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Current Aging Science


ISSN (Print): 1874-6098
ISSN (Online): 1874-6128

Research Article

Development of an Efficient, Non-Invasive Method for Cardiovascular Disease Risk Stratification in a Resource-Limited Setting

Author(s): Biswarup Pramanik and Amit Ghosh*

Volume 12, Issue 2, 2019

Page: [91 - 99] Pages: 9

DOI: 10.2174/1874609812666190618105111


Background: Augmentation Index (AIx) is considered as an important predictor of cardiovascular disease. So, quantification of AIx may provide a rapid cost-effective and non-invasive means of cardiovascular risk stratification. At present, WHO/ISH risk prediction charts are used to predict 10-year risk of a fatal or nonfatal major cardiovascular event, an assessment which requires laboratory support for blood chemistry and thus making it ill-suited for resource-limited settings.

Objectives: In this study, we examined the association of AIx with cardiovascular risk as determined by the WHO/ISH chart and identified AIx cut-offs to stratify patients into different risk categories.

Methods: A case-control study with 162 cases and 61 controls was conducted in a tertiary care hospital in eastern India. Data were obtained for demographic, anthropometric, cardiovascular, and biochemical parameters. Cardiovascular risk assessment was carried out by WHO/ISH risk model in R. Statistical analysis was done for examining the association of AIx with WHO/ISH cardiovascular risk and for identifying AIx cut-offs to stratify patients into different risk categories.

Results: Box and whisker plots for assessing the correlation between AIx and WHO/ISH cardiovascular risk showed an increase in the median value of AIx with increasing risk in both cases and controls. Heart rate corrected AIx showed a steady increase with increasing risk in males. AIx cutoffs showed good sensitivity and specificity for each risk category.

Conclusion: AIx is remarkably associated with cardiovascular risk as assessed by the WHO/ISH chart and the AIx cut-offs obtained in the study can be used as an efficient, non-invasive surrogate biomarker of cardiovascular risk even in resource-limited settings.

Keywords: Cardiovascular diseases, vascular stiffness, pulse wave analysis, risk assessment, AIx, anthropometric.

