Fig. 1The utility of cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), mean intima medial thickness (IMT), and maximal IMT for predicting the prevalence of atherosclerotic cardiovascular disease (ASCVD) in all subjects (A), and 10-year ASCVD risk scores in subjects without ASCVD (B). CA, carotid artery.
Table 1Baseline clinical characteristics
Characteristic |
Total (n=219) |
ASCVD (n=39) |
Non-ASCVD (n=180) |
P value |
Age, yr |
58.8±9.7 |
62.0±9.9 |
58.1±9.5 |
0.022 |
Sex |
|
|
|
0.876 |
Men |
126 (57.5) |
22 (56.4) |
104 (57.8) |
Women |
93 (42.5) |
17 (43.6) |
76 (42.2) |
Height, cm |
162.3±8.8 |
160.1±7.8 |
162.8±8.9 |
0.080 |
Weight, kg |
67.3±11.2 |
67.9±10.7 |
67.1±11.3 |
0.686 |
Body mass index, kg/m2
|
25.5±3.2 |
26.4±2.4 |
25.3±3.3 |
0.049 |
Waist circumference, cm |
90.6±9.4 |
95.3±11.9 |
89.5±8.5 |
<0.001 |
Duration of diabetes mellitus, yr |
9.0±6.7 |
9.4±6.7 |
8.8±6.7 |
0.615 |
Past medical history Hypertension |
144 (65.8) |
35 (89.7) |
109 (60.6) |
<0.001 |
Cardiovascular disease |
13 (5.9) |
13 (5.9) |
- |
Cerebral vascular disease |
28 (12.8) |
28 (12.8) |
- |
Medication history Antihypertensive agents |
144 (65.8) |
35 (89.7) |
109 (60.6) |
<0.001 |
Antiplatelet agents |
121 (55.3) |
33 (84.6) |
88 (48.9) |
<0.001 |
Lipid lowering agents |
124 (56.6) |
32 (82.1) |
92 (51.1) |
<0.001 |
Smoking |
43 (19.6) |
10 (25.6) |
33 (18.3) |
0.298 |
Drinking |
33 (15.1) |
8 (20.5) |
25 (13.9) |
0.294 |
Exercise |
|
|
|
0.727 |
<Twice per a week |
101 (46.1) |
17 (43.6) |
84 (46.7) |
≥Twice per a week |
118 (53.9) |
22 (56.4) |
96 (53.3) |
Systolic blood pressure, mm Hg |
128±14 |
130±13 |
127±14 |
0.356 |
Diastolic blood pressure, mm Hg |
77±10 |
79±13 |
77±10 |
0.391 |
Heart rate, beat/min |
76±12 |
73±14 |
76±12 |
0.139 |
WBC, ×1,000/µL |
7.00±2.12 |
6.99±1.90 |
7.00±2.17 |
0.976 |
GOT, IU/L |
25.5±18.6 |
23.7±8.7 |
25.9±20.2 |
0.497 |
GPT, IU/L |
25.3±18.3 |
22.9±11.9 |
25.9±19.4 |
0.367 |
GGT, IU/L |
45.6±60.7 |
54.1±60.4 |
43.8±60.8 |
0.350 |
HbA1c, % |
7.4±1.3 |
7.4±1.5 |
7.4±1.2 |
0.988 |
Total cholesterol, mg/dL |
164.5±45.9 |
158.9±34.8 |
172.8±35.5 |
0.027 |
Triglyceride, mg/dL |
151.6±108.3 |
172.0±121.6 |
148.3±108.0 |
0.226 |
HDL-C, mg/dL |
51.7±15.3 |
48.1±12.3 |
51.6±13.1 |
0.134 |
LDL-C, mg/dL |
96.9±23.4 |
85.9±29.5 |
99.4±32.3 |
0.018 |
BUN, mg/dL |
15.1±4.0 |
15.5±4.9 |
15.0±3.7 |
0.493 |
Creatinine, mg/dL |
0.8±0.2 |
0.8±0.2 |
0.7±0.2 |
0.072 |
eGFR, mL/min/1.73 m² |
109.1±30.0 |
99.8±30.5 |
