Abstract
Background
Vascular aging, defined by aortic pulse wave velocity (aoPWV), as well as coronary artery calcium (CaC), are emerging risk predictors.
Purpose
To investigate the prognostic role of functional (vascular aging) and structural (CaC) arterial parameters in individuals without established cardiovascular disease.
Methods
We utilized our recently established population-based reference values for healthy (HVA), normal (NVA) and early (EVA) vascular aging in the poipulation-based Heinz Nixdorf Recall (HNR) study. HVA was the lowest, and EVA the highest age- and sex-specific decile of estimated aoPWV, derived from radial waveforms with a validated regression formula. CaC was measured with electron beam computed tomography (Agatston-score). The additive prognostic value of both parameters for all-cause mortality was tested, using Kaplan Meier curves and Cox Regression models. The latter included age, sex, diastolic blood pressure, cholesterol, and diabetes as covariates.
Results
We included 1805 participants (976 women), mean age was 68.2 years (range 55–85), mean blood pressure 129/76 mm Hg. 64.7% were hypertensives, 17.0% diabetics. The percentage of participants with CaC = 0 was 44.8, 40.6, amd 33.5 in HVA, NVA, and EVA, respectively. During a mean follow up of 4.7 years, 67 participants died. Mortality was 0% / 2.2%, 1.8% / 4.8%, 3.5% / 7.1% in participants with HVA: CaC 0 / >0, NVA: CaC 0 / >0, EVA: CAC 0 / >0, respectively (p=0.003, log rank test) – Figure. In Cox regression analysis, vascular aging (HR for HVA: 0.18, CI 0.04–0.73, and HR for NVA: 0.48, CI 0.27–0.88; both compared to EVA), CaC, as well as age (directly related) and diastolic blood pressure (inversely related) were independently associated with all-cause mortality.
Conclusion
Aortic stiffness, expressed as vascular aging, as well as coronary artery calcium, provide additive and independent prognostic information regarding all-cause mortality in a middle-aged and elderly primary -prevention population.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Heinz Nixdorf Foundation, German Ministry of Education and Science (BMBF)
VASCULAR AGING INDEPENDENTLY PREDICTS ALL-CAUSE MORTALITY IN THE HEINZ NIXDORF RECALL STUDY
