3.2 Is Aortic Stiffness Ready for Clinical Practice? Results from the Rotterdam Study

Abstract

Background

It has been demonstrated that aortic stiffness, as determined by the carotid-femoral pulse wave velocity, is an independent predictor of cardiovascular disease. Whether this measure is of use in cardiovascular risk stratification in clinical practice needs to be determined. We investigated whether aortic stiffness had an additional predictive value beyond traditional risk factors in older subjects.

Methods:

Within the framework of the Rotterdam Study, a population-based prospective study, we stratified subjects free of cardiovascular disease at baseline into categories of low (<10%), intermediate (10-20%) and high (>20%) 10-year risk of cardiovascular disease based on Framingham risk factors. Within each risk category, we determined the percentages of subjects moving into a higher or lower risk category using a model that included prior risk and pulse wave velocity. Reclassification percentages and corresponding pulse wave velocity cut-off values are presented for the midpoint of prior risk within each risk category.

Results:

Among 2855 participants, 304 cardiovascular events occurred during a median follow-up of 5.9 years. In subjects in the intermediate risk group (prior 10-year risk probability of 15%), 1.5% was reclassified to the high-risk group. Reclassified subjects had pulse wave velocity levels of above 19.7 m/s. In the low and high-risk groups additional measurements of pulse wave velocity did not result in reclassification to another risk category.

Conclusion:

In an elderly population, addition of aortic stiffness measurement to traditional cardiovascular risk factors does not seem to be a powerful clinical tool for classification of subjects in 10-year cardiovascular disease risk categories.