Arterial stiffness may predict coronary heart disease beyond classic risk factors.
In a longitudinal study, we assessed the predictive value of arterial stiffness on
coronary heart disease in patients with essential hypertension and without known clinical
cardiovascular disease. Aortic stiffness was determined from carotid-femoral pulse
wave velocity at baseline in 1045 hypertensives. The risk assessment of coronary heart
disease was made by calculating the Framingham risk score according to the categories
of gender, age, blood pressure, cholesterol, diabetes, and smoking. Mean age at entry
was 51 years, and mean follow-up was 5.7 years. Coronary events (fatal and nonfatal
myocardial infarction, coronary revascularization, and angina pectoris) and all cardiovascular
events served as outcome variables in Cox proportional-hazard regression models. Fifty-three
coronary events and 97 total cardiovascular events occurred. In univariate analysis,
the relative risk of follow-up coronary event or any cardiovascular event increased
with increasing level of pulse wave velocity; for 1 SD, ie, 3.5 m/s, relatives risks
were 1.42 (95% confidence interval [CI], 1.10 to 1.82; P<0.01) and 1.41 (95% CI, 1.17
to 1.70; P<0.001), respectively. Framingham score significantly predicted the occurrence
of coronary and all cardiovascular events in this population (P<0.01 and P<0.0001,
respectively). In multivariate analysis, pulse wave velocity remained significantly
associated with the occurrence of coronary event after adjustment either of Framingham
score (for 3.5 m/s: relative risk, 1.34; 95% CI, 1.01 to 1.79; P=0.039) or classic
risk factors (for 3.5 m/s: relative risk, 1.39; 95% CI, 1.08 to 1.79; P=0.01). Parallel
results were observed for all cardiovascular events. This study provides the first
direct evidence in a longitudinal study that aortic stiffness is an independent predictor
of primary coronary events in patients with essential hypertension.