Estimated pulse wave velocity for cardiovascular risk assessment in rural populations: the ENAH study

INTRODUCTION: Arterial stiffness, typically measured by pulse wave velocity (PWV), is a recognized biomarker of cardiovascular (CV) risk and mortality. Our study assesses the predictive value of arterial stiffness measured by estimated pulse wave velocity (ePWV) for fatal and nonfatal outcomes in a general rural adult population. METHODS: This prospective observational cohort study was conducted within the ENAH project, which initially included 3,305 adults, with 2,232 participants followed-up over a median of 11.3 years. Baseline demographic, clinical, and laboratory data, including blood pressure, anthropometry, and biochemical analyses of blood and urine, were collected using standardized protocols. The primary outcome was all-cause mortality, while secondary outcomes comprised nonfatal cardiovascular, cerebrovascular, and renal events, analyzed using Kaplan-Meier survival curves and multivariable regression models. RESULTS: In our cohort, which consisted of 1,175 adult subjects and was followed for an average of 11.3 years, in total, there were 263 deaths (22.4%), and 171 (14.5%) subjects experienced one of the non-fatal outcomes (myocardial infarction, atrial fibrillation, heart failure, stroke, TIA (transitory ischemic attack), dialysis). Kaplan-Meier analysis (KMa) showed that survival is lower in group with ePWV > 10m/s compared to the group with ePWV < 10m/s (HR=12.8, 95%CI 9.9-16.6, p<0.001). Similarly, KMa showed that survival to non-fatal outcome is lower in group with ePWV > 10m/s compared to the group with ePWV < 10m/s (HR=1.50, 95%CI 1.0-2.1, p=0.008). In the multivariate analysis of predictors for fatal outcome, male gender and ePWV maintained statistical significance in predicting increased risk for death (HR 1.75, 95%CI 1.18-2.61, p=0.006 and HR 1.81, 95%CI 1.08-3.04, p=0.030, respectively). In the multivariate analysis, significance was not confirmed for any predictor for non-fatal outcomes, however, in the multivariate analysis for composite fatal and non-fatal outcome results showed that men were exposed to a greater risk compared to women (HR=1.54; 95%CI 1.14-2.08, p=0.006), and ePWV showed to be a risk factor (HR=1.94, 95%CI 1.50-2.51, p<0.001). CONCLUSION: ePWV was found to be significant independent predictor for overall mortality and composite fatal and non-fatal outcomes suggesting that this simple and reliable measure of arterial stiffness could be recommended for clinical work at least in remote rural areas where measurements of arterial stiffness is not feasible.