J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 4, April 2018, pages 330-336

Clinical Significance of Cardio-Ankle Vascular Index as a Cardiovascular Risk Factor in Elderly Patients With Type 2 Diabetes Mellitus

Figure 1. Comparisons of CAVI values between patients with and without CVD. CAVI was significantly higher in patients with CVD than in those without CVD (10.4 ± 1.4 vs. 9.5 ± 1.0, respectively, P < 0.001) even though mean age was similar between the two groups (76 ± 7 years vs. 75 ± 7 years, respectively). *P < 0.001 vs. CVD (-). CAVI: cardio-ankle vascular index; CVD: cardiovascular disease.

Figure 2. Results of multiple logistic regression analysis of CVD incidence or high hs-cTnT levels. (a) Subordinate factor is CVD incidence. Adjustment factors are skin autofluorescence, hs-cTnT, d-ROMs test, and age. (b) Subordinate factor is high hs-cTnT levels. High hs-cTnT was defined as hs-cTnT ≥ 0.014 ng/mL. Adjustment factors are skin autofluorescence, CVD, d-ROMs test, and age. *P < 0.05 vs. CAVI ≤ 9; **P < 0.001 vs. CAVI ≤ 9. CAVI: cardio-ankle vascular index; CVD: cardiovascular disease; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites.

**Table 1.** Patient Characteristics
Continuous values are mean ± SD. CVD: cardiovascular disease; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis assessment insulin resistance; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs- cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
n (male/female)	216 (96/120)
Age (years)	75 ± 7
CVD, n (%)	73 (34)
Body mass index	23.5 ± 4.3
Current smoker, n (%)	46 (21)
Hypertension, n (%)	156 (72)
Systolic blood pressure (mm Hg)	141 ± 21
Diastolic blood pressure (mm Hg)	86 ± 13
Dyslipidemia, n (%)	130 (60)
Total cholesterol (mg/dL)	219 ± 42
LDL-cholesterol (mg/dL)	138 ± 38
Triglyceride (mg/dL)	145 ± 57
HDL-cholesterol (mg/dL)	49 ± 18
Fasting blood glucose (mg/dL)	134 ± 26
HOMA-IR	2.5 ± 1.3
Hemoglobin A1c (%)	7.2 ± 1.0
Skin autofluorescence (AU)	2.7 ± 0.6
eGFR (mL/min/1.73 m²)	62.0 ± 19.5
Log-BNP (pg/mL)	1.7 ± 0.3
Log-hs-cTnT (ng/mL)	-2.1 ± 0.2
d-ROMs test (U. CARR)	365 ± 113
CAVI	9.8 ± 1.2
Medication
Sulfonylurea, n (%)	151 (70)
Metformin, n (%)	43 (20)
DPP-4 inhibitor, n (%)	125 (58)
Insulin, n (%)	17 (8)
RAS inhibitor, n (%)	118 (55)
Statin, n (%)	95 (44)

Table 1. Patient Characteristics

Continuous values are mean ± SD. CVD: cardiovascular disease; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis assessment insulin resistance; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs- cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

n (male/female)

216 (96/120)

Age (years)

75 ± 7

CVD, n (%)

73 (34)

Body mass index

23.5 ± 4.3

Current smoker, n (%)

46 (21)

Hypertension, n (%)

156 (72)

Systolic blood pressure (mm Hg)

141 ± 21

Diastolic blood pressure (mm Hg)

86 ± 13

Dyslipidemia, n (%)

130 (60)

Total cholesterol (mg/dL)

219 ± 42

LDL-cholesterol (mg/dL)

138 ± 38

Triglyceride (mg/dL)

145 ± 57

HDL-cholesterol (mg/dL)

49 ± 18

Fasting blood glucose (mg/dL)

134 ± 26

HOMA-IR

2.5 ± 1.3

Hemoglobin A1c (%)

7.2 ± 1.0

Skin autofluorescence (AU)

2.7 ± 0.6

eGFR (mL/min/1.73 m²)

62.0 ± 19.5

Log-BNP (pg/mL)

1.7 ± 0.3

Log-hs-cTnT (ng/mL)

-2.1 ± 0.2

d-ROMs test (U. CARR)

365 ± 113

CAVI

9.8 ± 1.2

Medication

Sulfonylurea, n (%)

151 (70)

Metformin, n (%)

43 (20)

DPP-4 inhibitor, n (%)

