Sex-Specific Trajectories of Arterial Stiffness and Major Adverse Cardiovascular Events

BACKGROUND: Sex-specific associations between brachial-ankle pulse wave velocity (baPWV) and major adverse cardiovascular events (MACE) remain unclear. Evidence for cardiovascular effects of longitudinal baPWV change is particularly lacking. METHODS: Using 57 957 repeated baPWV measurements among 20 687 participants free of myocardial infarction or stroke before the first measurement in the Kailuan study, sex-specific baPWV trajectories were depicted by generalized additive mixed models. Longitudinal associations between baPWV level or change rate and MACE and the associations between baPWV temporal patterns and MACE were then evaluated by joint models and Cox proportional hazard regression models, respectively. The impacts of life’s essential 8 score on baPWV and MACE, along with the mediation effect of baPWV, were further explored. RESULTS: Female participants exhibited the lower baPWV levels (median [interquartile range], 1284 [1154–1487] cm/s; 1452 [1304–1651] cm/s; P interaction <0.001) and the larger relative increases with advancing age (16.3 [14.7–17.9] cm/s per year; 12.8 [11.0–14.6] cm/s per year; P interaction <0.001). Over a median 6.9-year follow-up, 160 and 623 MACE events occurred among 6749 female and 13 938 male participants. Both baPWV levels (per 1 m/s increment; hazard ratio [ HR ] female , 1.118, 95% confidence interval [1.057–1.176]; HR male , 1.085 [1.050–1.125]) and change slopes (per 1 cm/s per year increment; HR female , 1.038 [1.019–1.065]; HR male , 1.033 [1.018–1.046]) during follow-up were associated with MACE. Participants with both higher baPWV levels and higher change rates against the median exhibited the highest MACE risk than those with both below median ( HR female , 2.150 [1.201–3.847]; HR male , 2.063 [1.623–2.623]). Moreover, a higher life’s essential 8 score was related to lower baPWV increments and could translate into lower MACE risk. CONCLUSIONS: BaPWV levels and change rates were positively associated with MACE risk. Favorable cardiovascular health can mitigate the adverse impacts of baPWV.