Aortic Pulse Wave Velocity as Adjunct Risk Marker for Assessing Cardiovascular Disease Risk: Prospective Study
Related Experiment Video
Updated: Oct 4, 2025
Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Carlos A Valencia-Hernández1, Joni V Lindbohm1,2, Martin J Shipley1
1Research Department of Epidemiology and Public Health, University College London, London, United Kingdom (C.A.V.-H., J.V. L., M.J.S., A.S.-M., M.K., E.J.B.).
Insights
Aortic stiffness, measured by aortic pulse wave velocity, predicts cardiovascular events and enhances risk scores. This noninvasive method improves cardiovascular disease risk assessment in older adults.
Area of Science:
- Cardiology
- Vascular Biology
- Preventive Medicine
Background:
- Aortic pulse wave velocity (PWV) quantifies aortic stiffness and arterial aging.
- Its role in current cardiovascular risk estimation is not well-established.
- Assessing PWV's impact on major adverse cardiovascular events (MACE) and risk score performance is crucial.
Purpose of the Study:
- To determine if aortic PWV identifies individuals at higher risk of MACE.
- To evaluate if aortic PWV improves the performance of the American Heart Association/American College of Cardiology atherosclerotic cardiovascular disease (ASCVD) risk score.
Main Methods:
- Prospective analysis of 3837 participants from the Whitehall II cohort (2008-2009).
- Follow-up duration of 11.7 years, excluding individuals with prior cardiovascular events.
- Aortic PWV measured as a predictor of MACE and its additive value to the ASCVD risk score.
Main Results:
- Individuals in the highest aortic PWV quartile had significantly higher MACE risk (HR, 2.99).
- Aortic PWV accelerated the time to reach the 7.5% statin medication threshold by 5 years compared to 10 years.
- Adding aortic PWV to the ASCVD risk score improved model discrimination (C-statistic) and reclassification (NRI).
Conclusions:
- Aortic stiffness, assessed by PWV, is a significant predictor of MACE in elderly individuals.
- Aortic PWV measurement is scalable, radiation-free, and easily performed.
- Further research is needed to integrate PWV into primary care cardiovascular risk assessment.
Background:
Aortic pulse wave velocity is a noninvasive measure of aortic stiffness and arterial aging. Its current value in cardiovascular risk estimation practice is unknown. We aimed to establish whether aortic pulse wave velocity identified individuals with higher risk of incident major adverse cardiovascular events and improved performance of the American Heart Association/American College of Cardiology atherosclerotic cardiovascular disease risk score.
Methods:
This prospective analysis included 3837 Whitehall II cohort participants screened in 2008 to 2009, and followed for 11.7 years (mean=10.3, SD=1.81), without history of stroke, myocardial infarction, or coronary heart disease.
Results:
Mean age of the sample was 65.0 years (SD=5.6), 2831 participants (73.8%) were male and mean atherosclerotic cardiovascular disease risk score was 13.8%. At the end of follow-up, 411 individuals (10.7%) had suffered a major cardiovascular event. Those in the highest aortic pulse wave velocity quartile were at high risk (hazard ratio, 2.99 [95% CI, 2.25-3.97]) and reached the threshold for statin medication (7.5% risk) after 5 years whereas others reached it after 10 years (difference P<0.001). The addition of aortic pulse wave velocity to the risk score improved the C statistic (0.68 versus 0.67, P=0.03) and net reclassification index (4.6%, P=0.04 and 11.3%, P=0.02).
Conclusions:
Our results show that aortic stiffness predicted major adverse cardiovascular events in a cohort of elderly individuals, improving the performance of a widely used cardiovascular disease risk estimator. Aortic pulse wave velocity measurement is scalable, radiation-free, and easy to perform. Further studies on its applicability in cardiovascular disease risk assessment in primary care settings are needed.
Related Concept Videos
01:16Pulse
The pulse serves as a clinical...
01:17Pulse amplitude and quality
A weak or absent pulse may indicate reduced cardiac output or poor left ventricular contraction, which can be signs of cardiovascular dysfunction or...
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
01:11Pulse Assessment Sites
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for: