BACKGROUND The aortic-femoral arterial stiffness gradient, calculated as the ratio of lower-limb pulse-wave velocity (PWV) to central (aortic) PWV, is a promising tool for assessing cardiovascular disease (CVD) risk, but whether it predicts incident CVD is unknown. METHODS We examined the association of the aortic-femoral arterial stiffness gradient measures carotid-femoral stiffness gradient (femoral-ankle PWV divided by carotid-femoral PWV) and the heart-femoral stiffness gradient (femoral-ankle PWV divided by heart-femoral PWV), as well as PWV, with incident CVD (coronary disease, stroke, and heart failure) and all-cause mortality among 3109 participants of the Atherosclerosis Risk in Communities Study cohort (age, 75±5 years; carotid-femoral PWV, 11.5±3.0 m/s), free of CVD. Cox regression was used to estimate hazard ratios (HR) and 95% CIs. RESULTS Over a median 7.4-year follow-up, there were 322 cases of incident CVD and 410 deaths. In fully adjusted models, only top quartiles of carotid-femoral stiffness gradient (quartile 4: HR, 1.43 [95% CI, 1.03-1.97]; and quartile 3: HR, 1.49 [95% CI, 1.08-2.05]) and heart-femoral stiffness gradient (quartile 4: HR, 1.77 [95% CI, 1.27-2.48]; and quartile 3: HR, 1.41 [95% CI, 1.00-2.00]) were significantly associated with a greater risk of incident CVD. Only high aortic stiffness in combination with low lower-limb stiffness was significantly associated with incident CVD (HR, 1.46 [95% CI, 1.06-2.02]) compared with the referent low aortic stiffness and high lower-limb stiffness. No PWVs were significantly associated with incident CVD. No exposures were associated with all-cause mortality. CONCLUSIONS The aortic-femoral arterial stiffness gradient may enhance CVD risk assessment in older adults in whom the predictive capacity of traditional risk factors and PWV are attenuated.

中文翻译：

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老年人的主动脉-股骨僵硬梯度和心血管风险。


背景 主动脉-股动脉僵化梯度，计算为下肢脉搏波速度 （PWV） 与中央（主动脉）PWV 的比率，是评估心血管疾病 （CVD） 风险的一种有前途的工具，但它是否能预测 CVD 事件尚不清楚。方法 我们检查了主动脉-股动脉刚度梯度测量颈动脉-股骨僵硬梯度（股踝 PWV 除以颈动脉-股骨 PWV）和心-股骨僵硬梯度（股骨-踝 PWV 除以心-股 PWV）以及 PWV 与社区动脉粥样硬化风险研究队列的 3109 名参与者（年龄、 75±5 年;颈股动脉 PWV，11.5±3.0 m/s），无 CVD。Cox 回归用于估计风险比 （HR） 和 95% CIs。结果 在中位 7.4 年的随访中，有 322 例 CVD 事件和 410 例死亡。在完全调整的模型中，只有颈动脉-股骨硬度梯度的前四分位数（四分位数 4：HR，1.43 [95% CI，1.03-1.97];四分位数 3：HR，1.49 [95% CI，1.08-2.05]）和心-股骨硬度梯度（四分位数 4：HR，1.77 [95% CI，1.27-2.48];和四分位数 3：HR，1.41 [95% CI，1.00-2.00]）与较高的 CVD 发生风险显著相关。与所指的低主动脉僵化和高下肢僵硬相比，只有高主动脉僵直联合低下肢僵硬与新发 CVD （HR， 1.46 [95% CI， 1.06-2.02]） 显著相关。没有 PWV 与新发 CVD 显著相关。没有暴露与全因死亡率相关。 结论 主动脉-股动脉硬度梯度可能会增强传统危险因素和 PWV 的预测能力减弱的老年人的 CVD 风险评估。