Prognostic Value and Population Attributable Fraction of Cardio‐Ankle Vascular Index for Mortality in the General Population

Background The cardio‐ankle vascular index (CAVI) is a blood pressure‐independent measure of arterial stiffness. While its association with cardiovascular disease (CVD) is well established, its prognostic value for non‐CVD mortality and its overall public health impact in the general population remain unclear. This study aimed to evaluate CAVI as a comprehensive predictor of cause‐specific mortality and to quantify its population attributable fraction (PAF). Methods In this 12.7‐year prospective cohort study, we examined 5994 community‐dwelling adults (aged 35–69 years) from the Japan Multi‐Institutional Collaborative Cohort Study. Baseline data (2005–2012) and mortality outcomes through December 2021 were analyzed. Participants were categorized into three groups: CAVI 1 (< 8.0), CAVI 2 (8.0–8.9), and CAVI 3 (≥ 9.0). Adjusted hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models. PAF was used to quantify the impact of elevated CAVI. Results During follow‐up, 295 deaths occurred. Compared with the CAVI 1 group, the CAVI 3 group showed increased risks of all‐cause (hazard ratio: 1.38, 95% confidence interval: 1.00–1.90), CVD (hazard ratio: 2.17, 95% confidence interval: 0.97–4.86), and non‐CVD mortality (hazard ratio: 1.26, 95% confidence interval: 0.88–1.79). PAFs were 8.9%, 23.4%, and 6.2% for all‐cause, CVD, and non‐CVD mortality, respectively. Conclusion Elevated arterial stiffness (CAVI ≥ 9.0) is an independent predictor of all‐cause mortality in the general Japanese population. Furthermore, a substantial proportion of CVD deaths (approximately 23.4%) could potentially be prevented by maintaining a CAVI below 9.0, highlighting the clinical utility of CAVI screening in primary prevention and nursing management.