Does Estimated Pulse Wave Velocity Add Prognostic Information?: MORGAM Prospective Cohort Project

Area of Science:

• Cardiology
• Vascular Biology
• Epidemiology

Background:

• Arterial stiffness, a marker of vascular aging, is linked to cardiovascular events.
• The Reference Values for Arterial Stiffness Collaboration developed an equation for estimated Pulse Wave Velocity (ePWV) using age and mean blood pressure.
• Previous research indicated ePWV predicts cardiovascular events independently of the Systematic Coronary Risk Evaluation (SCORE) and Framingham Risk Score.

Purpose of the Study:

• To investigate the independent association between ePWV and clinical outcomes in a large cohort of apparently healthy individuals.
• To determine if ePWV provides additional predictive value beyond established risk scores and traditional cardiovascular risk factors.

Main Methods:

• Analysis of 107,599 apparently healthy subjects from the MORGAM Project (1982-2002, 38 cohorts, 11 countries).
• Multiple Cox-regression analyses were used to calculate the predictive value of ePWV.
• Adjustments were made for country, SCORE, Framingham Risk Score, and traditional cardiovascular risk factors (age, sex, smoking, systolic blood pressure, BMI, cholesterol levels).

Main Results:

• Adjusting for SCORE or Framingham Risk Score, ePWV was significantly associated with all-cause mortality, cardiovascular mortality, and a composite cardiovascular endpoint.
• However, after adjusting for traditional cardiovascular risk factors, ePWV was only associated with all-cause mortality and not with cardiovascular mortality or the composite endpoint.
• Adding ePWV to models did not improve the discrimination of risk prediction (assessed by receiver operating characteristic curves).

Conclusions:

• Elevated ePWV is associated with subsequent mortality and cardiovascular morbidity independently of SCORE and Framingham Risk Score.
• This independent association is not maintained when traditional cardiovascular risk factors are accounted for.
• ePWV may not offer significant independent predictive value for cardiovascular outcomes in individuals where traditional risk factors are well-characterized.