Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study.
BACKGROUND
Hypertension guidelines underline the importance of quantification of total cardiovascular risk; an extensive evaluation of target organ damage (TOD) may increase the number of patients classified at high-added cardiovascular risk.


OBJECTIVE
To assess the effect of the evaluation of different forms of TOD, in addition to 'routine' workup, on cardiovascular risk stratification in a general population sample in Northern Italy.


METHODS
In 385 patients (age 57 +/- 10 years, 44% men, 64% hypertensives, 32% treated), left ventricular and carotid artery structure and carotid-femoral pulse wave velocity (PWV) were measured. All patients underwent laboratory examinations. Patients were divided into risk categories according to European Society of Hypertension/European Society of Cardiology guidelines before and after TOD evaluation.


RESULTS
After routine workup, patients were classified as follows: 6% at average cardiovascular risk, 35% at low cardiovascular risk, 25% at moderate cardiovascular risk, 33% at high cardiovascular risk and 1% at very high cardiovascular risk. The proportion of patients at low or moderate cardiovascular risk reclassified at high cardiovascular risk were 5, 14, 30 and 14% after echocardiography, measurement of albuminuria and estimated glomerular filtration rate, carotid ultrasound and PWV, respectively (chi P < 0.001 for all vs. routine). Assessment of PWV in addition to echocardiography led to an increase of the proportion of patients at high risk (from 5 to 15%, P < 0.001), as for PWV in addition to albuminuria, estimated glomerular filtration rate or both (from 14 to 31%, P < 0.01), but did not affect risk stratification in addition to carotid ultrasound (from 30 to 34%, P = NS).


CONCLUSIONS
Our data suggest that measurement of PWV may significantly change cardiovascular risk stratification in addition to echocardiography and to detection of albuminuria and/or of a reduction of estimated glomerular filtration rate, but not after carotid ultrasound. Our results confirm that evaluation of different forms of TOD is useful for a more accurate assessment of global cardiovascular risk.
Muiesan
M Lorenza
ML
Department of Medical and Surgical Sciences, Clinica Medica, University of Brescia, Brescia, Italy. muiesan@med.unibs.it
Salvetti
Massimo
M
Paini
Anna
A
Monteduro
Cristina
C
Rosei
Claudia Agabiti
CA
Aggiusti
Carlo
C
Belotti
Eugenia
E
Bertacchini
Fabio
F
Galbassini
Gloria
G
Stassaldi
Deborah
D
Castellano
Maurizio
M
Rosei
Enrico Agabiti
EA
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007558:Italy; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D011674:Pulse; D012307:Risk Factors