Arterial stiffness in a Mediterranean population: variation of cardio-ankle vascular index related to the presence of traditional cardiovascular risk factors and CV risk score

Abstract

Cardiovascular diseases are the main cause of mortality and morbidity in high-income countries being arteriosclerosis the main pathological mechanism involved. The cardio-ankle vascular index (CAVI) is a novel stiffness measurement used to assess the extent of arteriosclerosis that enables us to detect it at early stages allowing for timely prevention treatment. In this study we want to describe the CAVI values in a Mediterranean population, as well as its associations with different clinical and behavioral risk factors. Additionally we want to analyze its relation with carotid arteriosclerosis burden assessed by other methods. A cross-sectional study was conducted with a representative sample of the general population of Girona between 40-90 years old (n=2502). The variables analyzed were: i) classical risk factors: hypertension, diabetes, obesity and hypercholesterolemia; ii) life styles: diet quality, smoking habits and physical activity; iii) carotid arteriosclerotic markers: common carotid artery intima-media thickness (CCA-IMT) and distensibility coefficient (DC); and iv) CAVI. The group with abnormally high CAVI consisted of 43.32% of our sample and had a higher prevalence of cardiovascular risk factors, except for obesity. They also had a higher proportion of non-smokers, as well as individuals who didn’t achieve the recommended cardio-protector physical activity, while no differences between groups were observed regarding the diet quality. A significant moderate correlation between CAVI and CCA-IMT and the DC was observed. We found a high prevalence of abnormally high arterial stiffness in a low coronary risk population. Since arterial stiffness is not included in the coronary risk scores, CAVI could be used to improve the classification of intermediate risk individuals sorting out those with higher risk that nowadays go undetected targeting them for timely prevention. CAVI has shown to be independently associated with aging, male sex and classical risk factors except for obesity where an inverse association was found. Physical activity in men was the only lifestyles independently associated with CAVI and did so with lower levels of CAVI. CAVI has also moderately correlated with carotid atherosclerotic burden assessed with CCA-IMT and DC