Reflection Magnitude, a Measure of Arterial Stiffness, Predicts Incident Heart Failure in Men But Not Women: Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Arterial stiffness is a risk factor for heart failure (HF) and is higher in women. Our objective was to investigate sex differences between arterial stiffness and incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA) population. Methods and Results: Applanation tonometry from 5959 participants (52.8% women) was used to calculate augmentation index (AIx), pulse pressure amplification (PPA), and reflection magnitude (RM). Sex specific risk of HF was assessed with the use of a competing-risk regression model. Women had higher AIx (P <.00001), higher RM (P =.023), and lower PPA (P <.00001) indicating greater arterial stiffness in women. However, increasing RM quartile independently predicted HF in men (adjusted hazard ratios and 95% confidence intervals: Q2: 2.05 [1.06-3.96; P =.033]; Q3: 2.49 [1.30-4.73; P =.006]; Q4: 3.26 [1.75-6.08; P =.0002]) but not in women (Q2: 1.04 [0.54-1.98; P =.91]; Q3: 1.30 [0.71-2.37; P =.4]; Q4: 0.79 [0.4-1.55; P =.49]). Conclusion: Women demonstrate greater arterial stiffness than men. Despite this, arterial stiffness, as measured by RM, predicts incident HF in men but not in women. RM represents a novel risk factor for HF in men but not in women. Further investigation of risk factors for HF in women is warranted. Conclusion: Arterial stiffness, measured by RM, predicts incident HF in men but not in women in this MESA cohort. (J Cardiac Fail 2017;23:353-362)