J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 8, August 2026, pages 556-566

Clinical Significance of Cardio-Ankle Vascular Index in Stage A/B Heart Failure Patients With Type 2 Diabetes Mellitus

↓ Figure 1. Association between the combination of high CAVI and high BNP and the presence of stage B heart failure. (a) Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for stage B heart failure according to the number of risk factors (0, 1, or 2), with the 0-factor group as reference. Compared to patients with low CAVI and low BNP (0 factors), those with one high parameter (one factor) showed a 3.81-fold higher odds (OR: 3.81; 95% CI: 1.54–9.41, *P = 0.004), and those with both high parameters (two factors) showed a 9.72-fold higher odds (OR: 9.72; 95% CI: 3.24–19.92, P < 0.001). (b) Comparison of the adjusted OR between subjects with both risk factors (two factors) and those with only one risk factor (one factor) as the reference. The adjusted OR for the two-factor group was 5.36 (95% CI: 2.39–12.90, P < 0.001). Risk factors are defined as CAVI > 9.0 and BNP > 34.0 pg/mL. Adjustment factor: calf circumference, RAS inhibitors, E/e' ratio, skin autofluorescence, SEVR, GLP-1 receptor agonists, age, eGFR, CAD, SGLT2 inhibitors. Data expressed OR and 95% CI. HF: heart failure; CAVI: cardio-ankle vascular index; BNP: brain natriuretic peptide; OR: odds ratio; CI: confidence interval; RAS: renin–angiotensin system; SEVR: subendocardial viability ratio; GLP-1: glucagon-like peptide-1; eGFR: estimated glomerular filtration rate; CAD: coronary artery disease; SGLT2: sodium glucose cotransporter 2.

↓ Figure 2. The optimal cut-off values of CAVI and BNP threshold for distinguishing between stage A HF and stage B HF using the receiver operating characteristic curve analysis. This analysis indicated that 9.0 is the CAVI threshold for distinguishing between the two HF stages (a). For BNP, 34.0 pg/mL was the threshold for distinguishing between the two HF stages (b). Comparison between the AUC of CAVI and BNP was performed using the DeLong test (P = 0.073). CAVI: cardio-ankle vascular index; BNP: brain natriuretic peptide; HF: heart failure; AUC: area under the curve; CI: confidence interval.

↓ **Table 1.** Multivariate Analysis for CAVI
Variable	β	P value
R² = 0.663, P < 0.001, β: standardized regression coefficient. RAS: renin-angiotensin system; SEVR: subendocardial viability ratio; GLP-1: glucagon-like peptide-1; eGFR: estimated glomerular filtration rate; CAD: coronary artery disease; HF: heart failure; hs-CRP: high-sensitivity C-reactive protein; LAD: left atrial dimension; HbA1c: hemoglobin A1c; SGLT2: sodium glucose cotransporter 2; BNP: brain natriuretic peptide; IVSTd: interventricular septal thickness at end-diastole.
Calf circumference	−0.21	< 0.001
RAS inhibitors	−0.19	< 0.001
E/e'	0.18	< 0.001
Skin autofluorescence	0.17	0.001
SEVR	−0.17	0.001
GLP-1 receptor agonists	−0.16	0.002
Age	0.15	0.003
eGFR	−0.14	0.004
CAD	0.13	0.012
Stage B HF (vs. stage A HF)	0.12	0.013
SGLT2 inhibitors	−0.11	0.014
LAD	0.08	0.067
HbA1c	0.08	0.071
Body mass index	−0.07	0.110
hs-CRP	0.06	0.203
BNP	0.05	0.377
IVSTd	0.04	0.496
Current smoker	0.02	0.623

↓ Table 1. Multivariate Analysis for CAVI

Variable

P value

R² = 0.663, P < 0.001, β: standardized regression coefficient. RAS: renin-angiotensin system; SEVR: subendocardial viability ratio; GLP-1: glucagon-like peptide-1; eGFR: estimated glomerular filtration rate; CAD: coronary artery disease; HF: heart failure; hs-CRP: high-sensitivity C-reactive protein; LAD: left atrial dimension; HbA1c: hemoglobin A1c; SGLT2: sodium glucose cotransporter 2; BNP: brain natriuretic peptide; IVSTd: interventricular septal thickness at end-diastole.

