Arterial Stiffness, Central Pressures and Incident Hospitalized Heart Failure in the Chronic Renal Insufficiency Cohort (CRIC) Study
Background—Chronic kidney disease (CKD) is associated with an increased risk of heart failure (HF). We aimed to evaluate the role of large artery stiffness, brachial and central blood pressure as predictors of incident hospitalized HF in the Chronic Renal Insufficiency Cohort (CRIC), a multi-ethnic multi-center prospective observational study of patients with CKD.
Methods and Results—We studied 2602 participants who were free of HF at baseline. Carotid-femoral pulse wave velocity (CF-PWV, the gold-standard index of large artery stiffness), brachial and central pressures (estimated via radial tonometry and a generalized transfer function) were assessed at baseline. Participants were prospectively followed to assess the development of new-onset hospitalized HF. During 3.5 years of follow-up, 154 participants had a first hospital admission for HF. CF-PWV was a significant independent predictor of incident hospitalized HF. Compared to the lowest tertile, the HR among subjects in the middle and top CF-PWV tertiles were 2.33 (95%CI=1.37-3.97; P=0.002) and 5.24 (95%CI=3.22-8.53; P<0.0001), respectively. After adjustment for multiple confounders, the HR for the middle and top CF-PWV tertiles were 1.95 (95%CI=0.92-4.13; P=0.079) and 3.01 (95%CI=1.45-6.26; P=0.003), respectively. Brachial systolic and pulse pressure were also independently associated with incident hospitalized HF, whereas central pressures were less consistently associated with this endpoint. The association between CF-PWV and incident HF persisted after adjustment for systolic blood pressure.
Conclusions—Large artery stiffness is an independent predictor of incident HF in CKD, an association with strong biologic plausibility given the known effects of large artery stiffening of left ventricular pulsatile load.
- Received December 10, 2013.
- Accepted July 17, 2014.