Arterial stiffness, wave reflections, and the risk of coronary artery disease
Abstract
BACKGROUND: Increased arterial stiffness, determined invasively, has been shown to predict a higher risk of coronary atherosclerosis. However, invasive techniques are of limited value for screening and risk stratification in larger patient groups. METHODS AND RESULTS: We prospectively enrolled 465 consecutive, symptomatic men undergoing coronary angiography for the assessment of suspected coronary artery disease. Arterial stiffness and wave reflections were quantified noninvasively using applanation tonometry of the radial artery with a validated transfer function to generate the corresponding ascending aortic pressure waveform. Augmented pressure (AP) was defined as the difference between the second and the first systolic peak, and augmentation index (AIx) was AP expressed as a percentage of the pulse pressure. In univariate analysis, a higher AIx was associated with an increased risk for coronary artery disease (OR, 4.06 for the difference between the first and the fourth quartile [1.72 to 9.57; P<0.01]). In multivariate analysis, after controlling for age, height, presence of hypertension, HDL cholesterol, and medications, the association with coronary artery disease risk remained significant (OR, 6.91; P<0.05). The results were exclusively driven by an increase in risk with premature vessel stiffening in the younger patient group (up to 60 years of age), with an unadjusted OR between AIx quartiles I and IV of 8.25 (P<0.01) and a multiple-adjusted OR between these quartiles of 16.81 (P<0.05). CONCLUSIONS: AIx and AP, noninvasively determined manifestations of arterial stiffening and increased wave reflections, are strong, independent risk markers for premature coronary artery disease.
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Large-artery stiffness and wave reflections are important determinants of left ventricular function, coronary blood flow, and mechanical integrity of arteries.
“Large-artery stiffness and wave reflections are important determinants of left ventricular (LV) function, coronary blood flow, and mechanical integrity of arteries and have been identified as markers of cardiovascular disease and independent prognosticators of cardiovascular risk (4 -12).”
From Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections (2004) · cites this paper as [12]
Large-artery stiffness and wave reflections have been identified as markers of cardiovascular disease and independent prognosticators of cardiovascular risk.
“Large-artery stiffness and wave reflections are important determinants of left ventricular (LV) function, coronary blood flow, and mechanical integrity of arteries and have been identified as markers of cardiovascular disease and independent prognosticators of cardiovascular risk (4 -12).”
From Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections (2004) · cites this paper as [12]
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Cites
Subcommittee, G. (1999) · Journal of Hypertension · doi:10.1097/00004872-199917020-00001 · Cited by 3,895 · see citing works
Laurent, S., Boutouyrie, P., Asmar, R., Gautier, I., Laloux, B., Guize, L., Ducimetiere, P., & Benetos, A. (2001) · Hypertension · doi:10.1161/01.hyp.37.5.1236 · Cited by 3,856 · see citing works
Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients
Blacher, J., Asmar, R., Djane, S., London, G. M., & Safar, M. E. (1999) · Hypertension · doi:10.1161/01.hyp.33.5.1111 · Cited by 1,493 · see citing works
Chen, C.-H., Nevo, E., Fetics, B., Pak, P. H., Yin, F. C. P., Maughan, W. L., & Kass, D. A. (1997) · Circulation · doi:10.1161/01.cir.95.7.1827 · Cited by 1,307 · see citing works
Pauca, A. L., O’Rourke, M. F., & Kon, N. D. (2001) · Hypertension · doi:10.1161/hy1001.096106 · Cited by 1,179 · see citing works
Self-citationThe influence of heart rate on augmentation index and central arterial pressure in humans
Wilkinson, I. B., MacCallum, H., Flint, L., Cockcroft, J. R., Newby, D. E., & Webb, D. J. (2000) · The Journal of Physiology · doi:10.1111/j.1469-7793.2000.t01-1-00263.x · Cited by 1,093 · see citing works
Bénétos, A., Safar, M. E., Rudnichi, A., Smulyan, H., Richard, J. L., Ducimetière, P., & Guize, L. (1997) · Hypertension · doi:10.1161/01.hyp.30.6.1410 · Cited by 1,033 · see citing works
Arterial wave reflections and survival in end-stage renal failure
London, G. M., Blacher, J., Pannier, B., Guérin, A. P., Marchais, S. J., & Safar, M. E. (2001) · Hypertension · doi:10.1161/01.hyp.38.3.434 · Cited by 853 · see citing works
Pulse pressure—a review of mechanisms and clinical relevance
Dart, A. M., & Kingwell, B. A. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01108-1 · Cited by 836 · see citing works
Hirai, T., Sasayama, S., Kawasaki, T., & Yagi, S. (1989) · Circulation · doi:10.1161/01.cir.80.1.78 · Cited by 746 · see citing works
Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction.
