Abstract
Carotid-femoral pulse wave velocity (cfPWV) and its risk factors may differ between various populations. Few studies have compared the risk profiles associated with cfPWV in different ethnic populations. The study population included 4321 subjects from Shanghai, China (n = 1272, age 75.0 ± 6.5 years, female 57.3%) and Malmö, Sweden (n = 3049, age 72.5 ± 5.5 years, female 60.4%). cfPWV was measured using the SphygmoCor device in both cohorts, with some difference in the determination of pulse transmission distance. The median cfPWV was 8.9 and 10.1 m/s (P < 0.001) respectively in the Chinese and Swedish subjects. cfPWV was associated (P < 0.05) with age, body mass index (BMI), mean arterial pressure (MAP), heart rate, fasting plasma glucose and serum triglycerides in both populations. The standardized effect size (m/s) associated with age (0.091 vs. 0.048, P < 0.001) and fasting plasma glucose (0.025 vs. 0.012, P = 0.046) was greater in the Swedish than Chinese subjects, whereas those with BMI (0.046 vs. 0.008, P < 0.001), MAP (0.079 vs. 0.067, P = 0.016), and heart rate (0.057 vs. 0.046, P = 0.036) were greater in Chinese. No difference was observed in those associated with serum triglycerides (P = 0.128). cfPWV was additionally associated with sex, serum total cholesterol, and on antihypertensive medication in the Swedish subjects, and with serum uric acid in the Chinese subjects (P ≤ 0.041). In conclusion, Chinese and Swedish subjects shared similar major risk factors of arterial stiffness, but with some differences in the strength of associations.
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References
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D. et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.
Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55:1318–27.
Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T. et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 2012;30:445–8.
Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63:636–46.
Cecelja M, Chowienczyk P. Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: a systematic review. Hypertension. 2009;54:1328–36.
Achimastos A, Benetos A, Stergiou G, Argyraki K, Karmaniolas K, Thomas F, et al. Determinants of arterial stiffness in Greek and French hypertensive men. Blood Press. 2002;11:218–22.
Moh MC, Sum CF, Tavintharan S, Ang K, Lee SBM, Tang WE, et al. Baseline predictors of aortic stiffness progression among multi-ethnic Asians with type 2 diabetes. Atherosclerosis. 2017;260:102–9.
Sheng CS, Liu M, Kang YY, Wei FF, Zhang L, Li GL, et al. Prevalence, awareness, treatment and control of hypertension in elderly Chinese. Hypertens Res. 2013;36:824–8.
Sheng CS, Li Y, Li LH, Huang QF, Zeng WF, Kang YY, et al. Brachial-ankle pulse wave velocity as a predictor of mortality in elderly Chinese. Hypertension. 2014;64:1124–30.
Sheng CS, Li Y, Huang QF, Kang YY, Li FK, Wang JG. Pulse waves in the lower extremities as a diagnostic tool of peripheral arterial disease and predictor of mortality in elderly Chinese. Hypertension. 2016;67:527–34.
Hedblad B, Nilsson P, Janzon L, Berglund G. Relation between insulin resistance and carotid intima-media thickness and stenosis in non-diabetic subjects. Results from a cross-sectional study in Malmö, Sweden. Diabet Med. 2000;17:299–307.
Gottsäter M, Östling G, Persson M, Engström G, Melander O, Nilsson PM. Non-hemodynamic predictors of arterial stiffness after 17 years of follow-up: the Malmö Diet and Cancer study. J Hypertens. 2015;33:957–65.
Huang QF, Sheng CS, Liu M, Li FH, Li Y, Wang JG. Arterial stiffness and wave reflections in relation to plasma advanced glycation end products in a Chinese population. Am J Hypertens. 2013;26:754–61.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and the European Society of Cardiology. 2013 ESH/ESC practice guidelines for the management of arterial hypertension. J Hypertens. 2013;31:1281–357.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(Suppl 1):S5–20.
Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T. et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367:20–29.
Bos WJ. How to assess mean blood pressure properly at the brachial artery level. J Hypertens. 2007;25:751–5.
Avolio AP, Chen SG, Wang RP, Zhang CL, Li MF, O’Rourke MF. Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation. 1983;68:50–58.
Reference Values for Arterial Stiffness’ Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’. Eur Heart J. 2010;31:2338–50.
