AORTIC PULSE WAVE VELOCITY AS ADDITIONAL PROGNOSTIC CRITERIA IN ABDOMINAL OBESITY

Material and methods. Totally 132 normotensive patients studied with AO and SCORE risk <5%, at the age 31-55 (mean age 45,0±5,3); we measured lipid profile, glycemic profile, glomerular filtration rate, microalbuminuria (MAU), performed triplex scanning of carotid arteries (CA) echocardioscopy, bifunctional 24-hour blood pressure monitoring with assessment of mean daily PWV in aorta. As additional prediction instrument in CVR stratification we meant PWV >75 percentile for the respective age range — 8,0 m/s for persons of 31-45 years old and 8,3 m/s for 46-55 years old.

Results. In patients with PWV in aorta >75th percentile organ damage was found more often — carotid atherosclerosis — 44,1% vs 5,1% (p<0,01); CA wall hypertrophy — 50,0% vs 26,5% (p<0,05); MAU — 32,4% vs 0% (p<0,01). The criteria chosen for vessel wall rigidity made it to reveal 100% of persons with MAU, 42,9% with left ventricle hypertrophy, 39,5% with CA wall hypertrophy, 75,0% with carotid atherosclerosis among all patients with AO, that was comparable with the analogic parameters in case of traditional method application with the same aim in model of metabolic syndrome. At the same time the prevalence of carotid atherosclerosis and MAU in the first subgroup was significantly higher — 44,1% vs 16,2% and 32,4% vs 10,8%, resp. (p<0,01).

Conclusion. For the patients with AO and low and moderate CVR by SCORE in case of PWV in aorta at the range >75 percentile for the respective age diapason it is aimfull to do screening of subclinical atherosclerosis for consequent reclassification of CVR and reconsideration of the necessary prevention events. 

1. Boytsov SA, Karpov YuA, Kukharchuk VV, et al. Identification of Patients at High Cardiovascular Risk: Problems and Possible Solutions. Ateroskleroz i Dislipidemii 2010; 1(1):8-14. Russian (Бойцов С. А., Карпов Ю. А., Кухарчук В. В. и др. Проблемы выявления лиц с высоким сердечно-сосудистым риском и возможные пути их решения. Атеросклероз и дислипидемии 2010; 1(1): 8-14).

2. Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012; 33: 1635-701.

3. Flegal K, Kit B, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories. JAMA 2013; 309(1): 71-82.

4. The consensus of experts on a multidisciplinary approach to the management, diagnosis and treatment of patients with metabolic syndrome. Cardiovascular Therapy and Prevention 2013; 12(6): 41-81. Russian (Консенсус экспертов по междисциплинарному подходу к ведению, диагностике и лечению больных с метаболическим синдромом. Кардиоваскулярная терапия и профилактика 2013; 12(6): 41-81).

5. Nilsson PМ, Boutouyrie P, Laurent S. Vascular Aging: A Tale of EVA and ADAM in Cardiovascular Risk Assessment and Prevention. Hypertension 2009; 54: 3-10.

6. Mithell GF, Parise H, Benjamin E, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women. Hypertension 2004; 45: 1239-48.

7. Reference Values for Arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values. Eur Heart J 2010; 31: 2338-50.

8. Scuteri A, Tesauro M, Rizza S, et al. Endothelial function and arterial stiffness in normotensive normoglycemic first-degree relatives of diabetic patients are independent of the metabolic syndrome. Nutr Metab Cardiovasc Dis 2008; 18: 349-56.

9. Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. JACC 2013; 25(63): 636-46.

10. Druzhilov MA, Otmakhov VV, Beteleva YuE et al. Subclinical vessel lesion in normotensive patients with abdominal obesity: focus on arterial stiffness. System Hypertension 2013; 10(2): 46-52. Russian (Дружилов М.А., Отмахов В.В., Бетелева Ю.Е. и др. Субклиническое поражение сосудов у нормотензивных пациентов с абдоминальным ожирением: фокус на артериальную жесткость. Системные гипертензии 2013; 10(2): 46-52).

11. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Hypertension 2013; 31:1281-357.

12. Posokhov IN. Pulse wave velocity 24-hour monitoring with one-site measurements by oscillometry. Medical Devices: Evidence and Research 2013; 6: 11-5.

13. Druzhilov MA, Beteleva YuE, Kuznetsova TYu. Epicardial adipose tissue thickness — an alternative to waist circumference as a stand-alone or secondary main criterion in metabolic syndrome diagnostics? Russ J Cardiol 2014; 3(107): 76-81. Russian (Дружилов М. А., Бетелева Ю. Е., Кузнецова Т. Ю. Толщина эпикардиального жира — альтернатива окружности талии как самостоятельный или второй основной критерий для диагностики метаболического синдрома? Российский кардиологический журнал 2014; 3(107): 76-81).

14. Nilsson PM. Hemodynamic Aging as the Consequence of Structural Changes Associated with Early Vascular Aging. Aging and Desease 2014; 5(2): 109-13.

15. Sehestedt T, Jeppesen J, Hansen T, et al. Risk prediction is improved by adding markers of subclinical organ damage to SCORE. Eur Heart J 2010; 31: 883-91.

16. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness A Systematic Review and Meta-Analysis. JACC 2010; 55: 1318-27.

17. Van Bortel L, Laurent S, Boutouyrie P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. Hypertension 2012; 30: 445-8.