The predictive value of arterial stiffness combined with hypertension in the index of atherosclerotic cardiovascular disease

Objective This study was conducted to investigate the hypertension and arterial stiffness (AS) in predicting future atherosclerotic cardiovascular disease (ASCVD) risk. Methods: We included 6530 participants from Chinese People′s Liberation Army General Hospital. AS was assessed by measuring brachial-ankle pulse wave velocity (baPWV) and participants were stratified into two groups: ASCVD≥10% or ASCVD<10% by a risk threshold of 10%. The Kaplan-Meier survival analysis and Cox proportional risk model were evaluated the risk of ASCVD between participants with ideal vascular function (IVF defined as normal AS with normotension), normotension with AS (NTAS), hypertension with normal baPWV (HTNAS) and hypertension with AS (HTAS). C statistics were used to compare hypertension and AS status in determining ASCVD risk. Results After a median follow-up of 2.17 years, 672 participants with high risk of ASCVD were identified. Compared to the IVF group, the highest risk of ASCVD was exhibited in the HTAS group ( HR =2.252, 95%CI =1.733∽2.927), followed by the NTAS group ( HR =1.888, 95%CI =1.583∽2.252) and HTNAS group ( HR =1.827, 95%CI =1.144∽2.916). Multiple sensitivity and subgroup analyses yielded similar results. Additionally, compared to the addition of hypertension in the traditional model, the addition of AS elevated the incremental effect on the predicted value of ASCVD (the C statistic was 0.824 vs 0.817, integrated discrimination improvement was 0.80% vs 0.20%, and net reclassification index was 25.00% vs 12.20%). Conclusions The individuals with AS had a higher risk of ASCVD, and hypertension amplified these associations after adjusting for cardiovascular confounders. Otherwise, AS showed better predictive power than hypertension in determining ASCVD risk.