Circulation. 2004;109:184-189
Published online before print December 8, 2003, doi: 10.1161/01.CIR.0000105767.94169.E3
Published online before print December 8, 2003, doi: 10.1161/01.CIR.0000105767.94169.E3
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(Circulation. 2004;109:184-189.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease
From the Cardiology Department of the General Hospital of the Kreuzschwestern (T.W., J.A., E.L., R.B., B.E.), Wels, Austria; University of New South Wales, St Vincents’ Clinic (M.F.O.), Sydney, Australia; and Hermesoft Biostatistics (E.K.), Graz, Austria.
Correspondence to Dr Thomas Weber, General Hospital of the Kreuzschwestern, Grieskirchnerstrasse 42, 4600 Wels, Austria. E-mail thomas.weber{at}khwels.at
Received April 24, 2003; de novo received July 16, 2003; revision received September 19, 2003; accepted September 22, 2003.
Background— Increased arterial stiffness, determined invasively, has been shown to predict a higher risk of coronary atherosclerosis. However, invasive techniques are of limited value for screening and risk stratification in larger patient groups.
Methods and Results— We prospectively enrolled 465 consecutive, symptomatic men undergoing coronary angiography for the assessment of suspected coronary artery disease. Arterial stiffness and wave reflections were quantified noninvasively using applanation tonometry of the radial artery with a validated transfer function to generate the corresponding ascending aortic pressure waveform. Augmented pressure (AP) was defined as the difference between the second and the first systolic peak, and augmentation index (AIx) was AP expressed as a percentage of the pulse pressure. In univariate analysis, a higher AIx was associated with an increased risk for coronary artery disease (OR, 4.06 for the difference between the first and the fourth quartile [1.72 to 9.57; P<0.01]). In multivariate analysis, after controlling for age, height, presence of hypertension, HDL cholesterol, and medications, the association with coronary artery disease risk remained significant (OR, 6.91; P<0.05). The results were exclusively driven by an increase in risk with premature vessel stiffening in the younger patient group (up to 60 years of age), with an unadjusted OR between AIx quartiles I and IV of 8.25 (P<0.01) and a multiple-adjusted OR between these quartiles of 16.81 (P<0.05).
Conclusions— AIx and AP, noninvasively determined manifestations of arterial stiffening and increased wave reflections, are strong, independent risk markers for premature coronary artery disease.
Key Words: coronary disease • waves • arteries • arteriosclerosis
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