title: Estimated carotid-femoral pulse wave velocity has similar predictive value as measured carotid-femoral pulse wave velocity.
abstract: Carotid-femoral pulse wave velocity (cfPWV) adds significantly to traditional cardiovascular risk prediction, but is not widely available. Therefore, it would be helpful if cfPWV could be replaced by an estimated carotid-femoral pulse wave velocity (ePWV) using age and mean blood pressure, and previously published equations. The aim of this study was to investigate whether ePWV could predict cardiovascular events independently of traditional cardiovascular risk factors and/or cfPWV.
  
  
  
  cfPWV was measured and ePWV was calculated in 2366 patients from four age groups of the Danish MONICA10 cohort. Additionally, the patients were divided into four cardiovascular risk groups based on Systematic COronary Risk Evaluation (SCORE) or Framingham risk score (FRS). In 2006, the combined cardiovascular endpoint of cardiovascular death, nonfatal myocardial infarction, stroke and hospitalization for ischemic heart disease was registered.
  
  
  
  Most results were retested in 1045 hypertensive patients from a Paris cohort. Bland-Altman plot demonstrated a relative difference of -0.3% [95% confidence interval (CI) -15 to 17%] between ePWV and cfPWV. In Cox regression models in apparently healthy patients, ePWV and cfPWV (per SD) added independently to SCORE in prediction of combined endpoint [hazard ratio (95%CI) = 1.38(1.09-1.76) and hazard ratio (95%CI) = 1.18(1.01-1.38)] and to FRS [hazard ratio (95%CI) = 1.33(1.06-1.66) and hazard ratio (95%CI) = 1.16(0.99-1.37)]. If healthy patients with ePWV and/or cfPWV at least 10 m/s were reclassified to a higher SCORE risk category, net reclassification index was 10.8%, P less than 0.01. These results were reproduced in the Paris cohort.
  
  
  
  ePWV predicted major cardiovascular events independently of SCORE, FRS and cfPWV indicating that these traditional risk scores have underestimated the complicated impact of age and blood pressure on arterial stiffness and cardiovascular risk.
authors.affiliation: aCardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Odense University Hospital, Odense C, Denmark bHypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa cDepartment of Cardiology, Bispebjerg University Hospital, Copenhagen dDepartment of Diagnostic Imaging, Gentofte University Hospital, Hellerup eResearch Centre for Prevention and Health, Glostrup University Hospital, Glostrup fDepartment of Cardiology, Gentofte University Hospital, Denmark gINSERM U 970, Team 7, Paris Cardiovascular Research Center (PARCC), Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Sara V
authors.initials: SV
authors.lastname: Greve
authors.forename: Marie K
authors.initials: MK
authors.lastname: Blicher
authors.forename: Ruan
authors.initials: R
authors.lastname: Kruger
authors.forename: Thomas
authors.initials: T
authors.lastname: Sehestedt
authors.forename: Eva
authors.initials: E
authors.lastname: Gram-Kampmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Julie K K
authors.initials: JK
authors.lastname: Vishram
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.forename: Stephane
authors.initials: S
authors.lastname: Laurent
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002339:Carotid Arteries / Q000502:physiology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005263:Femoral Artery / Q000502:physiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010297:Paris / Q000453:epidemiology; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D059289:Vascular Stiffness