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Comparison of arterial stiffness indices measured by pulse wave velocity and pulse wave analysis for predicting cardiovascular and all-cause mortality in a Chinese population

Hypertension Research volume 47, pages 767–777 (2024)Cite this article

Abstract

Arterial stiffness measured by pulse wave velocity and pulse wave analysis has been widely studied in different populations in terms of its correlation with cardiovascular events and all-cause mortality. It remains unknown which arterial stiffness index is better for risk stratification in the general population. We included 4129 participants from Gaoyou County, Jiangsu Province, China, with a median follow-up of 11 years. The primary endpoint was cardiovascular mortality, and the secondary endpoint was all-cause mortality. Harrell’s C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) based on the Cox proportional hazards regression model were evaluated to assess predictive discrimination and accuracy. The associations between the 4 indices and cardiovascular mortality remained significant after adjusting for the Framingham Risk Score (FRS) and/or associated risk factors. Considering reclassification based on the newly integrated models (FRS model combined with the 4 indices), NRI for cardiovascular mortality showed that haPWV and baPWV had more significant improvement in reclassification compared with C1 and C2 [NRI with 95% CI: haPWV 0.410 (0.293, 0.523); baPWV 0.447 (0.330, 0.553); C1 0.312 (0.182, 0.454); C2 0.328 (0.159, 0.463); all P < 0.05]. This study showed that pulse wave velocity (haPWV and baPWV) provides better discrimination of long-term risk than arterial elasticity indices (C1 and C2) in the general population.

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Acknowledgements

We gratefully acknowledge the voluntary collaboration of the participants, the support of the Local Health Bureau and the technicians for their data collection.

Funding

This work was supported by General Program of National Natural Science Foundation of China (82270394 to HF Zhang, 81970339 to XL Li, 82200425 to RR Gao), Gusu Health Personnel Training Project (GSWS2021042 to HF Zhang), project from Gusu School (GSRCKY20210204 to HF Zhang), and Natural Science Foundation project of Jiangsu (BK20191072 to RR Gao). Dr. XL Li and HF Zhang are Associate Fellows at the Collaborative Innovation Center for Cardiovascular Disease Translational Medicine.

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Author notes

  1. These authors contributed equally: Xin Yue, Lu Chen, Yanping Shi.

  2. These authors jointly supervised this work: Xin Yue, Lu Chen, Yanping Shi.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China

    Xin Yue, Shengen Liao, Iokfai Cheang, Rongrong Gao, Xu Zhu, Yanli Zhou, Wenming Yao, Yanhui Sheng, Xiangqing Kong & Xinli Li

  2. Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, 215002, China

    Lu Chen, Yanping Shi, Yifang Suo & Haifeng Zhang

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Correspondence to Haifeng Zhang.

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Yue, X., Chen, L., Shi, Y. et al. Comparison of arterial stiffness indices measured by pulse wave velocity and pulse wave analysis for predicting cardiovascular and all-cause mortality in a Chinese population. Hypertens Res 47, 767–777 (2024). https://doi.org/10.1038/s41440-023-01552-z

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