LAUSR

Objective: Current guidelines recommend a carotid-femoral pulse wave velocity (cf-PWV) > 10m/s of as a sign of large arterial stiffening, which was mainly based on cross-sectional analyses on the distribution of cf-PWV in healthy populations. Using data from the International Database of Central Arterial Properties for Risk Stratification (IDCARS), we aimed to determine an outcome-driven threshold for cf-PWV. Methods: Adults (> = 18 years) recruited from eight IDCARS centres and followed up for 6 months or longer were qualified for inclusion in the current meta-analysis. Cf PWV was measured using the Sphygmocor device. The primary endpoint consisted of fatal and nonfatal cardiovascular events. Secondary endpoints were total and cardiovascular mortality, and fatal and nonfatal coronary events. We calculated multivariable-adjusted hazard ratios (HRs) versus the average risk of the whole population for cf-PWV ranging from the 10th to the 90th percentile with an increment of 0.1 m/s. We plotted the HRs and their 95% confidence limits versus the increasing cutoff points of cf-PWV with the goal to determine at which level the lower confidence limit crossed unity. Results: Of 3494 participants (mean age: 52.2 years; women: 55.3%; mean cf-PWV: 7.8 m/s) followed up for a median of 5.0 years, 156 (4.5%) experienced the primary endpoint and 104 (3.0%) died. Multivariable adjusted outcome-driven thresholds of cf-PWV (m/s) were 8.6 for the primary cardiovascular endpoint, and 9.1, 8.7 and 8.6 for all-cause and cardiovascular mortality and coronary event, respectively. Subjects with a cf-PWV > = 9 m/s (n = 752, 21.5%), compared with the rest of the population, had an increased risk of the primary cardiovascular endpoint (HR: 1.75; 95% CI: 1.20–2.54, P = 0.004). Conclusions: The outcome-based threshold of > = 9 m/s for cf-PWV is close to the cut-off proposed by the current guidelines, according to which 20% of the IDCARS participants had arterial stiffness and were associated with increased cardiovascular risk.