Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis

Holly Pavey; Angela Wood; Carmel M Mceniery; Majd AlGhatrif; Banafsheh Arshi; Eric Brunner; Chen-Huan Chen; Hao-Min Cheng; Tine W Hansen; M Kamram Ikram; Maryam Kavousi; Diana Kuh; Allison L Kuipers; Edward G Lakatta; Allan Linneberg; Francesco Mattace Raso; Gary F Mitchell; João Maldonado; Anne B Newman; Telmo Pereira; Kaisa Maki-Petaja; Martin Shipley; Ramachandran S Vasan; Andrew Wong; Yoav Ben-Shlomo; Ian B Wilkinson

doi:10.1136/bmjopen-2025-101368

Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis

Holly Pavey^*, Angela Wood, Carmel M Mceniery, Majd AlGhatrif, Banafsheh Arshi, Eric Brunner, Chen-Huan Chen, Hao-Min Cheng, Tine W Hansen, M Kamram Ikram, Maryam Kavousi, Diana Kuh, Allison L Kuipers, Edward G Lakatta, Allan Linneberg, Francesco Mattace Raso, Gary F Mitchell, João Maldonado, Anne B Newman, Telmo PereiraKaisa Maki-Petaja, Martin Shipley, Ramachandran S Vasan, Andrew Wong, Yoav Ben-Shlomo, Ian B Wilkinson

^*Corresponding author for this work

1 Citation (Scopus)

Abstract

OBJECTIVES: The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular (CV) events in individuals with blood pressure (BP) 120-159/80-99 mm Hg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aims to determine whether cfPWV improves the prediction of CV events beyond traditional risk factors in individuals with moderate BP.

DESIGN: A systematic review and meta-analysis.

DATA SOURCES: PubMed and EMBASE were searched through April 2023.

ELIGIBILITY CRITERIA: We included prospective, population-based cohort studies with ≥1 year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident CV disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease, stroke or all-cause mortality outcomes.

DATA EXTRACTION AND SYNTHESIS: Individual participant data from 11 cohorts (n=15 987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV.

RESULTS: There were 1279 first atherosclerotic CV events over a median follow-up of 9.9 years. A 1-SD increase in loge(cfPWV) was associated with a 1.21-fold (95% CI 1.08 to 1.36) increase in risk of ASCVD. Adding cfPWV to traditional risk factors improved ASCVD prediction: change in discrimination (C-index): 0.0048 (95% CI 0.0002 to 0.0094), p=0.041. In hypothetical populations of 100 000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7% and 3.1% under European and US guidelines, respectively.

CONCLUSIONS: Adding cfPWV to traditional CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.

Original language	English
Article number	e101368
Journal	BMJ Open
Volume	15
Issue number	12
Pages (from-to)	e101368
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2025-101368
Publication status	Published - 15 Dec 2025

Keywords

Humans
Cardiovascular Diseases/physiopathology
Carotid-Femoral Pulse Wave Velocity
Blood Pressure/physiology
Risk Assessment
Vascular Stiffness
Risk Factors
Hypertension/physiopathology
Pulse Wave Analysis
Hypertension
Meta-Analysis
EPIDEMIOLOGY

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Pavey, H., Wood, A., Mceniery, C. M., AlGhatrif, M., Arshi, B., Brunner, E., Chen, C.-H., Cheng, H.-M., Hansen, T. W., Ikram, M. K., Kavousi, M., Kuh, D., Kuipers, A. L., Lakatta, E. G., Linneberg, A., Mattace Raso, F., Mitchell, G. F., Maldonado, J., Newman, A. B., ... Wilkinson, I. B. (2025). Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis. BMJ Open, 15(12), e101368. Article e101368. https://doi.org/10.1136/bmjopen-2025-101368

Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis. / Pavey, Holly; Wood, Angela; Mceniery, Carmel M et al.
In: BMJ Open, Vol. 15, No. 12, e101368, 15.12.2025, p. e101368.

Research output: Contribution to journal › Review › peer-review

Pavey, H, Wood, A, Mceniery, CM, AlGhatrif, M, Arshi, B, Brunner, E, Chen, C-H, Cheng, H-M, Hansen, TW, Ikram, MK, Kavousi, M, Kuh, D, Kuipers, AL, Lakatta, EG, Linneberg, A, Mattace Raso, F, Mitchell, GF, Maldonado, J, Newman, AB, Pereira, T, Maki-Petaja, K, Shipley, M, Vasan, RS, Wong, A, Ben-Shlomo, Y & Wilkinson, IB 2025, 'Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis', BMJ Open, vol. 15, no. 12, e101368, pp. e101368. https://doi.org/10.1136/bmjopen-2025-101368

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title = "Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis",

abstract = "OBJECTIVES: The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular (CV) events in individuals with blood pressure (BP) 120-159/80-99 mm Hg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aims to determine whether cfPWV improves the prediction of CV events beyond traditional risk factors in individuals with moderate BP.DESIGN: A systematic review and meta-analysis.DATA SOURCES: PubMed and EMBASE were searched through April 2023.ELIGIBILITY CRITERIA: We included prospective, population-based cohort studies with ≥1 year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident CV disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease, stroke or all-cause mortality outcomes.DATA EXTRACTION AND SYNTHESIS: Individual participant data from 11 cohorts (n=15 987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV.RESULTS: There were 1279 first atherosclerotic CV events over a median follow-up of 9.9 years. A 1-SD increase in loge(cfPWV) was associated with a 1.21-fold (95\% CI 1.08 to 1.36) increase in risk of ASCVD. Adding cfPWV to traditional risk factors improved ASCVD prediction: change in discrimination (C-index): 0.0048 (95\% CI 0.0002 to 0.0094), p=0.041. In hypothetical populations of 100 000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7\% and 3.1\% under European and US guidelines, respectively.CONCLUSIONS: Adding cfPWV to traditional CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.",

