Prognostic Value of Aortic Pulse Wave Velocity as Index of Arterial Stiffness in the General Population

Abstract

Background: During a person’s lifetime, as part of the aging process or as a consequence of hypertension, atherosclerosis, or other pathological processes, the aorta stiffens. Accordingly, the forward pulse wave travels faster, and the arterial waves reflected from the periphery reach the heart early during systole, which leads to higher systolic but lower diastolic blood pressure, an augmentation of the cardiac workload, and a decrease of the coronary perfusion pressure. The aortic pulse wave velocity (APWV) reflects central arterial stiffness. Some studies addressed the prognostic significance of APWV above and beyond other cardiovascular risk factors. Furthermore, pulse pressure, an indirect measure of increased arterial stiffness, predicts a poor prognosis in treated and untreated hypertensive subjects.

Methods: The study was conducted on a sex- and age-stratified random sample of 167 rural and suburban population of Haryana state aged 40 to 70 years. Results: Cox regression analysis was used to investigate the prognostic value of APWV, pulse pressure (PP) and other covariates. We adjusted for sex, age, body mass index. MAP measured in the office (conventional PP) and APWV by Periscope TM. With these adjustments, APWV maintained its prognostic significance in relation to each end point (P<0.05), whereas office PP lost their predictive value (P>0.19). In sensitivity analyses, APWV still predicted all cardiovascular events after standardization to a heart rate of 60 beats per minute, after adjustment for MAP. Conclusions: In a general population of Haryana, APWV predicted a composite of cardiovascular outcomes above and beyond traditional cardiovascular risk factors.