Estimated Pulse Wave Velocity and All-Cause Mortality: Findings From the Health and Retirement Study

Abstract

Background and Objectives The gold standard method for the assessment of vascular aging is carotid-femoral pulse wave velocity (cfPWV). cfPWV can be estimated from two commonly assessed clinical variables—age and blood pressure. This analysis uses data from the Health and Retirement Study to examine the relationship between estimated pulse wave velocity (ePWV) and mortality among 9,293 middle-age and older adults. Research Design and Methods Cox proportional hazard models were used to predict mortality occurring over a 10 to12-year period. Controls were included for sociodemographic characteristics (age, gender, race, ethnicity, wealth, income, education), health status (history of cardiovascular disease, diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, body mass index), and cardiovascular disease (CVD)-related biomarkers (systolic and diastolic blood pressure, C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol). Results By 2018, 26.19% of the weighted analytic sample were reported as deceased. In the fully specified models that control for age, age-squared, systolic and diastolic blood pressure, sociodemographic variables, health status and behaviors, and biomarkers, ePWV was associated with a greater likelihood of mortality. Discussion and Implications An estimate of PWV derived from age and blood pressure is independently associated with increased likelihood of death in a representative sample of middle-age and older adults in the U.S.

Estimated pulse wave velocity as a predictor of all-cause and cardiovascular mortality in patients with hypertension in China: a prospective cohort study

“…Moreover, the group receiving intensive blood pressure therapy showed a notable decrease in the ePWV progression rate, leading to a relative reduction in cardiovascular event occurrence. Prospective cohort studies conducted across diverse racial populations have consistently demonstrated that the ePWV can serve as an independent prognostic indicator for overall mortality ( 18 – 20 ). Combined, these findings underscore the significance of ePWV as an autonomous predictor of cardiovascular events and mortality risk.…”

“…The ePWV only requires age and average blood pressure to easily obtain results. Recently, ePWV has been shown to be an independent predictor of cardiovascular disease events and survival status (17)(18)(19)(20)(21)(22)(23)(24). However, whether ePWV can independently predict cardiovascular and all-cause mortality in Chinese patients with hypertension and whether it is superior to baPWV in predicting mortality remains unclear.…”

Predictive value of estimated pulse wave velocity with all-cause and cause-specific mortality in the hypertensive population: the National Health and Nutrition Examination Surveys 1999–2014

“…Studies have demonstrated a correlation between ePWV and established markers of vascular aging, including carotid thickness, carotid stiffness and augmentation dilatation index [42]. Although ePWV cannot completely replace cfPWV to assess arterial stiffness, ePWV has been shown to provide a robust predictive value as a 'gatekeeper' for all-cause mortality in different cohorts [43][44][45]. Laugesen et al [46] observed 25,066 patients with stable angina for 8.5 years and found a 13% increase in the risk of all-cause mortality with a 1 m/s increase in ePWV levels.…”

Estimated pulse wave velocity added additional prognostic information in general population: Evidence from National Health and Nutrition Examination Survey (NHANES) 1999–2018

“…However, there is still controversy over whether the association between ePWV and adverse clinical outcomes is independent of traditional cardiovascular risk estimation model or risk factors. Previous researches aiming in this issue either excluded the CVDs population [ 16 , 17 ] or conducted in specific population with increased cardiovascular risk [ 15 , 18 ] or established CVDs [ 19 ]. Thus, it is not yet known whether their conclusions can be extrapolated to the general population.…”