Objective: We examined the relationship between brachial-ankle pulse wave velocity and the development of cardiovascular disease in a general Japanese population.
Methods: A total of 2916 community-dwelling Japanese individuals without history of cardiovascular disease aged at least 40 years were followed up for an average of 7.1 years, and the relationship between brachial-ankle pulse wave velocity and the cardiovascular risk was estimated using the Cox proportional hazards model. To compare the accuracy of the risk assessment for cardiovascular events between the models adjusted for known cardiovascular risk factors with and without brachial-ankle pulse wave velocity, the area under the receiver-operating characteristic curve and net reclassification improvement were computed.
Results: During the follow-up period, 126 patients experienced cardiovascular events. Age and sex-adjusted incidence rates of cardiovascular disease increased linearly with elevating brachial-ankle pulse wave velocity levels (P for trend <0.001). After adjusting for confounding factors, every 20% increment in brachial-ankle pulse wave velocity was associated with a 1.30-fold [95% confidential interval (CI) 1.10–1.53] greater cardiovascular risk. When brachial-ankle pulse wave velocity was incorporated into a model with known cardiovascular risk factors, the area under the receiver-operating characteristic curve was significantly increased (0.776 vs. 0.760; P = 0.01), and the net reclassification improvement was 0.085 (P = 0.008).
Conclusions: Our findings suggest that brachial-ankle pulse wave velocity is a significant predictive factor for cardiovascular disease in the general Japanese population and that information on brachial-ankle pulse wave velocity substantially improves cardiovascular risk assessment beyond that achieved by a model based on potential risk factors in general practice.
aDepartment of Medicine and Clinical Science
bDepartment of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Correspondence to Toshiharu Ninomiya, MD, PhD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3–1–1 Maidashi, Higashiku, Fukuoka City 812–8582, Japan. Tel: +81 92 642 6107; fax: +81 92 642 6108; e-mail: firstname.lastname@example.org
Abbreviations: baPWV, brachial-ankle pulse wave velocity; cfPWV, carotid-femoral pulse wave velocity; CI, confidence interval; CVD, cardiovascular disease; NRI, net reclassification improvement; ROC, receiver-operating characteristic
Received 26 January, 2012
Revised 5 November, 2012
Accepted 7 November, 2012