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. 2020 Feb 24;22(3):465–474. doi: 10.1111/jch.13764

Table 5.

Summary of studies investigating the association between cardio‐ankle vascular index (CAVI) and cardiovascular (CV) outcomes

Study Subjects (n) Follow‐up Baseline data CV outcomes
Kato et al, 201223 HD pts (n = 135) 5.3 y

Mean age: 60 ± 11 y

Male: 67.4%

Time on HD: 110 ± 93 mo

CAVI: 9.7 ± 3.0
In a Cox proportional hazard analysis, CAVI tertile was not significantly associated with CV mortality. HR (95% CI) for CV mortality in CAVI tertiles:
  • <8.0: reference (HR 1.0)
  • 8.0‐<9.9:0.98 (0.28‐3.37)
  • ≥9.9:2.59 (0.91‐7.34)
Otsuka et al, 201417 Newly‐diagnosed CAD (n = 211) 2.9 y

Mean age: 65 ± 10 y

Male: 56%

CAVI: 10.05 ± 0.78 and 9.87 ± 0.65 in pt subgroups who went on to have improved or persistently impaired CAVI at 6 mo, respectively
In a Cox proportional hazards model, persistently impaired CAVI at 6 mo was a significant independent predictor of CV events (cardiac death, non‐fatal MI, unstable angina, coronary revascularization, stroke) vs improved CAVI at 6 mo:
  • HR 3.3; 95% CI 1.47‐8.59; P < .01
Chung, 201518 T2DM (n = 626) 4.1 y

Mean age: 64 y (range 37‐90)

Male: 46%

CAVI: 8.8 ± 1.4
In a logistic regression analysis, CAVI of ≥9.0 vs <9.0 was a significant predictor of CV events (PCI, CABG, coronary revascularization, ACS, ischemic stroke, death):
  • Adjusted OR 1.23 (95% CI 1.07‐1.42); P = .05
Sato‐Asahara et al, 201519 Obese pts (n = 425) 5 y

Mean age: 51.5 ± 14.1 y

Male: 44.5%

CAVI: 7.6 ± 1.5
In a step‐wise multivariate Cox analysis adjusted for age and sex, CAVI was a significant predictor of CV events (PCI, MI, stroke, atherosclerosis):
  • HR per 1‐unit increase in CAVI, 1.44 (95% CI 1.02‐2.02); P = .037
Laucevicius et al, 201520 MS without overt atherosclerosis (n = 2106) 3.8 y

Mean age: 53.8 ± 6.2 y

Male: 38%

CAVI: 7.92 ± 1.43
Cox proportional hazard regression analysis showed that each SD increase in CAVI increased the risk of CV events (MI, stroke or TIA, sudden cardiac death) by 26%:
  • HR 1.26, 95% CI 1.03‐1.55; P = .026

This relationship was no longer statistically significant in the model adjusted for significant variables on univariate analysis. Kaplan‐Meier analysis showed that CAVI above the median was significantly associated with better CV event‐free survival (P = .038)
Sato et al, 201621 Outputs with metabolic disorders (n = 1003) 6.7 y

Mean age: 62.5 ± 11.2 y

Male: 51.2%

CAVI: 9.25 ± 1.61
Cox proportional hazards regression analysis showed that CAVI was independently associated with future CV event risk (acute MI, unstable angina pectoris, stable angina pectoris):
  • HR per 1‐unit increase in CAVI, 1.13 (95% CI 1.01‐1.26); P = .039
Gohbara et al, 201622 ACS (n = 288) 1.25 y

Low CAVI group (≤8.325):

Mean age: 58 ± 11 y

Male: 87%

High CAVI group (>8.325):

Mean age: 71 ± 9 y

Male: 78%
Multivariate Cox proportional hazards analysis for CV events (CV death, non‐fatal MI, non‐fatal ischemic stroke) in the high CAVI vs low CAVI group:
  • HR 18.0 (95% CI 2.4‐136.8); P = .005
Kusunose et al, 201624 Pts with ≥ 2 CV risk factors (n = 114) 4.25 y

Mean age: 69 ± 11 y

Male: 78%

CAVI: 8.5 ± 1.5
CAVI was not a significant predictor of CV events (cardiac death, non‐fatal MI/coronary revascularization, acute pulmonary edema, stroke) on univariable Cox proportional hazard analysis:
  • HR per 1‐unit increase in CAVI, 1.12 (95% CI 0.77‐1.63); P = .545
Furusawa et al, 201925 Asymptomatic pre‐dialysis CKD (n = 218) 3.4 y

Mean age: 68 ± 12 y

Male: 70%

CAVI: 9.1 ± 1.3
CAVI was not a significant predictor of CV events (CV death, MI, PCI, CABG, heart failure, cerebral infarction) on univariate Cox regression analysis:
  • HR 1.18 (95% CI 0.84‐1.18), P = .337

CAVI‐J study (NCT01859897);

Ongoing

 Pts with CV risk factors (n = 3000) 5 y Not yet reported Primary CV endpoints: cardiac death, non‐fatal MI, stroke
Coupling study (UMIN000018474); Ongoing Pts with CV risk factors 7 y

Mean age: 68.7 ± 11.4 y

Male: 52.4%

CAVI: 8.8 ± 1.4

 Primary CV endpoints: a composite of cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, stroke of unknown etiology, MI, CV intervention for angina pectoris, and sudden death

Abbreviations: ACI, aortic calcification index; ACS, acute coronary syndrome; CABG, coronary artery bypass graft; CAD, coronary artery disease; CAVI, cardio‐ankle vascular index; CI, confidence interval; CKD, chronic kidney disease; CV, cardiovascular; HD, hemodialysis; HR, hazard ratio; MI, myocardial infarction; mo, months; MS, metabolic syndrome; OR, odds ratio; PCI, percutaneous coronary intervention; pts, patients; SD, standard deviation; T2DM, type 2 diabetes mellitus; TIA, transient ischemic attack; y, years.