Stroke and cardio-ankle vascular stiffness index.

BACKGROUND: We investigated the relationship between stroke and cardio-ankle vascular stiffness index (CAVI), a novel noninvasive measure of vascular stiffness. METHODS: Eighty-five patients with cerebrovascular disease who underwent CAVI were enrolled in the current study. They were 63 men and 22 women with a mean age of 70.0 ± 10.8 years. They were divided into 4 groups according to neurologic abnormalities and magnetic resonance imaging (MRI) findings: 12 with transient ischemic attack (TIA), 26 with white matter ischemic lesions (WMLs), 17 with large artery atherosclerosis, and 30 with small vessel occlusion. Eight hundred fifty-four healthy patients (487 men and 367 women; mean age 65.1 ± 9.4 years) served as controls. The results were stratified by gender and age and statistically analyzed using the Fisher, Bonferroni-Dunn, and Scheffe tests. RESULTS: The average of CAVI was as follows: control males 60 to 69 years of age, 9.05 ± 0.82 (as a representative value); TIA, 9.3 ± 1.5; WML, 10.3 ± 1.3; large artery atherosclerosis, 10.2 ± 1.2; and small vessel occlusion, 10.0 ± 1.6, respectively. The difference in CAVI between each group and age- and gender-matched controls was 0.492 for TIA (no statistical significance); WML, 0.733 (P < .001, and P = .002 Scheffe); large artery atherosclerosis, 0.838 (P < .001, and P = .005 Scheffe); and small vessel occlusion, 1.034 (P < .001), respectively. Linear regression analysis of CAVI and plaque score revealed a significant relationship in patients with ischemic cerebrovascular disease (P < .05). CONCLUSIONS: Compared with healthy control subjects, CAVI is statistically greater in patients with ischemic cerebrovascular diseases, particularly with WML, large artery atherosclerosis, and small vessel occlusion, but not in patients with TIA. CAVI had a clear relationship with carotid ultrasound plaque score. It appears that CAVI is a simple and noninvasive test for indicating atherosclerosis in patients with stroke.

Cardio-ankle vascular index relates to left ventricular ejection fraction in patients with heart failure. A retrospective study.

The cardio-ankle vascular index (CAVI) has been proposed as a new noninvasive marker of arterial stiffness independent of blood pressure. Arterial stiffness is closely related to afterload, and elevated afterload aggravates heart failure. We hypothesized that CAVI is a potential marker of afterload in patients with heart failure. Thirty patients who were admitted because of acute heart failure were identified retrospectively from a review of clinical records. Plasma brain natriuretic peptide (BNP) levels, CAVI, cardiothoracic ratio (CTR), and echocardiographic parameters obtained during acute and chronic phases of heart failure were analyzed. Left ventricular ejection fraction (LVEF) increased significantly and CTR, BNP and CAVI decreased significantly after treatment of heart failure. A significant negative correlation was observed between the change in CAVI and change in LVEF in all subjects (r = -0.3272, P < 0.05). To examine the relationship between CAVI and LVEF, we divided the patients into two subgroups (∆CAVI < -0.5; CAVI decrease group, ∆CAVI ≥ -0.5; CAVI non-decrease group). CAVI was significantly improved after heart failure treatment only in the CAVI decrease group. LVEF decreased significantly in both groups, but the P value was smaller in the CAVI decrease group than in the CAVI non-decrease group. The change in LVEF correlated significantly with the change in CAVI in the CAVI decrease group (r = -0.4201, P < 0.05), whereas no significant correlation was found in the CAVI non-decrease group. CAVI correlates inversely with LVEF after heart failure treatment. Our results suggest that CAVI might partially reflect the afterload in patients with heart failure.

[Relation between cardio-ankle vascular index (Cavi) and preheparin serum lipoprotein lipase mass--effect of age adjustment].

Many risk factors for coronary arterial diseases have been reported. Lipoprotein lipase (LPL) mass in serum has been suggested to be a new risk factor, but remains to be proven. The cardio-ankle vascular index (CAVI) was developed as a new arterial stiffness index and is considered to be a surrogate marker of arteriosclerosis. The purpose of this study was to establish the role of LPL mass in arteriosclerosis by examining the relationship between LPL mass and CAVI in patients with arteriosclerotic risk factors. We studied 216 patients who attended our diabetic center with diagnoses of diabetes, hypertension and/or dyslipidemia. CAVI was measured using VaSera1500 (Fukuda Denshi, Tokyo). Serum level of LPL mass was measured by ELISA(Sekisui Co. Ltd.). When the subjects were divided by a CAVI cutoff level of 9.0, the glucose level, glycohemoglobin A1c (HbA1c) level and systolic blood pressure level were significantly higher in the over 9.0 individuals than in the under 9.0 individuals (p < 0.05). CAVI level was significantly higher in patients with hyperglycemia and hypertension. LPL mass was lower in subjects with higher CAVI than in those with lower CAVI. CAVI level correlated inversely with LPL mass. CAVI adjusted for the age was associated significantly with LPL mass. These results suggest that decreased LPL mass may be a risk marker for arteriosclerosis as indicated by the surrogate marker CAVI.

