Abstract
Objectives
The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular events in individuals with blood pressure (BP) 120-159/80-99 mmHg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aimed to determine whether cfPWV improves prediction of cardiovascular events beyond traditional risk factors in individuals with moderate BP.
Design
A systematic review and meta-analysis.
Data Sources
PubMed and EMBASE were searched through April 2023.
Eligibility Criteria
We included prospective, population-based cohort studies with ≥1-year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident atherosclerotic cardiovascular disease (ASCVD), cardiovascular disease (CVD), coronary heart disease (CHD), stroke, or all-cause mortality outcomes.
Data Extraction and Synthesis
Individual participant data from 11 cohorts (n = 15,987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV.
Results
There were 1,279 first atherosclerotic cardiovascular events over a median follow-up of 9.9 years. A 1-standard-deviation increase in loge(cfPWV) was associated with a 1.21 (95% CI: 1.08, 1.36) fold increase in risk of atherosclerotic cardiovascular disease (ASCVD). Adding cfPWV to traditional risk factors improved ASCVD prediction: change in C-index: 0.0048 (0.0002, 0.0094), p=0.041. In hypothetical populations of 100,000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7% and 3.1% under European and US guidelines, respectively.
Conclusions
Adding cfPWV to traditional cardiovascular risk factors may improve prediction and classification of first cardiovascular events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiation.
The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular events in individuals with blood pressure (BP) 120-159/80-99 mmHg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aimed to determine whether cfPWV improves prediction of cardiovascular events beyond traditional risk factors in individuals with moderate BP.
Design
A systematic review and meta-analysis.
Data Sources
PubMed and EMBASE were searched through April 2023.
Eligibility Criteria
We included prospective, population-based cohort studies with ≥1-year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident atherosclerotic cardiovascular disease (ASCVD), cardiovascular disease (CVD), coronary heart disease (CHD), stroke, or all-cause mortality outcomes.
Data Extraction and Synthesis
Individual participant data from 11 cohorts (n = 15,987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV.
Results
There were 1,279 first atherosclerotic cardiovascular events over a median follow-up of 9.9 years. A 1-standard-deviation increase in loge(cfPWV) was associated with a 1.21 (95% CI: 1.08, 1.36) fold increase in risk of atherosclerotic cardiovascular disease (ASCVD). Adding cfPWV to traditional risk factors improved ASCVD prediction: change in C-index: 0.0048 (0.0002, 0.0094), p=0.041. In hypothetical populations of 100,000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7% and 3.1% under European and US guidelines, respectively.
Conclusions
Adding cfPWV to traditional cardiovascular risk factors may improve prediction and classification of first cardiovascular events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiation.
| Original language | English |
|---|---|
| Journal | BMJ Open |
| Publication status | Accepted/In press - 20 Nov 2025 |