AlGhatrif M, Strait JB, Morrell CH, Canepa M, Wright J, Elango P, et al. Longitudinal trajectories of arterial stiffness and the role of blood pressure: the Baltimore Longitudinal Study of Aging. Hypertension. 2013;62:934–41.
Wildman RP, Mackey RH, Bostom A, Thompson T, Sutton-Tyrrell K. Measures of obesity are associated with vascular stiffness in young and older adults. Hypertension. 2003;42:468–73.
Brunner EJ, Shipley MJ, Ahmadi-Abhari S, Tabak AG, McEniery CM, Wilkinson IB, et al. Adiposity, obesity, and arterial aging: longitudinal study of aortic stiffness in the Whitehall II cohort. Hypertension. 2015;66:294–300.
Wang X, Ye P, Cao R, Yang X, Xiao W, Zhang Y, et al. Triglycerides are a predictive factor for arterial stiffness: a community-based 4.8-year prospective study. Lipids Health Dis. 2016;15:97.
Tan I, Spronck B, Kiat H, Barin E, Reesink KD, Delhaas T, et al. Heart rate dependency of large artery stiffness. Hypertension. 2016;68:236–42.
McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft JR. et al. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005;46:1753–60.
Meani P, Maloberti A, Sormani P, Colombo G, Giupponi L, Stucchi M, et al. Determinants of carotid-femoral pulse wave velocity progression in hypertensive patients over a 3.7 years follow-up. Blood Press. 2018;27:32–40.
Scuteri A, Cunha PG, Rosei EA, Badariere J, Bekaert S, Cockcroft JR. et al. Arterial stiffness and influences of the metabolic syndrome: a cross-countries study. Atherosclerosis. 2014;233:654–60.
Webb DR, Khunti K, Silverman R, Gray LJ, Srinivasan B, Lacy PS, et al. Impact of metabolic indices on central artery stiffness: independent association of insulin resistance and glucose with aortic pulse wave velocity. Diabetologia. 2010;53:1190–8.
Kokubo Y. Prevention of hypertension and cardiovascular diseases: a comparison of lifestyle factors in Westerners and East Asians. Hypertension. 2014;63:655–60.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.
Lawes CM, Rodgers A, Bennett DA, Parag V, Suh I, Ueshima H. et al. Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens. 2003;21:707–16.
Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension. 2015;66:698–722.
Sugawara J, Hayashi K, Yokoi T, Tanaka H. Carotid-femoral pulse wave velocity: impact of different arterial path length measurements. Artery Res. 2010;4:27–31.
Mozos I, Malainer C, Horbańczuk J, Gug C, Stoian D, Luca CT, et al. Inflammatory markers for arterial stiffness in cardiovascular diseases. Front Immunol. 2017;8:1058.
Acknowledgements
We gratefully acknowledge the voluntary participation of all subjects from both cohorts. We thank the expert assistance of the staff from the Clinical Research Unit at Skåne University Hospital, Malmö, Sweden and the physicians and nurses from the Zhaoxiang Community Health Centre (Qingpu District, Shanghai), as well as the technicians and doctoral and master students from the Shanghai Institute of Hypertension, Shanghai, China.
Funding
The Chinese study was financially supported by grants from the National Natural Science Foundation of China (81470533, 91639203 and 81770455), and the Ministry of Science and Technology, Beijing, China (2015AA020105–06 and 2016YFC1300100), and from the Shanghai Commissions of Science and Technology (14ZR1436200 and 15XD1503200) and Education (Gaofeng Clinical Medicine Grant Support 20152503), the Shanghai Bureau of Health and Family Planning (20144Y0213, 15GWZK0802, 2017BR025 and a grant for leading academics) and Shanghai Jiaotong University School of Medicine (14XJ10071), Shanghai, China. The Swedish study was supported by the Medical Research Council of Sweden (grant K2011-65X-20752-04-6), the Heart- and Lung Foundation, the Region Skåne County Council, and the Ernhold Lundstrom Foundation.
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J-GW reports receiving grants and lecture and consulting fees from Omron Healthcare (Kyoto, Japan). The other authors declare that they have no conflict of interest.
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Guo, QH., Muhammad, I.F., Borné, Y. et al. Difference in the risk profiles of carotid-femoral pulse wave velocity: results from two community-based studies in China and Sweden. J Hum Hypertens 34, 207–213 (2020). https://doi.org/10.1038/s41371-018-0160-0
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DOI: https://doi.org/10.1038/s41371-018-0160-0