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Exploring and comparing definitions of healthy vascular ageing in the population: characteristics and prospective cardiovascular risk

Journal of Human Hypertension volume 35, pages 428–436 (2021)Cite this article

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Abstract

Different methods can be used to define healthy vascular ageing (HVA). In this prospective cohort study, we explored three different definitions in order to provide guidance for which to use. 2718 subjects were included from the Cardiovascular (CV) arm of the Malmö Diet Cancer Study (MDCS; median age 71.9 years, 62.2% females). Three different definitions of HVA were used: HVA-1 (<15th percentile of aortic pulse wave velocity (aPWV) distribution from age-quintiles); HVA-2 (<35th percentile of aPWV+ <35th percentile of carotid Intima-Media Thickness. cIMT); and HVA-3 (aPWV < 7.6 m/s + no hypertension). The HVA-1 and HVA-2 groups were compared with the HVA-3, and to the corresponding groups without HVA (non-HVA), in cross-sectional analyses for baseline characteristics and using Cox regressions for prospective risk, yielding hazard ratios (HRs) adjusted for conventional risk factors. A composite CVD endpoint was used, consisting of myocardial infarctions, ischemic heart disease mortality, and coronary artery procedures. The baseline characteristics were, with minor exceptions, similar across HVA groups. In the fully adjusted model, the HRs (95%CI) were 0.62 (0.41–0.93), 0.45 (0.26–0.76), and 0.56 (0.34–0.91) for HVA-1, HVA-2, and HVA-3, respectively. In summary, this observational study of elderly subjects provides examples of integrating hypertension and cIMT in the definition of HVA, as compared with only using aPWV. As aPWV itself is such a robust marker of HVA, it is demanding to find additional markers which improve the definition. There is a need to create a generally accepted definition of HVA.

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Fig. 1: Inclusion/exclusion flowchart for the Malmö Diet Cancer Study—Cardiovascular Arm.
Fig. 2: Venn diagram showing overlap between the three HVA (1–3) definitions.
Fig. 3: Cumulative CVD events based on the three HVA (1–3) definitions.

Code availability

The statistical analyses were done using “R: A language and environment for statistical computing”, version 3.4.2 for Windows 64 bit. The package “Regression Modeling Strategies”, version 5.1-2 (https://CRAN.R-project.org/package=rms) was used for the regressions. The code used for the analyses can be accessed by contacting the author Benjamin Nilsson Wadström at: benjamin.wadstrom@gmail.com.

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Acknowledgements

We thank Gerd Östling, PhD, and Cecilia Kennbäck, ultrasound technicians at the clinical sciences department, responsible for aPWV and cIMT data collection. We also thank Associate Professor Margaretha Persson, responsible for study logistics and flow.

Funding

The study was supported by the Research Council of Sweden [grant number K2011-65X-20752-04-6]; the Region Skane County Council; the Heart- and Lung Foundation and the Ernhold Lundstrom Foundation to PM Nilsson.

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  1. Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden

    Benjamin Nilsson Wadström, Gunnar Engström & Peter M. Nilsson

  2. Clinical Research Unit, Department of Internal medicine, Skåne University Hospital, Malmö, Sweden

    Peter M. Nilsson

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Correspondence to Peter M. Nilsson.

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Nilsson Wadström, B., Engström, G. & Nilsson, P.M. Exploring and comparing definitions of healthy vascular ageing in the population: characteristics and prospective cardiovascular risk. J Hum Hypertens 35, 428–436 (2021). https://doi.org/10.1038/s41371-020-0353-1

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