Association of arterial stiffness with all-cause and cause-specific mortality in the diabetic population: A national cohort study

Abstract

BackgroundEstimated pulse wave velocity (ePWV) has been proposed as a potential alternative to carotid-femoral pulse wave velocity to assess the degree of aortic stiffness, and may predict cardiovascular disease (CVD) outcomes and mortality in the general population. However, whether arterial stiffness estimated by ePWV predicts all-cause and cause-specific mortality in patients with diabetes mellitus (DM) has not been reported.MethodsThis was a prospective cohort study with data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 and followed up until the end of December 2019. 5,235U.S. adults with DM (age≥20years) were included in the study. Arterial stiffness was estimated by ePWV. Survey-weighted Cox proportional hazards models were performed to assess the hazard ratios (HRs), and 95% confidence intervals (CIs) for the associations of ePWV with all-cause and cause-specific mortality. Meanwhile, the generalized additive model was used to visually assess the dose-dependent relationship between ePWV and mortality. As a complementary analysis, the relationship between mean blood pressure (MBP) and risk of mortality was also examined. Multiple imputations accounted for missing data.ResultsFor the 5,235 DM patients, the weighted mean age was 57.4 years, and 51.07% were male. During a median follow-up period of 115 months (interquartile range 81-155 months; 53,159 person-years), 1,604 all-cause deaths were recorded. In the fully adjusted Cox regression model, every 1 m/s increase in ePWV was associated with 56% (HR 1.56; 95% CI, 1.44 to 1.69) increase in the risk of all-cause. In addition, a nonlinear relationship between ePWV and all-cause mortality was observed (P for non-linear=0.033). Similar results were obtained after subgroup analysis and multiple imputations. Besides, the risk of most cause-specific mortality, except for accident and renal disease-specific mortality, increased from 53% to 102% for every 1 m/s increase in ePWV.ConclusionsIn the diabetic population, ePWV is independently associated with all-cause and most cause-specific mortality risks. ePWV may be a useful tool for assessing mortality risk.

Estimated Pulse Wave Velocity in the Prediction of Clinical Outcomes in Patients Undergoing Drug-Eluting Stent Implantation

“…In the Systolic Blood Pressure Intervention Trial, which included 9361 participants with high risk profiles, an elevated ePWV was associated with cardiovascular risk, independently of Framingham Risk scores [ 12 ]. Further studies have underscored the prognostic value of ePWV in stroke patients [ 13 ] and those with diabetes mellitus [ 21 ]. Yet, the significance of ePWV for patients undergoing a PCI has not been firmly established.…”

Associations between estimated glucose disposal rate and arterial stiffness and mortality among US adults with non-alcoholic fatty liver disease

“…We applied hypertension assessment criteria: SBP ≥ 140 mmHg or DBP ≥ 90 mmHg and the patients using anti-hypertensive medications for the period of being investigated ( 26 ). We applied diabetes evaluation criteria: doctor diagnosis as diabetes, HbA1c ≥ 6.5%, fasting glucose ≥ 7.0mmol/L, random blood glucose ≥ 11.1mmol/L, 2h OGTT blood glucose ≥ 11.1mmol/L, or being treated with diabetes drugs and insulin ( 27 ).…”

Estimated pulse wave velocity added additional prognostic information in general population: Evidence from National Health and Nutrition Examination Survey (NHANES) 1999–2018

“…Previous research showed that ePWV had a good consistency with both cfPWV and baPWV [ 11 ], and further investigation found that ePWV was closely related to the incidence of new-onset hypertension [ 12 ], cardiovascular events [ 13 , 14 ], all-cause [ 13 , 15 ] and specific-cause mortality [ 15 ]. However, there is still controversy over whether the association between ePWV and adverse clinical outcomes is independent of traditional cardiovascular risk estimation model or risk factors.…”

“…However, there is still controversy over whether the association between ePWV and adverse clinical outcomes is independent of traditional cardiovascular risk estimation model or risk factors. Previous researches aiming in this issue either excluded the CVDs population [ 16 , 17 ] or conducted in specific population with increased cardiovascular risk [ 15 , 18 ] or established CVDs [ 19 ]. Thus, it is not yet known whether their conclusions can be extrapolated to the general population.…”