Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 3, June 2021, pages 161-168

The Relationship Between Ambulatory Arterial Stiffness Index and Cardiovascular Outcomes in Women

Figure 1. Receiver operating characteristic curve of AASI for the prediction of major adverse cardiac events (MACEs).

Figure 2. Kaplan-Meier survival analysis showing the event-free survival for major adverse cardiac events in patients with an AASI ≥ 0.56 (red) versus < 0.56 (blue line). AASI: ambulatory arterial stiffness index.

**Table 1.** Baseline Demographics and Clinical Characteristics of the Total Cohort and Patients With and Without MACE
Characteristic	Full cohort	No MACE	MACE	P value
MACE: major adverse cardiovascular event; TIA: transient ischemic attack; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; HDL: high-density lipoprotein; HbA1c: glycated hemoglobin. P values refer to the results of comparison between the MACE and non-MACE groups only.
Number	219	203	16
Age	57.4 ± 13.3	57.0 ± 13.50	63.50 ± 10.4	0.047
Body mass, kg	76.6 ± 17.9	81.80 ± 22.23	81.0 ± 22.8	0.32
Body mass index, kg/m²	29.2 ± 6.7	29.1 ± 6.6	31.1 ± 7.6	0.26
Caucasian	213 (97.3%)	197(97.0%)	15 (100%)	0.99
Ischemic heart disease	24 (4.4%)	21 (10.3%)	3 (18.8%)	0.39
Diabetes mellitus	27 (12.3%)	20 (9.8%)	8 (50.0%)	0.0002
Previous stroke or TIA	11 (5.0%)	9 (4.4%)	2 (12.5%)	0.19
Heart failure	7 (3.2%)	5 (2.5%)	2 (12.5%)	0.09
Peripheral vascular disease	4 (1.8%)	1 (0.5%)	3 (20%)	0.001
Hypertension	146 (66.7%)	132 (65.0%)	14 (87.5%)	0.10
Smoking status
Current/ex	85 (40.7%)	85(41.9%)	4 (25%)	0.49
Never	130 (59.3%)	118 (58.1%	12 (75%)
Medication
ACE-I/ARB	102 (46.6%)	92 (45.3%)	10 (62.5%)	0.20
Calcium channel blocker	80 (36.5%)	72 (35.5%)	8 (50.0%)	0.28
Beta blockers	51 (23.3%)	45 (22.2%)	6 (37.5%)	0.22
Diuretics	36 (16.4%)	32 (15.8%)	4 (25.0%)	0.31
Alpha blockers	20 (9.1%)	16 (7.9%)	4 (25.0%)	0.045
Statins	63 (28.8%)	54 (26.6%)	9 (56.3%)	0.02
Aldosterone antagonists	8 (3.7%)	8 (3.9%)	0 (0%)	0.99
Ejection fraction, %	60.4 ± 9.32	60.4 ± 9.5	60.8 ± 7.3	0.88
Hemoglobin g/L	136.1 ± 12.8	136.3 ± 12.9	132.5 ± 11.7	0.26
Estimated glomerular filtration rate, mL/min/1.73m²	70.8 ± 15.5	71.4 ± 14.9	63.0 ± 20.4	0.037
Total cholesterol, mmol/L	5.1 ± 1.1	5.1 ± 1.1	4.8 ± 1.4	0.34
HDL cholesterol, mmol/L	1.7 ± 0.5	1.7 ± 0.5	1.3 ± 0.3	0.001
Triglycerides, mmol/L	1.5 ± 0.9	1.5 ± 0.9	1.7 ± 0.9	0.25
HbA1c	42.0 ± 14.0	41.3 ± 12.4	49.9 ± 26.1	0.44

Table 1. Baseline Demographics and Clinical Characteristics of the Total Cohort and Patients With and Without MACE

Characteristic

Full cohort

No MACE

MACE

P value

MACE: major adverse cardiovascular event; TIA: transient ischemic attack; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; HDL: high-density lipoprotein; HbA1c: glycated hemoglobin. P values refer to the results of comparison between the MACE and non-MACE groups only.

Number

219

203

Age

57.4 ± 13.3

57.0 ± 13.50

63.50 ± 10.4

0.047

Body mass, kg

76.6 ± 17.9

81.80 ± 22.23

81.0 ± 22.8

0.32

Body mass index, kg/m²

29.2 ± 6.7

29.1 ± 6.6

31.1 ± 7.6

0.26

Caucasian

213 (97.3%)

197(97.0%)

15 (100%)

0.99

Ischemic heart disease

24 (4.4%)

21 (10.3%)

3 (18.8%)

0.39

Diabetes mellitus

27 (12.3%)

20 (9.8%)

8 (50.0%)

0.0002

Previous stroke or TIA

11 (5.0%)

9 (4.4%)

2 (12.5%)

0.19

Heart failure

7 (3.2%)

5 (2.5%)

2 (12.5%)

