Research Department of Epidemiology and Public Health, University College London, London, United Kingdom (C.A.V.-H., J.V. L., M.J.S., A.S.-M., M.K., E.J.B.).
Clinicum, Department of Public Health, University of Helsinki (J.V.L.).
Hypertension. 2022 Apr;79(4):836-843. doi: 10.1161/HYPERTENSIONAHA.121.17589. Epub 2022 Feb 10.
Aortic pulse wave velocity is a noninvasive measure of aortic stiffness and arterial aging. Its current value in cardiovascular risk estimation practice is unknown. We aimed to establish whether aortic pulse wave velocity identified individuals with higher risk of incident major adverse cardiovascular events and improved performance of the American Heart Association/American College of Cardiology atherosclerotic cardiovascular disease risk score.
This prospective analysis included 3837 Whitehall II cohort participants screened in 2008 to 2009, and followed for 11.7 years (mean=10.3, SD=1.81), without history of stroke, myocardial infarction, or coronary heart disease.
Mean age of the sample was 65.0 years (SD=5.6), 2831 participants (73.8%) were male and mean atherosclerotic cardiovascular disease risk score was 13.8%. At the end of follow-up, 411 individuals (10.7%) had suffered a major cardiovascular event. Those in the highest aortic pulse wave velocity quartile were at high risk (hazard ratio, 2.99 [95% CI, 2.25-3.97]) and reached the threshold for statin medication (7.5% risk) after 5 years whereas others reached it after 10 years (difference <0.001). The addition of aortic pulse wave velocity to the risk score improved the C statistic (0.68 versus 0.67, =0.03) and net reclassification index (4.6%, =0.04 and 11.3%, =0.02).
Our results show that aortic stiffness predicted major adverse cardiovascular events in a cohort of elderly individuals, improving the performance of a widely used cardiovascular disease risk estimator. Aortic pulse wave velocity measurement is scalable, radiation-free, and easy to perform. Further studies on its applicability in cardiovascular disease risk assessment in primary care settings are needed.
主动脉脉搏波速度是一种无创的测量主动脉僵硬度和动脉老化的方法。目前尚不清楚其在心血管风险评估实践中的价值。我们旨在确定主动脉脉搏波速度是否能识别出发生重大不良心血管事件风险较高的个体，并改善美国心脏协会/美国心脏病学会动脉粥样硬化性心血管疾病风险评分的性能。
本前瞻性分析纳入了 2008 年至 2009 年筛查的 3837 名 Whitehall II 队列参与者，随访 11.7 年（平均 10.3 年，标准差 1.81 年），无卒中和心肌梗死或冠心病病史。
样本的平均年龄为 65.0 岁（标准差 5.6），2831 名参与者（73.8%）为男性，平均动脉粥样硬化性心血管疾病风险评分 13.8%。随访结束时，411 名参与者（10.7%）发生了重大心血管事件。处于主动脉脉搏波速度最高四分位的人风险较高（危险比，2.99[95%CI，2.25-3.97]），并在 5 年内达到他汀类药物治疗的阈值（7.5%的风险），而其他人则在 10 年内达到该阈值（差异<0.001）。将主动脉脉搏波速度加入风险评分后，C 统计量（0.68 比 0.67，=0.03）和净重新分类指数（4.6%，=0.04 和 11.3%，=0.02）均得到改善。
我们的研究结果表明，主动脉僵硬度可预测老年人群的重大不良心血管事件，改善了一种广泛使用的心血管疾病风险评估工具的性能。主动脉脉搏波速度测量具有可扩展性、无辐射、易于操作等优点。需要进一步研究其在基层医疗环境中进行心血管疾病风险评估的适用性。
