Predictivity of estimated pulse wave velocity for fatal and nonfatal outcomes in rural population

Objective: Our study assesses the predictive value of arterial stiffness measured by estimated pulse wave velocity (ePWV) for fatal and nonfatal outcomes in general rural adult population. Design and method: This was a prospective observational study (1175 adult subjects) from the ENAH rural project in Croatia. Subjects were followed up for an average of 11.3 (8.3-13.65) years. Mortality data were collected from the National Institute for Public Health, and data for morbidity from the medical records of local physicians. ePWV was calculated using a validated equation. Results: In total, there were 264 deaths (22.5%), and 171 (14.5%) subjects experienced one of the non-fatal outcomes (myocardial infarction, atrial fibrilation, heart failure, stroke, TIA, dialysis). Kaplan Meier analysis (KMa) showed that survival is lower in group with ePWV>10m/s compared with group with ePWV<10m/s (HR=12.8, 95%CI 9.9-16.6, p<0.001) (Figure 1A). Similarly, KMa showed that survival to non-fatal outcome is lower in group with ePWV>10m/s compared to group with ePWV<10m/s (HR=1.50, 95%CI 1.0-2.1, p=0.008), Figure 1B. In the multivariate analysis of predictors for fatal outcome, male gender and ePWV maintained statistical significance in predicting increased risk for death (HR 1.75, 95%CI 1.18-2.61, p=0.006 and HR 1.81, 95%CI 1.08-3.04, p=0.030, respectively). In the multivariate analysis, significance was not confirmed for any predictor for non-fatal outcomes, however, in the multivariate analysis for composite fatal and non-fatal outcome results showed that men were exposed to a greater risk compared to women (HR=1.54; 95%CI 1.14-2.08, p=0.006), and ePWV showed to be a risk factor (HR=1.94, 95%CI 1.50-2.51, p<0.001). Conclusions: ePWV was found to be significant independent predictor for cardiovascular deaths and composite fatal and non-fatal outcomes suggesting that this simple and reliable measure of arterials stiffness could be recommended for clinical work at least in remote rural areas where measurements of arterial stiffness is not feasible.