Relative Contributions of Arterial Stiffness to Cardiovascular Disease Risk Score in Chinese Women in Framingham and China-PAR Model

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Jul 3

PMID 37396573

Authors

Lin Jin

Jianxiong Chen

Lingheng Wu

Mengjiao Zhang

Jiali Sun

Cuiqin Shen

Lianfang Du

Dingqian Wang

Zhaojun Li

Affiliations

Soon will be listed here.

Abstract

Background: Arterial stiffness played an important role in the development of cardiovascular disease (CVD) events. The aim of this study was to verify the relative importance of arterial stiffness for different CVD risk scores in a large sample of Chinese women.

Methods: We measured arterial velocity pulse index (AVI) and CVD risk scores in 2220 female participants (mean age 57 years). Framingham Risk Score (FRS), and the prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) were used to estimate CVD risk, respectively. The relationships between AVI and risk scores were investigated by linear regressions and restricted cubic spline (RCS) analysis. To determine the relative importance of AVI in predicting CVD risk scores, random forest analysis was used.

Results: There was a significant positive correlation between AVI and FRS, China-PAR in all subgroup groups stratified by age, blood pressure and BMI. AVI showed higher importance in predicting CVD risk scores in FRS model, compared with these traditional risk factors. In China-PAR model, although AVI was not as predictive as SBP, it had better predictive power than many known risk factors such as lipids. Furthermore, AVI had significant J-shaped associations both with FRS and China-PAR scores.

Conclusions: AVI was significantly associated with CVD risk score. In FRS and China-PAR model, AVI showed relatively high importance in predicting CVD risk scores. These findings may support the use of arterial stiffness measurements in CVD risk assessment.

References

Wilson P, DAgostino R, Levy D, Belanger A, Silbershatz H, Kannel W . Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97(18):1837-47. DOI: 10.1161/01.cir.97.18.1837. View

Okamoto M, Nakamura F, Musha T, Kobayashi Y . Association between novel arterial stiffness indices and risk factors of cardiovascular disease. BMC Cardiovasc Disord. 2016; 16(1):211. PMC: 5100265. DOI: 10.1186/s12872-016-0389-x. View

Michos E, Nasir K, Braunstein J, Rumberger J, Budoff M, Post W . Framingham risk equation underestimates subclinical atherosclerosis risk in asymptomatic women. Atherosclerosis. 2005; 184(1):201-6. DOI: 10.1016/j.atherosclerosis.2005.04.004. View

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M . 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31(7):1281-357. DOI: 10.1097/01.hjh.0000431740.32696.cc. View

Yang X, Li J, Hu D, Chen J, Li Y, Huang J . Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project (Prediction for ASCVD Risk in China). Circulation. 2016; 134(19):1430-1440. DOI: 10.1161/CIRCULATIONAHA.116.022367. View

Vogel B, Acevedo M, Appelman Y, Merz C, Chieffo A, Figtree G . The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet. 2021; 397(10292):2385-2438. DOI: 10.1016/S0140-6736(21)00684-X. View

Jacobson T, Ito M, Maki K, Orringer C, Bays H, Jones P . National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol. 2015; 9(2):129-69. DOI: 10.1016/j.jacl.2015.02.003. View

Strobl C, Malley J, Tutz G . An introduction to recursive partitioning: rationale, application, and characteristics of classification and regression trees, bagging, and random forests. Psychol Methods. 2009; 14(4):323-48. PMC: 2927982. DOI: 10.1037/a0016973. View

Petersmann A, Muller-Wieland D, Muller U, Landgraf R, Nauck M, Freckmann G . Definition, Classification and Diagnosis of Diabetes Mellitus. Exp Clin Endocrinol Diabetes. 2019; 127(S 01):S1-S7. DOI: 10.1055/a-1018-9078. View

10.

Tang B, Luo F, Zhao J, Ma J, Tan I, Butlin M . Relationship between body mass index and arterial stiffness in a health assessment Chinese population. Medicine (Baltimore). 2020; 99(3):e18793. PMC: 7220472. DOI: 10.1097/MD.0000000000018793. View

11.

Liu X, Li Y, Guo Y, Li L, Yang K, Liu R . The burden, management rates and influencing factors of high blood pressure in a Chinese rural population: the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study. J Hum Hypertens. 2018; 32(3):236-246. DOI: 10.1038/s41371-018-0039-0. View

12.

Mitchell G, Hwang S, Vasan R, Larson M, Pencina M, Hamburg N . Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010; 121(4):505-11. PMC: 2836717. DOI: 10.1161/CIRCULATIONAHA.109.886655. View

13.

Doi H, Ishigami T, Nakashima-Sasaki R, Kino T, Chen L, Arakawa K . New non-invasive indexes of arterial stiffness are significantly correlated with severity and complexity of coronary atherosclerosis. Clin Exp Hypertens. 2018; :1-7. DOI: 10.1080/10641963.2018.1465072. View

14.

Sasaki-Nakashima R, Kino T, Chen L, Doi H, Minegishi S, Abe K . Successful prediction of cardiovascular risk by new non-invasive vascular indexes using suprasystolic cuff oscillometric waveform analysis. J Cardiol. 2016; 69(1):30-37. DOI: 10.1016/j.jjcc.2016.06.004. View

15.

Niiranen T, Kalesan B, Hamburg N, Benjamin E, Mitchell G, Vasan R . Relative Contributions of Arterial Stiffness and Hypertension to Cardiovascular Disease: The Framingham Heart Study. J Am Heart Assoc. 2016; 5(11). PMC: 5210358. DOI: 10.1161/JAHA.116.004271. View

16.

Zhang M, Shi Y, Zhou B, Huang Z, Zhao Z, Li C . Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey. BMJ. 2023; 380:e071952. PMC: 10498511. DOI: 10.1136/bmj-2022-071952. View

17.

Piepoli M, Hoes A, Agewall S, Albus C, Brotons C, Catapano A . 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by.... Eur Heart J. 2016; 37(29):2315-2381. PMC: 4986030. DOI: 10.1093/eurheartj/ehw106. View

18.

Jin L, Tong L, Shen C, Du L, Mao J, Liu L . Association of Arterial Stiffness Indices with Framingham Cardiovascular Disease Risk Score. Rev Cardiovasc Med. 2024; 23(8):287. PMC: 11266941. DOI: 10.31083/j.rcm2308287. View

19.

Taylor F, Huffman M, Macedo A, Moore T, Burke M, Davey Smith G . Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013; (1):CD004816. PMC: 6481400. DOI: 10.1002/14651858.CD004816.pub5. View

20.

Ma H, Liu F, Li J, Chen J, Cao J, Chen S . Sex Differences in Associations Between Socioeconomic Status and Incident Hypertension Among Chinese Adults. Hypertension. 2023; 80(4):783-791. DOI: 10.1161/HYPERTENSIONAHA.122.20061. View