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J Am Coll Cardiol, 2002; 39:1005-1011
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CORONARY ARTERY DISEASE

Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia

Ian B. Wilkinson, MA, BM*, Krishna Prasad, MB{dagger}, Ian R. Hall, BSc, MB{dagger}, Anne Thomas, BN{dagger}, Helen MacCallum, BN*, David J. Webb, MD{dagger}, Michael P. Frenneaux, MD{dagger} and John R. Cockcroft, BSc, MB{dagger},*

* Clinical Pharmacology Unit, Department of Medical Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
{dagger} Department of Cardiology, University of Wales College of Medicine, University Hospital, Cardiff, United Kingdom

Manuscript received January 13, 2000; revised manuscript received December 7, 2001, accepted December 21, 2001.

* Reprint requests and correspondence: Dr. John R. Cockcroft, Department of Cardiology, University of Wales College of Medicine, University Hospital, Cardiff CF4 4XN, United Kingdom.
cockcroftjr{at}cf.ac.uk

OBJECTIVES: The goal of this study was to investigate the relation between serum cholesterol, arterial stiffness and central blood pressure.

BACKGROUND: Arterial stiffness and pulse pressure are important determinants of cardiovascular risk. However, the effect of hypercholesterolemia on arterial stiffness is controversial, and central pulse pressure has not been previously investigated.

METHODS: Pressure waveforms were recorded from the radial artery in 68 subjects with hypercholesterolemia and 68 controls, and corresponding central waveforms were generated using pulse wave analysis. Central pressure, augmentation index (AIx) (a measure of systemic stiffness) and aortic pulse wave velocity were determined.

RESULTS: There was no significant difference in peripheral blood pressure between the two groups, but central pulse pressure was significantly higher in the group with hypercholesterolemia (37 ± 11 mm Hg vs. 33 ± 10 mm Hg [means ± SD]; p = 0.028). Augmentation index was also significantly higher in the patients with hypercholesterolemia group (24.8 ± 11.3% vs. 15.6 ± 12.1%; p < 0.001), as was the estimated aortic pulse wave velocity. In a multiple regression model, age, short stature, peripheral mean arterial pressure, smoking and low-density lipoprotein cholesterol correlated positively with AIx, and there was an inverse correlation with heart rate and male gender.

CONCLUSIONS: Patients with hypercholesterolemia have a higher central pulse pressure and stiffer blood vessels than matched controls, despite similar peripheral blood pressures. These hemodynamic changes may contribute to the increased risk of cardiovascular disease associated with hypercholesterolemia, and assessment may improve risk stratification.

Abbreviations and Acronyms
  PMAP
  AIx
  augmentation index
  DPTI
  diastolic pressure time integral
  FH
  familial hypercholesterolemia
  HDL
  high-density lipoprotein
  LDL
  low-density lipoprotein
  PMAP
  peripheral mean arterial pressure
  PWA
  pulse wave analysis
  TTI
  tension time index




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