Comparisons of prognostic value between brachial-ankle pulse wave velocity and estimated pulse wave velocity

Arterial stiffness is a key marker of vascular aging. We compared the prognostic performance of brachial-ankle pulse wave velocity (baPWV) and estimated PWV (ePWV) for major adverse cardiovascular events (MACE). We retrospectively analyzed adults aged 40-75 years who underwent baPWV at a tertiary center (n = 9521). ePWV was computed from age and mean blood pressure. The primary endpoint was MACE (cardiac death, non-fatal myocardial infarction, coronary revascularization, non-fatal ischemic stroke). During a median follow-up of 3.77 years, 271 MACEs occurred (2.8%). Multivariable Cox regression models showed that higher arterial stiffness by both baPWV and ePWV was independently associated with increased MACE risk (P < 0.05 for each). Consistently, baPWV identified stepwise increases in risk from lower to higher categories and produced larger effect estimates. However, ePWV retained independent prognostic value but with a weaker gradient. With dichotomized cutoffs, C-index values were similar for baPWV and ePWV (0.736 vs. 0.728; P = 0.323). When participants were stratified into tertiles, baPWV showed superior discrimination, yielding a higher C-index than ePWV (0.755 vs. 0.729; P = 0.033) and clearer separation of Kaplan-Meier curves across risk strata. These findings indicate that both measures add information beyond traditional risk factors, but baPWV provides stronger risk stratification, particularly when risk is partitioned into multiple levels. ePWV remains a practical alternative in settings where device-based testing is not feasible.