RESERVOIR-EXCESS PRESSURE PARAMTERS PREDICTS MAJOR ADVERSE CARDIOVASCULAR EVENTS IN MULTI-ETHNIC COHORT LIVING IN UK: RESULTS FROM THE SABRE STUDY

Objective: Reservoir-excess pressure analysis has been demonstrated to predict major adverse cardiovascular events (MACE) in various populations. However, evidence in multi-ethnic general populations to date is scarce. We determined whether reservoir-excess pressure parameters predicted MACE in a multi-ethnic general population living in UK. Design and method: We studied 1312 adults who were part of the UK-based tri-ethnic general population cohort (70±6 yrs, 315 females, 617 Europeans, 474 South Asians, 221 African Caribbeans). Radial artery tonometry was performed using a SphygmoCor system at baseline, and reservoir-excess pressure parameters were calculated from an ensemble-averaged radial pressure waveform including reservoir pressure integral (INTPR), peak reservoir pressure (MAXPR), excess pressure integral, systolic rate constant and diastolic rate constant (DRC). Associations between reservoir-excess pressure parameters and MACE (a composite of coronary heart disease, heart failure, stroke and cardiovascular mortality) were determined using multivariable Cox proportional hazard regression analyses. Data were expressed as hazard ratio with 95% confidence intervals. Results: 412 MACE occurred after the median follow-up period of 11 yrs. One standard deviation (SD) increase in INTPR was not convincingly associated with MACE after adjusting for age, sex and ethnicity [1.103 (0.997, 1.221), p=0.057], but was associated with MACE after additionally accounting for conventional cardiovascular risk factors and potential confounders [1.269 (1.089, 1.480), p=0.002]. One SD increase in MAXPR was associated with MACE after adjusting for age, sex and ethnicity [1.182 (1.068, 1.308), p=0.001], and the association remained after additionally accounting for conventional cardiovascular risk factors and potential confounders [1.180 (1.029, 1.354), p=0.018]. Results were similar after further accounting for non-cardiovascular deaths as a competing risk. There was no convincing evidence of the association between DRC and MACE even after extensive adjustments [0.760 (0.564, 1.025), p=0.072]. Other reservoir-excess pressure parameters did not demonstrate an association with MACE. Conclusions: Reservoir-excess pressure parameters were associated with MACE in a multi-ethnic general population living in UK. These findings support and extend a growing body of literature demonstrating a clinical utility of reservoir-excess pressure analysis for cardiovascular risk stratification.