• Acute heart failure
• Atrial stiffness
• Cardio-ankle vascular index
• Obstructive sleep apnea
• Sleep-disordered breathing

• Male
• Humans
• Female
• Vascular Stiffness
• Sleep Apnea Syndromes/complications
• Blood Pressure/physiology
• Polysomnography
• Heart Failure

• arteriosclerosis
• cardio–ankle vascular index
• knee osteoarthritis
• total knee arthroplasty

• A body shape index
• Abdominal obesity
• Cardio-ankle vascular index
• Cigarette smoking

• Male
• Humans
• Female
• Cross-Sectional Studies
• Obesity, Abdominal/diagnosis
• Obesity, Abdominal/etiology
• Body Mass Index
• Risk Factors
• Ankle
• Smoking/adverse effects
• Obesity/diagnosis
• Tobacco Products

• arterial stiffness
• cardio-ankle vascular index
• hypertension
• right atrial phasic function
• speckle-tracking echocardiography

• arterial stiffness parameter
• cardio-ankle vascular index
• cardio-ankle vascular index₀
• pulse wave velocity
• renal function decline

• Aged
• Ankle/blood supply
• Ankle Brachial Index
• Atrial Fibrillation/diagnosis
• Atrial Fibrillation/epidemiology
• Cohort Studies
• Cross-Sectional Studies
• Humans
• Japan/epidemiology
• Prevalence
• Retrospective Studies
• Urban Population
• Vascular Stiffness

• funding

Mortality rate of maintenance hemodialysis patients is known to be high. Cardio-ankle vascular index (CAVI) is an index reflecting the proper stiffness of the arterial tree from the origin of the aorta to the ankle. We aimed to clarify the utility of CAVI as a predictor of mortality in hemodialysis patients. The roles of age and nutritional conditions on survival were also examined.

We followed 242 patients undergoing hemodialysis for 6 consecutive years. Data from 209 patients (mean age was 60 ± 11 years) excluding those with ankle-brachial index <0.90 were then analyzed. CAVI and heart to ankle pulse wave velocity (haPWV) were measured using Vasera 1500.

Thirty-eight hemodialysis patients who died during the 6-year period had higher age, cardiothoracic ratio (CTR), CAVI, and haPWV, and lower diastolic blood pressure, albumin, phosphate, and calcium phosphate product. The Kaplan–Meier curves for cumulative survival among the tertile groups showed that the mortality rate was higher in the highest tertile (T3) compared to T1/T2 for both CAVI and haPWV. Receiver operating characteristic (ROC) analysis revealed that CAVI had better discriminatory power for all-cause mortality compared to haPWV. In the Cox-proportional hazards analyses, 1 SD increase in both parameters contributed independently to all-cause mortality [CAVI: HR 1.595 (95% CI 1.108–2.297), haPWV: HR 1.695 (95% CI 1.185–2.425)], as well as age and CTR. Both parameters above the cut-offs estimated in the ROC analysis (CAVI ≥ 9.2, haPWV ≥ 8.9) also had independent contributions to mortality.

Through the 6 consecutive years of follow-up in 209 HD patients, increased CAVI might represent a major modifiable risk factor for all-cause mortality. Further research is needed to examine whether CAVI-lowering interventions contribute to improved prognosis.

• cardio-ankle vascular index
• hemodialysis patient
• mortality
• phosphorus

• Arterial stiffness
• Cardio-vascular event
• Cardio–Ankle Vascular Index
• Wave reflection

The cardio-ankle vascular index (CAVI) is a physiological indicator of arterial elasticity. However, limited information regarding the clinical significance of the CAVI in patients with hypercholesterolemia is available. This cross-sectional study aimed to elucidate the clinical significance of the CAVI for the primary prevention of cardiovascular disease (CVD) among postmenopausal women with hypercholesterolemia.

A total of 168 untreated postmenopausal hypercholesterolemic women (low-density lipoprotein cholesterol levels ≥ 140 mg/dL, mean age ± standard deviation, 63 ± 10 years) with no history of CVD events were enrolled. The CAVI was measured using commercial devices, after which, its relationships with various clinical parameters, such as carotid artery ultrasonography findings and CVD biomarkers, were examined.

