Carotid Artery Stiffness Mechanisms, Heart Failure Events and Atrial Fibrillation in MESA: The Multi-Ethnic Study of Atherosclerosis

Background Arterial stiffness can be separated into 2 main mechanisms: (1) load-dependent stiffening from higher blood pressure and (2) structural stiffening due to remodeling of the vessel wall. The relationship of stiffness mechanisms with heart failure (HF) and atrial fibrillation (AF) is unknown. Methods and Results MESA (Multi-Ethnic Study of Atherosclerosis) participants with baseline carotid ultrasound images were included in this study (HF n=6278; AF n=5292). Carotid pulse wave velocity (cPWV) was calculated from B-mode carotid ultrasound to represent total stiffness. Structural stiffness was calculated by adjusting cPWV to a 120/80 mm Hg blood pressure with participant-specific models. Load-dependent stiffness was the difference of total and structural stiffness. Associations with incident heart failure events and atrial fibrillation diagnosis were assessed with adjusted Cox hazard models. 407 HF events and 1157 AF diagnoses occurred during a median 17.7 and 16.8 years of follow-up. The associations of carotid artery stiffness mechanisms with HF events were: total cPWV (adjusted HR per 1SD 1.09 [0.98-1.22], p=0.11; structural cPWV adjusted HR 1.06 [0.94-1.18], p=0.33; and load-dependent PWV adjusted HR 1.23 [1.05-1.44] per 1 m/s, p=0.009. The associations of carotid artery stiffness mechanisms with AF diagnoses were: total cPWV adjusted HR 1.11 [1.04-1.20], p=0.004; structural cPWV adjusted HR 1.10 [1.02-1.16], p=0.017; load-dependent cPWV adjusted HR 1.12 [1.02-1.23], p=0.020. Conclusions Both structural and load-dependent cPWV were associated with the development of AF and load dependent cPWV was associated with HF events. These findings indicate that load-dependent cPWV may be a potential treatment target to reduce the incidence of both HF and AF.