111.1±29.6 |
0.037 |
hsCRP, mg/L |
1.4±2.9 |
1.2±1.9 |
1.5±3.0 |
0.580 |
Microalbuminuria, mg/day |
42.2±87.8 |
48.2±80.0 |
40.9±89.5 |
0.650 |
CAVI |
8.2±1.4 |
8.8±1.4 |
8.1±1.3 |
0.004 |
CAVI <8 |
103 (47.0) |
11 (28.2) |
92 (51.1) |
0.012 |
8≤CAVI<9 |
62 (28.3) |
12 (30.8) |
50 (27.8) |
|
CAVI ≥9 |
54 (24.7) |
16 (41.0) |
38 (21.1) |
|
ABI |
1.1±0.1 |
1.1±0.2 |
1.1±0.1 |
0.108 |
ABI <0.9 |
3 (1.4) |
2 (5.1) |
1 (0.6) |
0.026 |
0.9≤ABI≤1.3 |
216 (98.6) |
37 (94.9) |
179 (99.4) |
|
ABI ≤1.3 |
0 |
0 |
0 |
|
Mean IMT, mm |
1.01±0.23 |
1.12±0.28 |
0.99±0.21 |
0.009 |
Maximal IMT, mm |
1.28±0.30 |
1.40±0.35 |
1.26±0.29 |
0.006 |
Atherosclerosis |
|
|
|
|
Mean IMT ≥1 mm |
107 (48.9) |
26 (66.7) |
81 (45.0) |
0.014 |
Maximal IMT ≥1 mm |
154 (83.3) |
36 (92.3) |
152 (84.4) |
0.202 |
Mean IMT ≥1 mm or with plaque |
158 (72.1) |
34 (87.2) |
124 (68.9) |
0.021 |
Maximal IMT ≥1 mm or with plaque |
201 (91.8) |
39 (100) |
162 (90.0) |
0.039 |
Plaque |
154 (70.3) |
34 (87.2) |
120 (66.7) |
0.011 |
Metabolic syndrome |
189 (86.3) |
39 (100) |
150 (83.3) |
0.006 |
Number of risk factor |
3.1±1.0 |
4.0±0.7 |
3.3±1.0 |
<0.001 |
Table 2The comparison of clinical characteristics according to the CAVI in the non-ASCVD group
Characteristic |
CAVI <8 (n=92) |
8≤CAVI<9 (n=50) |
CAVI ≥9 (n=38) |
P value |
Age, yra,b,c
|
53.0±8.9 |
61.4±6.1 |
66.3±7.0 |
<0.001 |
Sex |
|
|
|
0.139 |
Men |
57 (62.0) |
23 (46.0) |
24 (63.2) |
Women |
35 (38.0) |
27 (54.0) |
14 (36.8) |
Height, cma
|
164.5±8.0 |
160.5±9.6 |
161.8±9.3 |
0.030 |
Weight, kga,b
|
70.3±11.7 |
64.3±10.2 |
63.2±9.6 |
<0.001 |
Body mass indexb, kg/m2
|
25.9±3.4 |
24.9±3.2 |
24.1±2.8 |
0.014 |
Waist circumference, cm |
89.8±8.9 |
89.4±8.9 |
89.1±86.9 |
0.912 |
Duration of diabetes mellitus, yr |
8.0±5.5 |
8.2±6.2 |
11.7±9.0 |
0.072 |
Hypertension |
49 (53.3) |
31 (62.0) |
29 (76.3) |
0.049 |
Medication history Antihypertensive agents |
49 (53.3) |
31 (62.0) |
29 (76.3) |
0.049 |
Antiplatelet agents |
42 (45.7) |
24 (48.0) |
22 (57.9) |
0.442 |
Lipid lowering agents |
48 (52.2) |
23 (46.0) |
21 (55.3) |
0.662 |
Smoking |
19 (20.7) |
8 (16.0) |
6 (15.8) |
0.713 |
Drinking |
13 (14.1) |
5 (10.0) |
7 (18.4) |
0.525 |
Exercise |
|
|
|
0.720 |
<Twice per a week |
44 (47.8) |
21 (42.0) |
19 (50.0) |
≥Twice per a week |
Weight, kga,b
|
29 (58.0) |
19 (50.0) |
Systolic blood pressure, mm Hgb,c
|
125±13 |
126±13 |
136±15 |
<0.001 |
Diastolic blood pressure, mm Hg |
78±10 |
75±10 |
79±9 |
0.060 |
