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 12, December 2018, pages 883-890

Clinical Usefulness of the Cardio-Ankle Vascular Index as a Predictor of Primary Cardiovascular Events in Patients With Chronic Kidney Disease

Figure 2. Kaplan-Meier curve for the incidence of major adverse cardiovascular events. The Kaplan-Meier curve confirmed that group H had a significantly higher incidence of major adverse cardiovascular events compared with groups M and L (log-rank test, P < 0.001). ^*P < 0.001 vs. group L, **P = 0.112 vs. group L, ^#P < 0.001 vs. group M.

Figure 3. Prediction of major adverse cardiovascular events at follow-up period using CAVI. A cut-off value for CAVI of 9.7 yielded the largest area under the curve of 0.701 (95% confidence interval: 0.657 - 0.743, P < 0.001), with a sensitivity of 74.0% and specificity of 59.6% for discriminating between those who did and did not experience major adverse cardiovascular events during the follow-up period. CAVI: cardio-ankle vascular index.

**Table 1.** Characteristics of Patients
	Overall	Group L	Group M	Group H	P value
Continuous values are mean ± SD. CAVI: cardio-ankle vascular index; SBP: systolic blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; U-Alb: urinary albumin; RAS: renin-angiotensin system. P < 0.001 vs. Group L; P < 0.01 vs. Group L; **P < 0.05 vs. Group L; ^#P < 0.001 vs. Group M; ^##P < 0.01 vs. Group M; ^###P < 0.05 vs. Group M.
n (male/female)	460 (152/308)	100 (25/75)	199 (63/136)	161 (64/97)***	< 0.05
Age (yrs)	74 ± 12	71 ± 10	73 ± 11	75 ± 13**	< 0.05
Risk factors
CAVI	9.7 ± 1.1	8.4 ± 0.5	9.5 ± 0.2*	10.9 ± 0.8*^#	< 0.001
Obesity, n (%)	136 (30)	27 (27)	56 (28)	53 (33)	0.503
Current smoker, n (%)	79 (17)	12 (12)	33 (17)	34 (21)	0.159
Hypertension, n (%)	323 (70)	65 (65)	135 (68)	123 (76)	0.09
SBP (mm Hg)	142 ± 16	138 ± 17	141 ± 16	144 ± 13**	< 0.05
DBP (mm Hg)	87 ± 11	85 ± 11	88 ± 11***	89 ± 11**	< 0.05
Dyslipidemia, n (%)	320 (70)	77 (77)	133 (67)	110 (68)	0.181
Diabetes mellitus, n (%)	155 (34)	24 (24)	65 (33)	66 (41)**	< 0.05
Laboratory findings
eGFR (mL/min/1.73m²)	47 ± 9	50 ± 8	47 ± 9**	45 ± 10*^###	< 0.001
Total cholesterol (mg/dL)	216 ± 37	217 ± 35	214 ± 39	218 ± 37	0.626
LDL cholesterol (mg/dL)	129 ± 35	130 ± 30	126 ± 35	133 ± 36	0.246
Triglyceride (mg/dL)	138 ± 63	148 ± 72	139 ± 62	130 ± 57	0.073
HDL cholesterol (mg/dL)	59 ± 15	58 ± 14	60 ± 15	59 ± 15	0.462
FBG (mg/dL)	110 ± 22	107 ± 20	108 ± 20	116 ± 25**^##	< 0.001
Skin AF (AU)	2.7 ± 0.5	2.5 ± 0.5	2.7 ± 0.5***	2.9 ± 0.5*^#	< 0.001
d-ROMs test (U.Carr)	328 ± 86	307 ± 88	324 ± 82	346 ± 88*^###	< 0.001
U-Alb (mg/g Cr)	1.5 ± 0.6	1.4 ± 0.5	1.5 ± 0.6	1.6 ± 0.6*^###	< 0.01
Medication
RAS inhibitor, n (%)	164 (36)	36 (36)	63 (32)	65 (40)	0.229
Statin, n (%)	158 (34)	32 (32)	75 (38)	51 (32)	0.421
Anti-diabetic drugs, n (%)	116 (25)	20 (20)	53 (27)	43 (27)	0.399

Table 1. Characteristics of Patients

Overall

Group L

Group M

Group H

P value

Continuous values are mean ± SD. CAVI: cardio-ankle vascular index; SBP: systolic blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; U-Alb: urinary albumin; RAS: renin-angiotensin system. *P < 0.001 vs. Group L; **P < 0.01 vs. Group L; ***P < 0.05 vs. Group L; ^#P < 0.001 vs. Group M; ^##P < 0.01 vs. Group M; ^###P < 0.05 vs. Group M.

