The objective of this five-year prospective observational follow-up study is to examine the additional benefits of using cardio-ankle vascular index (CAVI) as a predictive indicator of cardiovascular events in high-risk patients.

Inclusion Criteria:

Patients between 40 and 74 years of age who have either of the following:

1. Type 2 diabetes mellitus
2. Metabolic syndrome
3. Grade I to III hypertension with the third layer of risk factors according to the guidelines for the management of hypertension japanese society of hypertension(JSH)2009
4. Chronic kidney disease(stage G3a or G3b) according ot the clinical Practice Guidebook for Diagnosis and Treatment of Chronic Kidney Disease 2012 in Japan
5. History of coronary artery disease or noncardiogenic cerebral infarction

Exclusion Criteria:

1. Under 40 years of age or over 74 years of age
2. An ankle-brachial index less than 0.9
3. Chronic atrial fibrillation
4. Current symptoms of heart failure(NYHA class III or IV) or left ventricular dysfunction (EF below 40%)
5. Malignancy
6. Chronic kidney disease(G4 or G5)according ot the clinical Practice Guidebook for Diagnosis and Treatment of Chronic Kidney Disease 2012 in Japan
7. chronic dialysis due to renal failure
8. Taking steroids/immunosuppressants
9. Hepatocirrhosis

primiary care clinic and hospital