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• Points to be considered when using cardio ankle vascular index (CAVI) as a marker of arterial stiffness
  Javad Alizargar, Nan-Chen Hsieh and Shu-Fang Vivienne Wu
  Published on: 13 December 2019

• Published on: 13 December 2019

  Points to be considered when using cardio ankle vascular index (CAVI) as a marker of arterial stiffness

  • Javad Alizargar, Assistant Researcher Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and health sciences, Taipei City 112,
  • Other Contributors:
    • Nan-Chen Hsieh, Professor
    • Shu-Fang Vivienne Wu, Professor

  Letter to editor:
  We read with interest the article by Zhang et al. [1], in which they concluded that total hip bone mineral density was correlated with cardio ankle vascular index (CAVI). However, some common mistakes can happen in the studies using CAVI as a marker of arterial stiffness. First, Pearson’s correlation between this marker and other continuous variables should be considered after testing both variables for normality. Normality of the variables had been proposed as an assumption for the Pearson’s correlation analysis [2], if this assumption is not met, Spearman’s correlation should be performed after categorization of the continuous variables.
  Second point that is essential in evaluation of CAVI is the effects of age on CAVI. Age has been proved to be largely correlated to CAVI and many studies tried to make reference values for CAVI in different age groups. Namekata et al. [3] provided reference values which can be used to categorize CAVI in the study individuals. Although Zhang et al. [1] controlled for age in the multiple linear regression, using reference values of CAVI in every individual could completely change the results and conclusions of their study. Although in the study of Zhange et al. [1] we can see the biggest correlation (r=0.631, P<0.001) between age and CAVI, correlation of age with other variables cannot be seen and there is a possibility that age and bone mineral density is also high. So, conclusions about the independent as...

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  Letter to editor:
  We read with interest the article by Zhang et al. [1], in which they concluded that total hip bone mineral density was correlated with cardio ankle vascular index (CAVI). However, some common mistakes can happen in the studies using CAVI as a marker of arterial stiffness. First, Pearson’s correlation between this marker and other continuous variables should be considered after testing both variables for normality. Normality of the variables had been proposed as an assumption for the Pearson’s correlation analysis [2], if this assumption is not met, Spearman’s correlation should be performed after categorization of the continuous variables.
  Second point that is essential in evaluation of CAVI is the effects of age on CAVI. Age has been proved to be largely correlated to CAVI and many studies tried to make reference values for CAVI in different age groups. Namekata et al. [3] provided reference values which can be used to categorize CAVI in the study individuals. Although Zhang et al. [1] controlled for age in the multiple linear regression, using reference values of CAVI in every individual could completely change the results and conclusions of their study. Although in the study of Zhange et al. [1] we can see the biggest correlation (r=0.631, P<0.001) between age and CAVI, correlation of age with other variables cannot be seen and there is a possibility that age and bone mineral density is also high. So, conclusions about the independent association of CAVI and bone mineral density is further questionable.
  References
  1. Zhang, M., et al., Links between arterial stiffness and bone mineral density in middle-aged and elderly Chinese individuals: a cross-sectional study. BMJ Open, 2019. 9(8): p. e029946.
  2. Hazra, A. and N. Gogtay, Biostatistics Series Module 6: Correlation and Linear Regression. Indian J Dermatol, 2016. 61(6): p. 593-601.
  3. Namekata, T., et al., Establishing baseline criteria of cardio-ankle vascular index as a new indicator of arteriosclerosis: a cross-sectional study. 2011. 11(1): p. 51.

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  Conflict of Interest:
  None declared.

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