Madhavan, S., Ooi, W. L., Cohen, H. W., & Alderman, M. H. (1994) · Hypertension · doi:10.1161/01.hyp.23.3.395 · Cited by 605 · see citing works
Stefanadis, C., Stratos, C., Boudoulas, H., Kourouklis, C. B., & TOUTOUZAS, P. K. (1990) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a059639 · Cited by 453 · see citing works
Augmentation index is associated with cardiovascular risk
Nürnberger, J., Keflioglu-Scheiber, A., Saez, A. M. O., Wenzel, R. R., Philipp, T., & Schäfers, R. F. (2002) · Journal of Hypertension · doi:10.1097/00004872-200212000-00020 · Cited by 441 · see citing works
(1996) · PubMed · Cited by 330 · see citing works
Gender-Related Differences in the Central Arterial Pressure Waveform
Hayward, C., & Kelly, R. P. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00378-1 · Cited by 323 · see citing works
Augmentation index as a measure of peripheral vascular disease state
Nichols, W. W., & Singh, B. M. (2002) · Current Opinion in Cardiology · doi:10.1097/00001573-200209000-00016 · Cited by 306 · see citing works
SULLIVAN, D. R., Marwick, T. H., & Freedman, B. (1990) · American Heart Journal · doi:10.1016/s0002-8703(05)80173-5 · Cited by 276 · see citing works
O’Rourke, M. F., & Mancia, G. (1999) · Journal of Hypertension · doi:10.1097/00004872-199917010-00001 · Cited by 257 · see citing works
Self-citationIncreased systolic pressure in chronic uremia. Role of arterial wave reflections.
London, G. M., Guérin, A. P., Pannier, B., Marchais, S. J., Benetos, A., & Safar, M. E. (1992) · Hypertension · doi:10.1161/01.hyp.20.1.10 · Cited by 249 · see citing works
Coronary Artery Calcification in Older Adults to Age 99
Newman, A. B., Naydeck, B. L., Sutton-Tyrrell, K., Feldman, A., Edmundowicz, D., & Kuller, L. H. (2001) · Circulation · doi:10.1161/hc4601.099464 · Cited by 225 · see citing works
Aortic distensibility abnormalities in coronary artery disease
Stefanadis, C., Wooley, C. F., Bush, C. A., Kolibash, A. J., & Boudoulas, H. K. (1987) · The American Journal of Cardiology · doi:10.1016/0002-9149(87)90908-8 · Cited by 214 · see citing works
Hjemdahl, P., & Friberg, P. (1996) · Journal of Hypertension · doi:10.1097/00004872-199602000-00001 · Cited by 196 · see citing works
Unfavorable effect of smoking on the elastic properties of the human aorta
Stefanadis, C., Tsiamis, E., Vlachopoulos, C., Stratos, C., Toutouzas, K., Pitsavos, C., Marakas, S., Boudoulas, H., & Toutouzas, P. (1997) · Circulation · doi:10.1161/01.cir.95.1.31 · Cited by 177 · see citing works
Gender differences in the timing of arterial wave reflection beyond differences in body height
Gatzka, C. D., Kingwell, B. A., Cameron, J. D., Berry, K. L., Liang, Y., Dewar, E. M., Reid, C. M., Jennings, G., & Dart, A. M. (2001) · Journal of Hypertension · doi:10.1097/00004872-200112000-00013 · Cited by 173 · see citing works
Measures of blood pressure and myocardial infarction in treated hypertensive patients
Fang, J., Madhavan, S., Cohen, H. W., & Alderman, M. H. (1995) · Journal of Hypertension · doi:10.1097/00004872-199504000-00006 · Cited by 163 · see citing works
Bogren, H. G., Mohiaddin, R. H., Klipstein, R. K., Firmin, D. N., Underwood, R., Rees, S., & Longmore, D. B. (1989) · American Heart Journal · doi:10.1016/0002-8703(89)90181-6 · Cited by 147 · see citing works
Ting, C.-T., Chen, C.-H., Chang, M.-S., & Yin, F. C. P. (1995) · Hypertension · doi:10.1161/01.hyp.26.3.524 · Cited by 124 · see citing works
