Associations Between Echocardiographic Arterial Compliance and Incident Cardiovascular Disease in Blacks: The ARIC Study

Systemic arterial compliance, the systolic to diastolic change in volume divided by the change in pressure, is a measure of vascular function that may be used to predict cardiovascular outcomes. The gold standard method of measurement, quantifying stroke volume and aortic pulse pressure (PP) invasively by thermodilution and catheter manometers, is a validated index of total arterial compliance.1,2 However, noninvasive estimates of systemic arterial compliance can be derived by the ratio of echocardiographic stroke volume and brachial arterial PP (SV/PP).2 Although noninvasive estimates of arterial compliance are well suited for prospective screenings and longitudinal epidemiologic studies, most observations relating arterial compliance and cardiovascular disease (CVD) have been drawn from cross-sectional analyses. Age,3,4 hypertension,5 concentric left ventricular hypertrophy,6 diastolic left ventricular dysfunction,7–9 hypercholesterolemia,10 fasting insulin,7,11 and Framingham risk score12 have all been associated with echocardiographic arterial compliance. Prospective analyses of echocardiographic arterial compliance have primarily been limited to Europeans but have predicted mortality in patients with diabetes13 and fatal and nonfatal cardiovascular events in hypertensives14,15 and in the general population.8 To date, few studies have assessed echocardiographic systemic arterial compliance in blacks, and none have analyzed cardiovascular events as explicit, rather than composite, outcomes. We analyzed associations between echocardiographic arterial compliance and incident stroke, heart failure, and coronary events in a cohort of blacks free of prevalent CVD and followed prospectively by the Atherosclerosis Risk in Communities (ARIC) study. We also compared the risks of cardiovascular outcomes associated with arterial compliance with those associated with PP and examined model performances to compare the predictive validity of echocardiographic arterial compliance and PP models.