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Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity: An Individual-Participant Meta-Analysis
DW. An, TW. Hansen, LS. Aparicio, B. Chori, QF. Huang, FF. Wei, YB. Cheng, YL. Yu, CS. Sheng, N. Gilis-Malinowska, J. Boggia, W. Wojciechowska, TJ. Niiranen, V. Tikhonoff, E. Casiglia, K. Narkiewicz, K. Stolarz-Skrzypek, K. Kawecka-Jaszcz, AM....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu metaanalýza, časopisecké články, práce podpořená grantem
NLK
Free Medical Journals
od 1979 do Před 1 rokem
Open Access Digital Library
od 1979-01-01
Open Access Digital Library
od 1979-01-01
- MeSH
- analýza pulzové vlny škodlivé účinky MeSH
- aorta MeSH
- arterie MeSH
- hypertenze * diagnóza epidemiologie komplikace MeSH
- kardiovaskulární nemoci * diagnóza epidemiologie etiologie MeSH
- lidé MeSH
- rizikové faktory MeSH
- tuhost cévní stěny * fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
BACKGROUND: Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen). METHODS: A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement. RESULTS: In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was ≈0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome. CONCLUSIONS: PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death.
Biomedical Science Group Faculty of Medicine University of Leuven Belgium
Centre for Environmental Sciences Hasselt University Belgium
Department of Cardiology Shanghai General Hospital China
Department of Cardiology the 1st Affiliated Hospital of Sun Yat Sen University Guangzhou China
Department of Chronic Disease Prevention Finnish Institute for Health and Welfare Turku Finland
Department of Medicine Turku University Hospital and University of Turku Finland
Department of Medicine University of Padova Italy
Faculty of Medicine Charles University Pilsen Czech Republic
Hypertension Unit Department of Hypertension and Diabetology Medical University of Gdańsk Poland
Non Profit Research Association Alliance for the Promotion of Preventive Medicine Belgium
School of Physiology University of the Witwatersrand Johannesburg South Africa
Servicio de Clínica Médica Sección Hipertensión Arterial Hospital Italiano de Buenos Aires Argentina
Citace poskytuje Crossref.org
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- $a An, De-Wei $u Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.) $u Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.) $u Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Belgium (D.-W.A, Y.-L.Y., T.S.N.) $1 https://orcid.org/0000000213957050
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- $a Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity: An Individual-Participant Meta-Analysis / $c DW. An, TW. Hansen, LS. Aparicio, B. Chori, QF. Huang, FF. Wei, YB. Cheng, YL. Yu, CS. Sheng, N. Gilis-Malinowska, J. Boggia, W. Wojciechowska, TJ. Niiranen, V. Tikhonoff, E. Casiglia, K. Narkiewicz, K. Stolarz-Skrzypek, K. Kawecka-Jaszcz, AM. Jula, WY. Yang, AJ. Woodiwiss, J. Filipovský, JG. Wang, MW. Rajzer, P. Verhamme, TS. Nawrot, JA. Staessen, Y. Li, International Database of Central Arterial Properties for Risk Stratification Investigators
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