Cardio-Ankle Vascular Index is Independently Associated with Future Cardiovascular Events in Outpatients with Metabolic Disorders.

AIM: We investigated whether cardio-ankle vascular index (CAVI), an arterial stiffness marker, independently predicts future cardiovascular events in subjects with metabolic disorders. METHODS: 1562 outpatients underwent CAVI between April 2004 and March 2006 at Toho University, Sakura Medical Center in Chiba, Japan. Patients who already had cardiovascular events at baseline, patients with low ankle brachial index (＜0.9), and patients with atrial fibrillation were excluded. After exclusion, 1080 subjects with metabolic disorders including diabetes mellitus, hypertension and dyslipidemia were screened and followed prospectively. RESULTS: Eventually, 1003 subjects (92.9% of 1,080 subjects) followed until March 2012 (follow-up duration 6.7±1.6 years) were analyzed. During the observation period, 90 subjects had new-onset myocardial infarction or angina pectoris confirmed by angiography. All subjects were stratified into quartiles by baseline CAVI (Q1: CAVI ≤8.27, Q2: CAVI 8.28-9.19, Q3: CAVI 9.20-10.08, Q4: CAVI ≥10.09). Age, male ratio and future cardiovascular events increased as CAVI quartile became higher. In Cox proportional hazards regression analysis, the factors independently associated with higher risk of future cardiovascular events were every 1.0 increment of CAVI [hazard ratio (HR) 1.126, p= 0.039], male gender (HR 2.276, p=0.001), smoking (HR 1.846, p=0.007), diabetes mellitus (HR 1.702,p=0.020), and hypertension (HR 1.682, p=0.023). CONCLUSION: In individuals with metabolic disorders, CAVI was a predictor of future cardiovascular events, independent of traditional coronary risk factors. CAVI is a potentially valuable tool to identify persons likely to benefit from more intensive therapeutic approaches.

Impact of cardiovascular risk factors on progression of arteriosclerosis in younger patients: evaluation by carotid duplex ultrasonography and cardio-ankle vascular index(CAVI).

AIM: To evaluate progression of arteriosclerosis using cardio-ankle vascular index(CAVI) and carotid duplex ultrasonography(DUS) in young and adolescent patients considered to be at risk of cardiovascular disease. METHODS: We evaluated the progression of arteriosclerosis using CAVI and carotid DUS in 240 young and adolescent patients. Dyslipidemia(DL), hypertension(HT), and diabetes mellitus(DM) were major cardiovascular risk factors. Patients were divided to 4 groups according to number of risk factors. RESULTS: In terms of risk factors, CAVI and CAVI difference(CAVI-D) were elevated only in the HT group(p=0.0290, p=0.0243 vs. no risk respectively). CAVI-D was positively associated with diastolic blood pressure(DBP). Mean IMT was positively associated with LDL-C or systolic blood pressure, and negatively with HDL-C. Plaque score was associated with LDL-C or DBP. In patients with the 3 risk factors, CAVI, CAVI-D and mean intima-media thickness(IMT) were significantly higher than in those without risk(p=0.0009, p=0.0042 and p=0.0151 respectively), and CAVI and CAVID were higher than in those with 1 risk(p=0.0204 and p=0.0231). Carotid plaque develops from around 30 years of age in Japan. Despite numbers of risk factors, there were no differences in CAVI, CAVI-D, mean IMT or plaque score between smoker and non-smoker groups. CONCLUSION: In conclusion, an increase in the number of risk factors also results in progression of arteriosclerosis in young and adolescent patients. HT was the most important risk factor for arteriosclerosis in these patients.

Parkinson's disease and the cardio-ankle vascular stiffness index.

