Estimated Pulse Wave Velocity for Cardiovascular Risk Assessment in Rural Populations: The ENAH Study

Arterial stiffness, typically measured by pulse wave velocity (PWV), is a recognized biomarker of cardiovascular (CV) risk and mortality. Our study assesses the predictive value of arterial stiffness measured by estimated pulse wave velocity (ePWV) for fatal and nonfatal outcomes in a general rural adult population.

This prospective observational cohort study was conducted within the ENAH project, which initially included 3,305 adults, with 2,232 participants followed up over a median of 11.3 years. Baseline demographic, clinical, and laboratory data, including blood pressure, anthropometry, and biochemical analyses of blood and urine, were collected using standardized protocols. The primary outcome was all-cause mortality, while secondary outcomes comprised nonfatal CV, cerebrovascular, and renal events, analyzed using Kaplan-Meier survival curves and multivariable regression models.

In this cohort of 1,175 adults followed for a mean of 11.3 years, 263 participants died (22.4%), and 171 (14.5%) experienced a nonfatal event (myocardial infarction, atrial fibrillation, heart failure, stroke, transient ischemic attack, or dialysis). Kaplan-Meier analysis showed lower survival in participants with ePWV of >10 m/s compared to those with ePWV of <10 m/s (hazard ratio [HR] = 12.8, 95% CI 9.9-16.6, p < 0.001). Similarly, event-free survival was lower for nonfatal outcomes in the higher ePWV group (HR = 1.50, 95% CI 1.0-2.1, p = 0.008). In multivariable analysis for mortality, male sex and ePWV remained significant predictors (HR 1.75, 95% CI 1.18-2.61, p = 0.006; HR 1.81, 95% CI 1.08-3.04, p = 0.030). No independent predictors were found for nonfatal outcomes. However, for the composite endpoint, both male sex (HR = 1.54, 95% CI 1.14-2.08, p = 0.006) and ePWV (HR = 1.94, 95% CI 1.50-2.51, p < 0.001) were associated with increased risk.

ePWV was an independent predictor of overall mortality as well as composite fatal and nonfatal outcomes. These findings suggest that this simple measure of arterial stiffness may be useful in clinical practice, particularly in rural settings where direct measurements are not available.