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Title: | Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity: An Individual-Participant Meta-Analysis | Authors: | An, De-Wei Hansen, Tine W. Aparicio, Lucas S. CHORI, Babangida Huang, Qi-Fang Wei, Fang-Fei Cheng, Yi-Bang Yu, Yu-Ling Sheng, Chang-Sheng Gilis-Malinowska, Natasza Boggia, Jose Wojciechowska, Wiktoria Niiranen, Teemu J. Tikhonoff, Valerie Casiglia, Edoardo Narkiewicz, Krzysztof Stolarz-Skrzypek, Katarzyna Kawecka-Jaszcz, Kalina Jula, Antti M. Yang, Wen-Yi Woodiwiss, Angela J. Filipovsky, Jan Wang, Ji-Guang Rajzer, Marek W. Verhamme, Peter NAWROT, Tim Staessen, Jan A. Li , Yan |
Issue Date: | 2023 | Publisher: | LIPPINCOTT WILLIAMS & WILKINS | Source: | HYPERTENSION, 80 (9) , p. 1949 -1959 | Abstract: | BACKGROUND:Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen).METHODS:A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement.RESULTS:In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was & AP;0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome.CONCLUSIONS:PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death. | Notes: | Staessen, JA (corresponding author), Res Assoc Alliance Promot Prevent Med, Leopoldstraat 59, BE-2800 Mechelen, Belgium.; Li, Y (corresponding author), Shanghai Jiao Tong Univ, Shanghai Inst Hypertens, Ruijin Hosp, Sch Med, 192 Ruijin Er Rd, Shanghai 2000025, Peoples R China. jan.staessen@appremed.org; liyanshcn@163.com |
Keywords: | cardiovascular diseases;diabetes mellitus;hypertension;pulse wave analysis;metabolic syndrome | Document URI: | http://hdl.handle.net/1942/41582 | ISSN: | 0194-911X | e-ISSN: | 1524-4563 | DOI: | 10.1161/HYPERTENSIONAHA.123.21318 | ISI #: | 001072405400019 | Rights: | 2023 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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