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Graphical Abstract
Islam SM, Purnat TD, Phuong NT, Mwingira U, Schacht K, Fröschl G. Non-communicable diseases (NCDs) in developing countries: a symposium report. Global Health 2014; 10: 81.
[] [PMID: 25498459]
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in india: Current epidemiology and future directions. Circulation 2016; 133(16): 1605-20.
[] [PMID: 27142605]
Nag T, Ghosh A. Cardiovascular disease risk factors in Asian Indian population: A systematic review. J Cardiovasc Dis Res 2013; 4(4): 222-8.
[PMID: 24653585]
Director General of Health Services, Ministry of Health and Family Welfare, Government of India. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke 2009 - A Manual for Medical Officer. 10-8.
Raghu A, Praveen D, Peiris D, Tarassenko L, Clifford G. Implications of cardiovascular disease risk assessment using the WHO/ISH risk prediction charts in rural India. PLoS One 2015; 10(8)e0133618
[] [PMID: 26287807]
Franklin SS. Beyond blood pressure: Arterial stiffness as a new biomarker of cardiovascular disease. J Am Soc Hypertens 2008; 2(3): 140-51.
[] [PMID: 20409896]
Yingchoncharoen T, Limpijankit T, Jongjirasiri S, Laothamatas J, Yamwong S, Sritara P. Arterial stiffness contributes to coronary artery disease risk prediction beyond the traditional risk score (RAMA-EGAT score). Heart Asia 2012; 4(1): 77-82.
[] [PMID: 23585778]
O’Rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol 2007; 50(1): 1-13.
[] [PMID: 17601538]
Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55(13): 1318-27.
[] [PMID: 20338492]
Obara S, Hayashi S, Hazama A, Murakawa M, Katsuda S. Correlation between augmentation index and pulse wave velocity in rabbits. J Hypertens 2009; 27(2): 332-40.
[] [PMID: 19155789]
Ghosh A, Dharmarajan A, Swain PK, Das D, Verma P, Tripathy PR. Impact of cardiovascular factors on pulse wave velocity and total vascular resistance in different age group patients with cardiovascular disorders. Curr Aging Sci 2019; 11(4): 261-8.
[] [PMID: 30813882]
Nichols WW, Singh BM. Augmentation index as a measure of peripheral vascular disease state. Curr Opin Cardiol 2002; 17(5): 543-51.
[] [PMID: 12357133]
Nürnberger J, Keflioglu-Scheiber A, Opazo Saez AM, Wenzel RR, Philipp T, Schäfers RF. Augmentation index is associated with cardiovascular risk. J Hypertens 2002; 20(12): 2407-14.
[] [PMID: 12473865]
Xiao WK, Ye P, Luo LM, Liu DJ, Wu HM. Radial augmentation index is associated with cardiovascular risk and arterial stiffness. Zhonghua Nei Ke Za Zhi 2011; 50(10): 831-5.
[PMID: 22321322]
Aminuddin A, Chellappan K, Maskon O, et al. Augmentation index is a better marker for cardiovascular risk in young Malaysian males. A comparison of involvement of pulse wave velocity, augmentation index, and C-reactive protein. Saudi Med J 2014; 35(2): 138-46.
[PMID: 24562512]
Fischer-Rasokat U, Brenck F, Zeiher AM, Spyridopoulos I. Radial augmentation index unmasks premature coronary artery disease in younger males. Blood Press Monit 2009; 14(2): 59-67.
[] [PMID: 19295416]
Luepker RV, Evans A, McKeigue P, Reddy KS. Cardiovascular survey methods . 3rd ed. Geneva: World Health Organization; 2004 [cited 2019 April 21]. Available from: http://wwwwhoint/iris/handle/10665/42569.
Misra A, Chowbey P, Makkar BM, et al. Concensus Group. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57: 163-70.
[PMID: 19582986]
Collins D, Lee J, Bobrovitz N, Koshiaris C, Ward A, Heneghan C. whoishRisk - An R package to calculate WHO/ISH cardiovascular risk scores for all epidemiological subregions of the world. Version 2 F1000Res 2016; 5: 2522.
R Core Team, R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, 2017
Robin X, Turck N, Hainard A, et al. pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 2011; 12: 77.
[] [PMID: 21414208]
Janić M, Lunder M, Sabovič M. Arterial stiffness and cardiovascular therapy. BioMed Res Int 2014.2014621437
[] [PMID: 25170513]
Shimizu M, Kario K. Role of the augmentation index in hypertension. Ther Adv Cardiovasc Dis 2008; 2(1): 25-35.
[] [PMID: 19124405]
Kuznetsov AA, Tsvetkova EE, Denisova DV, Ragino YI, Voevoda MI. Central aortic pressure: Reference and diagnostic values. Kardiologiia 2019; 59(3): 11-7.
[] [PMID: 30990136]
Teren A, Beutner F, Wirkner K, Löffler M, Scholz M. Relationship between determinants of arterial stiffness assessed by diastolic and suprasystolic pulse oscillometry: Comparison of vicorder and vascular explorer. Medicine (Baltimore) 2016; 95(10)e2963
[] [PMID: 26962797]
Sharma KH, Sharma N, Shah K, Patil S. Impact of coronary artery disease on augmentation index as measured by estimated central blood pressure: A case control study in Asian Indians. Indian Heart J 2018; 70(5): 615-21.
[] [PMID: 30392497]
Ghorpade AG, Shrivastava SR, Kar SS, Sarkar S, Majgi SM, Roy G. Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India. Int J Health Policy Manag 2015; 4(8): 531-6.
[] [PMID: 26340393]
Wilkinson IB, Prasad K, Hall IR, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol 2002; 39(6): 1005-11.
[] [PMID: 11897443]
Barraclough JY, Garden FL, Toelle B, et al. Sex differences in aortic augmentation index in adolescents. J Hypertens 2017; 35(10): 2016-24.
[] [PMID: 28590266]
Choi J, Kim SY, Joo SJ, Kim KS. Augmentation index is associated with coronary revascularization in patients with high Framingham risk scores: A hospital-based observational study. BMC Cardiovasc Disord 2015; 15: 131.
[] [PMID: 26481213]

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