Long-term prognosis of cardiovascular events in hypertensive patients: the role of arterial stiffness (assessing the cardio-ankle vascular index — CAVI)

Background. Hypertension is one of the leading risk factors for cardiovascular diseases (CVD). Vascular stiffness, reflecting structural and functional changes in the arterial wall, is recognized as an important predictor of adverse cardiovascular events (CVE). Objective. To assess the prognostic significance of the cardio-ankle vascular index (CAVI) concerning cardiovascular outcomes in patients with hypertension in the Russian population. Design and methods. The study included 505 patients with hypertension between the ages of 25 and 64 without established CVD, selected as part of the ESSE-RF project in the Kemerovo region. CAVI was assessed using the VaSera VS-1000 device. The prospective follow-up lasted an average of 10,4 years. The study cohort was divided into two groups: the first with baseline CAVI ≥ 9,0 (n = 85), and the second with baseline CAVI < 9,0 (n = 420). The endpoints were CVE including cardiac death, non-fatal myocardial infarction, and stroke. Results. Participants with elevated CAVI (≥ 9,0) were older, had a longer smoking history, and higher levels of depression. Over 10 years, they experienced more adverse CVE: non-fatal myocardial infarction (5,4 % vs. 1,8 %, p = 0,003), myocardial revascularization (9,4 % vs. 3,6 %, p = 0,018), and the combined endpoint (16,5 % vs. 9,1 %, p = 0,04). The risk of adverse CVEs over 10 years was independently associated with smoking (p < 0,001), blood glucose levels (p = 0,014), and increased CAVI values (p = 0,008). The use of antihypertensive therapy reduced the risk of adverse events (p = 0,04). Conclusion. Long-term follow-up demonstrated that the CAVI is a significant prognostic marker of CVE in patients with hypertension in the Russian population. Its use in clinical practice may facilitate more accurate risk stratification and individualized therapy.

1. Kobalava ZhD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117. (In Russ.) https://doi.org/10.15829/1560-4071-2024-6117

2. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13. https://doi.org/10.1016/s01406736(02)11911-8

3. Perrone-Filardi P, Coca A, Galderisi M, Paolillo S, Alpendurada F, de Simone G, et al. Noninvasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients: a consensus article from the European Association of Cardiovascular Imaging, the European Society of Cardiology Council on Hypertension and the European Society of Hypertension. J Hypertens. 2017;35(9):1727–1741. https://doi. org/10.1097/HJH.0000000000001396

4. Jae SY, Heffernan KS, Park JB, Kurl S, Kunutsor SK, Kim JY, et al. Association between estimated pulse wave velocity and the risk of cardiovascular outcomes in men. Eur J Prev Cardiol. 2021;28(7):e25-e27. https://doi.org/10.1177/2047487320920767

5. Heffernan KS, Charry D, Xu J, Tanaka H, Churilla JR. Estimated pulse wave velocity and incident heart failure and its subtypes: findings from the multi-ethnic study of atherosclerosis. Am Heart J Plus. 2023;25:10023. https://doi.org/10.1016/j. ahjo.2022.100238

6. Heffernan KS, Stoner L, London AS, Augustine JA, Lefferts WK. Estimated pulse wave velocity as a measure of vascular aging. PLoS One. 2023;18(1):e0280896. https://doi.org/10.1371/ journal.pone.0280896

7. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: еndorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874–2071. https://doi.org/10.1097/HJH.0000000000003480

8. Shirai K, Utino J, Otsuka K, Takata M. A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb. 2006;13(2):101–107. https://doi.org/10.5551/jat.13.101

9. Sumin AN, Osokina AV, Shcheglova AV, Frolova SA, Barbarash OL. Assessment of cardio-ankle vascular index in patients with coronary artery disease with a different type of diastolic dysfunction of the left ventricle. Complex Issues of Cardiovascular Diseases. 2016;(2):51–58. (In Russ.) https://doi.org/10.17802/23061278-2016-2-51-58

10. Budoff MJ, Alpert B, Chirinos JA, Fernhall B, Hamburg N, Kario K, et al. Clinical applications measuring arterial stiffness: an expert consensus for the application of cardio-ankle vascular index. Am J Hypertens. 2022;35(5):441–453. https://doi.org/10.1093/ajh/hpab178

11. Saravanan CR, Chowdhury SR, Inban P, Chandrasekaran SH, Pattani HH, Santoshi K, et al. Predictive significance of cardio ankle vascular index for the assessment of cardiovascular risk in hypertensive patients: a systematic review. J Clin Hypertens (Greenwich). 2024;26(9):1005–1014. https://doi.org/10.1111/jch.14878

12. Agac MT, Ağaç S, Aksoy MNM, Vatan MB. Cardio-ankle vascular index represents the best surrogate for 10-year ASCVD risk estimation in patients with primary hypertension. Clin Exp Hypertens. 2021;43(4):349–355. https://doi.org/10.1080/10641963.2021.1883052

13. Vasyuk YuA, Ivanova SV, Shkolnik EL, Kotovskaya YuV, Milyagin VA, Oleynikov VE, et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovascular Therapy and Prevention. 2016;15(2):4–19. (In Russ.) https://doi.org/10.15829/1728-8800-2016-2-4-19

14. Yakhontov DA, Ostanina JO. Early vascular aging syndrome in young and middle age patients with hypertension and coronary artery disease. Medical alphabet. 2018;1(3):33–36. (In Russ.)

