Pulse wave velocity, pulse pressure and number of carotid or femoral plaques improve prediction of cardiovascular death in a population at low risk

• Published in: Journal of human hypertension Vol. 27; no. 9; pp. 529 - 534
• Main Authors: Bérard, E, Bongard, V, Ruidavets, J-B, Amar, J, Ferrières, J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2013; Nature Publishing Group
• Subjects: 692/699/75; 692/700/1750; Adult; American Heart Association; Arteriosclerosis; Blood Pressure - physiology; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Care and treatment; Carotid Arteries - diagnostic imaging; Complications and side effects; Diagnosis; Disease Management; Epidemiology; Female; Femoral Artery - diagnostic imaging; Femur; Health Administration; Health risk assessment; Humans; Hypertension; Incidence; Male; Medicine; Medicine & Public Health; Methods; Middle Aged; original-article; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - epidemiology; Plaques; Prediction models; Predictive Value of Tests; Prevention; Prognosis; Public Health; Pulse Wave Analysis; Reclassification; Risk Factors; Surveys; Survival Rate; Ultrasonography; United States; Velocity; France; C-statistic; cardiovascular mortality; pulse pressure; discrimination; pulse wave velocity; Framingham Risk Score
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/jhh.2013.8

The assessment of cardiovascular risk is uniformly recommended as a decision-support for therapies aimed at preventing cardiovascular diseases. Our objective was to determine the prognostic significance of vascular markers in apparently healthy subjects. Analyses were based on the Third Toulouse MONICA Survey (1995–1997) carried out in participants aged 35–64, from the general population of South-western France. Causes of death were obtained 14 years after inclusion. There were 1132 participants (51% men). Over the 14-year follow-up period, 61 deaths were recorded, 20% due to a cardiovascular cause. Adding pulse wave velocity (PWV) to Framingham Risk Score (FRS) improved the accuracy of the risk prediction model. The C-statistic increased from 0.76 (95% confidence interval (CI): 0.64–0.89) (FRS alone) to 0.79 (95% CI: 0.64–0.95) (FRS+PWV). The Integrated Discrimination Improvement (IDI) reached 3.81% ( P -value<0.001) and the net reclassification improvement (NRI) was equal to 32%. Risk prediction was also improved by integrating pulse pressure (PP) in the model (C-statistic=0.81 (95% CI: 0.66–0.96); IDI=4.99% ( P -value<0.001); NRI=30%) or the number of carotid or femoral atherosclerotic plaques (C-statistic=0.78 (95% CI: 0.63–0.93); IDI=2.21% ( P -value<0.001); NRI=21%). Vascular markers are independent determinants of cardiovascular mortality in apparently healthy subjects and improve risk prediction.