Joo-Hee Zo

This retrospective study investigated the impact of socioeconomic status (SES) on patients at high risk of cardiovascular disease, focusing on obstructive coronary artery disease (CAD) presence and long-term cardiovascular outcomes in individuals undergoing invasive coronary angiography (ICA). Analyzing data from 9530 patients categorized by health insurance type (medical aid beneficiaries (MABs) as the low SES group; national health insurance beneficiaries (NHIBs) as the high SES group), this research explores the relationship between SES and outcomes. Despite a higher prevalence of cardiovascular risk factors, the MAB group exhibited similar rates of obstructive CAD compared to the NHIB group. However, over a median 3.5-year follow-up, the MAB group experienced a higher incidence of composite cardiovascular events, including cardiac death, acute myocardial infarction, coronary revascularization, and ischemic stroke, compared with the NHIB group (20.2% vs. 16.2%, p < 0.001). Multivariable Cox regression analysis, adjusting for potential confounders, revealed independently worse clinical outcomes for the MAB group (adjusted odds ratio 1.28; 95% confidence interval 1.07–1.54; p = 0.006). Despite comparable CAD rates, this study underscores the fact that individuals with low SES encounter an elevated risk of composite cardiovascular events, emphasizing the association between socioeconomic disadvantage and heightened susceptibility to cardiovascular disease, even among those already at high risk.

The impact of socioeconomic status (SES) on arterial stiffness remains unclear. This study aimed to explore the association between both personal and household income, as well as education level, and estimated pulse wave velocity (ePWV). A total of 13,539 participants (mean age 52.9 ± 16.7 years; 57.1% women) from the Korean National Health and Nutrition Survey database were analyzed. For SES variables, information on personal and household income and education level was collected using standardized questionnaires. The ePWV did not show significant differences across groups categorized by individual income levels (P = 0.183). However, there was a noticeable trend of decreasing ePWV with increasing household income levels (P < 0.001). Additionally, ePWV demonstrated a significant negative correlation with higher education levels, indicating that ePWV decreased in groups with higher educational attainment (P < 0.001). In multiple linear regression analyses, both household income (β = -0.055; P < 0.001) and education level (β = -0.076; P < 0.001) were negatively associated with ePWV, even after adjusting for potential confounders. Lower household income and lower education levels were associated with higher ePWV, providing further evidence of the influence of SES on arterial stiffness.

Kim HL, et al. Cardiometab Syndr J. 2024 May;4:e9. https://doi.org/10.51789/cmsj.2024.4.e9

Background: Individuals of low socioeconomic status (SES) often exhibit increased cardiovascular risk factors and a worse prognosis. We conducted this study to ascertain whether brachial-ankle pulse wave velocity (baPWV), a straightforward and reliable measure of arterial stiffness, can hold prognostic value for people with low SES. Methods: We retrospectively analyzed a total of 1266 subjects (mean age 64.6 ± 11.6 years; 47.2% female) without documented cardiovascular disease who had undergone baPWV measurement. The subjects included 633 National Health Insurance Beneficiaries (NHIB) and 633 Medical Aid Beneficiaries (MAB), matched for major clinical features through a 1:1 propensity score matching method. Major adverse cardiovascular events (MACE), such as death, non-fatal myocardial infarction, non-fatal ischemic stroke, coronary revascularization, and heart failure necessitating admission, were assessed during the clinical follow-up. Results: During a median follow-up period of 4.2 years (interquartile range, 2.2–5.7 years), there were 77 MACE cases (6.1%). In multivariable Cox regression analyses, baPWV was identified as a significant predictor of MACE in both groups, regardless of the use of three different baPWV criteria (median value, Asian consensus recommendation, and cut-off value obtained by receiver operating characteristic [ROC] curve analysis). In both groups, the baPWV value obtained using ROC curve analysis emerged as the best predictor of MACE. This predictive value was stronger in the NHIB group (hazard ratio, 5.80; 95% confidence interval, 2.30–14.65; p < 0.001) than in the MAB group (hazard ratio, 3.30; 95% confidence interval, 1.57–6.92; p = 0.002). Conclusions: baPWV was associated with future MACE incidence in both NHIB and MAB groups. Since baPWV is simple and cost-effective to measure, it could be efficiently used as a risk stratification tool for individuals with low SES.

The correlation between body fat parameters and arterial stiffness is still under debate. This study aimed to examine the associations of body mass index (BMI) and waist circumference (WC) with estimated pulse wave velocity (ePWV). We utilized data from 14,228 subjects (mean age 53.4 ± 16.8 years; 56.9% were female) from the Korean National Health and Nutrition Examination Survey. The ePWV was calculated using a formula based on age and blood pressure. Simple linear correlation analyses revealed significant associations between both BMI and ePWV (r = 0.098; p < 0.001) and WC and ePWV (r = 0.291; p < 0.001), with a stronger correlation observed between WC and ePWV. Multiple linear regression analysis demonstrated that WC remained significantly associated with ePWV after adjusting for potential confounders (β = 0.020; p = 0.001). However, a statistically significant association was not found between BMI and ePWV (β = 0.011; p = 0.076). Multiple binary logistic regression analysis further indicated that both higher BMI and WC were independently associated with higher ePWV, but the association was more pronounced between WC and ePWV than between BMI and ePWV. These findings underscore a stronger correlation between visceral obesity (as indicated by WC) and arterial stiffness (as indicated by ePWV) compared to overall obesity (as indicated by BMI). This highlights the potential significance of abdominal obesity in assessing cardiovascular risk.