15. Nauchno-organizatsionnyĭ komitet proekta ÉSSE-RF. Epidemiology of cardiovascular diseases in different regions of Russia (ESSE-RF). The rationale and design of the study. Russian Journal of Preventive Medicine. 2013;16(6):25–34. (In Russ.)

16. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Med Assoc. 2013;310(20):2191–4. https://doi.org/10.1001/jama.2013.281053

17. State Standard R 52379–2005 “Good clinical practice”. National standard of the Russian Federation. M., 2006. (In Russ.)

18. Sumin AN, Bezdenezhnykh NA, Fedorova NV, Shcheglova AV, Indukaeva EV, Artamonova GV. The values of cardio-ankle vascular and ankle-brachial indices in patients with carbohydrate metabolic disorders: The ESSE-RF study in the Kemerovo Region. Terapevticheskii arkhiv. 2016;88(12):11–20. (In Russ.) https://doi.org/10.17116/terarkh2016881211-20

19. Karelin A. A. The great encyclopedia of psychological tests. Moscow: Eksmo; 2007. 416 p. (In Russ.)

20. Alieva AS, Boyarinova МA, Orlov AV, Moguchaya EV, Kolesova EP, Vasilyeva ЕYu, et al. Comparative analysis of diagnostic methods for subclinical vessels lesion (under the cohort of epidemiological study ESSE-RF). Russian Journal of Cardiology. 2016;(6):20–26. (In Russ.) https://doi.org/10.15829/1560-4071-2016-6-20-26

21. Rogoza AN, Kaveshnikov VS, Trubacheva IA, Serebriakova VN, Zairova AR, Zhernakova YuV, et al. The state of the vascular wall in adult population of Tomsk in the framework of the project ESSAY RF. Systemic Hypertension. 2014;11(4):42–48. (In Russ.)

22. Saiki A, Ohira M, Yamaguchi T, Nagayama D, Shimizu N, Shirai K, Tatsuno I. New horizons of arterial stiffness developed using cardio-ankle vascular index (CAVI). J Atheroscler Thromb. 2020;27(8):732–748. https://doi.org/10.5551/jat.RV17043

23. Den Ruijter HM, Peters SA, Anderson TJ, Britton AR, Dekker JM, Eijkemans MJ, et al. Common carotid intima-media thickness measurements in cardiovascular risk prediction: a metaanalysis. J Am Med Assoc. 2012;308(8):796–803. https://doi.org/10.1001/jama.2012.9630

24. Ershova AI, Meshkov AN, Deev AD, Aleksandrova EL, Lishchenko NE, Novikova АS, et al. Atherosclerotic plaque in carotid arteries as a risk marker for cardiovascular events risk in middle aged population. Cardiovascular Therapy and Prevention. 2018;17(4):34–39. (In Russ.) https://doi.org/10.15829/1728-8800-2018-4-34-39

25. Inaba Y, Chen JA, Bergmann SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis. 2012;220(1):128–33. https://doi.org/10.1016/j.atherosclerosis.2011.06.044

26. Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP. Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol. 1987;59(9):956–60. https://doi.org/10.1016/00029149(87)91133-7

27. Симонова Г. И., Малютина С. К., Рагино Ю. И., Гафаров В. В., Григорьева И. Н., Денисова Д. В. и др. Эпидемиология артериальной гипертензии в Сибири. Новосибирск; Б.м., 2024. 308 c.

28. Zairova AR, Rogoza AN, Oshchepkova EV, Yarovaya EB, Kutsenko VA, Shalnova SA, et al. Contribution of cardio-ankle vascular index to prediction of cardiovascular events in the adult urban population: data from the ESSE-RF study (Tomsk). Cardiovascular Therapy and Prevention. 2021;20(5):2967. (In Russ.) https://doi.org/10.15829/1728-8800-2021-2967

29. Miyoshi T, Ito H, Shirai K, Horinaka S, Higaki J, Yamamura S, et al. Predictive value of the cardio-ankle vascular index for cardiovascular events in patients at cardiovascular risk. J Am Heart Assoc. 2021;10(16):e020103. https://doi.org/10.1161/JAHA.120.020103

30. Sumin AN, Shcheglova AV, Ivanov SV, Barbarash OL. Long-term prognosis after coronary artery bypass grafting: the impact of arterial stiffness and multifocal atherosclerosis. J Clin Med. 2022;11(15):4585. https://doi.org/10.3390/jcm11154585

31. Wang MC, Lloyd-Jones DM. Cardiovascular risk assessment in hypertensive patients. Am J Hypertens. 2021;34(6):569–577. https://doi.org/10.1093/ajh/hpab021

32. Milutina MY, Makarova EV, Menkov NV, Plastinina SS, Lyubavina NA, Martynov SV, et al. Effect of smoking on arterial stiffness in men of working age. Clinical Medicine (Russian Journal). 2021;99(1):53–57. (In Russ.) https://doi.org/10.30629/0023-2149-2021-99-1-53-57