A significant positive correlation was observed between the CAVI and maximum intima-media thickness of the common carotid artery (max-C-IMT), which was evaluated using carotid artery ultrasonography (r = 0.49, P < 0.001). Regarding CVD biomarkers, the CAVI was significantly correlated with estimated glomerular filtration rate (r = -0.18, P < 0.001), high-sensitivity C-reactive protein (r = 0.36, P < 0.001), whole blood passage time as a marker of blood rheology (r = 0.41, P < 0.001), and skin autofluorescence as a marker of advanced glycation end products in tissues (r = 0.46, P < 0.001), although no significant correlation was noted between serum lipid parameters and the CAVI. Multiple regression analysis identified max-C-IMT (β = 0.35, P < 0.001), whole blood passage time (β = 0.18, P = 0.007), skin autofluorescence (β = 0.17, P = 0.011), and age (β = 0.16, P = 0.018) as variables independently associated with CAVI.

The present study indicated that the CAVI is an essential CVD risk factor among postmenopausal women with hypercholesterolemia. Moreover, impaired blood rheology and increase of skin autofluorescence were associated with elevated CAVI in such patients.

• Blood rheology
• Cardio-ankle vascular index
• Cardiovascular risk factors
• Carotid atherosclerosis
• Hypercholesterolemia
• Postmenopausal women
• Skin autofluorescence

• CAVI
• arterial stiffness
• atherosclerosis
• smooth muscle cell contraction

• Atherosclerosis/complications
• Atherosclerosis/diagnosis
• Atherosclerosis/physiopathology
• Cardio Ankle Vascular Index
• Cardiovascular Diseases/etiology
• Cardiovascular Diseases/physiopathology
• Cerebrovascular Disorders/etiology
• Cerebrovascular Disorders/physiopathology
• Humans
• Muscle, Smooth, Vascular/physiopathology
• Plaque, Atherosclerotic
• Predictive Value of Tests
• Prognosis
• Risk Factors
• Rupture, Spontaneous
• Stress, Psychological/complications
• Vascular Stiffness
• Vasoconstriction

• arterial stiffness
• stroke
• the cardio-ankle vascular index

• Arterial stiffness
• atherosclerosis
• cardio-ankle vascular index (CAVI)
• continuous positive airway pressure (CPAP)
• obstructive sleep apnea (OSA)

• Cardio Ankle Vascular Index
• Continuous Positive Airway Pressure
• Heart Disease Risk Factors
• Humans
• Peripheral Arterial Disease/diagnosis
• Peripheral Arterial Disease/epidemiology
• Peripheral Arterial Disease/physiopathology
• Peripheral Arterial Disease/therapy
• Predictive Value of Tests
• Risk Assessment
• Sleep Apnea, Obstructive/diagnosis
• Sleep Apnea, Obstructive/epidemiology
• Sleep Apnea, Obstructive/physiopathology
• Sleep Apnea, Obstructive/therapy
• Treatment Outcome
• Vascular Stiffness

• JP17K09527 JSPS KAKENHI

Arterial stiffness is recognized mainly as an indicator of arteriosclerosis and a predictor of cardiovascular events. Cardio-ankle vascular index (CAVI), which reflects arterial stiffness from the origin of the aorta to the ankle, was developed in 2004. An important feature of this index is the independency from blood pressure at the time of measurement. A large volume of clinical evidence obtained using CAVI has been reported. CAVI is high in patients with various atherosclerotic diseases including coronary artery disease and chronic kidney disease. Most coronary risk factors increase CAVI and their improvement reduces CAVI. Many prospective studies have investigated the association between CAVI and future cardiovascular disease (CVD), and proposed CAVI of 9 as the optimal cut-off value for predicting CVD. Research also shows that CAVI reflects afterload and left ventricular diastolic dysfunction in patients with heart failure. Furthermore, relatively acute changes in CAVI are observed under various pathophysiological conditions including mental stress, septic shock and congestive heart failure, and in pharmacological studies. CAVI seems to reflect not only structural stiffness but also functional stiffness involved in acute vascular functions. In 2016, Spronck and colleagues proposed a variant index CAVI₀, and claimed that CAVI₀ was truly independent of blood pressure while CAVI was not. This argument was settled, and the independence of CAVI from blood pressure was reaffirmed. In this review, we summarize the recently accumulated evidence of CAVI, focusing on the proposed cut-off values for CVD events, and suggest the development of new horizons of vascular function index using CAVI.