n (male/female)

460 (152/308)

100 (25/75)

199 (63/136)

161 (64/97)***

< 0.05

Age (yrs)

74 ± 12

71 ± 10

73 ± 11

75 ± 13**

< 0.05

Risk factors

CAVI

9.7 ± 1.1

8.4 ± 0.5

9.5 ± 0.2*

10.9 ± 0.8*^#

< 0.001

Obesity, n (%)

136 (30)

27 (27)

56 (28)

53 (33)

0.503

Current smoker, n (%)

79 (17)

12 (12)

33 (17)

34 (21)

0.159

Hypertension, n (%)

323 (70)

65 (65)

135 (68)

123 (76)

0.09

SBP (mm Hg)

142 ± 16

138 ± 17

141 ± 16

144 ± 13**

< 0.05

DBP (mm Hg)

87 ± 11

85 ± 11

88 ± 11***

89 ± 11**

< 0.05

Dyslipidemia, n (%)

320 (70)

77 (77)

133 (67)

110 (68)

0.181

Diabetes mellitus, n (%)

155 (34)

24 (24)

65 (33)

66 (41)**

< 0.05

Laboratory findings

eGFR (mL/min/1.73m²)

47 ± 9

50 ± 8

47 ± 9**

45 ± 10*^###

< 0.001

Total cholesterol (mg/dL)

216 ± 37

217 ± 35

214 ± 39

218 ± 37

0.626

LDL cholesterol (mg/dL)

129 ± 35

130 ± 30

126 ± 35

133 ± 36

0.246

Triglyceride (mg/dL)

138 ± 63

148 ± 72

139 ± 62

130 ± 57

0.073

HDL cholesterol (mg/dL)

59 ± 15

58 ± 14

60 ± 15

59 ± 15

0.462

FBG (mg/dL)

110 ± 22

107 ± 20

108 ± 20

116 ± 25**^##

< 0.001

Skin AF (AU)

2.7 ± 0.5

2.5 ± 0.5

2.7 ± 0.5***

2.9 ± 0.5*^#

< 0.001

d-ROMs test (U.Carr)

328 ± 86

307 ± 88

324 ± 82

346 ± 88*^###

< 0.001

U-Alb (mg/g Cr)

1.5 ± 0.6

1.4 ± 0.5

1.5 ± 0.6

1.6 ± 0.6*^###

< 0.01

Medication

RAS inhibitor, n (%)

164 (36)

36 (36)

63 (32)

65 (40)

0.229

Statin, n (%)

158 (34)

32 (32)

75 (38)

51 (32)

0.421

Anti-diabetic drugs, n (%)

116 (25)

20 (20)

53 (27)

43 (27)

0.399

**Table 2.** Clinical Parameters at Registration of Patients With and Without Major Adverse Cardiovascular Events
	MACE (-)	MACE (+)	P value
Continuous values are mean ± SD. SBP: systolic blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; U-Alb: urinary albumin, RAS: renin-angiotensin system.
n (male/female)	363 (121/242)	97 (31/66)	0.798
Age (yrs)	72 ± 11	79 ± 11	< 0.001
Obesity, n (%)	110 (30)	26 (27)	0.503
Current smoker, n (%)	55 (15)	24 (25)	< 0.05
Hypertension, n (%)	241 (66)	82 (85)	< 0.001
SBP (mm Hg)	140 ± 15	147 ± 16	< 0.001
DBP (mm Hg)	87 ± 11	89 ± 11	0.093
Dyslipidemia, n (%)	257 (71)	63 (65)	0.267
Diabetes mellitus, n (%)	104 (29)	51 (53)	< 0.001
eGFR (mL/min/1.73m²)	48 ± 8	43 ± 11	< 0.001
Total cholesterol (mg/dL)	216 ± 38	217 ± 36	0.852
LDL cholesterol (mg/dL)	129 ± 35	130 ± 35	0.893
Triglyceride (mg/dL)	138 ± 63	139 ± 62	0.927
HDL cholesterol (mg/dL)	59 ± 15	59 ± 14	0.939
FBG (mg/dL)	109 ± 20	116 ± 27	< 0.01
Skin AF (AU)	2.6 ± 0.5	3.0 ± 0.5	< 0.001
d-ROMs test (U. Carr)	319 ± 84	360 ± 89	< 0.001
U-Alb (mg/g Cr)	1.5 ± 0.5	1.7 ± 0.7	< 0.001
RAS inhibitor, n (%)	143 (39)	21 (21)	< 0.01
Statin, n (%)	135 (37)	23 (24)	< 0.05
Anti-diabetic drug, n (%)	94 (26)	22 (23)	0.518