Heart rate, beat/minc
|
76±12 |
73±11 |
80±13 |
0.024 |
WBC, ×1,000/µL |
6.70±1.96 |
7.36±2.58 |
7.24±2.00 |
0.182 |
GOT, IU/La
|
29.4±27.3 |
21.5±5.0 |
23.4±7.8 |
0.024 |
GPT, IU/La,b
|
30.6±24.8 |
19.9±8.0 |
22.3±10.7 |
0.002 |
GGT, IU/L |
51.1±79.8 |
32.2±25.5 |
40.7±30.6 |
0.220 |
HbA1c, % |
7.3±1.2 |
7.3±1.3 |
7.7±1.1 |
0.165 |
Total cholesterol, mg/dL |
173.4±35.4 |
173.8±36.1 |
169.8±35.7 |
0.845 |
Triglyceride, mg/dL |
157.7±123.2 |
127.4±98.2 |
153.2±74.3 |
0.267 |
HDL-C, mg/dLa,c
|
50.3±12.1 |
56.3±14.8 |
48.4±11.7 |
0.008 |
LDL-C, mg/dL |
100.0±31.4 |
98.9±35.5 |
98.2±30.9 |
0.953 |
BUN, mg/dL |
14.6±3.4 |
15.3±4.5 |
15.4±3.4 |
0.368 |
Creatinine, mg/dL |
0.75±0.19 |
0.70±0.22 |
0.75±0.20 |
0.376 |
hsCRP, mg/L |
1.1±1.8 |
1.8±2.7 |
2.0±5.1 |
0.251 |
Microalbuminuria, µg/mg Cr |
30.5±67.1 |
31.4±88.7 |
78.6±123.9 |
0.083 |
ABIb
|
1.12±0.07 |
1.11±0.07 |
1.08±0.08 |
0.013 |
ABI <0.9 |
0 |
0 |
1 (2.6) |
0.153 |
0.9≤ABI≤1.3 |
92 (100) |
50 (100) |
37 (97.4) |
|
Mean IMT, mmb |
0.94±0.18 |
1.00±0.20 |
1.09±0.27 |
0.001 |
Maximal IMT, mmb
|
1.21±0.27 |
1.26±0.28 |
1.37±0.31 |
0.012 |
Atherosclerosis |
|
|
|
|
Mean IMT ≥1 mm |
31 (33.7) |
26 (52.0) |
24 (63.2) |
0.005 |
Maximal IMT ≥1 mm |
74 (80.4) |
41 (82.0) |
37 (97.4) |
0.045 |
Mean IMT ≥1 mm or with plaque |
50 (54.3) |
40 (80.0) |
34 (89.5) |
<0.001 |
Maximal IMT ≥1 mm or with plaque |
79 (85.9) |
45 (90.0) |
38 (100) |
0.051 |
Plaque |
47 (51.1) |
40 (80.0) |
33 (86.8) |
<0.001 |
Metabolic syndrome |
58 (63.0) |
34 (68.0) |
32 (86.5) |
0.032 |
Number of risk factorb,c
|
3.2±1.0 |
3.2±1.0 |
3.7±0.7 |
0.007 |
10-Year ASCVD risk, %b,c
|
10.1±8.4 |
14.0±9.2 |
26.9±16.3 |
<0.001 |
Table 3Correlations among CAVI, IMT, and ABI, and the association of 10-year ASCVD risk
Variable |
Total subjects |
Non-ASCVD |
ABI |
CAVI |
Mean IMT, mm |
ABI |
CAVI |
Mean IMT, mm |
Maximal IMT, mm |
CAVI |
−0.184a
|
|
|
−0.138 |
|
|
|
Mean CA IMT, mm |
−0.089 |
0.364b
|
|
−0.022 |
0.338b
|
|
|
Maximal CA IMT, mm |
−0.065 |
0.338b
|
0.929b
|
−0.004 |
0.302b
|
0.919b
|
|
10-Year ASCVD risk |
|
|
|
−0.034 |
0.481b
|
0.346b
|
0.291b
|
Numbers of MS risk factors |
|
|
|
−0.099 |
0.141 |
0.168a
|
0.176a
|
Table 4The value of CAVI to predict the ASCVD
|
CAVI |
P value |
Total subjects |
|
|
Model 1 (ASCVD)a
|
1.38 (1.06–1.80) |
0.017 |
Non-ASCVD group |
|
|
Model 2 (atherosclerosis [mean IMT ≥1 mm])b
|
1.53 (1.12–2.08) |
0.007 |
Model 3 (high 10-year ASCVD risk [≥7.5%])c
|
2.42 (1.64–3.58) |
<0.001 |