• Arterial stiffness
• Cardio-ankle vascular index
• Cardiovascular disease
• Heart failure
• Stiffness parameter β

• Arteriosclerosis
• Atheromatosis
• Cardiovascular disease
• Chronic kidney disease
• Kidney transplantation
• Mortality
• Vascular calcification
• Waiting-list

• Atherosclerosis
• CAVI
• CKD
• DM
• Inflammation
• MCP-1

• Body composition
• Dapagliflozin
• Diabetes
• Formula diet
• Skeletal muscle

• AstraZeneca Co., Ltd. and Ono Pharmaceutical Co., Ltd.

• Cardio-ankle vascular index
• Cardiovascular risk factor
• Hemorheology
• Microchannel array flow analyzer
• Primary cardiovascular events
• Whole blood passage time

• Arterial stiffness
• Cardio-ankle vascular index (CAVI)
• Lipid

• Adult
• Ankle/blood supply
• Ankle Brachial Index
• Blood Pressure/physiology
• Body Mass Index
• Cross-Sectional Studies
• Female
• Healthy Volunteers
• Humans
• Japan
• Lipids/blood
• Male
• Middle Aged
• Odds Ratio
• ROC Curve
• Regression Analysis
• Retrospective Studies
• Risk Factors
• Vascular Stiffness
• Young Adult

• Atherosclerosis
• Body weight
• Oxidative stress
• Polyphenol
• Vascular function
• Weight loss
• d-ROMs

Aim: The effect of nitroglycerin on proper arterial stiffness of the arterial tree has not been fully clarified. The cardio-ankle vascular index (CAVI), which is an application of the stiffness parameter β theory on the arterial tree from the origin of the aorta to the ankle, was developed recently. Furthermore, the stiffness of the aorta (heart-thigh β (htBeta)) and of the femoral-tibial arteries (thigh to ankle β (taBeta)) could be monitored by applying the same theory. The effects of nitroglycerin on CAVI, htBeta, and taBeta were studied comparing the values of healthy people and those of arteriosclerotic patients.

Methods: The subjects were healthy people (CAVI < 7.5, n = 25) and arteriosclerotic patients (CAVI > 9, n = 25). Nitroglycerin (0.3 mg) was administrated sublingually, and various arterial stiffness indices were measured at one-minute intervals for a period of 20 minutes using Vasera VS-1500 (Fukuda Denshi, Tokyo).

Results: After the administration of nitroglycerin in healthy people, CAVI decreased significantly after 5 min. [from 6.76(6.32–7.27) to 5.50(4.70–6.21), P < 0.05], and recovered after 15 min. htBeta [from 5.10(4.76–5.76) to 3.96(3.35–4.79), P < 0.05], and taBeta [from 14.41(10.80–16.33) to 10.72 (9.19–13.01), P < 0.05] also decreased significantly. In arteriosclerotic patients, CAVI decreased after 5 min. [from 10.47(9.67–11.29) to 9.71(8.74–10.57), P < 0.05] and recovered after 15 min. htBeta did not significantly change [from 12.00(11.46–13.21) to 11.81(10.14–13.83), ns], but taBeta decreased significantly [from 18.55(12.93–23.42) to 12.37(9.68–16.99), P < 0.05].

Conclusion: These results indicate that a nitroglycerin-induced decrease of arterial stiffness is more prominent in muscular arteries than in elastic arteries, and this effect was preserved much more prominently in arteriosclerotic patients than in healthy people.

• Arterial stiffness
• Cardio-ankle vascular index
• Nitroglycerin
• Stiffness parameter

• Arterial stiffness
• Cardiovascular diseases
• Protocol
• Risk factor

The objective of this study is to investigate the association of body mass index (BMI) with arterial stiffness assessed by cardioankle vascular index (CAVI).

A retrospective cross-sectional study was conducted in 23,257 healthy Japanese subjects (12,729 men and 10,528 women, aged 47.1 ± 12.5 years, BMI 22.9 ± 3.4 kg/m²) who underwent health screening between 2004 and 2006 in Japan. Exclusion criteria were current medication use and a past history of cardiovascular disease, hypertension, stroke, diabetes, and nephritis.

