Circulation. 2006;113:657-663
doi: 10.1161/CIRCULATIONAHA.105.555235
doi: 10.1161/CIRCULATIONAHA.105.555235
(Circulation. 2006;113:657-663.)
© 2006 American Heart Association, Inc.
Epidemiology |
Arterial Stiffness and Risk of Coronary Heart Disease and Stroke
The Rotterdam Study
From the Department of Epidemiology and Biostatistics (F.U.S.M.-R., T.J.M.v.d.C., A.H., N.M.v.P., M.L.B., M.M.B.B., J.C.M.W.), Section of Geriatric Medicine, Department of Internal Medicine (F.U.S.M.-R., T.J.M.v.d.C.), and Department of Internal Medicine (M.A.D.H.S.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiovascular Institute, Paris, France (R.A.); and Departments of Physiology (R.S.R.) and Biophysics (A.P.G.H.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
Correspondence to Dr J.C.M. Witteman, Department of Epidemiology and Biostatistics, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail j.witteman{at}erasmusmc.nl
Received April 12, 2005; revision received October 27, 2005; accepted October 31, 2005.
Background— Arterial stiffness has been associated with the risk of cardiovascular disease in selected groups of patients. We evaluated whether arterial stiffness is a predictor of coronary heart disease and stroke in a population-based study among apparently healthy subjects.
Methods and Results— The present study included 2835 subjects participating in the third examination phase of the Rotterdam Study. Arterial stiffness was measured as aortic pulse wave velocity and carotid distensibility. Cox proportional hazards regression analysis was performed to compute hazard ratios. During follow-up, 101 subjects developed coronary heart disease (mean follow-up period, 4.1 years), and 63 subjects developed a stroke (mean follow-up period, 3.2 years). The risk of cardiovascular disease increased with increasing aortic pulse wave velocity index. Hazard ratios and corresponding 95% CIs of coronary heart disease for subjects in the second and third tertiles of the aortic pulse wave velocity index compared with subjects in the reference category were 1.72 (0.91 to 3.24) and 2.45 (1.29 to 4.66), respectively, after adjustment for age, gender, mean arterial pressure, and heart rate. Corresponding estimates for stroke were 1.22 (0.55 to 2.70) and 2.28 (1.05 to 4.96). Estimates decreased only slightly after adjustment for cardiovascular risk factors, carotid intima-media thickness, the ankle-arm index, and pulse pressure. The aortic pulse wave velocity index provided additional predictive value above cardiovascular risk factors, measures of atherosclerosis, and pulse pressure. Carotid distensibility as measured in this study was not independently associated with cardiovascular disease.
Conclusions— Aortic pulse wave velocity is an independent predictor of coronary heart disease and stroke in apparently healthy subjects.
CLINICAL PERSPECTIVE
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