Cf-PWV Versus ba-PWV in Predicting Cardiovascular Events: Insights From a Community-Based Cohort

BACKGROUND: To directly compare the predictive ability of carotid-femoral pulse wave velocity (cf-PWV) and brachial-ankle pulse wave velocity (ba-PWV) for cardiovascular events within the same population. METHODS: This is a community-based prospective cohort study that included older adults (>65 years). The primary end point was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke. RESULTS: A total of 3309 participants (median age [quartiles], 70 [67–75] years; 1434 [43.3%] male) were included. The median follow-up time was 6.40 [6.37–6.41] years. Cf-PWV and ba-PWV were moderately correlated ( R =0.588; P <0.001). Participants were divided into 4 groups by quartiles or 2 groups using cutoff values. Aalen-Johansen estimators and Cox regression analyses indicated that both cf-PWV and ba-PWV were associated with an increased rate of MACEs. When cf-PWV and ba-PWV were cross-adjusted, only cf-PWV remained significantly associated with MACEs and mortality (hazard ratio, 1.12 [95% CI, 1.00–1.25]; P =0.048 and 1.16 [95% CI, 1.03–1.29]; P =0.032, respectively) in both full-model and stepwise regressions. Stratification based on cf-PWV and ba-PWV cutoff values further revealed that elevated cf-PWV was associated with a higher risk of MACEs, independent of baseline ba-PWV. Concordance index, net reclassification improvement, and integrated discrimination improvement analyses confirmed the additive value of cf-PWV to conventional cardiovascular risk factors. Other stiffness-related parameters, including pulse pressure and its amplification, were not independently associated with MACEs. CONCLUSIONS: Both cf-PWV and ba-PWV are associated with cardiovascular events, and cf-PWV demonstrates a higher predictive value compared with ba-PWV. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02368938.