0.09

Peripheral vascular disease

4 (1.8%)

1 (0.5%)

3 (20%)

0.001

Hypertension

146 (66.7%)

132 (65.0%)

14 (87.5%)

0.10

Smoking status

Current/ex

85 (40.7%)

85(41.9%)

4 (25%)

0.49

Never

130 (59.3%)

118 (58.1%

12 (75%)

Medication

ACE-I/ARB

102 (46.6%)

92 (45.3%)

10 (62.5%)

0.20

Calcium channel blocker

80 (36.5%)

72 (35.5%)

8 (50.0%)

0.28

Beta blockers

51 (23.3%)

45 (22.2%)

6 (37.5%)

0.22

Diuretics

36 (16.4%)

32 (15.8%)

4 (25.0%)

0.31

Alpha blockers

20 (9.1%)

16 (7.9%)

4 (25.0%)

0.045

Statins

63 (28.8%)

54 (26.6%)

9 (56.3%)

0.02

Aldosterone antagonists

8 (3.7%)

8 (3.9%)

0 (0%)

0.99

Ejection fraction, %

60.4 ± 9.32

60.4 ± 9.5

60.8 ± 7.3

0.88

Hemoglobin g/L

136.1 ± 12.8

136.3 ± 12.9

132.5 ± 11.7

0.26

Estimated glomerular filtration rate, mL/min/1.73m²

70.8 ± 15.5

71.4 ± 14.9

63.0 ± 20.4

0.037

Total cholesterol, mmol/L

5.1 ± 1.1

4.8 ± 1.4

0.34

HDL cholesterol, mmol/L

1.7 ± 0.5

1.3 ± 0.3

0.001

Triglycerides, mmol/L

1.5 ± 0.9

1.7 ± 0.9

0.25

HbA1c

42.0 ± 14.0

41.3 ± 12.4

49.9 ± 26.1

0.44

**Table 2.** Baseline Demographics and 24-Hour Ambulatory Blood Pressure Readings of the Full Cohort and Those With and Without MACE
Characteristic	Full cohort	No MACE	MACE	P value
ABPM: ambulatory blood pressure monitoring; MACE: major adverse cardiovascular event; TIA: transient ischemic attack; ACE-I: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blocker; HDL: high-density lipoprotein. P value refers to difference between MACE and non-MACE groups only.
Number of readings	29.5 ± 3.7	27.1 ± 5.3	26.8 ± 5.3	0.15
24-h ABPM averages
Systolic blood pressure dip, mm Hg	9.6 (4.2 - 14.1)	9.6 (4.8 - 14.1)	7.5 (0.44 - 15.1)	0.16
Diastolic blood pressure dip, mm Hg	14.1 (8.7 - 19.4)	14.1 (8.9 - 20.1)	9.2 (4.9 - 17.8)	0.09
Mean arterial blood pressure dip, mm Hg	11.1 (5.8 - 16.4)	11.3 (6.1 - 16.6)	8.5 (1.8 - 14.2)	0.10
Systolic blood pressure, mm Hg	132.6 ± 16.9	132.3 ± 16.9	137.3 ± 17.4	0.12
Diastolic blood pressure, mm Hg	76.6 ± 10.8	76.9 ± 10.9	73.4 ± 8.8	0.15
Mean arterial pressure, mm Hg	96.3 ± 11.2	96.3 ± 11.4	96.4 ± 9.2	0.86
Pulse pressure, mm Hg	56.2 ± 14.0	55.5 ± 13.5	64.2 ± 17.7	0.02
Day-time averages
Systolic blood pressure, mm Hg	135.8 ± 16.7	135.5 ± 16.7	139.8 ± 16.8	0.16
Diastolic blood pressure, mm Hg	79.2 ± 10.9	79.6 ± 11.1	75.2 ± 8.0	0.13
Mean arterial pressure, mm Hg	99.0 ± 11.2	99.1 ± 11.4	998.3 ± 8.3	0.80
Pulse pressure, mm Hg	56.6 ± 14.1	56.0 ± 13.6	64.8 ± 18.2	0.02
Night-time averages
Systolic blood pressure, mm Hg	123.0 ± 18.2	122.2 ± 17.8	130.8 ± 21.4	0.07
Diastolic blood pressure, mm Hg	68.1 ± 10.4	68.2 ± 10.3	67.4 ± 11.8	0.79
Mean arterial pressure, mm Hg	87.7 ± 11.8	87.5 ± 11.7	90.7 ± 12.9	0.30
Pulse pressure, mm Hg	54.9 ± 10.0	54.2 ± 13.5	63.2 ± 18.5	0.02
Ambulatory arterial stiffness index	0.45 ± 0.16	0.44 ± 0.16	0.60 ± 0.15	< 0.0001
Morning surge index	0 (0 - 9.7)	0 (0 - 10.2)	0 (0 - 7.8)	0.86

Table 2. Baseline Demographics and 24-Hour Ambulatory Blood Pressure Readings of the Full Cohort and Those With and Without MACE

Characteristic

Full cohort

No MACE

MACE

P value

ABPM: ambulatory blood pressure monitoring; MACE: major adverse cardiovascular event; TIA: transient ischemic attack; ACE-I: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blocker; HDL: high-density lipoprotein. P value refers to difference between MACE and non-MACE groups only.

