Association of carotid-femoral pulse wave velocity and risk thresholds of index of atherosclerotic cardiovascular disease (ascvd) in hypertension

Objective: As index of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV) is strongly associated with cardiovascular risk. This study aimed to assess association of cfPWV and cardiovascular disease (CVD) in a Chinese hypertensive cohort and determine the cfPWV threshold value for assessment of future risk of CVD. Design and method: This cross-sectional study was conducted in hospital in-patients with multiple CVD risk factors or complications due to target organ damage. cfPWV was measured with the Complior device (Alam Medical, France) and central aortic pressure (cAP) with the SphygmoCor device (AtCor Medical [CardieX], Sydney) giving cAP indices: augmented pressure (AP), augmentation index (Aix), aortic pulse pressure, (aPP) aortic systolic pressure (aSBP). Framingham Risk Scores (FRS) were computed for all participants. Criteria specified by American College of Cardiology and American Heart Association were used to calculate atherosclerotic cardiovascular disease (ASCVD) risk scores. Patients were stratified by ASCVD risk threshold of 10% and divided into two groups: ASCVD >10% or ASCVD<10%. cfPWV cut-off value associated with or without ASCVD risk was obtained by receiver operating characteristics (ROC) curve. Results: All participants (n = 630; age 63.6 ± 8.6 years, 61.7% male) had primary hypertension. aAP, AIx, aPP, aSBP and were greater in females than in males (p < 0.001); ASCVD risk scores and brachial diastolic pressure (DBP) were higher in males (p<0.05). All hemodynamic indices showed significant correlation with ASCVD and FRS, except for AIx with no correlation with ASCVD. In multivariate logistic analysis, cfPWV was significantly associated with ASCVD risk (OR: 1.324, [1.119–1.565], p < 0.001) after adjusting for age, gender, smoking, body mass index, total cholesterol, fasting blood glucose, antihypertensive treatment, statin treatment, DBP. Area under the ROC curve was 0.758 and 0.672 for cfPWV and aortic SBP (p < 0.001 and p < 0.001, respectively); the critical value of cfPWV and aSBP was 12.5 m/s (sensitivity 63.2%; specificity: 77.8%) and 124.5 mmHg (sensitivity 63.9%; specificity: 65.3%). cfPWV significantly correlated with the ASCVD risk. Conclusions: The optimal cut-off value of cfPWV for assessing future CVD risk in the hypertensive population in China is 12.5 m/s.