Arterial Stiffness Predicts Cardiovascular Death Independent of Arterial Thickness in a Cohort of Hemodialysis Patients
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Objective: Both arterial thickness and stiffness are predictors of cardiovascular disease (CVD). Although these arterial changes develop in parallel, no study has ever tested a hypothesis that arterial stiffness can predict mortality from CVD independent of arterial thickness. This study tested this possibility.
Methods: This was an observational cohort study in 423 hemodialysis patients (CKD stage 5D). We simultaneously measured intima-media thickness (CA-IMT) and stiffness parameter beta (CA-beta) by carotid ultrasonography at baseline, and the cohort was followed-up for a mean period of 70 months.
Results: During the follow-up, 216 all-cause deaths occurred including 124 deaths from CVD. Univariate analyses indicated both CA-IMT and CA-beta were significant predictors for CVD death. Kaplan-Meier analysis, in which the total subjects were divided into four groups by the medians of CA-IMT and CA-beta, showed that the hazards ratio (95% confidence interval) was 5.87 (3.43-10.05) for the group with higher CA-IMT/higher CA-beta as compared to the group with lower CA-IMT/lower CA-beta. The hazards ratios for the group with lower CA-IMT/higher CA-beta (2.22, 1.16-4.25) and the group with higher CA-IMT/lower CA-beta (2.85, 1.52-5.33) were comparable. Multivariate Cox analysis revealed that both CA-IMT and CA-beta were independently predictive of CVD mortality even after adjustment for other relevant covariates.
Conclusion: Increased arterial stiffness predicted cardiovascular mortality independent of arterial thickness in this cohort, implicating the distinct roles of stiffness and thickness of arterial wall in the pathogenesis of CVD.
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