Reflection in the arterial system and the risk of coronary heart disease
Hayashi, T., Nakayama, Y., Tsumura, K., Yoshimaru, K., & Ueda, H. (2002) · American Journal of Hypertension · doi:10.1016/s0895-7061(02)02260-4 · Cited by 109 · see citing works
AORTIC STIFFNESS IS AN INDEPENDENT PREDICTOR OF ALL-CAUSE MORTALITY IN HYPERTENSIVE PATIENTS: 3B.8
Laurent, S., Boutouyrie, P., Asmar, R., Gautier, I., Laloux, B., Guize, L., Ducimetiere, P., & Benetos, A. (2000) · Journal of Hypertension · doi:10.1097/00004872-200006001-00271 · Cited by 39 · see citing works
Eckert, S., Gleichmann, U., Zagorski, O., & Klapp, A. (1997) · PubMed · Cited by 25 · see citing works
Shimojo, M., Tsuda, N., Iwasaka, T., et al. (1991) · The American Journal of Cardiology · doi:10.1016/0002-9149(91)90415-h · Cited by 21 · see citing works
Generation of ascending aortic from radial artery pressure waveform
O’Rourke, M. F., Pauca, A. L., & Kon, N. D. (2003) · Heart Lung and Circulation · doi:10.1046/j.1443-9506.2003.01958.x · Cited by 14 · see citing works
Self-citationOuchi, Y., Terashita, K., Nakamura, T., et al. (1991) · Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics · doi:10.3143/geriatrics.28.40 · Cited by 9 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Cheitlin MD, Zipes DP. Cardiovascular disease in the elderly. In: Braunwald E, Zipes DP, Libby P, eds. Heart Disease. 6th ed. Phila- delphia: WB Saunders; 2001.
Cited by
Sorted by citations
The Clinical Significance of Subclinical Thyroid Dysfunction
Biondi, B., & Cooper, D. S. (2008) · Endocrine Reviews · doi:10.1210/er.2006-0043 · Cited by 1,418 · see citing works
O’Rourke, M. F., & Safar, M. E. (2005) · Hypertension · doi:10.1161/01.hyp.0000168052.00426.65 · Cited by 1,279 · see citing works
Self-citationArterial Aging: Is It an Immutable Cardiovascular Risk Factor?
Najjar, S. S., Scuteri, A., & Lakatta, E. G. (2005) · Hypertension · doi:10.1161/01.hyp.0000177474.06749.98 · Cited by 640 · see citing works
Plant Protein and Animal Proteins: Do They Differentially Affect Cardiovascular Disease Risk?
Richter, C. K., Skulas-Ray, A. C., Champagne, C. M., & Kris-Etherton, P. M. (2015) · Advances in Nutrition · doi:10.3945/an.115.009654 · Cited by 279 · see citing works
CPAP and measures of cardiovascular risk in males with OSAS
Kohler, M., Pepperell, J. C. T., Casadei, B., Craig, S., Crosthwaite, N., Stradling, J. R., & Davies, R. J. O. (2008) · European Respiratory Journal · doi:10.1183/09031936.00026608 · Cited by 197 · see citing works
Arterial stiffness or endothelial dysfunction as a surrogate marker of vascular risk
Anderson, T. J. (2006) · Canadian Journal of Cardiology · doi:10.1016/s0828-282x(06)70990-4 · Cited by 178 · see citing works
Arterial Stiffness in Mild Primary Hyperparathyroidism
Rubin, M. R., Maurer, M. S., McMahon, D. J., Bilezikian, J. P., & Silverberg, S. J. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1400 · Cited by 145 · see citing works
Safar, M. E., Blacher, J., & Jankowski, P. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.04.039 · Cited by 141 · see citing works
Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections
Vlachopoulos, C., Kosmopoulou, F., Panagiotakos, D., Ioakeimidis, N., Alexopoulos, N., Pitsavos, C., & Stefanadis, C. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.07.049 · Cited by 135 · see citing works
Aging of the Nitric Oxide System: Are We as Old as Our NO?
