Comparison of Vascular Aging Models on the Basis of Different Vascular Indicators for Cardiovascular Events Prediction: A Chinese Community‐Based Cohort Study

BACKGROUND: Vascular aging (VA) is a promising concept for cardiovascular risk assessment, but the optimal vascular indicator for vascular age calculation remains uncertain. This study aimed to compare VA indices on the basis of different vascular indicators for predicting cardiovascular events. METHODS: This prospective study included 3561 participants from a Chinese community-based cohort. Four distinct VA indices including brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness, carotid plaque, or ankle-brachial index, and conventional risk factors were calculated to predict age. ΔAge was defined as the residual from a linear regression of vascular age on chronological age. Supernormal VA and early VA were defined by the 10th and 90th percentiles of ΔAge, respectively. Cox proportional hazards models were used to investigate associations with major adverse cardiovascular events (MACEs). RESULTS: During a mean 7.2-year follow-up, 294 participants experienced MACEs. After multivariable adjustment, only baPWV-based ΔAge was associated with MACE (hazard ratio [HR] per SD, 1.14 [95% CI, 1.02-1.27]). Early VA phenotype based on baPWV was associated with a higher risk of MACEs (HR, 1.44 [95% CI, 1.05-1.97]), whereas supernormal VA phenotype was not protective. VA indices based on carotid intima-media thickness, carotid plaque, or ankle-brachial index showed no significant associations with MACEs. CONCLUSIONS: In this Chinese community-based cohort, baPWV was the superior indicator for calculating VA indices, compared with carotid intima-media thickness, carotid plaque, and ankle-brachial index. baPWV-based ΔAge and early VA phenotype were independently associated with cardiovascular events, while other indicators were not. baPWV-based VA demonstrates clinical utility for improving cardiovascular risk stratification.