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Reference values for local arterial stiffness. Part A

carotid artery

Engelen, Liana,b,c; Bossuyt, Jelled; Ferreira, Isabelb,e; van Bortel, Luc M.d; Reesink, Koen D.b,f; Segers, Patrickg; Stehouwer, Coen D.a,b; Laurent, Stéphaneh; Boutouyrie, Pierreh on behalf of the Reference Values for Arterial Measurements Collaboration

doi: 10.1097/HJH.0000000000000654

Objective: Non-invasive measures of common carotid artery properties, such as diameter and distension, and pulse pressure, have been widely used to determine carotid artery distensibility coefficient – a measure of carotid stiffness (stiffness ∼1/distensibility coefficient). Carotid stiffness has been associated with incident cardiovascular disease (CVD) and may therefore be a useful intermediate marker for CVD. We aimed to establish age and sex-specific reference intervals of carotid stiffness.

Methods: We combined data on 22 708 individuals (age range 15–99 years, 54% men) from 24 research centres worldwide. Individuals without CVD and established cardiovascular risk factors constituted a healthy sub-population (n = 3601, 48% men) and were used to establish sex-specific equations for percentiles of carotid distensibility coefficient across age.

Results: In the sub-population without CVD and treatment (n = 12 906, 52% men), carotid distensibility coefficient Z-scores based on these percentile equations were independently and negatively associated, in men and women, respectively, with diabetes {−0.28 [95% confidence interval (CI) −0.41; −0.15] and −0.27 (−0.43; −0.12)}, mean arterial pressure [−0.26 (−0.29; −0.24) and −0.32 (−0.35; −0.29)], total-to-high-density lipoprotein cholesterol ratio [−0.05 (−0.09; −0.02) and −0.05 (−0.11; 0.01)] and BMI [−0.06 (−0.09; −0.04) and −0.05 (−0.08; −0.02)], whereas these were positively associated with smoking [0.30 (0.24; 0.36) and 0.24 (0.18; 0.31)].

Conclusions: We estimated age and sex-specific percentiles of carotid stiffness in a healthy population and assessed the association between cardiovascular risk factors and carotid distensibility coefficient Z-scores, which enables comparison of carotid stiffness values between (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures.

aDepartment of Internal Medicine

bCARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht

cTop Institute Food and Nutrition, Wageningen, the Netherlands

dHeymans Institute of Pharmacology, Research Unit of Clinical Pharmacology, Ghent University, Ghent, Belgium

eDepartment of Clinical Epidemiology and Medical Technology Assessment (KEMTA)

fDepartment of Biomedical Engineering, Maastricht University Medical Centre, Maastricht, the Netherlands

gInstitute Biomedical Technology, iMinds Medical IT, Ghent University, Ghent, Belgium

hDepartment of Pharmacology and INSERM U970, Hôpital Européen Georges Pompidou, Paris, France

*A complete author list is included in the Appendix (Table A1,

Correspondence to Lian Engelen, Department of Internal Medicine, Maastricht University Medical Centre, Universiteitssingel 50, 6200 MD Maastricht, the Netherlands.Tel: +31 43 388 2134; fax: +31 43 387 7005; e-mail:

Abbreviations: BP, blood pressure; CVD, cardiovascular disease; CV-RFs, cardiovascular risk factors; MAP, mean arterial pressure; PP, pulse pressure; PWV, pulse wave velocity

Received 5 December, 2014

Revised 11 May, 2015

Accepted 12 May, 2015

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