Sverdlov, A. L., Ngo, D. T. M., Chan, W. P. A., Chirkov, Y. Y., & Horowitz, J. D. (2014) · Journal of the American Heart Association · doi:10.1161/jaha.114.000973 · Cited by 97 · see citing works
Ryan, K. E., McCance, D. R., Powell, L., McMahon, R., & Trimble, E. R. (2007) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2006.11.007 · Cited by 94 · see citing works
Casey, D. P., Curry, T. B., Joyner, M. J., Charkoudian, N., & Hart, E. C. (2011) · Hypertension · doi:10.1161/hypertensionaha.110.164517 · Cited by 83 · see citing works
Time domain analysis of the arterial pulse in clinical medicine
O’Rourke, M. F. (2009) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-008-0370-7 · Cited by 79 · see citing works
Self-citationEndothelial dysfunction and arterial abnormalities in childhood obesity
Skilton, M. R., & Celermajer, D. S. (2006) · International Journal of Obesity · doi:10.1038/sj.ijo.0803397 · Cited by 66 · see citing works
Heydari, M., Boutcher, Y. N., & Boutcher, S. H. (2013) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2012.11.013 · Cited by 40 · see citing works
Kingsley, J. D., Tai, Y. L., Mayo, X., Glasgow, A., & Marshall, E. (2017) · European Journal of Sport Science · doi:10.1080/17461391.2017.1342275 · Cited by 28 · see citing works
Arciero, P., Ives, S., Norton, C., Escudero, D., Minicucci, O., O’Brien, G., Paul, M., Ormsbee, M., Miller, V., Sheridan, C., et al. (2016) · Nutrients · doi:10.3390/nu8060332 · Cited by 26 · see citing works
Ives, S. J., Norton, C., Miller, V., Minicucci, O., Robinson, J., O'Brien, G., Escudero, D., Paul, M., Sheridan, C., Curran, K., et al. (2017) · Growth Hormone & IGF Research · doi:10.1016/j.ghir.2016.10.002 · Cited by 18 · see citing works
The assessment of vascular function during dietary intervention trials in human subjects
McCall, D. O., McKinley, M. C., Noad, R., McKeown, P. P., McCance, D. R., Young, I. S., & Woodside, J. V. (2011) · British Journal Of Nutrition · doi:10.1017/s0007114511002996 · Cited by 14 · see citing works
Acute resistance exercise using free weights on aortic wave reflection characteristics
Tai, Y. L., Gerhart, H., Mayo, X., & Kingsley, J. D. (2018) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12396 · Cited by 14 · see citing works
Lee, B. J., Jeon, Y. J., & Kim, J. Y. (2017) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2017.08.007 · Cited by 8 · see citing works
(2022) · Journal of Men's Health · doi:10.31083/j.jomh1808171 · Cited by 3 · see citing works
- Authors
- Weber, T., Auer, J., O’Rourke, M. F., Kvas, E., Lassnig, E., Berent, R., & Eber, B.
- Affiliations
- UNSW Sydney (AU)
- Venue
- Circulation
- Published
- 2004-01-20
- Volume
- 109
- Issue
- 2
- Pages
- 184-189
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2141731247
- Cited by
- 1,081
- References
- 33
- Citations by year
- 2026: 17 · 2025: 8 · 2024: 23 · 2023: 29 · 2022: 30 · 2021: 39 · 2020: 31 · 2019: 33 · 2018: 47 · 2017: 48 · 2016: 49 · 2015: 62 · 2014: 77 · 2013: 61 · 2012: 74
- FWCI
- 31.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- arterial stiffness, wave reflection, coronary artery disease, augmentation index, applanation tonometry, radial artery, aortic pressure waveform, non-invasive risk stratification, premature coronary artery disease, men
- MeSH terms
- Aorta, Arteries, Blood Pressure, Coronary Artery Disease, Elasticity, Humans, Male, Middle Aged, Prospective Studies, Pulsatile Flow, Risk Factors, Coronary Angiography
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