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(Circulation. 2002;106:2085.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance

An Integrated Index of Vascular Function?

Kennedy Cruickshank, MB, MD; Lisa Riste, PhD; Simon G. Anderson, PhD; John S. Wright, PhD; Graham Dunn, PhD; Ray G. Gosling, PhD

From the Clinical Epidemiology Group (K.C., L.R., S.G.A.) and the Biostatistics Group (G.D.), School of Epidemiology & Health Sciences, University of Manchester Medical School, Manchester, UK; Department of Medicine (J.S.W.), Northwick Park Hospital and Clinical Research Centre, Harrow, UK; and Emeritus Professor (R.G.G.), Department of Ultrasonic Angiology, Guy’s Hospital, University of London, London, UK.

Correspondence to Dr Kennedy Cruickshank., Clinical Epidemiology Group, School of Epidemiology & Health Sciences, University of Manchester Medical School, Manchester M13 9PT, UK. E-mail clinep{at}man.ac.uk

Background— Arterial distensibility measures, generally from pulse-wave velocity (PWV), are widely used with little knowledge of relationships to patient outcome. We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance–tested (GTT) multiethnic population samples.

Methods and Results— Participants were randomly sampled from (1) a type 2 diabetes outpatient clinic and (2) primary care population registers, from which nondiabetic control subjects were given a GTT. Brachial blood pressures and Doppler-derived aortic PWV were measured. Mortality data over 10 years’ follow-up were obtained. At any level of systolic blood pressure (SBP), aortic PWV was greater in subjects with diabetes than in controls. Mortality risk doubled in subjects with diabetes (hazard ratio 2.34, 95% CI 1.5 to 3.74) and in those with glucose intolerance (2.12, 95% CI 1.11 to 4.0) compared with controls. For all groups combined, age, sex, and SBP predicted mortality; the addition of PWV independently predicted all-cause and cardiovascular mortality (hazard ratio 1.08, 95% CI 1.03 to 1.14 for each 1 m/s increase) but displaced SBP. Glucose tolerance status and smoking were other independent contributors, with African-Caribbeans experiencing reduced mortality risk (hazard ratio 0.41, 95% CI 0.25 to 0.69).

Conclusions— Aortic PWV is a powerful independent predictor of mortality in both diabetes and GTT population samples. In displacing SBP as a prognostic factor, aortic PWV is probably further along the causal pathway for arterial disease and may represent a useful integrated index of vascular status and hence cardiovascular risk.

Key Words: blood flow • vasculature • diabetes mellitus • mortality

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				B. Cariou, J.-C. Fruchart, and B. Staels Review: Vascular protective effects of peroxisome proliferator-activated receptor agonists The British Journal of Diabetes & Vascular Disease, May 1, 2005; 5(3): 126 - 132. [Abstract] [PDF]

				N. Gungor, T. Thompson, K. Sutton-Tyrrell, J. Janosky, and S. Arslanian Early Signs of Cardiovascular Disease in Youth With Obesity and Type 2 Diabetes Diabetes Care, May 1, 2005; 28(5): 1219 - 1221. [Full Text] [PDF]

				D A Stakos, D P Schuster, E A Sparks, C F Wooley, K Osei, and H Boudoulas Long term cardiovascular effects of oral antidiabetic agents in non-diabetic patients with insulin resistance: double blind, prospective, randomised study Heart, May 1, 2005; 91(5): 589 - 594. [Abstract] [Full Text] [PDF]

				D. M. Sengstock, P. V. Vaitkevicius, and M. A. Supiano Arterial Stiffness Is Related to Insulin Resistance in Nondiabetic Hypertensive Older Adults J. Clin. Endocrinol. Metab., May 1, 2005; 90(5): 2823 - 2827. [Abstract] [Full Text] [PDF]

				J. A. Chirinos, J. P. Zambrano, S. Chakko, A. Veerani, A. Schob, H. J. Willens, G. Perez, and A. J. Mendez Aortic Pressure Augmentation Predicts Adverse Cardiovascular Events in Patients With Established Coronary Artery Disease Hypertension, May 1, 2005; 45(5): 980 - 985. [Abstract] [Full Text] [PDF]

				H. Tomiyama, Y. Koji, M. Yambe, K. Motobe, K. Shiina, Z. Gulnisa, Y. Yamamoto, and A. Yamashina Elevated C-Reactive Protein Augments Increased Arterial Stiffness in Subjects With the Metabolic Syndrome Hypertension, May 1, 2005; 45(5): 997 - 1003. [Abstract] [Full Text] [PDF]