Number of readings

29.5 ± 3.7

27.1 ± 5.3

26.8 ± 5.3

0.15

24-h ABPM averages

Systolic blood pressure dip, mm Hg

9.6 (4.2 - 14.1)

9.6 (4.8 - 14.1)

7.5 (0.44 - 15.1)

0.16

Diastolic blood pressure dip, mm Hg

14.1 (8.7 - 19.4)

14.1 (8.9 - 20.1)

9.2 (4.9 - 17.8)

0.09

Mean arterial blood pressure dip, mm Hg

11.1 (5.8 - 16.4)

11.3 (6.1 - 16.6)

8.5 (1.8 - 14.2)

0.10

Systolic blood pressure, mm Hg

132.6 ± 16.9

132.3 ± 16.9

137.3 ± 17.4

0.12

Diastolic blood pressure, mm Hg

76.6 ± 10.8

76.9 ± 10.9

73.4 ± 8.8

0.15

Mean arterial pressure, mm Hg

96.3 ± 11.2

96.3 ± 11.4

96.4 ± 9.2

0.86

Pulse pressure, mm Hg

56.2 ± 14.0

55.5 ± 13.5

64.2 ± 17.7

0.02

Day-time averages

Systolic blood pressure, mm Hg

135.8 ± 16.7

135.5 ± 16.7

139.8 ± 16.8

0.16

Diastolic blood pressure, mm Hg

79.2 ± 10.9

79.6 ± 11.1

75.2 ± 8.0

0.13

Mean arterial pressure, mm Hg

99.0 ± 11.2

99.1 ± 11.4

998.3 ± 8.3

0.80

Pulse pressure, mm Hg

56.6 ± 14.1

56.0 ± 13.6

64.8 ± 18.2

0.02

Night-time averages

Systolic blood pressure, mm Hg

123.0 ± 18.2

122.2 ± 17.8

130.8 ± 21.4

0.07

Diastolic blood pressure, mm Hg

68.1 ± 10.4

68.2 ± 10.3

67.4 ± 11.8

0.79

Mean arterial pressure, mm Hg

87.7 ± 11.8

87.5 ± 11.7

90.7 ± 12.9

0.30

Pulse pressure, mm Hg

54.9 ± 10.0

54.2 ± 13.5

63.2 ± 18.5

0.02

Ambulatory arterial stiffness index

0.45 ± 0.16

0.44 ± 0.16

0.60 ± 0.15

< 0.0001

Morning surge index

0 (0 - 9.7)

0 (0 - 10.2)

0 (0 - 7.8)

0.86

**Table 3.** Results of Cox Regression Analysis for Outcome of MACE
Variable	Hazard ratio (95% CI)	P value
MACE: major adverse cardiovascular event; CI: confidence interval; AASI: ambulatory arterial stiffness index; eGFR: estimated glomerular filtration rate; HDL: high-density lipoprotein.
Age	1.05 (0.98 - 1.12)	0.18
Diabetes mellitus	5.4 (1.3 - 23.4)	0.02
Peripheral vascular disease	4.0 (0.26 - 60.8)	0.32
AASI ≥ 0.56	4.2 (1.1 - 15.2)	0.03
eGFR	1.02 (0.98 - 1.06)	0.28
HDL cholesterol	0.09 (0.01 - 0.74)	0.03
Heart failure	1.58 (0.24 - 10.61)	0.64
Statin use	1.76 (0.54 - 5.7)	0.35
Alpha blockers	0.26 (0.02 - 2.7)	0.26
Hypertension	1.90 (0.37 - 0.7)	0.44

Table 3. Results of Cox Regression Analysis for Outcome of MACE

Variable

Hazard ratio (95% CI)

P value

MACE: major adverse cardiovascular event; CI: confidence interval; AASI: ambulatory arterial stiffness index; eGFR: estimated glomerular filtration rate; HDL: high-density lipoprotein.

Age

1.05 (0.98 - 1.12)

0.18

Diabetes mellitus

5.4 (1.3 - 23.4)

0.02

Peripheral vascular disease

4.0 (0.26 - 60.8)

0.32

AASI ≥ 0.56

4.2 (1.1 - 15.2)

0.03

eGFR

1.02 (0.98 - 1.06)

0.28

HDL cholesterol

0.09 (0.01 - 0.74)

0.03

Heart failure

1.58 (0.24 - 10.61)

0.64

Statin use

1.76 (0.54 - 5.7)

0.35

Alpha blockers

0.26 (0.02 - 2.7)

0.26

Hypertension

1.90 (0.37 - 0.7)

0.44