Novel vascular risk markers in community-dwelling adults with and without stroke

Abstract

Stroke is the leading cause of adult neurological disability. Novel markers of vascular disease progression, such as arterial stiffness and endothelial function, may provide early and sensitive stroke risk detection. However, measurement properties of these novel vascular risk markers have not yet been established in the post-stroke population, nor has the association between these risk markers and measures of physical function. Moreover, given that subclinical vascular disease may initially manifest as a decline in cognitive function, understanding vascular disease progression in older adults with and without cognitive impairment may provide information regarding early stroke risk. This study aimed to investigate 1) test-retest reliability and between-side differences in novel vascular risk markers in individuals with stroke, 2) differences in arterial stiffness and endothelial function between older adults without cognitive impairment, with cognitive impairment, and with stroke, and 3) relationships between novel vascular risk markers and physical function in individuals with and without stroke. Participants were 50-80 years of age, able to ambulate ≥10 meters, and for those with stroke, ≥1 year post-stroke. Carotid-femoral, carotid-radial, and femoral-foot pulse wave velocity (cfPWV, crPWV, and ffPWV, respectively) were used to quantify systemic arterial stiffness, and compliance and distensibility were used to quantify local carotid arterial stiffness. Flow-mediated dilation (FMD) was used to quantify endothelial function. Findings revealed almost perfect test-retest reliability of cfPWV (ICC>0.91, P<0.0001) and substantial test-retest reliability of FMD in individuals with stroke (ICC>0.70, P<0.01). There were no between-side differences in novel vascular measures, no differences in these measures across subgroups of increasing vascular risk, and a positive correlation between cfPWV and walking speed. Findings suggest that in the post-stroke population, cfPWV and FMD may be the most appropriate measures of vascular risk progression, that it may be more clinically feasibly to assess these measures on the unaffected side.