Introduction: Indirect measures of arterial stiffness such as wide pulse-pressure, high BP variability, elevated LDL, and abnormal ankle-brachial index (ABI) each predict cerebrovascular events and outcomes; however, less is known about the utility of these markers in combination.
Hypothesis: Higher number of abnormal indirect measurements of arterial stiffness is associated with higher mortality after stroke.
Methods: Using the US National Health and Nutrition Examination Surveys 1999-2004 (with linked mortality through 2010), we assessed arterial stiffness scores for adults aged ≥40 years. Arterial stiffness score (range 0-4) was defined as number of positive findings among the following: high SBP variability (highest quartile), wide pulse pressure (highest quartile), abnormal ABI (<0.9 or >1.3), or LDL ≥ 100 mg/dL. We assessed stroke prevalence across arterial stiffness scores. Independent relationships between arterial stiffness score and all-cause-mortality were assessed using Cox regression models.
Results: Among 6,711 individuals, 25% were aged ≥ 65 years, 51% were women, and 79% were White. Factors associated with higher arterial stiffness scores were: older age, female sex, lower education, and lower socioeconomic status (all P<0.001). Higher arterial stiffness score was associated with higher odds of stroke (OR 3.3, 95% CI 1.9-5.5). Of the score components, stroke survivors were more likely to have wide pulse pressure and abnormal ABI compared to those without stroke (P<0.001). There was a dose-dependent relationship between arterial stiffness score and all-cause mortality after stroke: adjusted mortality rate ratios were 1.0. 1.9, 3.1, 3.4 across increasing arterial stiffness scores (trend p=0.0039). Mortality curves are shown.
Conclusions: Simultaneous assessment of common ambulatory markers for arterial stiffness provides a simple, readily available scheme for stroke risk outcome stratification.