Male subjects showed significantly higher BMI, CAVI, and triglycerides and lower high-density lipoprotein (HDL)-cholesterol compared with female subjects. Next, the subjects were divided into tertiles of BMI: lower, middle, and upper, in a gender-specific manner. After adjusting for confounders including age, systolic blood pressure, and HDL-cholesterol identified by multiple regression analysis, the mean CAVI decreased progressively as BMI tertile increased in both genders. Furthermore, a negative inverse relationship between BMI and adjusted CAVI was observed throughout the BMI distribution. Multivariate logistic regression model for contributors of high CAVI (≥90th percentile) identified obesity (odds ratios (95% confidence interval): 0.804 (0.720–0.899)], older age [15.6 (14.0–17.4)], male gender [2.26 (2.03–2.51)], hypertension [2.28 (2.06–2.54)], impaired fasting glucose [1.17 (1.01–1.37)], and low HDL-cholesterol [0.843 (0.669–1.06)] as independent factors.

We demonstrated an inverse relationship between CAVI and BMI in healthy Japanese subjects, suggesting that systemic accumulation of adipose tissue per se may lead to a linear decrease of arterial stiffness in nonobese and obese subjects without metabolic disorders.

• BMI
• arterial stiffness
• cardioankle vascular index

• Atherosclerosis
• CAVI
• CTP
• LDL-C/HDL-C ratio
• TAGE

The purpose of this study was to clarify the difference between effects of nitroglycerin (NTG) on the functional stiffness in patients with and without coronary artery disease (CAD) using a newly developed stiffness index, cardio-ankle vascular index (CAVI).

The two subject groups in this study were normal controls (n=31) and CAD patients (n=25). The normal controls had no medical history and were not on regular medications. On the other hand, the CAD patients had received various treatments like antihypertensive drugs, hypoglycemic agents, and statins. This study was conducted in CAD patients under medications. After a single sublingual administration of NTG 0.3 mg, CAVI, blood pressure (BP), and heart rate (HR) were measured every 5 minutes for 20 minutes. Comparisons of each parameter before and after taking NTG were evaluated for statistical significance using analysis of variance and post hoc tests. Tukey–Kramer test was used for post hoc comparisons.

In the normal controls, CAVI significantly decreased from baseline after 5, 10, and 15 minutes (from 6.5±0.9 to 5.2±0.9, 5.5±0.9, and 5.7±0.9, respectively). Systolic BP and HR were not significantly changed. Diastolic BP significantly decreased from baseline after 5 and 10 minutes (from 72±8 to 64±9 and 63±9 mmHg, respectively). On the other hand, CAVI, HR, and diastolic BP were not changed significantly in CAD patients. Systolic BP was significantly decreased from baseline after 5, 10, and 15 minutes (from 147±16 to 131±14, 129±12, and 129±13 mmHg, respectively). In the comparison of the two groups, ΔCAVI was not significantly different between the normal controls and CAD patients (−1.4±0.7 vs −1.4±0.9, −1.1±0.7 vs −1.4±1.0, −0.8±0.7 vs −1.2±1.0, and −0.5±0.7 vs −1.1±1.0 at 5, 10, 15, and 20 minutes, respectively). ΔHR was not significantly different between the two groups. ΔSystolic BP in the CAD patients was significantly higher than in the normal controls at 5, 10, 15, and 20 minutes (normal controls vs CAD; −3±7 vs −10±11, −3±5 vs −10±11, −3±6 vs −13±10, and −1±6 vs −11±10 mmHg, respectively). ΔDiastolic BP in the normal controls was significantly higher than in the CAD patients at 5 and 10 minutes (normal controls vs CAD; −8±6 vs −4±4 and −9±4 vs −6±5 mmHg, respectively).

After NTG administration, the stiffness of the arteries from the origin of the aorta to the ankle as measured by CAVI decreased in both the normal controls and CAD patients, indicating that the response of arterial smooth muscle cells to nitric oxide is preserved even in CAD patients under medication.

