Segment-specific Pulse Wave Velocity and Subclinical Cardiac Overload and Damage in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Arterial stiffness, often assessed as pulse wave velocity (PWV), independently predicts cardiovascular disease. However, few studies have explored the associations of segment-specific PWV measures with biomarkers of both cardiac overload (N-terminal pro-B-type natriuretic peptide, NT-proBNP) or damage (high sensitivity cardiac troponin T, hs-cTnT) among adults without clinical cardiovascular disease. Methods: We examined PWV for six segments (cf [carotid-femoral], hc [heart-carotid], hf [heart-femoral], ha [heart-ankle], ba [brachial-ankle], and fa [femoral-ankle]) and their associations with NT-proBNP and hs-cTnT in 2,845 whites and black participants of the ARIC Study aged 67-90 years and without clinical history of cardiovascular disease. We conducted a cross-sectional analysis of data collected in 2011-13 using linear and logistic regression models with adjustment for demographic characteristics, traditional cardiovascular risk factors, and echo parameters of left ventricular (LV) remodeling and function. Results: Most PWV measures demonstrated J- or U-shaped associations with NT-proBNP and hs-cTnT. Higher values of central PWV measures (cfPWV, hcPWV, and hfPWV) tended to be associated with higher levels of NT-proBNP, independently of demographic characteristics. The associations were attenuated after additional adjustment for clinical cardiovascular risk factors but remained borderline significant for hcPWV with NT-proBNP (but not with hs-cTnT). The other three PWV measures including peripheral elements (haPWV, baPWV, and faPWV) had overall less evident positive associations with cardiac biomarkers. faPWV, reflecting peripheral arterial stiffness, was inversely associated with both cardiac biomarkers. Inverse association that higher values of NT-proBNP in the lowest quartile than in the second quartile were seen in six PWV measures and were most robust in PWV measures incorporating peripheral component. Conclusion: Overall, the positive associations between PWV and cardiac biomarkers were more evident for central stiffness measures than for peripheral measures of PWV and were stronger for NT-proBNP than for hs-cTnT among this population of older adults without prevalent cardiovascular disease. Our findings suggest the importance of central arterial stiffness over peripheral arterial stiffness in the development of subclinical cardiac overload