1.4 Prognostic Relevance of Augmentation Index in Prevalent Cardiovascular Disease and Total Mortality: Data From the General Population

Abstract

Objectives

To investigate the role of peripheral augmentation index (AIx) for the prediction of prevalent cardiovascular disease (CVD) and total mortality in the general population in age- and sex- specific manner.

Methods

AIx was measured in 11,250 participants of the population-based Gutenberg Health Study by Endo-PAT device. For analysis, the study population was stratified by age and sex (men: <60/≥60 years; women: <55/≥55 years), since a non-linear increase in AIx with aging with a plateau-building at age of 55 years in women and at 60 years in men was observed.

Results

During the 8-yrs follow-up, a total of 584 deaths (382 men/202 women) occurred. In males, top tertile (T) of AIx was associated with all-cause mortality (hazard ratio (HR) in younger men was 2.30 (95% CI 1.41–3.76) and 1.42 (95% CI 1.09–1.85) among men ≥60 years (T3 vs T1/T2; adjusted for height, heart rate, CVD risk factors). No association was found in females. A stronger predictive ability was observed in younger males, with AIx values above the reference limit (HR 3.15 (95% CI 1.73–5.74), multivariable-adjusted). Finally, an increased AIx was also associated with almost 2-fold higher prevalence of CVD in males <60 years (Prevalence ratio 1.81 (95% CI 1.33–2.45) for T3 vs T1/T2; or 2.01 (95% CI 1.40–2.86) for AIx values above reference in a fully adjusted model), but not in older males or women.

Conclusion

Within the present analysis, AIx demonstrated a strong predictive value for prevalent CVD and worse survival in younger males, thereby underlying its clinical usefulness in this particular population.