Risk Stratification Of Brachial-ankle Pulse Wave Velocity, Mean Arterial Pressure And Pulse Pressure In Chinese Population

Background: Brachial-ankle pulse wave velocity(ba PWV)can be easily measured in an observer-independent way,but lacks robust population-based validation in terms of fatal combined with nonfatal outcomes.Methods: To address this issue,we studied 4251 Chinese randomly recruited Gaoyou County(54.1% women;mean age,52.1).Results: In the whole study population,mean values were 102.4 mm Hg for mean arterial pressure(MAP),51.1 mm Hg for pulse pressure,and 14.8 m/s for ba PWV.Over 4.4 years(median),74 participants experienced a fatal or nonfatal cardiovascular event and 44 a stroke.In multivariable-adjusted Cox regression,standardized hazard ratios(HRs)expressing the risk of a composite cardiovascular endpoint were 1.77(95% confidence interval,1.43-2.20),1.37(1.14-1.64)and1.50(1.26-1.78)for MAP,PP and ba PWV,respectively;the corresponding HRs for stroke were 1.82(1.39-2.38),1.39(1.12-1.74)and 1.53(1.25-1.89).ba PWV did not add to the prediction of cardiovascular events or stroke by MAP(HRs for ba PWV,1.25 and 1.27,respectively;P≥0.053)but refined models including PP(HRs,1.42 and 1.45;P≤0.0033).The optimized ba PWV threshold,obtained by maximizing Youden’s index(16.7 m/s),increased the Integrated Discrimination Improvement over and beyond MAP(+1.27%;P=0.021)and PP(+1.37%;P=0.038)for the cardiovascular outcome,but not stroke,and increased the net reclassification improvement for both endpoints(≥42.2%;P≤0.004).Conclusions: With fatal plus nonfatal cardiovascular and cerebrovascular endpoints as outcome,ba PWV marginally increases risk stratification over and beyond MAP,but is a better predictor than PP.A threshold of 16.7m/s might be used in Chinese populations.