				A. Smith, J. Karalliedde, L. De Angelis, D. Goldsmith, and G. Viberti Aortic Pulse Wave Velocity and Albuminuria in Patients with Type 2 Diabetes J. Am. Soc. Nephrol., April 1, 2005; 16(4): 1069 - 1075. [Abstract] [Full Text] [PDF]

				B. Pannier, A. P. Guerin, S. J. Marchais, M. E. Safar, and G. M. London Stiffness of Capacitive and Conduit Arteries: Prognostic Significance for End-Stage Renal Disease Patients Hypertension, April 1, 2005; 45(4): 592 - 596. [Abstract] [Full Text] [PDF]

				M. Diamant, H. J. Lamb, M. A. van de Ree, E. L. Endert, Y. Groeneveld, M. L. Bots, P. J. Kostense, and J. K. Radder The Association between Abdominal Visceral Fat and Carotid Stiffness Is Mediated by Circulating Inflammatory Markers in Uncomplicated Type 2 Diabetes J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1495 - 1501. [Abstract] [Full Text] [PDF]

				Yasmin, S. Wallace, C. M. McEniery, Z. Dakham, P. Pusalkar, K. Maki-Petaja, M. J. Ashby, J. R. Cockcroft, and I. B. Wilkinson Matrix Metalloproteinase-9 (MMP-9), MMP-2, and Serum Elastase Activity Are Associated With Systolic Hypertension and Arterial Stiffness Arterioscler Thromb Vasc Biol, February 1, 2005; 25(2): 372 - 378. [Abstract] [Full Text] [PDF]

				S. C. Millasseau, A. D. Stewart, S. J. Patel, S. R. Redwood, and P. J. Chowienczyk Evaluation of Carotid-Femoral Pulse Wave Velocity: Influence of Timing Algorithm and Heart Rate Hypertension, February 1, 2005; 45(2): 222 - 226. [Abstract] [Full Text] [PDF]

				A. F. Kernohan, A. Spiers, N. Sattar, C. Hillier, S. J Cleland, M. Small, M.-A. Lumsden, J. M. Connell, and J. R Petrie Effects of low-dose continuous combined HRT on vascular function in women with type 2 diabetes Diabetes and Vascular Disease Research, October 1, 2004; 1(2): 82 - 88. [Abstract] [PDF]

				C. M. McEniery, M. Schmitt, A. Qasem, D. J. Webb, A. P. Avolio, I. B. Wilkinson, and J. R. Cockcroft Nebivolol Increases Arterial Distensibility In Vivo Hypertension, September 1, 2004; 44(3): 305 - 310. [Abstract] [Full Text] [PDF]

				I. B. Wilkinson, S. S. Franklin, and J. R. Cockcroft Nitric Oxide and the Regulation of Large Artery Stiffness: From Physiology to Pharmacology Hypertension, August 1, 2004; 44(2): 112 - 116. [Full Text] [PDF]

				L. De Angelis, S. C. Millasseau, A. Smith, G. Viberti, R. H. Jones, J. M. Ritter, and P. J. Chowienczyk Sex Differences in Age-Related Stiffening of the Aorta in Subjects With Type 2 Diabetes Hypertension, July 1, 2004; 44(1): 67 - 71. [Abstract] [Full Text] [PDF]

				Yasmin, C. M. McEniery, S. Wallace, I. S. Mackenzie, J. R. Cockcroft, and I. B. Wilkinson C-Reactive Protein Is Associated With Arterial Stiffness in Apparently Healthy Individuals Arterioscler Thromb Vasc Biol, May 1, 2004; 24(5): 969 - 974. [Abstract] [Full Text]

				L Hadjinikolaou, K Kotidis, and M Galinanes Relationship between reduced elasticity of extracardiac vessels and left main stem coronary artery disease Eur. Heart J., March 2, 2004; 25(6): 508 - 513. [Abstract] [Full Text] [PDF]

				K. Mather and R. Lewanczuk Measurement of Arterial Stiffness in Diabetes: A cautionary tale Diabetes Care, March 1, 2004; 27(3): 831 - 833. [Full Text] [PDF]

				I. B Wilkinson and J. R Cockcroft Commentary: Birthweight arterial stiffness and blood pressure: in search of a unifying hypothesis Int. J. Epidemiol., February 1, 2004; 33(1): 161 - 162. [Full Text] [PDF]