Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults
Abstract Background Estimated pulse wave velocity (ePWV) has been proposed as a potential approach to estimate carotid-femoral pulse wave velocity. However, the potential of ePWV in predicting all-cause mortality (ACM) and cardiovascular disease mortality (CVM) in the general population is unclear....
| Main Authors: | , , , , , |
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BMC
2024-02-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-024-18071-2 |
| _version_ | 1827325931269652480 |
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| author | Wenke Cheng Fanliang Kong Huachun Pan Sisi Luan Shumin Yang Siwei Chen |
| author_facet | Wenke Cheng Fanliang Kong Huachun Pan Sisi Luan Shumin Yang Siwei Chen |
| author_sort | Wenke Cheng |
| collection | DOAJ |
| description | Abstract Background Estimated pulse wave velocity (ePWV) has been proposed as a potential approach to estimate carotid-femoral pulse wave velocity. However, the potential of ePWV in predicting all-cause mortality (ACM) and cardiovascular disease mortality (CVM) in the general population is unclear. Methods We conducted a prospective cohort study using the data of 33,930 adults (age ≥ 20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 until the end of December 2019. The study outcomes included ACM and CVM. Survey-weighted Cox proportional hazards models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the association between ePWV and ACM and CVM. To further investigate whether ePWV was superior to traditional risk factors in predicting ACM and CVM, comparisons between ePWV and the Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) models were performed. Integrated Discriminant Improvement (IDI) and Net Reclassification Improvement (NRI) were employed to analyze differences in predictive ability between models. Results The weighted mean age of the 33,930 adults included was 45.2 years, and 50.28% of all participants were men. In the fully adjusted Cox regression model, each 1 m/s increase in ePWV was associated with 50% and 49% increases in the risk of ACM (HR 1.50; 95% CI, 1.45–1.54) and CVM (HR 1.49; 95% CI, 1.41–1.57), respectively. After adjusting for FRS, each 1 m/s increase in ePWV was still associated with 29% (HR 1.29; 95% CI, 1.24–1.34) and 34% (HR 1.34; 95% CI, 1.23–1.45) increases in the risk of ACM and CVM, respectively. The area under the curve (AUC) predicted by ePWV for 10-year ACM and CVM were 0.822 and 0.835, respectively. Compared with the FRS model, the ePWV model improved the predictive value of ACM and CVM by 5.1% and 3.8%, respectively, with no further improvement in event classification. In comparison with the PCE model, the ePWV model’s ability to predict 10-year ACM and CVM was improved by 5.1% and 3.5%, and event classification improvement was improved by 34.5% and 37.4%. Conclusions In the U.S. adults, ePWV is an independent risk factor for ACM and CVM and is independent of traditional risk factors. In the general population aged 20 to 85 years, ePWV has a robust predictive value for the risk of ACM and CVM, superior to the FRS and PCE models. The predictive power of ePWV likely originates from the traditional risk factors incorporated into its calculation, rather than from an indirect association with measured pulse wave velocity. |
| first_indexed | 2024-03-07T14:37:23Z |
| format | Article |
| id | doaj.art-f186e98f4c2c4a9e8b754507cd4ebcfe |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-07T14:37:23Z |
| publishDate | 2024-02-01 |
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| series | BMC Public Health |
| spelling | doaj.art-f186e98f4c2c4a9e8b754507cd4ebcfe2024-03-05T20:36:03ZengBMCBMC Public Health1471-24582024-02-0124111410.1186/s12889-024-18071-2Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adultsWenke Cheng0Fanliang Kong1Huachun Pan2Sisi Luan3Shumin Yang4Siwei Chen5Medical Faculty, University of LeipzigUniversity Medical Center of Göttingen, Georg-August UniversityCollege of Veterinary Medicine, Huazhong Agricultural UniversityDepartment of Endocrinology, Beijing Tongren Hospital, Capital Medical UniversityState Key Laboratory of Agriculture Microbiology, College of Veterinary Medicine, Huazhong Agricultural UniversityDepartment of Cardiovascular Medicine, Nanchang People’s Hospital (The Third Hospital of Nanchang)Abstract Background Estimated pulse wave velocity (ePWV) has been proposed as a potential approach to estimate carotid-femoral pulse wave velocity. However, the potential of ePWV in predicting all-cause mortality (ACM) and cardiovascular disease mortality (CVM) in the general population is unclear. Methods We conducted a prospective cohort study using the data of 33,930 adults (age ≥ 20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 until the end of December 2019. The study outcomes included ACM and CVM. Survey-weighted Cox proportional hazards models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the association between ePWV and ACM and CVM. To further investigate whether ePWV was superior to traditional risk factors in predicting ACM and CVM, comparisons between ePWV and the Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) models were performed. Integrated Discriminant Improvement (IDI) and Net Reclassification Improvement (NRI) were employed to analyze differences in predictive ability between models. Results The weighted mean age of the 33,930 adults included was 45.2 years, and 50.28% of all participants were men. In the fully adjusted Cox regression model, each 1 m/s increase in ePWV was associated with 50% and 49% increases in the risk of ACM (HR 1.50; 95% CI, 1.45–1.54) and CVM (HR 1.49; 95% CI, 1.41–1.57), respectively. After adjusting for FRS, each 1 m/s increase in ePWV was still associated with 29% (HR 1.29; 95% CI, 1.24–1.34) and 34% (HR 1.34; 95% CI, 1.23–1.45) increases in the risk of ACM and CVM, respectively. The area under the curve (AUC) predicted by ePWV for 10-year ACM and CVM were 0.822 and 0.835, respectively. Compared with the FRS model, the ePWV model improved the predictive value of ACM and CVM by 5.1% and 3.8%, respectively, with no further improvement in event classification. In comparison with the PCE model, the ePWV model’s ability to predict 10-year ACM and CVM was improved by 5.1% and 3.5%, and event classification improvement was improved by 34.5% and 37.4%. Conclusions In the U.S. adults, ePWV is an independent risk factor for ACM and CVM and is independent of traditional risk factors. In the general population aged 20 to 85 years, ePWV has a robust predictive value for the risk of ACM and CVM, superior to the FRS and PCE models. The predictive power of ePWV likely originates from the traditional risk factors incorporated into its calculation, rather than from an indirect association with measured pulse wave velocity.https://doi.org/10.1186/s12889-024-18071-2Estimated pulse wave velocityNational Health and Nutrition Examination SurveyAll-cause mortalityCardiovascular diseaseMortality |
| spellingShingle | Wenke Cheng Fanliang Kong Huachun Pan Sisi Luan Shumin Yang Siwei Chen Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults BMC Public Health Estimated pulse wave velocity National Health and Nutrition Examination Survey All-cause mortality Cardiovascular disease Mortality |
| title | Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults |
| title_full | Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults |
| title_fullStr | Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults |
| title_full_unstemmed | Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults |
| title_short | Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults |
| title_sort | superior predictive value of estimated pulse wave velocity for all cause and cardiovascular disease mortality risk in u s general adults |
| topic | Estimated pulse wave velocity National Health and Nutrition Examination Survey All-cause mortality Cardiovascular disease Mortality |
| url | https://doi.org/10.1186/s12889-024-18071-2 |
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