Carotid artery stiffness mechanisms, heart failure events, and atrial fibrillation in MESA: the Multi-Ethnic Study of Atherosclerosis

Arterial stiffness can be separated into two main mechanisms: <i>1</i>) load-dependent stiffening from higher blood pressure and <i>2</i>) structural stiffening due to remodeling of the vessel wall. The relationship of stiffness mechanisms with heart failure (HF) and atrial fibrillation (AF) is unknown. MESA (multi-ethnic study of atherosclerosis) participants with baseline carotid ultrasound images were included in this study (HF <i>n</i> = 6,278; AF <i>n</i> = 5,292). 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 mmHg blood pressure with participant-specific models. Load-dependent stiffness was the difference between total and structural stiffness. Associations with incident heart failure events and atrial fibrillation diagnosis were assessed with adjusted Cox hazard models. Four hundred-seven HF events and 1,157 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 1 SD 1.09 [0.98-1.22], <i>P</i> = 0.11; structural cPWV adjusted HR 1.06 [0.94-1.18], <i>P</i> = 0.33; and load-dependent PWV adjusted HR 1.23 [1.05-1.44] per 1 m/s, <i>P</i> = 0.009. The associations of carotid artery stiffness mechanisms with AF diagnoses were: total cPWV adjusted HR 1.11 (1.04-1.20), <i>P</i> = 0.004; structural cPWV adjusted HR 1.10 [1.02-1.16], <i>P</i> = 0.017; load-dependent cPWV adjusted HR 1.12 [1.02-1.23], <i>P</i> = 0.020. 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.<b>NEW & NOTEWORTHY</b> We evaluated associations between novel components of arterial stiffness: <i>1</i>) load-dependent stiffening from higher blood pressure and <i>2</i>) structural stiffening due to remodeling of the vessel wall and their associations with incident heart failure (<i>n</i> = 6,278) and atrial fibrillation (<i>n</i> = 5,292) over ∼17 years of follow-up. We found that both baseline structural and load-dependent stiffness were associated with the development of atrial fibrillation and load-dependent stiffness was associated with heart failure events.