Calf circumference

−0.21

< 0.001

RAS inhibitors

−0.19

< 0.001

E/e'

0.18

< 0.001

Skin autofluorescence

0.17

0.001

SEVR

−0.17

0.001

GLP-1 receptor agonists

−0.16

0.002

Age

0.15

0.003

eGFR

−0.14

0.004

CAD

0.13

0.012

Stage B HF (vs. stage A HF)

0.12

0.013

SGLT2 inhibitors

−0.11

0.014

LAD

0.08

0.067

HbA1c

0.08

0.071

Body mass index

−0.07

0.110

hs-CRP

0.06

0.203

BNP

0.05

0.377

IVSTd

0.04

0.496

Current smoker

0.02

0.623

↓ **Table 2.** Baseline Characteristics of the Study Population
Characteristics	N = 292
Continuous values are mean ± SD or median (25th–75th percentile). CAVI: cardio-ankle vascular index; HF: heart failure; CAD: coronary artery disease; LDL: low-density lipoprotein; HDL: high-density lipoprotein; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; HbA1c: hemoglobin A1c; AU: arbitrary unit; BNP: brain natriuretic peptide; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; SEVR: subendocardial viability ratio; DPP-4: dipeptidyl peptidase 4; SGLT2: sodium glucose cotransporter 2; GLP-1: glucagon-like peptide-1; RAS: renin–angiotensin system.
Age (years)	70 ± 7
Sex (men/women)	113/179
CAVI	9.2 ± 1.7
Stage (A HF/B HF)	157/135
Height (m)	1.59 ± 0.08
Body weight (kg)	59.3 ± 10.2
Body mass index (kg/m²)	23.3 ± 3.5
Current smoker, n (%)	39 (13)
CAD, n (%)	36 (12)
Systolic blood pressure (mm Hg)	134 ± 13
LDL cholesterol (mg/dL)	127 ± 39
HDL cholesterol (mg/dL)	49 ± 15
IVSTd (mm)	9.4 ± 2.0
LVDd (mm)	49.9 ± 3.4
LVEF (%)	62.6 ± 8.1
LAD (mm)	43.3 ± 6.1
E/e'	8.4 ± 2.2
Fasting blood glucose (mg/dL)	143 ± 26
HbA1c (%)	7.1 ± 1.0
Skin autofluorescence (AU)	2.7 ± 0.6
BNP (pg/mL)	29.0 (22.0–64.0)
eGFR (mL/min/1.73 m²)	62.3 ± 16.5
hs-CRP (mg/L)	0.90 (0.31–2.33)
SEVR (%)	140 ± 24
Calf circumference (cm)	35.3 ± 4.7
Medication
Metformin, n (%)	129 (44)
DPP-4 inhibitors, n (%)	214 (73)
SGLT2 inhibitors, n (%)	78 (27)
GLP-1 receptor agonists, n (%)	23 (8)
Insulin, n (%)	25 (9)
RAS inhibitors, n (%)	175 (60)
β blockers, n (%)	50 (17)
Statins, n (%)	150 (51)

↓ Table 2. Baseline Characteristics of the Study Population

Characteristics

N = 292

Continuous values are mean ± SD or median (25th–75th percentile). CAVI: cardio-ankle vascular index; HF: heart failure; CAD: coronary artery disease; LDL: low-density lipoprotein; HDL: high-density lipoprotein; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; HbA1c: hemoglobin A1c; AU: arbitrary unit; BNP: brain natriuretic peptide; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; SEVR: subendocardial viability ratio; DPP-4: dipeptidyl peptidase 4; SGLT2: sodium glucose cotransporter 2; GLP-1: glucagon-like peptide-1; RAS: renin–angiotensin system.

Age (years)

70 ± 7

Sex (men/women)

113/179

CAVI

9.2 ± 1.7

Stage (A HF/B HF)

157/135

Height (m)

1.59 ± 0.08

Body weight (kg)

59.3 ± 10.2

Body mass index (kg/m²)

23.3 ± 3.5

Current smoker, n (%)

39 (13)

CAD, n (%)

36 (12)

Systolic blood pressure (mm Hg)

134 ± 13

LDL cholesterol (mg/dL)

127 ± 39

HDL cholesterol (mg/dL)

49 ± 15

IVSTd (mm)

9.4 ± 2.0

LVDd (mm)

49.9 ± 3.4

LVEF (%)

62.6 ± 8.1

LAD (mm)

43.3 ± 6.1

E/e'

8.4 ± 2.2

Fasting blood glucose (mg/dL)

143 ± 26

HbA1c (%)

7.1 ± 1.0

Skin autofluorescence (AU)

2.7 ± 0.6

BNP (pg/mL)

29.0 (22.0–64.0)

eGFR (mL/min/1.73 m²)

62.3 ± 16.5

hs-CRP (mg/L)

0.90 (0.31–2.33)

SEVR (%)

140 ± 24

Calf circumference (cm)

35.3 ± 4.7

Medication

Metformin, n (%)

129 (44)

DPP-4 inhibitors, n (%)

214 (73)

SGLT2 inhibitors, n (%)

78 (27)

GLP-1 receptor agonists, n (%)

23 (8)

Insulin, n (%)

25 (9)

RAS inhibitors, n (%)

175 (60)

β blockers, n (%)

50 (17)

Statins, n (%)

150 (51)

