Improved prognosis prediction of all‐cause mortality and cardiovascular events by combined assessment of both ankle‐brachial index and brachial‐ankle pulse wave velocity in individuals with diabetes: The Kyushu prevention study for atherosclerosis, a prospective, multicenter survey

Figures

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  Figure 1. Flow diagram of analysis: This flow diagram illustrates the study population selection process and outlines the exclusion criteria, which included individuals with known severe peripheral artery disease (PAD), diabetic foot, invalid measurements due to incompressible arteries, and those who withdrew consent. Ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) were measured in all participants.

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  Figure 2. Risk classification based on ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) for all‐cause mortality and cardiovascular events using recursive partitioning analysis. As shown in the flowchart, participants were categorized into three groups: high‐risk, intermediate‐risk, and low‐risk, according to their incidence rates. Differences in incidence rates among the three groups were assessed using Pearson's χ2 test. (a) All‐cause mortality: The high‐risk group was defined by a significantly lower ABI (<0.70). The intermediate‐risk group included individuals with ABI 0.7 or more, but less than 1.0, or those with ABI ≥1.0 and baPWV ≥24 m/s. (b) Coronary heart disease (CHD): Risk stratification was determined by both ABI and baPWV. The high‐risk group included individuals with ABI <1.0 or baPWV ≥19 m/s. The intermediate‐risk group comprised those with ABI ≥1.0 and baPWV 14 or more, but less than 19 m/s. (c) Cerebrovascular disease: Risk was primarily determined by baPWV. The high‐risk group consisted of individuals with baPWV ≥23 m/s, while the intermediate‐risk group included those with baPWV 14 or more, but less than 23 m/s.

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  Figure 3. Kaplan–Meier event‐free survival curves for all‐cause mortality and cardiovascular events, stratified by risk classification. The panels illustrate survival probabilities over time for all‐cause mortality, coronary heart disease (CHD), and cerebrovascular disease, categorized into high‐risk, intermediate‐risk, and low‐risk groups based on ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV).

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  Figure 4. Receiver operating characteristic (ROC) analysis comparing the predictive performance of ABI alone, baPWV alone, and their combined model for all‐cause mortality and cardiovascular events prediction. The figure illustrates the area under the curve (AUC) for each method, demonstrating the improved accuracy of risk stratification when both ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) are used together.