Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: The Cardiovascular Risk in Young Finns Study and the Health 2000 Survey
Introduction
Arterial pulse wave velocity (PWV) is a commonly used measure of arterial stiffness and a marker of vascular damage [1]. Increased PWV correlates with cardiovascular risk factors [2], [3] and predicts cardiovascular events and all-cause mortality [4]. Additionally, other non-invasive methods – such as the measurement of brachial artery flow-mediated dilation (FMD), carotid artery distensibility (Cdist) and carotid artery intima-media thickness (IMT) – are widely used to assess functional and structural vascular damage [5], [6], [7].
Brachial FMD, as a surrogate marker of endothelial function, reflects early and predominantly functional changes in the arterial wall, whereas carotid IMT represents a marker of more advanced structural changes [5]. We [8] and others [9], [10] have previously shown that brachial FMD and carotid IMT are inversely related, suggesting that both are representatives of the same atherosclerotic process. Moreover, we have previously shown that the status of the brachial endothelial function may modify the association between cardiovascular risk factors and carotid IMT [8]. However, findings with respect to relationships between PWV and brachial FMD or carotid IMT have been inconsistent [11], [12], [13], [14], [15], [16], [17], [18]. It therefore remains unclear whether segmental arterial stiffening, at least in its early stages, reflects the atherosclerotic process or an alternative pathology of the arterial wall [19], [20]. Furthermore, although PWV and Cdist, as measures of segmental and local arterial stiffness, are often used interchangeably, the relationships between PWV and Cdist have received little interest to date.
The objective of the present study was to gain more insight into the associations of PWV with the markers of subclinical atherosclerosis (brachial FMD, carotid IMT) and local arterial stiffness (Cdist). In addition, we studied whether the status of the brachial endothelial function modifies the relationship between cardiovascular risk factors and PWV. The analyses were based on 1754 subjects from the Cardiovascular Risk in Young Finns Study (YFS) and 336 subjects from the Health 2000 Survey.
Section snippets
Subjects
The YFS is an on-going, five-centre follow-up study of atherosclerosis risk factors in Finnish children and young adults. The first cross-sectional survey was conducted in 1980 including 3596 randomly selected participants aged 3, 6, 9, 12, 15, and 18 years [21]. The latest follow-up study was conducted in 2007, with 1872 subjects (aged 30, 33, 36, 39, 42, and 45 years) attending the PWV measurement. After excluding subjects with incomplete brachial or carotid ultrasound data (n = 23) and those
Results
The characteristics of the study subjects are shown in Table 1. There was an overall tendency towards a deteriorating trend in various cardiovascular risk factors with the advancing age. Moreover, the frequency of antihypertensive, lipid-lowering and anti-diabetic medications increased with the advancing age (p for trend <0.002 for all). PWV was directly associated with male sex, BMI, LDL cholesterol (only in subjects aged 30–36 years and 39–45 years), triglycerides, systolic and diastolic
Discussion
In this large-scale study with data from 2 cohorts, we found that PWV is not associated with brachial FMD or carotid IMT in young adults; but in older individuals PWV is directly and independently correlated with carotid IMT. Our observations therefore suggest that PWV reflects a different aspect of vascular damage than brachial FMD or carotid IMT in young adults, whereas the information provided by PWV and IMT in older adults, as regards subclinical vascular damage, may be partially similar.
Conflicts of interest
None.
Acknowledgements
This study was financially supported by the Academy of Finland (grant nos. 77841, 117832, 201888, 121584, 124282 and 126925); the Social Insurance Institution of Finland; the Turku University Foundation; the Tampere University Medical Fund; the Kuopio, Tampere (EVO grants 9M048, 9L054 and 9J055) and Turku University Hospital Medical Funds; the Paavo Nurmi Foundation; the Emil Aaltonen Foundation; the Juha Vainio Foundation; the Finnish Foundation of Cardiovascular Research; the Finnish Cultural
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