Estimated pulse wave velocity is associated with all-cause and cardio-cerebrovascular disease mortality in stroke population: Results from NHANES (2003–2014)

Abstract

BackgroundArterial stiffness is a significant determinant and evaluation of cardio-cerebrovascular disease and all-cause mortality risk in the stroke population. Estimated pulse wave velocity (ePWV) is a well-established indirect measure of arterial stiffness. We examined the association of ePWV with all-cause and cardio-cerebrovascular disease (CCD) mortality in the stroke population in a large sample of US adults.MethodsThe study design was a prospective cohort study with data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014, between the ages of 18–85 years, with follow-up through December 31, 2019. 1,316 individuals with stroke among 58,759 participants were identified and ultimately, 879 stroke patients were included in the analysis. ePWV was calculated from a regression equation using age and mean blood pressure according to the following formula: ePWV = 9.587 − (0.402 × age) + [4.560 × 0.001 × (age2)] − [2.621 × 0.00001 × (age2) × MBP] + (3.176 × 0.001 × age × MBP) − (1.832 × 0.01 × MBP). Survey-weighted Cox regression models were used to assess the association between ePWV and all-cause and CCD mortality risk.ResultsThe high ePWV level group had a higher increased risk of all-cause mortality and CCD mortality compared to the low ePWV level group after fully adjusting for covariates. With an increase in ePWV of 1 m/s, the risk of all-cause and CCD mortality increased by 44%–57% and 47%–72% respectively. ePWV levels were linearly correlated with the risk of all-cause mortality (P for nonlinear = 0.187). With each 1 m/s increase in ePWV, the risk of all-cause mortality increased by 44% (HR 1.44, 95% CI: 1.22–1.69; P < 0.001). When ePWV was <12.1 m/s, an increase in ePWV per 1 m/s was associated with a 119% (HR 2.19, 95% CI: 1.43–3.36; P < 0.001) increase in CCD mortality risk; when ePWV was ≥12.1 m/s, an increase in ePWV per 1 m/s was not associated with in CCD mortality risk.ConclusionePWV is an independent risk factor for all-cause and CCD mortality in stroke patients. Higher levels of ePWV are associated with higher all-cause mortality and CCD mortality in stroke patients.

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.…”

“…Traditionally, PWV is determined by dividing the distance between two specific points by the time difference of pulse wave arrival using specialized equipment. However, it can also be estimated based on age and blood pressure (BP), the primary factors known to influence arterial elasticity [ 11 , 12 , 13 , 14 ]. In this study, we utilized this “estimated PWV (ePWV)” as a prognostic tool for patients who had undergone a PCI.…”

Association of novel inflammatory markers with gestational diabetes mellitus in a representative U.S. sample: evidence from NHANES 2007-2018

“…And SII is an emerging marker that can re ect the immune and in ammatory response of human body. It was rst de ned in 2014 as a novel in ammatory biomarker combining platelet count (PC), neutrophil count (NC), and lymphocyte count (LC) with the formula PC*NC / LC [14,15] . Numerous studies have demonstrated the promising value of SII in assessing the risk and prognosis of cardiovascular, metabolic, and immune diseases.…”

Estimated Pulse Wave Velocity and All-Cause and Cardiovascular Mortality in the General Population

“…This result was confirmed by Vlachopoulos et al in very high-risk hypertensive patients (the SPRINT study), showing that ePWV predicted the primary composite CV outcome and all-cause death independent of the FRS [ 14 ]. Later on, observations that ePWV predicted all-cause and CV mortality independently of traditional CV risk factors were reported in the general population, apparently healthy individuals and high-risk patients [ 8 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. However, in most of these studies, several groups of subjects were excluded, so the results could not be extrapolated to the general population.…”