OBJECTIVE: To investigate the relationship between Parkinson's disease (PD) and the cardio-ankle vascular stiffness index (CAVI), a novel non-invasive measurement of vascular stiffness. METHODS: A total of 63 PD subjects who underwent CAVI measurement were enrolled, including 30 men and 33 women 69.1±7.5 years of age (range: 46-79 years). Sixty-three non-PD subjects (30 men, 33 women, mean age: 68.7±7.6 years [range: 43-79 years]) served as controls. Comparisons between the control and PD subjects were made using Fisher's protected least significant difference, the Bonferroni-Dunn test, Scheffe's test and the unpaired t-test. RESULTS: 1) The average CAVI values were as follows: control, 9.3±0.9; PD, 9.0±1.0 (p=0.049). The differences in the CAVI values between the groups and the index values (normative data provided internally in the VaSera system) were as follows: control, 0.4±0.8; PD, 0.03±0.9 (p=0.011). The CAVI values of the PD patients were significantly smaller than those of the control subjects. 2) Among the control subjects, the CAVI values in the subjects with atherosclerotic risk factors (hypertension, dyslipidemia and/or diabetes) were significantly higher than those observed in the subjects without risk factors. In contrast, among the PD patients, the CAVI values in the subjects with atherosclerotic risk factors were equivalent to those observed in the subjects without risk factors. 3) Among the PD patients, the CAVI values did not change with the motor stage. CONCLUSION: The results of the present study show that, compared with control subjects, PD patients exhibit normal CAVI values despite having mild but significant atherosclerotic risk factors, e.g., hypertension and diabetes. These findings suggest that PD patients are less vulnerable to systemic atherosclerosis than their risk factors may suggest.

Contradictory effects of ß1- and α1- aderenergic receptor blockers on cardio-ankle vascular stiffness index (CAVI)--CAVI independent of blood pressure.

AIM: The cardio-ankle vascular stiffness index (CAVI) is a new parameter that reflects the stiffness of the aorta, femoral artery and tibial artery as a whole. One of its conspicuous features is that CAVI is independent of blood pressure at measuring time, theoretically. But, it has not been experimentally proved yet. For confirmation, pharmacological studies were performed comparing with brachial-ankle pulse wave velocity (baPWV). METHODS: Used drugs were a ß1-adrenoceptor blocker, metoprorol and an α1- adrenoceptor blocker doxazosin. Both were administered to 12 healthy volunteer men. CAVI and baPWV were measured every one hour for 6 hours using VaSera. RESULTS: When metoprolol (80 mg) was administered to 12 healthy volunteer men, systolic blood pressure decreased from 131.4 ± 4.5 to 118.3 ± 4.1 mmHg (mean ± SE) (p < 0.05) at the 3rd hour, and diastolic blood pressure decreased from 85.3 ± 4.0 to 75.3 ± 3.0 mm Hg (p < 0.05). baP-WV decreased from 13.93 ± 0.46 to 12.46 ± 0.49 m/sec (p < 0.05), significantly, but CAVI did not change (8.16 ± 0.29 to 8.24 ± 0.27) (p = 0.449). ΔbaPWV at each time was significantly correlated with both Δsystolic and Δdiastolic blood pressures, but ΔCAVI was not correlated with either Δblood pressure. When doxazosin (4 mg) was administered to the same men, systolic blood pressure decreased from 130.2 ± 4.6 to 117.2 ± 4.8 mmHg (p < 0.05) at the 3rd hour. Diastolic blood pressure also decreased from 85.1 ± 4.1 to 74.2 ± 3.9 mmHg (p < 0.05). baPWV decreased from 13.98 ± 0.68 to 12.25 ± 0.53 m/sec (p < 0.05), significantly. CAVI also decreased from 8.15 ± 0.28 to 7.18 ± 0.37 (p < 0.05), significantly. CONCLUSION: These results suggested that CAVI was not affected by blood pressure at the measuring time directly, but affected by the changes of contractility of smooth muscle cells.

Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives.

The cardio-ankle vascular index (CAVI) is a new index of the overall stiffness of the artery from the origin of the aorta to the ankle. The most conspicuous feature of CAVI is its independence of blood pressure at the time of measurement.CAVI increases with age and in many arteriosclerotic diseases, such as coronary artery disease, carotid arteriosclerosis, chronic kidney disease and cerebrovascular disease, and is related to many coronary risk factors, such as hypertension, diabetes mellitus, dyslipidemia and smoking. Furthermore, CAVI decreases by controlling diabetes mellitus and hypertension, and also by abstaining from smoking. This suggests that CAVI is a physiological surrogate marker of athero- or arteriosclerosis, and also might be an indicator of lifestyle modification.Recently, it has been reported that CAVI and several left ventricular functions are co-related, suggesting a connection between the heart muscle and vascular function.This review covers the principles of CAVI and our current knowledge about CAVI, focusing on its roles and future outlook.