125 (58)

Insulin, n (%)

17 (8)

RAS inhibitor, n (%)

118 (55)

Statin, n (%)

95 (44)

**Table 2.** Relationship Between CAVI and Various Clinical Parameters
	r	P value
r expressed correlation coefficient. CAVI: cardio-ankle vascular index; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis assessment insulin resistance; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
Sex (female = 0, male = 1)	0.12	0.079
Age	0.19	< 0.001
Body mass index	0.04	0.566
Current smoker (no = 0, yes = 1)	0.11	0.105
Hypertension (no = 0, yes = 1)	0.13	0.059
Systolic blood pressure	0.30	< 0.001
Diastolic blood pressure	0.11	0.112
Dyslipidemia (no = 0, yes = 1)	0.08	0.288
Total cholesterol	-0.04	0.587
LDL-cholesterol	0.07	0.320
Triglyceride	-0.04	0.488
HDL-cholesterol	-0.10	0.139
Fasting blood glucose	0.11	0.105
HOMA-IR	0.14	< 0.05
Hemoglobin A1c	0.12	0.079
Skin autofluorescence	0.47	< 0.001
eGFR	-0.17	< 0.01
Log-BNP	0.13	< 0.05
Log-hs-cTnT	0.39	< 0.001
d-ROMs test	0.28	< 0.001
Sulfonylurea (no = 0, yes = 1)	0.03	0.501
Metformin (no = 0, yes = 1)	0.04	0.594
DPP-4 inhibitor (no = 0, yes = 1)	-0.06	0.320
Insulin (no = 0, yes = 1)	0.02	0.739
RAS inhibitor (no = 0, yes = 1)	-0.09	0.159
Statin (no = 0, yes = 1)	-0.10	0.142

Table 2. Relationship Between CAVI and Various Clinical Parameters

P value

r expressed correlation coefficient. CAVI: cardio-ankle vascular index; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis assessment insulin resistance; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

Sex (female = 0, male = 1)

0.12

0.079

Age

0.19

< 0.001

Body mass index

0.04

0.566

Current smoker (no = 0, yes = 1)

0.11

0.105

Hypertension (no = 0, yes = 1)

0.13

0.059

Systolic blood pressure

0.30

< 0.001

Diastolic blood pressure

0.11

0.112

Dyslipidemia (no = 0, yes = 1)

0.08

0.288

Total cholesterol

-0.04

0.587

LDL-cholesterol

0.07

0.320

Triglyceride

-0.04

0.488

HDL-cholesterol

-0.10

0.139

Fasting blood glucose

0.11

0.105

HOMA-IR

0.14

< 0.05

Hemoglobin A1c

0.12

0.079

Skin autofluorescence

0.47

< 0.001

eGFR

-0.17

< 0.01

Log-BNP

0.13

< 0.05

Log-hs-cTnT

0.39

< 0.001

d-ROMs test

0.28

< 0.001

Sulfonylurea (no = 0, yes = 1)

0.03

0.501

Metformin (no = 0, yes = 1)

0.04

0.594

DPP-4 inhibitor (no = 0, yes = 1)

-0.06

0.320

Insulin (no = 0, yes = 1)

0.02

0.739

RAS inhibitor (no = 0, yes = 1)

-0.09

0.159

Statin (no = 0, yes = 1)

-0.10

0.142

**Table 3.** Multiple Regression Analysis for CAVI
Explanatory factor	β	P value
CAVI: cardio-ankle vascular index; CVD: cardiovascular disease; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; eGFR: estimated glomerular filtration rate; β: standardized regression coefficient; R²: coefficient of determination.
Skin autofluorescence	0.30	< 0.001
CVD	0.19	< 0.001
Log-hs-cTnT	0.18	< 0.01
d-ROMs test	0.15	< 0.01
Age	0.12	< 0.05
eGFR	-0.08	0.193
R² = 0.32

Table 3. Multiple Regression Analysis for CAVI

Explanatory factor

P value

CAVI: cardio-ankle vascular index; CVD: cardiovascular disease; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; eGFR: estimated glomerular filtration rate; β: standardized regression coefficient; R²: coefficient of determination.

Skin autofluorescence

0.30

< 0.001

CVD

0.19

< 0.001

Log-hs-cTnT

0.18

< 0.01

d-ROMs test

0.15

< 0.01

Age

0.12

< 0.05

eGFR

-0.08

0.193

R² = 0.32