↓ **Table 3.** Correlation Between CAVI and Various Clinical Characteristics
Characteristics	Correlation coefficient	P value
Data are expressed as Pearson’s r or Spearman’s ρ. CAVI: cardio-ankle vascular index; HF: heart failure; CAD: coronary artery disease; LDL: low-density lipoprotein; HDL: high-density lipoprotein; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; HbA1c: hemoglobin A1c; BNP: brain natriuretic peptide; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; SEVR: subendocardial viability ratio; DPP-4: dipeptidyl peptidase 4; SGLT2: sodium glucose cotransporter 2; GLP-1: glucagon-like peptide-1; RAS: renin–angiotensin system.
Age (actual value)	0.30	< 0.001
Sex (women = 0, men = 1)	0.03	0.608
Stage (A HF = 0, B HF = 1)	0.31	< 0.001
Body mass index (actual value)	−0.21	0.001
Current smoker (no = 0, yes = 1)	0.18	0.002
CAD (no = 0, yes = 1)	0.19	0.001
Systolic blood pressure (actual value)	0.09	0.107
LDL cholesterol (actual value)	−0.04	0.502
HDL cholesterol (actual value)	−0.08	0.156
IVSTd (actual value)	0.12	0.048
LVDd (actual value)	0.11	0.060
LVEF (actual value)	0.09	0.109
LAD (actual value)	0.25	< 0.001
E/e' (actual value)	0.39	< 0.001
Fasting blood glucose (actual value)	0.09	0.119
HbA1c (actual value)	0.23	< 0.001
Skin autofluorescence (actual value)	0.43	< 0.001
BNP (actual value)	0.26	< 0.001
eGFR (actual value)	−0.35	< 0.001
hs-CRP (actual value)	0.20	0.006
SEVR (actual value)	−0.49	< 0.001
Calf circumference (actual value)	−0.33	< 0.001
Metformin (no = 0, yes = 1)	−0.03	0.583
DPP-4 inhibitors (no = 0, yes = 1)	−0.11	0.063
SGLT2 inhibitors (no = 0, yes = 1)	−0.25	< 0.001
GLP-1 receptor agonists (no = 0, yes = 1)	−0.26	< 0.001
Insulin (no = 0, yes = 1)	0.06	0.349
RAS inhibitors (no = 0, yes = 1)	−0.26	< 0.001
β blockers (no = 0, yes = 1)	0.06	0.327
Statins (no = 0, yes = 1)	−0.04	0.490

↓ Table 3. Correlation Between CAVI and Various Clinical Characteristics

Characteristics

Correlation coefficient

P value

Data are expressed as Pearson’s r or Spearman’s ρ. CAVI: cardio-ankle vascular index; HF: heart failure; CAD: coronary artery disease; LDL: low-density lipoprotein; HDL: high-density lipoprotein; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; HbA1c: hemoglobin A1c; BNP: brain natriuretic peptide; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; SEVR: subendocardial viability ratio; DPP-4: dipeptidyl peptidase 4; SGLT2: sodium glucose cotransporter 2; GLP-1: glucagon-like peptide-1; RAS: renin–angiotensin system.

Age (actual value)

0.30

< 0.001

Sex (women = 0, men = 1)

0.03

0.608

Stage (A HF = 0, B HF = 1)

0.31

< 0.001

Body mass index (actual value)

−0.21

0.001

Current smoker (no = 0, yes = 1)

0.18

0.002

CAD (no = 0, yes = 1)

0.19

0.001

Systolic blood pressure (actual value)

0.09

0.107

LDL cholesterol (actual value)

−0.04

0.502

HDL cholesterol (actual value)

−0.08

0.156

IVSTd (actual value)

0.12

0.048

LVDd (actual value)

0.11

0.060

LVEF (actual value)

0.09

0.109

LAD (actual value)

0.25

< 0.001

E/e' (actual value)

0.39

< 0.001

Fasting blood glucose (actual value)

0.09

0.119

HbA1c (actual value)

0.23

< 0.001

Skin autofluorescence (actual value)

0.43

< 0.001

BNP (actual value)

0.26

< 0.001

eGFR (actual value)

−0.35

< 0.001

hs-CRP (actual value)

0.20

0.006

SEVR (actual value)

−0.49

< 0.001

Calf circumference (actual value)

−0.33

< 0.001

Metformin (no = 0, yes = 1)

−0.03

0.583

DPP-4 inhibitors (no = 0, yes = 1)

−0.11

0.063

SGLT2 inhibitors (no = 0, yes = 1)

−0.25

< 0.001

GLP-1 receptor agonists (no = 0, yes = 1)

−0.26

< 0.001

Insulin (no = 0, yes = 1)

0.06

0.349

RAS inhibitors (no = 0, yes = 1)

−0.26

< 0.001

β blockers (no = 0, yes = 1)

0.06

0.327

Statins (no = 0, yes = 1)

−0.04

0.490