of Medicine (J.S.W.), Northwick Park Hospital and Clinical Research Centre, Harrow, UK; and Emeritus Professor (R.G.G.), Department of Ultrasonic Angiology, Guy’s Hospital, University of London, London, UK.
Correspondence to Dr Kennedy Cruickshank., Clinical Epidemiology Group, School of Epidemiology & Health Sciences, University of Manchester Medical School, Manchester M13 9PT, UK. E-mail clinep{at}man.ac.uk
Background— Arterial distensibility measures, generally from pulse-wave velocity (PWV), are widely used with little knowledge of relationships to patient outcome. We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance–tested (GTT) multiethnic population samples.
Methods and Results— Participants were randomly sampled from (1) a type 2 diabetes outpatient clinic and (2) primary care population registers, from which nondiabetic control subjects were given a GTT. Brachial blood pressures and Doppler-derived aortic PWV were measured. Mortality data over 10 years’ follow-up were obtained. At any level of systolic blood pressure (SBP), aortic PWV was greater in subjects with diabetes than in controls. Mortality risk doubled in subjects with diabetes (hazard ratio 2.34, 95% CI 1.5 to 3.74) and in those with glucose intolerance (2.12, 95% CI 1.11 to 4.0) compared with controls. For all groups combined, age, sex, and SBP predicted mortality; the addition of PWV independently predicted all-cause and cardiovascular mortality (hazard ratio 1.08, 95% CI 1.03 to 1.14 for each 1 m/s increase) but displaced SBP. Glucose tolerance status and smoking were other independent contributors, with African-Caribbeans experiencing reduced mortality risk (hazard ratio 0.41, 95% CI 0.25 to 0.69).
Conclusions— Aortic PWV is a powerful independent predictor of mortality in both diabetes and GTT population samples. In displacing SBP as a prognostic factor, aortic PWV is probably further along the causal pathway for arterial disease and may represent a useful integrated index of vascular status and hence cardiovascular risk.
Key Words: blood flow • vasculature • diabetes mellitus • mortality
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