Background The prognostic value of estimated pulse wave velocity (ePWV) has been infrequently explored in high-risk patient groups. Our study aimed to evaluate the prognostic significance of ePWV among patients undergoing a percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). Methods A total of 4119 consecutive subjects who underwent a PCI with a DES (mean age, 67.1 ± 11.6 years and 33.1% were female) were retrospectively analyzed. ePWV was calculated based on the patient’s age and mean blood pressure. Major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke, were evaluated. Results During a median follow-up duration of 3.51 years (interquartile range, 1.35–6.37 years), there were 746 MACEs (18.1%). A multivariable analysis showed that a higher ePWV was associated with a higher MACE incidence (middle tertile vs. the lowest tertile: hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.81–3.42; p < 0.001; the highest tertile vs. the lowest tertile: HR, 6.18; 95% CI, 4.33–8.80; p < 0.001) The inclusion of ePWV data significantly increased the global chi-square values when added to the clinical information (from 96 to 128; p < 0.001). Conclusion ePWV demonstrated a significant association with MACEs in patients who underwent DES implantation. Given its relative simplicity to calculate, ePWV could potentially serve as a valuable instrument for stratifying cardiovascular risks within this high-risk patient population.

Background The prognostic value of estimated pulse wave velocity (ePWV) has been infrequently explored in high-risk patient groups. Our study aimed to evaluate the prognostic significance of ePWV among patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Methods A total of 4,119 consecutive subjects who underwent PCI with DES (mean age, 67.1 ± 11.6 years and 33.1% were female) were retrospectively analyzed. ePWV was calculated based on the patient’s age and mean blood pressure. Major adverse cardiovascular event (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke, were evaluated. Reults During a median follow-up duration of 3.51 years (interquartile range, 1.35 ~ 6.37 years), there were 746 MACE (18.1%). Multivariable analysis showed that higher ePWV was associated with higher MACE incidence (middle tertile vs. the lowest tertile: hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.81-3.42; P < 0.001; the highest tertile vs. the lowest tertile: HR, 6.18; 95% CI, 4.33-8.80; P < 0.001) The inclusion of ePWV data significantly increased the global chi-square values when added to the clinical information (from 96 to 128; P < 0.001). Conclusion ePWV demonstrated a significant association with MACE in patients who underwent DES implantation. Given its relative simplicity to calculate, ePWV could potentially serve as a valuable instrument for stratifying cardiovascular risk within this high-risk patient population.

Kim HL, et al. J Korean Med Sci. 2023 Dec;38:e414. https://doi.org/10.3346/jkms.2023.38.e414

Little is known about the characteristics of arterial stiffness in heart failure (HF). This study was performed to compare the degree of arterial stiffness and its association with left ventricular (LV) diastolic function among three groups: control subjects, patients with HF with reduced ejection fraction (HFrEF), and patients with HF with preserved ejection fraction (HFpEF). A total of 83 patients with HFrEF, 68 patients with HFpEF, and 84 control subjects were analyzed. All HF patients had a history of hospitalization for HF treatment. Brachial-ankle pulse wave velocity (baPWV) measurement and transthoracic echocardiography were performed at the same day in a stable condition. The baPWV was significantly higher in patients with both HFrEF and HFpEF compared to control subjects (1,661 ± 390, 1,909 ± 466, and 1,477 ± 296 cm/sec, respectively; P < 0.05 for each). After adjustment of age, baPWV values were similar between patients with HFrEF and HFpEF (P = 0.948). In the multiple linear regression analysis, baPWV was significantly associated with both septal e′ velocity (β = –0.360, P = 0.001) and E/e′ (β = 0.344, P = 0.001). However, baPWV was not associated with either of the diastolic indices in HFrEF group. The baPWV was associated only with septal e′ velocity (β = –0.429, P = 0.002) but not with E/e′ in the HFpEF group in the same multivariable analysis. Although arterial stiffness was increased, its association with LV diastolic function was attenuated in HF patients compared to control subjects. The degree of arterial stiffening was similar between HFrEF and HFpEF.

The prognostic value of arterial stiffness in patients with diabetes mellitus (DM) remains unclear. The aim of this study was to investigate the association between brachial-ankle pulse wave velocity (baPWV) and the occurrence of cardiovascular events in people with DM. A total of 2714 subjects (mean age, 63.6 years; males, 59.3%) with type 2 DM and without documented cardiovascular disease and stroke were analyzed. The primary end-point of this study was composite cardiovascular events of cardiac death, non-fatal myocardial infarction, coronary revascularization and stroke. There were 118 composite events (4.3%) during a median follow-up period of 3.84 years (interquartile range, 1.60–5.52 years). In multivariable Cox regression analysis, higher baPWV (≥1672 cm/s) was associated with composite events even after controlling for potential confounders (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.31–3.07; P = .001). Compared to the lowest baPWV tertile, both middle (HR, 1.84; 95% CI, 1.03–3.27; P = .037) and the highest (HR, 2.97; 95% CI, 1.69–5.22; P < .001) tertile of baPWV were associated with increased risk of cardiovascular events in the same multivariable model. In conclusion, the baPWV was associated with cardiovascular events in people with type 2 DM. Considering the simplicity and convenience of baPWV measurement, baPWV may be useful for risk stratification of people with type 2 DM.