Introduction:
The role of pulse wave velocity (PWV) in assessing cardiovascular disease (CVD) risk in asymptomatic non-elderly adults is unclear. PWV assessment, however, is readily available, non-invasive, cheap, and does not involve radiation exposure.
Hypothesis:
The aim of our study was to evaluate the hypothesis that brachial-ankle PWV was associated with coronary artery calcium (CAC) in a large sample of young and middle-aged asymptomatic adults, and that PWV increases the predictive value of traditional CVD risk factors for predicting the presence of CAC.
Methods:
Cross-sectional study of 15,009 asymptomatic men and women without a history of cardiovascular disease who underwent a health screening program that included both PWV and CAC measurements. Brachial-ankle PWV was obtained from bilateral brachial and posterior tibial artery pressure waveforms using the oscillometric method. Robust tobit regression was used to assess the association between PWV and natural log(CAC+1) and logistic regression was used to model the presence of detectable CAC (CAC>0) and CAC>100 adjusting for multiple CVD risk factors. Measures of calibration and discrimination were calculated to test the incremental value of adding PWV to traditional risk factors in predicting prevalent CAC.
Results:
The mean age of the study participants was 41.6 years (SD 7.2) and 83% (12,452) were men. Subjects with higher PWV had generally less favorable CVD risk profiles. The multivariable-adjusted CAC score ratios (95% confidence interval) comparing quintiles 2 - 5 of PWV to the first quintile were 1.21 (0.78, 1.86), 1.54 (1.01, 2.33), 1.98 (1.30, 3.01), and 2.83 (1.84, 4.37), respectively (P trend 100 were consistent with the results for CAC ratios. The addition of PWV to traditional risk factors significantly improved the discrimination and calibration of models for predicting the prevalence of detectable CAC (net reclassification index [NRI] for predicting detectable CAC and CAC score > 100 of 0.167 and 0.252, respectively; both p<0.001).
Conclusions:
In this large sample of young and middle-aged asymptomatic adults, brachial-ankle PWV was independently associated with the presence and the extent of CAC. PWV measurements improve the prediction of detectable CAC compared to traditional CVD risk factors and may help identify young and middle-age subjects with increased risk of subclinical disease.
Dissociation of Aortic Pulse Wave Velocity With Risk Factors for Cardiovascular Disease Other Than Hypertension
