The predictive value of arterial stiffness combined with hypertension in the index of atherosclerotic cardiovascular disease

Objective This study was conducted to investigate the hypertension and arterial stiffness (AS) in predicting future atherosclerotic cardiovascular disease (ASCVD) risk. Methods: We included 6530 participants from Chinese People′s Liberation Army General Hospital. AS was assessed by measuring brachial-ankle pulse wave velocity (baPWV) and participants were stratified into two groups: ASCVD≥10% or ASCVD<10% by a risk threshold of 10%. The Kaplan-Meier survival analysis and Cox proportional risk model were evaluated the risk of ASCVD between participants with ideal vascular function (IVF defined as normal AS with normotension), normotension with AS (NTAS), hypertension with normal baPWV (HTNAS) and hypertension with AS (HTAS). C statistics were used to compare hypertension and AS status in determining ASCVD risk. Results After a median follow-up of 2.17 years, 672 participants with high risk of ASCVD were identified. Compared to the IVF group, the highest risk of ASCVD was exhibited in the HTAS group ( HR =2.252, 95%CI =1.733∽2.927), followed by the NTAS group ( HR =1.888, 95%CI =1.583∽2.252) and HTNAS group ( HR =1.827, 95%CI =1.144∽2.916). Multiple sensitivity and subgroup analyses yielded similar results. Additionally, compared to the addition of hypertension in the traditional model, the addition of AS elevated the incremental effect on the predicted value of ASCVD (the C statistic was 0.824 vs 0.817, integrated discrimination improvement was 0.80% vs 0.20%, and net reclassification index was 25.00% vs 12.20%). Conclusions The individuals with AS had a higher risk of ASCVD, and hypertension amplified these associations after adjusting for cardiovascular confounders. Otherwise, AS showed better predictive power than hypertension in determining ASCVD risk. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Chinese government(Science and Technology Research Project of Henan Province (222102310226); Key Research Projects of Colleges and Universities of Henan Province(21A320035); Henan Province Medical Science and Technology Research Plan Joint Construction Project (LHGJ20210354)) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study has been approved by the Ethics Committee of the Chinese People's Liberation Army General Hospital (S2021-636-01). All participants signed informed consent forms. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available on request from the corresponding author.The data are not publicly available due to privacy or ethical restrictions.