Two temporally validated diagnostic models for arterial stiffness using routine clinical indicators: a practical tool...

Arterial stiffness is a strong independent predictor of cardiovascular diseases, yet its direct assessment (e.g., pulse wave velocity) is often impractical in resource-limited settings. The present study aimed to develop and validate diagnostic models for arterial stiffness using easily collectible clinical indicators.

A cross-sectional analysis was conducted using data from two community-based cardiovascular health surveys in Yinchuan City, Ningxia, China. The derivation cohort (January 2020 to January 2021, n=2,440) and a temporally independent validation cohort (January 2025 to January 2026, n=2,512) were included. Two logistic regression models were developed: Model 1 included sex, age, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP); Model 2 additionally incorporated triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). Model performance was assessed using area under the receiver operating characteristic curve (AUC), calibration curves, bootstrap internal validation, and decision curve analysis (DCA). The models were compared against five metabolic indices: Lipid Accumulation Product (LAP), Weight-Adjusted Waist Index (WWI), Visceral Adiposity Index (VAI), triglyceride-glucose index (TyG), and TG/HDL-C ratio. Nomograms were constructed for clinical application.

In the derivation cohort, the AUCs for Model 1 and Model 2 were 0.926 and 0.927, respectively; in the validation cohort, both models achieved an AUC of 0.916. Both models significantly outperformed LAP, WWI, VAI, TyG, and TG/HDL-C (all P < 0.001). Calibration curves demonstrated good agreement between predicted and observed risks, and DCA confirmed positive net benefit across a wide range of threshold probabilities.

The two models provide an accurate, easy-to-use tool for screening arterial stiffness, with temporal validation in an independent cohort from the same geographic region. Their excellent discriminative performance and favorable clinical utility make them particularly suitable for large-scale community-based screening or home-based self-management in resource-limited settings.