• arterial stiffness
• cardio-ankle vascular index
• nitric oxide
• nitroglycerin
• stiffness parameter

• Arterial stiffness
• Atherosclerosis
• Blood pressure
• Cardiovascular disease
• Intima-media thickness
• Left ventricular mass index
• Pulse wave velocity

• Arterial stiffness
• Cardio-ankle vascular index
• Pulse-wave velocity
• Renin-angiotensin-aldosterone system antagonist

Several studies have shown that cocoa and cocoa-containing foods have the potential to lower blood pressure and improve endothelial function. Most of the studies reporting the beneficial effects of dark chocolate on blood pressure have been short (≤ 4 weeks). The aim of the present 8-wks (weeks) study was to assess the effects of regular consumption of dark chocolate during a reduced snack consumption intervention on blood pressure and other cardiovascular risk factors in mildly hypertensive individuals.

This was a randomized, controlled, cross-over trial involving 22 adults (8 women, 14 men), aged 33–64 y, BMI 27.7 ± 3.7 kg/m² with mild hypertension. During the intervention period (8-wks) the participants reduced the intake of habitual snacks and replaced them with dark chocolate (49 g/day). In the control period, they only reduced the snacks without any added chocolate. Data (blood lipid profile, glucose, insulin, 24 h blood pressure) was collected in the beginning and end of both periods (intervention and control), and some variables also in the run-in and run-out periods (weight, body fat percentage, blood pressure, arterial stiffness index, diet and physical activity).

Daily consumption of dark chocolate had no effects on 24 h blood pressure, resting blood pressure (mean ± SD, pre 142 ± 11.5/89 ± 8.4 mmHg vs. post 142 ± 14.2/88 ± 9.4 mmHg in systolic and diastolic blood pressure, respectively) or arterial stiffness (mean ± SD, pre 7.68 ± 0.88 vs. post 7.76 ± 0.89).

Weight was reduced by 1.0 ± 2.2 kg during the control (reduced snack only) period, but was unchanged while eating chocolate (p < 0.027 between the treatments).

The data collected in this study indicates that inclusion of dark chocolate daily in the diet had no significant effects on blood pressure or other cardiovascular risk factors during a reduced snack period.

ClinicalTrials.gov identifier NCT02130141

• Arterial stiffness
• Arteriosclerosis
• Cardiac dysfunction
• Cardio-ankle vascular index
• Coronary risk factor
• Diabetes mellitus
• Hypertension
• Pulse wave velocity

• Cardio-ankle vascular index (CAVI)
• Gender difference
• Serum uric acid

Arterial stiffness has been known to be a surrogate marker of arteriosclerosis, and also of vascular function. Pulse wave velocity (PWV) had been the most popular index and was known to be a predictor of cardiovascular events. But, it depends on blood pressure at measuring time. To overcome this problem, cardio-ankle vascular index (CAVI) is developed. CAVI is derived from stiffness parameter β by Hayashi, and the equation of Bramwell-Hill, and is independent from blood pressure at a measuring time. Then, CAVI might reflect the proper change of arterial wall by antihypertensive agents.

CAVI shows high value with aging and in many arteriosclerotic diseases and is also high in persons with main coronary risk factors. Furthermore, CAVI is decreased by an administration of α₁ blocker, doxazosin for 2-4 hours, Those results suggested that CAVI reflected the arterial stiffness composed of organic components and of smooth muscle cell contracture. Angiotensin II receptor blocker, olmesartan decreased CAVI much more than that of calcium channel antagonist, amlodipine, even though the rates of decreased blood pressure were almost same. CAVI might differentiate the blood pressure-lowering agents from the point of the effects on proper arterial stiffness.

This paper reviewed the principle and rationale of CAVI, and the possibilities of clinical applications, especially in the studies of hypertension.

• Cardio-ankle vascular index
• angiotensin II receptor blockers
• arterial stiffness
• calcium channel blocker
• hypertension.

• Adult
• Aged
• Ankle/blood supply
• Atherosclerosis/complications
• Atherosclerosis/epidemiology
• Atherosclerosis/physiopathology
• Autonomic Nervous System/physiopathology
• Blood Pressure/physiology
• Female
• Hand/blood supply
• Humans
• Incidence
• Japan/epidemiology
• Male
• Middle Aged
• Parkinson Disease/complications
• Parkinson Disease/physiopathology
• Reproducibility of Results
• Retrospective Studies
• Risk Factors
• Vascular Stiffness/physiology