Arterial stiffness predicts cardiovascular outcome in a low-to-moderate cardiovascular risk population: the EDIVA (Estudo de DIstensibilidade VAscular) project

Background Pulse wave velocity (PWV) is a recognized marker of arterial stiffness, although little knowledge exists of their relationship to long-term cardiovascular risk in general populations. Methods and results A prospective, multicenter, observational study included 2200 Portuguese nationals (1290 men), aged between 18 and 91 years (mean 46.33 +/- 13.76 years). They underwent clinical assessment and annual PWV measurement using a Complior device, and major adverse cardiovascular events (MACEs) - death, stroke, myocardial infarction, unstable angina, peripheral arterial disease, revascularization, or renal failure - were recorded. During a mean follow-up of 21.42 +/- 10.76 months, there were 47 nonfatal MACEs (2.1% of the sample). PWV was significantly higher in individuals with events than in those without events (11.76 +/- 2.13 vs. 10.01 +/- 2.01 m/s, respectively, P < 0.001). The study population was divided into two groups by PWV, classified as normal (PWV < 95th percentile) or high (PWV > 95th percentile), according to predefined criteria for normality. Cumulative event-free survival at 2 years was 99.3% in the normal PWV group and 95% in the high PWV group. The hazard ratio for MACE in the high PWV group was 9.901 [95% confidence interval (CI) 5.00-19.59, P < 0.001], and 4.832 (95% CI 2.35-9.94, P < 0.001) when adjusted for other risk factors. For absolute PWV, the adjusted hazard ratio (per 1 m/s change) was 1.316 (95% CI 1.13-1.53, P < 0.001). Conclusion The results of the initial analysis of this study highlight the clinical relevance of PWV as a cardiovascular risk marker and demonstrate that PWV measurement can make an important contribution to assessment of cardiovascular prognosis. J Hypertens 29:669-675 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.