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14th July 2022
Arterial stiffness progression, based on measurement of brachial-ankle pulse wave velocity, is slower among patients at high atherosclerotic risk who are prescribed statin drugs according to the findings of retrospective cohort study by Chinese researchers.
The term ‘arterial stiffness’ refers to the loss of elasticity in the walls of large arteries, especially the aorta, over time and results from a degenerative process affecting mainly the extracellular matrix as a result of aging and other risk factors. Moreover, arterial stiffness and wave reflections are now well accepted as the most important determinants of increasing systolic and pulse pressures in aging societies and increasingly used in the clinical assessment of patients with hypertension and various cardiovascular risk factors. The use of brachial-ankle pulse wave velocity, which can be used to non-invasively assess arterial stiffness progression, has been proposed as a surrogate end point for cardiovascular disease and a systematic review in 2012 found that an increase in brachial-ankle pulse wave velocity by 1 m/s corresponded with an increase of total cardiovascular events, cardiovascular mortality, and all-cause mortality.
Patients at a high risk of atherosclerotic disease are usually prescribed statin therapy although whether these drugs can reduce or prevent the development of arterial stiffness is unclear. For example, one analysis concluded that statin therapy had a beneficial effect on aortic arterial stiffness. In contrast, another study revealed how the use of atorvastatin actually increased arterial stiffness. Nonetheless, in many cases, the currently available studies included a low number of patients or were undertaken over a short period of time.
For the present study, the Chinese team retrospectively examined the relationship between statin use and the progression of arterial stiffness, based on measurement of brachial-ankle pulse wave velocity. The researchers used data from the Kailuan study which is a large, prospective study including over 100,000 individuals. A wide range of data was collected during the study including demographic and socioeconomic information, e.g., education level, average income of each family member as well as medical and lifestyle measures such as physical activity. Since 2010, individuals within the study at a high risk of peripheral artery disease, i.e., those with at least one risk factor such as hypertension or diabetes, were invited to have a baseline brachial-ankle pulse wave velocity (BaPWV) measurements and which was repeated at follow-up visits. The team included patients prescribed statins at least 6 months prior to their first BaPWV measurement. Furthermore, statin users were also divided into those who discontinued with their treatment within the first two years and those who had a high level of statin adherence. These statin users were then propensity matched with non-users.
Arterial stiffness and statin use
A total of 1310 individuals with a mean age of 64.6 years (75.7% male) using statins were propensity matched with the same number of non-statin users although the non-users had a slightly lower mean age (61.9 years).
The use of statins was associated with a significantly lower baseline BaPWV value compared to non-users (difference = -33.6 cm/s, 95% CI -62.1 to -5.1 cm/s).
During a mean follow-up of 4.8 years, the BaPWV increased from a mean of 1778.8 cm/s to 1831.9 cm/s in the statin group and from 1799 to 1870.8 in the non-statin group. Using a multivariable linear regression model, the authors found that statin use was associated with a significantly slower progression of BaPWV (difference = -23.3 cm/s/year).
They concluded that statin use appeared to be linked with a slowing of BaPWV progression in adults with a high atherosclerotic risk, suggesting that these drugs were able to prevent the development and worsening of subclinical cardiovascular lesions at an early stage.
Zhou YF et al. Association Between Statin Use and Progression of Arterial Stiffness Among Adults With High Atherosclerotic Risk JAMA Netw Open 2022
20th May 2022
Higher arterial stiffness (AS) rather than the presence of hypertension is a better predictor for the development of diabetes according to the findings of a prospective study by a team of Chinese researchers.
The World Health Organization estimates that there are approximately 422 million people worldwide that have diabetes. The most common form of diabetes is type 2 and in 2017, it was estimated that approximately 462 million individuals were affected by the condition, corresponding to 6.28% of the world’s population. Hypertension is common in those with type 2 diabetes and reportedly affects over two-thirds of patients and a Chinese study has suggested that a higher blood pressure is a risk factor for type 2 diabetes in both middle-aged and elderly patients.
Furthermore, the presence of arterial stiffness, especially in the aorta, has been shown to be an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension. In addition, other work has suggested that the presence of arterial stiffness is associated with an increased incidence of diabetes, independent of other risk factors and may represent an early risk marker for developing diabetes. However, whether arterial stiffness among hypertensive patients is a useful prognostic marker for the development of diabetes compared with hypertension alone is unclear.
For the present study, the Chinese researchers looked at data obtained from the Kailuan study, which is an ongoing prospective study following patients initially free of hypertension and examines factors associated with development of the condition. In a subgroup of patients, brachial-ankle pulse wave velocity measurements, which is a widely used technique to assess arterial stiffness, were taken. The researchers set the primary outcome as the development of diabetes during the follow-up period. Participants blood pressure and arterial stiffness was categorised as ideal vascular function (IVF) and normotensive, normotensive with AS, hypertensive and with normal AS and hypertensive and with elevated AS (HTAS).
Arterial stiffness and the development of type 2 diabetes
A total of 11,166 participants were enrolled in the study and followed for 6.16 years during which time 768 (6.88%) of incident cases of type 2 diabetes were identified.
After adjustment for covariates (e.g., age, gender, co-morbidities), compared to the IVF group, individuals in the HTAS group had the highest risk developing type 2 diabetes (hazard ratio, HR = 2.42, 95% CI 1.93 – 3.03). This was followed by the normotensive, elevated AS group (HR = 2.11, 95% CI 1.64 – 2.61). Interestingly, the lowest risk was associated with those who were hypertensive and with normal AS (HR = 1.48). These results did not change when further adjusted for mean arterial or diastolic pressure.
The researchers then examined whether an elevated AS or hypertension, or both, increased the predictive power of a conventional model, i.e., with age, sex, BMI, smoking status etc, for the development of diabetes The results showed that the C statistic increased from 0.690 to 0.707 (p = 0.0003), i.e., had more predictive power, after addition of AS. However, the predictive power increased to 0.709 when both hypertension and AS were added, in other words, there was little additional benefit to the model by adding hypertension alone.
The authors concluded that an elevated AS performed better than hypertension for the prediction of type 2 diabetes and suggested that future strategies for the prevention of type 2 diabetes should focus on both hypertension and AS.
Tian X et al. Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study Hypertension 2022