TY - JOUR
T1 - Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity
T2 - An Individual-Participant Meta-Analysis
AU - An, De-Wei
AU - Hansen, Tine W
AU - Aparicio, Lucas S
AU - Chori, Babangida
AU - Huang, Qi-Fang
AU - Wei, Fang-Fei
AU - Cheng, Yi-Bang
AU - Yu, Yu-Ling
AU - Sheng, Chang-Sheng
AU - Gilis-Malinowska, Natasza
AU - Boggia, José
AU - Wojciechowska, Wiktoria
AU - Niiranen, Teemu J
AU - Tikhonoff, Valérie
AU - Casiglia, Edoardo
AU - Narkiewicz, Krzysztof
AU - Stolarz-Skrzypek, Katarzyna
AU - Kawecka-Jaszcz, Kalina
AU - Jula, Antti M
AU - Yang, Wen-Yi
AU - Woodiwiss, Angela J
AU - Filipovský, Jan
AU - Wang, Ji-Guang
AU - Rajzer, Marek W
AU - Verhamme, Peter
AU - Nawrot, Tim S
AU - Staessen, Jan A
AU - Li, Yan
AU - International Database of Central Arterial Properties for Risk Stratification Investigators‡
PY - 2023/9/1
Y1 - 2023/9/1
N2 - BACKGROUND: Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen).METHODS: A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement.RESULTS: In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was ≈0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome.CONCLUSIONS: PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death.
AB - BACKGROUND: Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen).METHODS: A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement.RESULTS: In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was ≈0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome.CONCLUSIONS: PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death.
KW - Aorta
KW - Arteries
KW - Cardiovascular Diseases/diagnosis
KW - Humans
KW - Hypertension/diagnosis
KW - Pulse Wave Analysis/adverse effects
KW - Risk Factors
KW - Vascular Stiffness/physiology
KW - diabetes mellitus
KW - cardiovascular diseases
KW - metabolic syndrome
KW - pulse wave analysis
KW - hypertension
UR - http://www.scopus.com/inward/record.url?scp=85168241502&partnerID=8YFLogxK
U2 - 10.1161/HYPERTENSIONAHA.123.21318
DO - 10.1161/HYPERTENSIONAHA.123.21318
M3 - Journal article
C2 - 37470187
SN - 0194-911X
VL - 80
SP - 1949
EP - 1959
JO - Hypertension
JF - Hypertension
IS - 9
ER -