Estimated Pulse Wave Velocity and All-Cause and Cardiovascular Mortality in General Population - (Ehuh Stuidy -Croatian Scientific Foundation)

Abstract

Objective: Carotid-femoral pulse wave velocity (cfPWV) was recommended by guidelines as biomarker and independent predictor of cardiovascular (CV) events. Measurements of cfPWV is demanding and expensive method. It was suggested that an estimated PWV (ePWV) could be used. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in general population. Design and method: In stratified random sample of 1087 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 +/-16) subjects were followed for 17 years. Mortality data were obtained from Croatian Institute of Public Health. In the follow-up period 1060 patients had all the data on death. ePWV was calculated using formula: ePWV = 9.587-0.402 × age + 4.560 × 10-3 × age2-2.621 × 10-5 × age2 × MBP + 3.176 × 10-3 × age × MBP-1.832 × 10-2 × MBP. MBP = (DBP) + 0.4(SBP-DBP). Results: At the end of follow up period 228 deaths (all-cause mortality 20.9%; CV, stroke, cancer, dementia and degenerative diseases, cold, others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the 2nd ePWV tertile there were more deaths due to cancer than from CV disease (46% vs. 30%), while in the 3rd tertile we observed opposite (20.5% vs. 51.04%). In the analysis of survival of subjects classified into the ePWV tertiles when all-cause and CV death and mortality were observed, the probability of survival of the 3rd tertile compared to the 2nd and 1st tertiles were significantly lower (p< 0.001 Log Rank test (Mantel-Cox)) (Figure 1). In unadjusted model, in Cox regression ePWV was significant predictor for CV death and for each increase of 1m/s there was 14% increase risk for CV death. In multivariate analyses ePWV was neither independent predictor for all-cause nor for CV mortality (p>0.05). However, in u subgroup of subjects with higher CV risk we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) β 1.108; p<0.029; HR 3.03,95% CI 1.118-8.211). Conclusions: In general population ePWV is associated with higher all-cause and CV mortality, although not independently of other risk factors. However, in a subgroup of subjects with high CV risk, ePWV was significant and independent predictor of CV mortality. Further studies are needed before ePWV could be recommended in general clinic work.