Correlation Between Arterial Stiffness Index and Arterial Wave Pattern and Incidence of Stroke
Article Outline
Summary
Background
Although there are several extensive studies on stroke risks and prevention, stroke has remained one of the top ten causes of death in Taiwan for many years. The key factor is a lack of an effective and non-invasive screening tool for stroke risk. The arterial stiffness index (ASI), which measures artery distensibility and is correlated with arthrosclerosis, is gaining popularity nowadays for stroke risk assessment. In our study, we investigated the relationship between stroke and ASI as well as other noninvasive screening tools such as the ankle brachial index (ABI) and arterial wave pattern.
Methods
This community-based prospective study was conducted between August 2005 and June 2006. The control group consisted of 629 volunteer adults above 30 years of age living in the northern Taipei area. The stroke group consisted of 266 newly diagnosed stroke patients. Participants completed a structured questionnaire, and blood samples were collected. In addition, a validated oscillometric automated digital blood pressure device was used to measure the participant's ASI, ABI and arterial wave pattern. The odds ratio was then computed to evaluate the association between each factor and stroke.
Results
Our study showed that abnormal ASI (ASI < 70) was associated with a six times higher risk of stroke. Even after adjustment, the adjusted odds ratio was still 1.8. We also found a significant association between stroke and both ABI and arterial wave pattern (odds ratios, 2.15 and 2.98, respectively). In addition, when we employed ASI and arterial wave pattern together, the adjusted odds ratio for stroke was 1.87. The odds ratio increased significantly to 10.53 when all three factors were taken into consideration.
Conclusion
Our study showed that ASI, arterial wave pattern and ABI are correlated with stroke risk. In addition, when all these factors are taken into consideration, they create a synergistic effect in evaluating the risk of stroke risk.
Key Words: ankle brachial index , atherosclerosis , cardiovascular diseases , stroke
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References
- Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: cosponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline . Circulation . 2006;113:e409–e449
- Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee . Circulation . 2009;119:e21–181
- . Stroke in Blacks: A Guide to Management and Prevention . Basel: Karger; 1999;
- . Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries . Lancet . 2001;357:995–1001
- Incidence of stroke in Taiwan . Stroke . 1992;23:1237–1241
- Predictive value of electron beam computed tomography of the coronary arteries: 19-month follow-up of 1173 asymptomatic subjects . Circulation . 1996;93:1951–1953
- . Risk stratification for the detection of preclinical coronary artery disease . Circulation . 1999;99:2610–2612
- . Prevention conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: executive summary . Circulation . 2000;101:111–116
- . Noninvasive assessment of cardiovascular risk: from Framingham to the future . Rev Cardiovasc Med . 2000;1:34–42
- . Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases . Circulation . 2003;107:2864–2869
- Ambulatory arterial stiffness index predicts stroke in a general population . J Hypertens . 2006;24:2247–2253
- Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in the Dublin Outcome Study . Hypertension . 2006;47:365–370
- Ambulatory arterial stiffness index or pulse pressure: which correlates better with arterial stiffness in resistant hypertension . Hypertens Res . 2008;31:607–613
- Aortic pulse wave velocity predicts cardiovascular mortality in middle-aged and elderly Japanese men . Circ J . 2009;73:549–553
- Usefulness of the ankle-brachial index in assessing vascular function in normal individuals . Rev Port Cardiol . 2008;27:465–476
- Limitation of brachialankle pulse wave velocity in assessing the risk of stroke: importance of instantaneous blood pressure . Cerebrovasc Dis . 2009;27:417–425
- Increased brachial-ankle pulse wave velocity is independently associated with risk of cerebral ischemic small vessel disease in elderly hypertensive patients . Clin Neurol Neurosurg . 2008;110:599–604
- Noninvasive measurements of arterial stiffness: repeatability and interrelationships with endothelial function and arterial morphology measures . Vasc Health Risk Manag . 2007;3:343–349
- Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform . J Clin Hypertens (Greenwich) . 2008;10:295–303
- Assessment of central and peripheral arterial stiffness: studies indicating the need to use a combination of techniques . Am J Hypertens . 2005;18:249–260
- Comparison of ankle-brachial index and brachial-ankle pulse wave velocity between patients with chronic kidney disease and hemodialysis . Am J Nephrol . 2009;29:374–380
- Composition of lower extremity in relation to a high ankle-brachial index . J Hypertens . 2009;27:167–173
- Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease) . Circulation . 1999;100:951–957
- Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging . Circulation . 1999;99:3248–3254
- Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association . Circulation . 2001;103:163–182
- . Pulse wave analysis and pulse wave velocity: a critical review of their strengths and weaknesses . J Hypertens . 2003;21:463–472
PII: S1873-9598(10)70027-2
doi:10.1016/S1873-9598(10)70027-2
© 2010 Elsevier B.V. All rights reserved.
