Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects.
OBJECTIVE
The goal of this study was to determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular disease (CVD) events beyond conventional risk factors.


BACKGROUND
Several studies have shown that aPWV may be a useful risk factor for predicting CVD, but they have been underpowered to examine whether this is true for different subgroups.


METHODS
We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with CVD outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects.


RESULTS
Of 17,635 participants, a total of 1,785 (10%) had a CVD event. The pooled age- and sex-adjusted hazard ratios (HRs) per 1-SD change in loge aPWV were 1.35 (95% confidence interval [CI]: 1.22 to 1.50; p < 0.001) for coronary heart disease, 1.54 (95% CI: 1.34 to 1.78; p < 0.001) for stroke, and 1.45 (95% CI: 1.30 to 1.61; p < 0.001) for CVD. Associations stratified according to sex, diabetes, and hypertension were similar but decreased with age (1.89, 1.77, 1.36, and 1.23 for age ≤50, 51 to 60, 61 to 70, and >70 years, respectively; pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor of coronary heart disease (HR: 1.23 [95% CI: 1.11 to 1.35]; p < 0.001), stroke (HR: 1.28 [95% CI: 1.16 to 1.42]; p < 0.001), and CVD events (HR: 1.30 [95% CI: 1.18 to 1.43]; p < 0.001). Reclassification indices showed that the addition of aPWV improved risk prediction (13% for 10-year CVD risk for intermediate risk) for some subgroups.


CONCLUSIONS
Consideration of aPWV improves model fit and reclassifies risk for future CVD events in models that include standard risk factors. aPWV may enable better identification of high-risk populations that might benefit from more aggressive CVD risk factor management.
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. Electronic address: y.ben-shlomo@bristol.ac.uk.
Yoav
Y
Ben-Shlomo
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Melissa
M
Spears
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Chris
C
Boustred
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Margaret
M
May
Institute of Cardiovascular Sciences, University of Manchester, United Kingdom.
Simon G
SG
Anderson
National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Cardiology Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Emelia J
EJ
Benjamin
INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France.
Pierre
P
Boutouyrie
Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia.
James
J
Cameron
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chen-Huan
CH
Chen
King's College & King's Health Partners, St. Thomas' & Guy's Hospital, London, United Kingdom.
J Kennedy
JK
Cruickshank
Branch of Population Sciences, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland.
Shih-Jen
SJ
Hwang
Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
Edward G
EG
Lakatta
INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France.
Stephane
S
Laurent
Instituto de Investigação e Formação Cardiovascular, Penacova, Portugal.
João
J
Maldonado
Cardiovascular Engineering, Inc., Norwood, Massachusetts.
Gary F
GF
Mitchell
Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland; MedStar Heart Research Institute, Washington, DC.
Samer S
SS
Najjar
Center for Aging and Population Health, Pittsburgh, Pennsylvania.
Anne B
AB
Newman
Department of Geriatric Medicine, Osaka University, Osaka, Japan.
Mitsuru
M
Ohishi
Centre d'Investigations Preventives et Cliniques, Paris, France.
Bruno
B
Pannier
Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal.
Telmo
T
Pereira
National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Department of Medicine, Boston University, Boston, Massachusetts.
Ramachandran S
RS
Vasan
Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Tomoki
T
Shokawa
Center for Aging and Population Health, Pittsburgh, Pennsylvania.
Kim
K
Sutton-Tyrell
Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
Francis
F
Verbeke
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Kang-Ling
KL
Wang
University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
David J
DJ
Webb
Research Center for Prevention and Health, Glostrup Hospital, Glostrup and Steno Diabetes Center, Glostrup, Denmark.
Tine
T
Willum Hansen
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Sophia
S
Zoungas
Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom.
Carmel M
CM
McEniery
Wales Heart Research Institute, Cardiff, United Kingdom.
John R
JR
Cockcroft
Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom.
Ian B
IB
Wilkinson
D001011:Aorta / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D064887:Observational Studies as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D063177:Pulse Wave Analysis / Q000379:methods*
cardiovascular disease; meta-analysis; prognostic factor; pulse wave velocity