Estimated pulse wave velocity is associated with all-cause and cardio-cerebrovascular disease mortality in stroke population: Results from NHANES (2003-2014)

Huoming Huang; Xiancong Bu; Huachun Pan; Shumin Yang; Wenke Cheng; Quazi T H Shubhra; Niya Ma

doi:10.3389/fcvm.2023.1140160

Estimated pulse wave velocity is associated with all-cause and cardio-cerebrovascular disease mortality in stroke population: Results from NHANES (2003-2014)

Front Cardiovasc Med. 2023 Apr 19:10:1140160. doi: 10.3389/fcvm.2023.1140160. eCollection 2023.

Authors

Huoming Huang¹, Xiancong Bu², Huachun Pan³, Shumin Yang⁴, Wenke Cheng⁵, Quazi T H Shubhra^{6

7}, Niya Ma⁵

Affiliations

¹ Department of Cardiovascular Medicine, Nanchang People's Hospital (The Third Hospital of Nanchang), Nanchang, China.
² Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China.
³ College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China.
⁴ State Key Laboratory of Agriculture Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China.
⁵ Medical Faculty, University of Leipzig, Leipzig, Germany.
⁶ Stomatology Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
⁷ Translational Medicine Engineering Research Center of Guangdong Province, Foshan First People's Hospital, Foshan, China.

Abstract

Background: Arterial stiffness is a significant determinant and evaluation of cardio-cerebrovascular disease and all-cause mortality risk in the stroke population. Estimated pulse wave velocity (ePWV) is a well-established indirect measure of arterial stiffness. We examined the association of ePWV with all-cause and cardio-cerebrovascular disease (CCD) mortality in the stroke population in a large sample of US adults.

Methods: The study design was a prospective cohort study with data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014, between the ages of 18-85 years, with follow-up through December 31, 2019. 1,316 individuals with stroke among 58,759 participants were identified and ultimately, 879 stroke patients were included in the analysis. ePWV was calculated from a regression equation using age and mean blood pressure according to the following formula: ePWV = 9.587 - (0.402 × age) + [4.560 × 0.001 × (age²)] - [2.621 × 0.00001 × (age²) × MBP] + (3.176 × 0.001 × age × MBP) - (1.832 × 0.01 × MBP). Survey-weighted Cox regression models were used to assess the association between ePWV and all-cause and CCD mortality risk.

Results: The high ePWV level group had a higher increased risk of all-cause mortality and CCD mortality compared to the low ePWV level group after fully adjusting for covariates. With an increase in ePWV of 1 m/s, the risk of all-cause and CCD mortality increased by 44%-57% and 47%-72% respectively. ePWV levels were linearly correlated with the risk of all-cause mortality (P for nonlinear = 0.187). With each 1 m/s increase in ePWV, the risk of all-cause mortality increased by 44% (HR 1.44, 95% CI: 1.22-1.69; P < 0.001). When ePWV was <12.1 m/s, an increase in ePWV per 1 m/s was associated with a 119% (HR 2.19, 95% CI: 1.43-3.36; P < 0.001) increase in CCD mortality risk; when ePWV was ≥12.1 m/s, an increase in ePWV per 1 m/s was not associated with in CCD mortality risk.

Conclusion: ePWV is an independent risk factor for all-cause and CCD mortality in stroke patients. Higher levels of ePWV are associated with higher all-cause mortality and CCD mortality in stroke patients.

Keywords: all-cause mortality; arterial stiffness; cardio-cerebrovascular disease mortality; estimated pulse wave velocity; stroke.