keywords = "Humans, Cardiovascular Diseases/physiopathology, Carotid-Femoral Pulse Wave Velocity, Blood Pressure/physiology, Risk Assessment, Vascular Stiffness, Risk Factors, Hypertension/physiopathology, Pulse Wave Analysis, Hypertension, Meta-Analysis, EPIDEMIOLOGY",

author = "Holly Pavey and Angela Wood and Mceniery, \{Carmel M\} and Majd AlGhatrif and Banafsheh Arshi and Eric Brunner and Chen-Huan Chen and Hao-Min Cheng and Hansen, \{Tine W\} and Ikram, \{M Kamram\} and Maryam Kavousi and Diana Kuh and Kuipers, \{Allison L\} and Lakatta, \{Edward G\} and Allan Linneberg and \{Mattace Raso\}, Francesco and Mitchell, \{Gary F\} and Jo{\~a}o Maldonado and Newman, \{Anne B\} and Telmo Pereira and Kaisa Maki-Petaja and Martin Shipley and Vasan, \{Ramachandran S\} and Andrew Wong and Yoav Ben-Shlomo and Wilkinson, \{Ian B\}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.",

year = "2025",

month = dec,

day = "15",

doi = "10.1136/bmjopen-2025-101368",

language = "English",

volume = "15",

pages = "e101368",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group Ltd",

number = "12",

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TY - JOUR

T1 - Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure

T2 - a systematic review and individual participant meta-analysis

AU - Pavey, Holly

AU - Wood, Angela

AU - Mceniery, Carmel M

AU - AlGhatrif, Majd

AU - Arshi, Banafsheh

AU - Brunner, Eric

AU - Chen, Chen-Huan

AU - Cheng, Hao-Min

AU - Hansen, Tine W

AU - Ikram, M Kamram

AU - Kavousi, Maryam

AU - Kuh, Diana

AU - Kuipers, Allison L

AU - Lakatta, Edward G

AU - Linneberg, Allan

AU - Mattace Raso, Francesco

AU - Mitchell, Gary F

AU - Maldonado, João

AU - Newman, Anne B

AU - Pereira, Telmo

AU - Maki-Petaja, Kaisa

AU - Shipley, Martin

AU - Vasan, Ramachandran S

AU - Wong, Andrew

AU - Ben-Shlomo, Yoav

AU - Wilkinson, Ian B

PY - 2025/12/15

Y1 - 2025/12/15

N2 - OBJECTIVES: The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular (CV) events in individuals with blood pressure (BP) 120-159/80-99 mm Hg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aims to determine whether cfPWV improves the prediction of CV events beyond traditional risk factors in individuals with moderate BP.DESIGN: A systematic review and meta-analysis.DATA SOURCES: PubMed and EMBASE were searched through April 2023.ELIGIBILITY CRITERIA: We included prospective, population-based cohort studies with ≥1 year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident CV disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease, stroke or all-cause mortality outcomes.DATA EXTRACTION AND SYNTHESIS: Individual participant data from 11 cohorts (n=15 987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV.RESULTS: There were 1279 first atherosclerotic CV events over a median follow-up of 9.9 years. A 1-SD increase in loge(cfPWV) was associated with a 1.21-fold (95% CI 1.08 to 1.36) increase in risk of ASCVD. Adding cfPWV to traditional risk factors improved ASCVD prediction: change in discrimination (C-index): 0.0048 (95% CI 0.0002 to 0.0094), p=0.041. In hypothetical populations of 100 000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7% and 3.1% under European and US guidelines, respectively.CONCLUSIONS: Adding cfPWV to traditional CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.

AB - OBJECTIVES: The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular (CV) events in individuals with blood pressure (BP) 120-159/80-99 mm Hg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aims to determine whether cfPWV improves the prediction of CV events beyond traditional risk factors in individuals with moderate BP.DESIGN: A systematic review and meta-analysis.DATA SOURCES: PubMed and EMBASE were searched through April 2023.ELIGIBILITY CRITERIA: We included prospective, population-based cohort studies with ≥1 year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident CV disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease, stroke or all-cause mortality outcomes.DATA EXTRACTION AND SYNTHESIS: Individual participant data from 11 cohorts (n=15 987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV.RESULTS: There were 1279 first atherosclerotic CV events over a median follow-up of 9.9 years. A 1-SD increase in loge(cfPWV) was associated with a 1.21-fold (95% CI 1.08 to 1.36) increase in risk of ASCVD. Adding cfPWV to traditional risk factors improved ASCVD prediction: change in discrimination (C-index): 0.0048 (95% CI 0.0002 to 0.0094), p=0.041. In hypothetical populations of 100 000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7% and 3.1% under European and US guidelines, respectively.CONCLUSIONS: Adding cfPWV to traditional CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.

KW - Humans

KW - Cardiovascular Diseases/physiopathology

KW - Carotid-Femoral Pulse Wave Velocity

KW - Blood Pressure/physiology

KW - Risk Assessment

KW - Vascular Stiffness

KW - Risk Factors

KW - Hypertension/physiopathology

KW - Pulse Wave Analysis

KW - Hypertension

KW - Meta-Analysis

KW - EPIDEMIOLOGY

UR - https://www.scopus.com/pages/publications/105024999542

U2 - 10.1136/bmjopen-2025-101368

DO - 10.1136/bmjopen-2025-101368

M3 - Review

C2 - 41401986

SN - 2044-6055

VL - 15

SP - e101368

JO - BMJ Open

JF - BMJ Open

IS - 12

M1 - e101368

ER -

Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis

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