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

Abstract

Xicong Li,1,2,* Yubiao Chen,3,* Baiyun Liu,3,* Mingyuan Ye,4 Bei Liu,2 Lifei Lu,3 Ruiwei Guo2 1Department of Cardiovascular, Kunming Medical University, Kunming, Yunnan, People’s Republic of China; 2Department of Cardiovascular, 920th Hospital of Joint Logistics Support Force, Chinese People’s Liberation Army (PLA), Kunming, Yunnan, People’s Republic of China; 3Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 4Department of Otolaryngology, Zhuhai Maternity and Child Health Hospital, Zhuhai, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lifei Lu, Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China, Email [email protected] Ruiwei Guo, Department of Cardiovascular, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, Yunnan, People’s Republic of China, Email [email protected]: 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: atherosclerotic cardiovascular disease, standard modifiable risk factors, estimated pulse wave velocity, all-cause mortality

Keywords

• atherosclerotic cardiovascular disease
• standard modifiable risk factors
• estimated pulse wave velocity
• all-cause mortality