Key result
Low and moderate Framingham cardiovascular risk categories had high rates of abnormal brachial-ankle pulse wave velocity (42.9% and 70.1%, respectively) compared to the high-risk group (85.7%).
Why the study?
The accordance between the incidence of subclinical atherosclerosis and subjects with low and moderate cardiovascular risk was unclear.
What is the incidence of subclinical atherosclerosis in subjects with low and moderate cardiovascular risk?
Cross-Sectional (n=421)
What is the incidence of subclinical atherosclerosis in subjects with low and moderate cardiovascular risk?
More than half of subjects classified as low or moderate cardiovascular risk by traditional models already have detectable subclinical atherosclerosis, suggesting traditional stratification may underestimate true risk.
Traditional risk models may underestimate subclinical atherosclerosis; leaves open whether arterial stiffness measures refine stratification.
BACKGROUND: The cardiovascular risk models and subclinical atherosclerotic indicators are both recommended for cardiovascular risk stratification. The accordance between the incidence of subclinical atherosclerosis and subjects with low and moderate cardiovascular risk is unclear. HYPOTHESIS: Subjects with low and moderate cardiovascular risk have a lower incidence of subclinical atherosclerosis compared with subjects with high risk. METHODS: Brachial-ankle pulse wave velocity (BaPWV) and brachial flow-mediated dilation (BFMD) were measured in 421 subjects without a history of atherosclerotic cardiovascular disease (ASCVD) from October 2016 to January 2020. All subjects were classified into low, moderate, and high risk based on Framingham and China-par risk models respectively. RESULTS: Mean age was 57.05 ± 9.35 years and 248 (58.9%) were male. In subjects with low, moderate, and high risk assessed by Framingham and China-par risk models, the percentage of abnormal BaPWV ( > 1400 cm/s) was 42.9%, 70.1%, 85.7%, and 40.4%, 71.4%, 89.7%, respectively. Meanwhile, the percentage of abnormal BFMD ( ≤ 7%) was 43.8%, 68.5%, 77.3%, and 44.9%,72.1%, and 76.6%. According to Framingham-based high-risk categories, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for BaPWV abnormality were 85.7%, 39.4%, 36.1%, and 87.5%, respectively. For BFMD abnormality, the values were 77.3%, 40.1%, 34.1%, and 81.8%, respectively. According to China-par high-risk categories, the values for BaPWV abnormality were 89.7%, 43.8%, 45.6%, and 89.0%, respectively. For BFMD abnormality, the values were 76.6%, 41.3%, 40.7%, and 77%, respectively. In multivariate analysis, age and blood pressure were the independent predictors for subclinical atherosclerosis in subjects with low-moderate risk. CONCLUSIONS: More than one-half of subjects with low and moderate risk already have detectable subclinical atherosclerosis, indicating higher cardiovascular risk beyond the traditional stratification.
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Li et al. (2023) conducted a cross-sectional in Cardiovascular risk without prior ASCVD (n=421). Low and moderate cardiovascular risk vs. High cardiovascular risk was evaluated on Abnormal brachial-ankle pulse wave velocity (> 1400 cm/s). Low and moderate Framingham cardiovascular risk categories had high rates of abnormal brachial-ankle pulse wave velocity (42.9% and 70.1%, respectively) compared to the high-risk group (85.7%).
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