Title: Is Arterial Stiffness Related to Body Height?
Abstract: HomeHypertensionVol. 55, No. 6Is Arterial Stiffness Related to Body Height? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBIs Arterial Stiffness Related to Body Height? Yan-Ping Liu Tom Richart Yan Li Wei-Wei Zhan Jan A. Staessen Yan-Ping LiuYan-Ping Liu Department of Ultrasonography, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China, Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium Search for more papers by this author Tom RichartTom Richart Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands Search for more papers by this author Yan LiYan Li Center for Epidemiologic Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Search for more papers by this author Wei-Wei ZhanWei-Wei Zhan Department of Ultrasonography, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Search for more papers by this author Jan A. StaessenJan A. Staessen Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands Search for more papers by this author Originally published12 Apr 2010https://doi.org/10.1161/HYPERTENSIONAHA.110.152553Hypertension. 2010;55:e24–e25Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: April 12, 2010: Previous Version 1 To the Editor:Experts1 consider aortic pulse wave velocity (PWV) as the supreme index of arterial stiffness, mainly because it is an independent predictor of cardiovascular complications.2 However, the noninvasive assessment of PWV is critically dependent on the measurement of the travel distance of the arterial pulse wave.3 Variability between estimates of PWV largely depends on inconsistencies in the measured travel distance.4 Travel distance is proportional to body height.5 This explains the inverse association between PWV and body height. In a recent publication in Hypertension, Wang et al6 recognized the problem and adjusted the hazard ratios expressing the risk of death related to a pulse wave reflection index for body height.The Colin VP-1000 (Omron Healthcare) is easy to operate and is used for risk stratification, in particular in Japan and China.7 This device measures brachial-ankle PWV (baPWV) by means of an automated wave form analyzer. In 200 subjects (51.5% women; mean age: 51.3 years; age range: 20 to 80 years) recruited in the framework of the Flemish Study on Environment Genes and Health Outcomes,8 we observed a strong inverse association between baPWV and body height (Table). However, the VP-1000 device computes baPWV automatically as (L1−L2)/T.9 L1 is the distance from the heart to the ankle, L2 is the distance from the heart to the arm, and T is the time delay between the feet of the brachial and tibial arterial waveforms. The VP-1000 computes L1 and L2 from the height (H) of the subjects as L1=0.2195×H−2.0734 and L2=0.5643×H−18.381.9 For this reason, we believe that the inverse association between baPWV and body height is spurious. Leading experts in the field recently proposed other formulas to extrapolate travel distance from height.5 Another limitation of baPWV is that this index mixes the characteristics of the elastic aorta and subclavian arteries and the muscular brachial, femoral, and tibial arteries. Table. Association of Various Indices of Arterial Stiffness With Body HeightCharacteristicAll SubjectsWomenMenAI indicates systolic augmentation index. Values are single regression coefficients±SE.*P<0.01 indicates significance of the regression coefficient.†P<0.0001 indicates significance of the regression coefficient.No. of subjects20010397Brachial-ankle PWV, cm/s per cm−5.39±2.00*−16.21±4.51†−14.88±2.82†Carotid-femoral PWV, cm/s per cm1.10±1.32−2.70±2.36−2.10±2.51Central AI, %/cm−1.26±0.18†−1.48±0.36†−1.24±0.37*Peripheral AI, %/cm−1.01±0.15†−1.31±0.29†−1.05±0.30†In the same Flemish Study on Environment Genes and Health Outcomes participants,8 we also measured aortic PWV from the length of the carotid-femoral segment and the transit time of the pulse wave. The carotid-femoral segment (cfD) was the distance between the suprasternal notch and the site of the femoral measurement (nfD) minus the distance between the site of the carotid measurement and the suprasternal notch (cnD). We measured these distances using a measuring tape. Thus, for aortic PWV, travel distance was not extrapolated from height. In contrast to baPWV, aortic PWV was not significantly correlated with body height (Table). Nevertheless, cfD (r=0.41), nfD (r=0.56), and cnD (r=0.43)) were all closely correlated (P<0.0001) with body height, highlighting that even the best index of arterial stiffness not only depends on the characteristics the measured arterial segment.We also measured the central and peripheral systolic augmentation indices.8 We used a high-fidelity SPC-301 micromanometer (Millar Instruments, Inc) interfaced with a laptop computer running the SphygmoCor software, version 7.1 (AtCor Medical Pty Ltd). Measurement of the systolic augmentation indices does not involve travel distance. Nevertheless, in line with our previous study of a Chinese population,10 we noticed a significant inverse association between systolic augmentation and body height (Table), which can be easily explained by the faster return of the reflected wave in shorter people.In conclusion, travel distance remains a major problem in the standardization and interpretation of PWV as the favored1 index of arterial stiffness. The inverse association between PWV and height is overestimated if travel distance is extrapolated from height. For the same height, aortic PWV reflects only arterial stiffness, but if height is dissimilar PWV reflects both arterial properties and the difference in stature. We suggest that PWV be expressed standardized to height (and heart rate) and that analyses involving PWV as the explanatory variable should be adjusted for body height (and heart rate), as done recently by Wang et al.6DisclosuresNone. References 1 Laurent S. Surrogate measures of arterial stiffness: do they have additive predictive value or are they only surrogates of a surrogate? Hypertension. 2006; 47: 325–326.LinkGoogle Scholar2 Hansen TW, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006; 113: 664–670.LinkGoogle Scholar3 Weber T, Ammer M, Rammer M, Adji A, O'Rourke MF, Wassertheurer S, Rosenkranz S, Eber B. Noninvasive determination of carotid-femoral pulse wave velocity depends critically on assessment of travel distance: a comparison with invasive measurement. J Hypertens. 2009; 27: 1624–1630.CrossrefMedlineGoogle Scholar4 Rajzer MW, Wojciechowska W, Klocek M, Palka I, Brzozowska-Kiszka M, Kawecka-Jaszcz K. Comparison of aortic pulse wave velocity measured by three techniques: Complior, SphygmoCor and Arteriograph. J Hypertens. 2008; 26: 2001–2007.CrossrefMedlineGoogle Scholar5 Vermeersch SJ, Rietzschel ER, De Buyzere ML, Van Bortel LM, Gillebert TC, Verdonck PR, Laurent S, Segers P, Boutouyrie P. Distance measurements for the assessment of carotid to femoral pulse wave velocity. J Hypertens. 2009; 27: 2377–2385.CrossrefMedlineGoogle Scholar6 Wang KL, Cheng HM, Chuang SY, Li CH, Spurgeon HA, Ting CT, Najjar SS, Lakatta EG, Yin FCP, Chou P, Chen CH. Wave reflection and arterial stiffness in the prediction of 15-year all-cause and cardiovascular mortalities: a community-based study. Hypertension. 2010; 55: 799–805.LinkGoogle Scholar7 Li Y, Staessen JA, Lu L, Li LH, Wang GL, Wang JG. Is isolated nocturnal hypertension a novel clinical entity? Findings from a Chinese population study. Hypertension. 2007; 50: 333–339.LinkGoogle Scholar8 Zebekakis PE, Nawrot T, Thijs L, Balkestein EJ, van der Heijden-Spek J, Van Bortel L, Struijker-Boudier HA, Safar ME, Staessen JA. Obesity is associated with increased arterial stiffness from adolescence until old age. J Hypertens. 2005; 23: 1839–1846.CrossrefMedlineGoogle Scholar9 Hung CS, Lin JW, Hsu CN, Chen HM, Tsai RY, Chien YF, Hwang JJ. Using brachial-ankle pulse wave velocity to associate arterial stiffness with cardiovascular risks. Nutr Metab Cardiovasc Dis. 2009; 19: 241–246.CrossrefMedlineGoogle Scholar10 Li Y, Wang JG, Dolan E, Gao PJ, Guo HF, Nawrot T, Stanton AV, Zhu DL, O'Brien E, Staessen JA. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension. 2006; 47: 359–364.LinkGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. 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Nishiwaki M, Kurobe K, Kiuchi A, Nakamura T, Matsumoto N and Song Q (2014) Sex Differences in Flexibility-Arterial Stiffness Relationship and Its Application for Diagnosis of Arterial Stiffening: A Cross-Sectional Observational Study, PLoS ONE, 10.1371/journal.pone.0113646, 9:11, (e113646) June 2010Vol 55, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/HYPERTENSIONAHA.110.152553PMID: 20385964 Originally publishedApril 12, 2010 PDF download Advertisement SubjectsBasic Science ResearchEpidemiologyPathophysiology