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. 2024 May 28:16:367-377.
doi: 10.2147/CLEP.S457054. eCollection 2024.

Associations Between Estimated Pulse Wave Velocity and Five-Year All-Cause Mortality in Patients with Atherosclerotic Cardiovascular Disease with and without Standard Modifiable Risk Factors: Evidence From NHANES 1999-2016

Xicong Li #  1   2 , Yubiao Chen #  3 , Baiyun Liu #  3 , Mingyuan Ye  4 , Bei Liu  2 , Lifei Lu  3 , Ruiwei Guo  2
Affiliations

Associations Between Estimated Pulse Wave Velocity and Five-Year All-Cause Mortality in Patients with Atherosclerotic Cardiovascular Disease with and without Standard Modifiable Risk Factors: Evidence From NHANES 1999-2016

Xicong Li et al. Clin Epidemiol. .

Abstract

Aim: The study aimed to analyze the associations between estimated pulse wave velocity (ePWV) and 5-year mortality in atherosclerotic cardiovascular disease (ASCVD) patients with and without standard modifiable risk factors (SMuRFs), which included smoking status, hypertension, diabetes, and hypercholesterolemia.

Methods: The present retrospective cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Patients with ASCVD who completed both the questionnaire survey and serum testing were included. Patients were categorized into the ≥1 SMuRF group if they had at least one SMuRF, while those without any SMuRFs were classified into the SMuRF-less group. The ePWV, which was calculated using the age and mean blood pressure, was evenly divided into three categories: low (Q1), medium (Q2), and high (Q3). Multivariable weighted Cox proportional-hazard regression analyses were utilized to explore the risk factors associated with 5-year mortality in patients with and without SMuRFs. And restricted cubic spline curve (RCS) was used to assess their nonlinear correlation.

Results: A total of 1901 patients with ASCVD were included in the study. For the patients in ≥1 SMuRF group, the Q3 group included patients who were older, with a higher proportion of males, more comorbidities, and a lower body mass index than the Q1 group (P<0.05). The Cox proportional-hazard regression model results revealed, the Q3 group had a higher risk of 5-year mortality than the Q1 group [hazard ratio (HR) 4.30, 95% confidence interval (CI) (2.66, 6.95), P<0.001]. RCS demonstrated a linear trend between high level of ePWV and decreased risks of mortality. Similar results were observed in the SMuRF-less group [HR 10.62, 95% CI (1.22, 92.06), P=0.032].

Conclusion: A high level of ePWV signified a higher risk of 5-year mortality in ASCVD patients with and without SMuRFs.

Keywords: all-cause mortality; atherosclerotic cardiovascular disease; estimated pulse wave velocity; standard modifiable risk factors.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The flow chart of inclusion and exclusion.
Figure 2
Figure 2
Association between ePWV and 5-year all-cause mortality in ASCVD patients with ≥1 SMuRF (A) and SMuRF-less (B). The solid line and red area represent the estimated values and their corresponding 95% CIs, respectively. (ePWV, estimated Pulse Wave Velocity; SMuRFs, Standard modifiable risk factors).
Figure 3
Figure 3
In the ≥1 SMuRF (A) and SMuRF-less groups (B), the 5-year all-cause mortality for different groups based on the level of ePWV. (ePWV, estimated Pulse Wave Velocity; SMuRFs, Standard modifiable risk factors).
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