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Pulse wave velocity, pulse pressure and number of carotid or femoral plaques improve prediction of cardiovascular death in a population at low risk

Journal of Human Hypertension volume 27, pages 529–534 (2013)Cite this article

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Abstract

The assessment of cardiovascular risk is uniformly recommended as a decision-support for therapies aimed at preventing cardiovascular diseases. Our objective was to determine the prognostic significance of vascular markers in apparently healthy subjects. Analyses were based on the Third Toulouse MONICA Survey (1995–1997) carried out in participants aged 35–64, from the general population of South-western France. Causes of death were obtained 14 years after inclusion. There were 1132 participants (51% men). Over the 14-year follow-up period, 61 deaths were recorded, 20% due to a cardiovascular cause. Adding pulse wave velocity (PWV) to Framingham Risk Score (FRS) improved the accuracy of the risk prediction model. The C-statistic increased from 0.76 (95% confidence interval (CI): 0.64–0.89) (FRS alone) to 0.79 (95% CI: 0.64–0.95) (FRS+PWV). The Integrated Discrimination Improvement (IDI) reached 3.81% (P-value<0.001) and the net reclassification improvement (NRI) was equal to 32%. Risk prediction was also improved by integrating pulse pressure (PP) in the model (C-statistic=0.81 (95% CI: 0.66–0.96); IDI=4.99% (P-value<0.001); NRI=30%) or the number of carotid or femoral atherosclerotic plaques (C-statistic=0.78 (95% CI: 0.63–0.93); IDI=2.21% (P-value<0.001); NRI=21%). Vascular markers are independent determinants of cardiovascular mortality in apparently healthy subjects and improve risk prediction.

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Acknowledgements

We thank the ‘Institut National de la Santé et de la Recherche Médicale’ (INSERM), the ‘Direction Générale de la Santé (DGS)’, the ‘Institut Pasteur de Lille’, the ‘University Hospital of Lille’, the ‘Fonds d’intervention en Santé Publique’, the ‘Mutuelle Générale de l'Education Nationale’, ‘ONIVINS’, the ‘Fondation de France’, the ‘CPAM of Selestat’, the ‘Fédération Française de Cardiologie’, the ‘Conseil Régional du Nord-Pas de Calais’, Parke-Davis and Bayer pharmaceuticals, and CERIN for their financial supports enabling this work. We appreciate the collaboration with the INSEE and the health centres. We would also like to thank all investigators of the MONICA Project for their contribution to the compilation, validation and analysis of the data.

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Authors and Affiliations

  1. Department of Epidemiology, Health Economics and Public Health, UMR-1027 INSERM Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

    E Bérard, V Bongard, J-B Ruidavets & J Ferrières

  2. Department of Internal Medicine and Hypertension, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

    J Amar

  3. Department of Cardiology B, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

    J Ferrières

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  1. E Bérard
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Correspondence to J Ferrières.

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Bérard, E., Bongard, V., Ruidavets, JB. et al. Pulse wave velocity, pulse pressure and number of carotid or femoral plaques improve prediction of cardiovascular death in a population at low risk. J Hum Hypertens 27, 529–534 (2013). https://doi.org/10.1038/jhh.2013.8

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