Aortic pulse wave velocity improved prediction of cardiovascular disease events beyond conventional risk factors (HR 1.30; 95% CI 1.18-1.43; p<0.001 per 1-SD change).
Systematic Review (n=17,635)
Yes
Effect estimate: HR 1.30 (95% CI 1.18 to 1.43)
p-value: p=<0.001
To determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular (CVD) events beyond conventional risk factors. Several studies have shown that aPWV may be a useful risk factor for predicting CVD but have been underpowered to examine whether this is true for different sub-groups. We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with cardiovascular outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. Of 17,635 participants, 1,785 (10%) had a cardiovascular (CVD) event. The pooled age- and sex-adjusted hazard ratio 95% CI per SD change in log e aPWV was 1.35 1.22, 1.50, p70 years respectively, p interaction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor: CHD 1.23, [1.11, 1.35 p<0.001; stroke 1.28, 1.16, 1.42 p<0.001; cardiovascular events 1.30 1.18, 1.43, p<0.001. Reclassification indices showed the addition of aPWV improved risk prediction (13% for 10 year CVD risk for intermediate risk) for some sub-groups. Consideration of aPWV improves model fit and reclassifies risk for future cardiovascular events in models that include standard risk factors. aPWV may enable better identification of high-risk populations who may benefit from more aggressive cardiovascular risk factor management. Keywords: pulse wave velocity, meta-analysis, cardiovascular disease, prognostic factor
“Importantly, the study of Ben-Shlomo et al. takes the issue of risk prediction with aPWV a decisive step further. Existing evidence is convincing that aPWV fulfills biomarker criteria 1, 2, and 3... However, to prove its predictive value, a biomarker should further demonstrate that a clinically meaningful proportion of individuals benefit by changing their risk status, or in other words, they are correctly reclassified to higher or lower risk categories when this biomarker is measured.”
Ben‐Shlomo et al. (2013) conducted a systematic review in Cardiovascular disease (n=17,635). Aortic pulse wave velocity (aPWV) vs. Conventional risk factors was evaluated on Cardiovascular disease (CVD) events (HR 1.30, 95% CI 1.18 to 1.43, p=<0.001). Aortic pulse wave velocity improved prediction of cardiovascular disease events beyond conventional risk factors (HR 1.30; 95% CI 1.18-1.43; p<0.001 per 1-SD change).
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