Table 2. Clinical Parameters at Registration of Patients With and Without Major Adverse Cardiovascular Events

MACE (-)

MACE (+)

P value

Continuous values are mean ± SD. SBP: systolic blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; U-Alb: urinary albumin, RAS: renin-angiotensin system.

n (male/female)

363 (121/242)

97 (31/66)

0.798

Age (yrs)

72 ± 11

79 ± 11

< 0.001

Obesity, n (%)

110 (30)

26 (27)

0.503

Current smoker, n (%)

55 (15)

24 (25)

< 0.05

Hypertension, n (%)

241 (66)

82 (85)

< 0.001

SBP (mm Hg)

140 ± 15

147 ± 16

< 0.001

DBP (mm Hg)

87 ± 11

89 ± 11

0.093

Dyslipidemia, n (%)

257 (71)

63 (65)

0.267

Diabetes mellitus, n (%)

104 (29)

51 (53)

< 0.001

eGFR (mL/min/1.73m²)

48 ± 8

43 ± 11

< 0.001

Total cholesterol (mg/dL)

216 ± 38

217 ± 36

0.852

LDL cholesterol (mg/dL)

129 ± 35

130 ± 35

0.893

Triglyceride (mg/dL)

138 ± 63

139 ± 62

0.927

HDL cholesterol (mg/dL)

59 ± 15

59 ± 14

0.939

FBG (mg/dL)

109 ± 20

116 ± 27

< 0.01

Skin AF (AU)

2.6 ± 0.5

3.0 ± 0.5

< 0.001

d-ROMs test (U. Carr)

319 ± 84

360 ± 89

< 0.001

U-Alb (mg/g Cr)

1.5 ± 0.5

1.7 ± 0.7

< 0.001

RAS inhibitor, n (%)

143 (39)

21 (21)

< 0.01

Statin, n (%)

135 (37)

23 (24)

< 0.05

Anti-diabetic drug, n (%)

94 (26)

22 (23)

0.518

**Table 3.** Multivariate Cox Regression Analysis for Major Adverse Cardiovascular Events
	HR	95% CI	P value
HR: hazard ratio; CI: confidence interval; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; RAS: renin-angiotensin system; eGFR: estimated glomerular filtration rate.
Diabetes mellitus	2.50	1.38 - 4.60	< 0.01
Group H (vs non-Group H)	2.04	1.31 - 3.02	< 0.01
Age (≥ 75yrs)	1.81	1.03 - 3.22	< 0.05
Skin AF (≥ 3.0AU)	1.64	1.09 - 2.63	< 0.05
d-ROMs test (≥ 330 U. Carr)	1.61	1.01 - 2.79	< 0.05
RAS inhibitor	0.58	0.23 - 0.99	< 0.05
Current smoker	1.58	0.93 - 2.69	0.089
Albuminuria	1.39	0.92 - 2.11	0.137
Statin	0.70	0.42 - 1.15	0.178
eGFR (< 30mL/min/1.73m²)	1.40	0.79 - 2.53	0.255
Hypertension	1.26	0.73 - 2.16	0.399

Table 3. Multivariate Cox Regression Analysis for Major Adverse Cardiovascular Events

95% CI

P value

HR: hazard ratio; CI: confidence interval; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites; RAS: renin-angiotensin system; eGFR: estimated glomerular filtration rate.

Diabetes mellitus

2.50

1.38 - 4.60

< 0.01

Group H (vs non-Group H)

2.04

1.31 - 3.02

< 0.01

Age (≥ 75yrs)

1.81

1.03 - 3.22

< 0.05

Skin AF (≥ 3.0AU)

1.64

1.09 - 2.63

< 0.05

d-ROMs test (≥ 330 U. Carr)

1.61

1.01 - 2.79

< 0.05

RAS inhibitor

0.58

0.23 - 0.99

< 0.05

Current smoker

1.58

0.93 - 2.69

0.089

Albuminuria

1.39

0.92 - 2.11

0.137

Statin

0.70

0.42 - 1.15

0.178

eGFR (< 30mL/min/1.73m²)

1.40

0.79 - 2.53

0.255

Hypertension

1.26

0.73 - 2.16

0.399