What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes (n=8916). Intervention: Estimated pulse wave velocity (ePWV). Primary outcome: All-cause mortality (HR 1.43, 95% CI 1.38-1.47, p=<0.001).

April 17, 2023Open Access

Estimated pulse wave velocity is associated with all-cause mortality and cardiovascular mortality among adults with diabetes

Q: What are the key findings of this study?

For every 1 m/s increase in estimated pulse wave velocity, there was a 43% increased risk of all-cause mortality (HR 1.43) and a 58% increased risk of cardiovascular mortality (HR 1.58) in adults with diabetes.

Key Result

For every 1 m/s increase in estimated pulse wave velocity, there was a 43% increased risk of all-cause mortality (HR 1.43) and a 58% increased risk of cardiovascular mortality (HR 1.58) in adults with diabetes.

Study Design

Type

Cohort (n=8,916)

Multicenter

Yes

Structured PICO

Does higher estimated pulse wave velocity (ePWV) predict all-cause and cardiovascular mortality in adults with diabetes?

Population

8,916 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) (1999-2018), mean age 59.0 ± 11.6 years, 51.3% male, United States. Key inclusion: self-reported diabetes, prescribed antidiabetic medications, fasting glucose ≥7.0 mmol/L, or plasma HbA1c ≥6.5%.

Intervention

Higher estimated pulse wave velocity (ePWV), calculated based on age and mean blood pressure

Comparator

Lower ePWV (<9.73 m/s) or continuous ePWV increment

Outcome

All-cause mortality and cardiovascular mortalityhard clinical

Estimated pulse wave velocity (ePWV) is a strong, independent predictor of all-cause and cardiovascular mortality in adults with diabetes, suggesting its utility as a simple tool for risk stratification.

Main Result

Effect estimate: HR 1.43 (95% CI 1.38-1.47)

p-value: p=<0.001

Limitations

cf-PWV is not available in NHANES database
experienced subjective bias due to the self-reported covariates from NHANES database
whether the conclusion based on US participants could be applicable to other populations need to be further explored

Abstract

Aims: We aim to examine the association of estimated pulse wave velocity (ePWV) with all-cause and cardiovascular mortality in patients with diabetes. Methods: All of adult participants with diabetes from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were enrolled. ePWV was calculated according to the previously published equation based on age and mean blood pressure. The mortality information was obtained from the National Death Index database. Weighted Kaplan-Meier (KM) plot and weighted multivariable Cox regression was used to investigate the association of ePWV with all-cause and cardiovascular mortality risks. Restricted cubic spline was adopted to visualize the relationship between ePWV and mortality risks. Results: 8,916 participants with diabetes were included in this study and the median follow-up duration was ten years. The mean age of study population was 59.0 ± 11.6 years, 51.3% of the participants were male, representing 27.4 million patients with diabetes in weighted analysis. The increment of ePWV was closely associated with increased risks of all-cause mortality (HR: 1.46, 95% CI: 1.42-1.51) and cardiovascular mortality (HR: 1.59, 95% CI: 1.50-1.68). After adjusting for cofounding factors, for every 1 m/s increase in ePWV, there was a 43% increased risk of all-cause mortality (HR: 1.43, 95% CI: 1.38-1.47) and 58% increased of cardiovascular mortality (HR: 1.58, 95% CI: 1.50-1.68). ePWV had positive linear associations with all-cause and cardiovascular mortality. KM plots also showed that the risks of all-cause and cardiovascular mortality were significantly elevated in patients with higher ePWV. Conclusions: ePWV had a close association with all-cause and cardiovascular mortality risks in patients with diabetes.

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