Vascular robustness: The missing parameter in cardiovascular risk prediction

Lutz E Kraushaar; Alexander Dressel; Alexander Maßmann

doi:10.1016/j.pmedr.2018.01.008

Vascular robustness: The missing parameter in cardiovascular risk prediction

Prev Med Rep. 2018 Jan 28:9:107-113. doi: 10.1016/j.pmedr.2018.01.008. eCollection 2018 Mar.

Authors

Lutz E Kraushaar¹, Alexander Dressel², Alexander Maßmann³

Affiliations

¹ Adiphea (Alliance for Disease Prevention & Healthy Aging) GmbH, Werbach, Germany.
² CaRe High Cascade Screening and Registry for High Cholesterol, D-A-CH-Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e.V., Industriestr. 41, 68169 Mannheim, Germany.
³ Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Saar, Germany.

Abstract

Undetected high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor scores is an acknowledged obstacle to CVD prevention. The vasculature's functional robustness against risk factor derailment may serve as a novel discriminator of mortality risk under similar risk factor loads. To test this assumption, we hypothesized that the expected inverse robustness-mortality association is verifiable as a significant trend along the age spectrum of risk factor-challenged cohorts. This is a retrospective cohort study of 372 adults (mean age 56.1 years, range 21-92; 45% female) with a variety of CV risk factors. An arterial model (VascAssist 2, iSYMED GmbH, Germany) was used to derive global parameters of arterial function from non-invasively acquired pulse pressure waves. Participants were stratified by health status: apparently healthy (AH; n = 221); with hypertension and/or hypercholesterolemia (CC; n = 61); with history of CV event(s) (CVE; n = 90). Multivariate linear regression was used to derive a robustness score which was calibrated against the CVD mortality hazard rate of a sub-cohort of the LURIC study (n = 1369; mean age 59.1 years, range 20-75; 37% female). Robustness correlated linearly with calendar age in CC (F(1, 59) = 10.42; p < 0.01) and CVE (F(1, 88) = 40.34; p < 0.0001) but not in the AH strata, supporting the hypothesis of preferential elimination of less robust individuals along the aging trajectory under risk factor challenges. Vascular robustness may serve as a biomarker of vulnerability to CVD risk factor challenges, prognosticating otherwise undetectable elevated risk for premature CVD mortality.

Keywords: AH, apparently healthy group; ATH, athletic group; BA, vascular biological age; CA, calendar age; CC, chronic condition group; CVD, cardiovascular disease; CVE, cardiovascular endpoint group; Cardiovascular diseases; FMD, flow mediated vasodilation; PWV, pulse wave velocity; Prevention; RCR, retrospective chart review; Risk factors; Robustness; UN, United Nations; VA2, VascAssist 2; aoPWV, aortic pulse wave velocity.