Key result
Adding cfPWV to traditional risk factors modestly improves ASCVD risk prediction in moderate blood pressure.
Why the study?
Does adding carotid-femoral pulse wave velocity to traditional risk factors improve the prediction of cardiovascular events in individuals with moderate blood pressure?
Meta-Analysis (n=15,987)
Yes
Does adding carotid-femoral pulse wave velocity to traditional risk factors improve the prediction of cardiovascular events in individuals with moderate blood pressure?
Adding carotid-femoral pulse wave velocity to traditional risk factors modestly improves the prediction of first cardiovascular events in individuals with moderate blood pressure, potentially guiding antihypertensive treatment initiation.
Answers are grounded in this paper and cite their sources.
May refine CV risk stratification in moderate BP; extends prediction models but leaves open need for prospective validation.
OBJECTIVES: The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular (CV) events in individuals with blood pressure (BP) 120-159/80-99 mm Hg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aims to determine whether cfPWV improves the prediction of CV events beyond traditional risk factors in individuals with moderate BP. DESIGN: A systematic review and meta-analysis. DATA SOURCES: PubMed and EMBASE were searched through April 2023. ELIGIBILITY CRITERIA: We included prospective, population-based cohort studies with ≥1 year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident CV disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease, stroke or all-cause mortality outcomes. DATA EXTRACTION AND SYNTHESIS: Individual participant data from 11 cohorts (n=15 987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV. RESULTS: (cfPWV) was associated with a 1.21-fold (95% CI 1.08 to 1.36) increase in risk of ASCVD. Adding cfPWV to traditional risk factors improved ASCVD prediction: change in discrimination (C-index): 0.0048 (95% CI 0.0002 to 0.0094), p=0.041. In hypothetical populations of 100 000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7% and 3.1% under European and US guidelines, respectively. CONCLUSIONS: Adding cfPWV to traditional CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.
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Pavey et al. (2025) conducted a meta-analysis in moderate blood pressure (n=15,987). carotid-femoral pulse wave velocity (cfPWV) vs. traditional risk factors alone was evaluated on ASCVD prediction (change in C-index) (Change in C-index 0.0048, 95% CI 0.0002-0.0094, p=0.041). Adding carotid-femoral pulse wave velocity to traditional risk factors improved ASCVD risk prediction in individuals with moderate blood pressure.
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