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Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease: An Individual Participant Data
Toshiaki Ohkuma1, Toshiharu Ninomiya1, Hirofumi Tomiyama2
1From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.).
Abstract:
An individual participant data meta-analysis was conducted in the data of 14 673 Japanese participants without a history of cardiovascular disease (CVD) to examine the association of the brachial-ankle pulse wave velocity (baPWV) with the risk of development of CVD. During the average 6.4-year follow-up period, 687 participants died and 735 developed cardiovascular events. A higher baPWV was significantly associated with a higher risk of CVD, even after adjustments for conventional risk factors (P for trend <0.001). When the baPWV values were classified into quintiles, the multivariable-adjusted hazard ratio for CVD increased significantly as the baPWV quintile increased. The hazard ratio in the subjects with baPWV values in quintile 5 versus that in those with the values in quintile 1 was 3.50 (2.14-5.74; P<0.001). Every 1 SD increase of the baPWV was associated with a 1.19-fold (1.10-1.29; P<0.001) increase in the risk of CVD. Moreover, addition of baPWV to a model incorporating the Framingham risk score significantly increased the C statistics from 0.8026 to 0.8131 (P<0.001) and also improved the category-free net reclassification (0.247; P<0.001). The present meta-analysis clearly established baPWV as an independent predictor of the risk of development of CVD in Japanese subjects without preexisting CVD. Thus, measurement of the baPWV could enhance the efficacy of prediction of the risk of development of CVD over that of the Framingham risk score, which is based on the traditional cardiovascular risk factors.
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