{ "abstract": "Objectives The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular (CV) events in individuals with blood pressure (BP) 120–159/80–99 mm Hg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aims to determine whether cfPWV improves the prediction of CV 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 CV disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease, 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 1279 first atherosclerotic CV events over a median follow-up of 9.9 years. A 1-SD increase in log e(cfPWV) was associated with a 1.21-fold (95% CI 1.08 to 1.36) increase in risk of ASCVD. Adding cfPWV to traditional risk factors improved ASCVD prediction: change in discrimination (C-index): 0.0048 (95% CI 0.0002 to 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 CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.", "authors": [ { "affiliations": [ "Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK", "Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria", "British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK", "Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK" ], "name": "Holly Pavey" }, { "affiliations": [ "British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK", "Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK", "British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK", "National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK", "Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK", "Cambridge Centre of Artifical Intelligence in Medicine, University of Cambridge, Cambridge, UK" ], "name": "Angela Wood" }, { "affiliations": [ "Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK" ], "name": "Carmel M Mceniery" }, { "affiliations": [ "Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA", "Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA" ], "name": "Majd AlGhatrif" }, { "affiliations": [ "Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands" ], "name": "Banafsheh Arshi" }, { "affiliations": [ "Institute of Epidemiology and Health Care, University College London, London, UK" ], "name": "Eric Brunner" }, { "affiliations": [ "School of Medicine, National Yang-Ming University, Taipei, Taiwan" ], "name": "Chen-Huan Chen" }, { "affiliations": [ "PhD Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Tapei, Taiwan", "Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan", "Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipai, Taiwan" ], "name": "Hao-Min Cheng" }, { "affiliations": [ "Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark", "Steno Diabetes Center Copenhagen, Herlev, Capital Region of Denmark, Denmark", "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark" ], "name": "Tine W Hansen" }, { "affiliations": [ "Department of Epidemiology and Neurology, Erasmus MC, Rotterdam, The Netherlands" ], "name": "M Kamram Ikram" }, { "affiliations": [ "Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands" ], "name": "Maryam Kavousi" }, { "affiliations": [ "MRC Unit for Lifelong Health and Ageing at UCL, London, UK" ], "name": "Diana Kuh" }, { "affiliations": [ "Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA" ], "name": "Allison L Kuipers" }, { "affiliations": [ "Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA" ], "name": "Edward G Lakatta" }, { "affiliations": [ "Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark", "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark" ], "name": "Allan Linneberg" }, { "affiliations": [ "Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands" ], "name": "Francesco Mattace Raso" }, { "affiliations": [ "Cardiovascular Engineering Inc, Norwood, Massachusetts, USA" ], "name": "Gary F Mitchell" }, { "affiliations": [ "Clinica de Aveleira, Instituto de Investigação e Formação Cardiovascular, Coimbra, Portugal" ], "name": "João Maldonado" }, { "affiliations": [ "Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA" ], "name": "Anne B Newman" }, { "affiliations": [ "Department of Tecnologia, Polytechnic University of Coimbra, Coimbra, Portugal" ], "name": "Telmo Pereira" }, { "affiliations": [ "Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK" ], "name": "Kaisa Maki-Petaja" }, { "affiliations": [ "Institute of Epidemiology and Health Care, University College London, London, UK" ], "name": "Martin Shipley" }, { "affiliations": [ "Department of Medicine, Boston University, Boston, Massachusetts, USA", "University of Texas Health Science Center, San Antonio, Texas, USA", "NHLBI FHS, Framingham, Massachusetts, USA" ], "name": "Ramachandran S Vasan" }, { "affiliations": [ "MRC Unit for Lifelong Health and Ageing at UCL, London, UK" ], "name": "Andrew Wong" }, { "affiliations": [ "Population Health Sciences, University of Bristol, Bristol, UK" ], "name": "Yoav Ben-Shlomo" }, { "affiliations": [ "Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK", "Cambridge Clinical Trials Unit, Cambridge, UK" ], "name": "Ian B Wilkinson" } ], "title": "Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis", "uid": "66cdc6e5-d2c3-563b-b243-4fc6c75bd3f5" }