Relationship of Noninvasive Assessment of Arterial Stiffness with 10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk in a General Middle-Age and Elderly Population

Figures & data

Table 1 Baseline Characteristics of Subjects

Characteristics	All Subjects	10-Year Risk< 7.5%	10-Year Risk≥7.5%	P-value
	(n=1768)	(n=992)	(n=776)
Age (years)	58.89±8.60	54.21±5.78	64.86±7.90	0.00
Gender (male, %)	578 (32.69)	304 (30.65)	274 (35.31)	0.04
Disease history (%)
Hypertension	600 (33.94)	113 (11.39)	487 (62.76)	0.00
Diabetes	135 (7.64)	10 (1.01)	125 (16.11)	0.00
Dyslipidemia	371 (20.98)	125 (12.60)	246 (31.70)	0.00
CKD	51 (2.88)	20 (2.02)	31 (3.99)	0.99
Smoking (%)	381 (21.55)	144 (14.52)	237 (30.54)	0.00
Drinking (%)	194 (10.97)	68 (6.85)	126 (16.24)	0.70

Notes: Continuous variables were represented as the mean±SD. Categorical variables were represented as the number of patients (column percentage).

Abbreviation: CKD, chronic kidney disease.

Table 2 Baseline Characteristics of Laboratory Tests and Echocardiography

Characteristics	All Subjects	10-Year Risk< 7.5%	10-Year Risk≥7.5%	P-value
	(n=1768)	(n=992)	(n=776)
BMI (kg/m^2)	24.03±3.29	23.63±3.13	24.76±3.38	0.00
CBP (mmHg)	138.98±21.73	132.09±18.72	146.41±21.04	0.00
SBP (mmHg)	133.88±20.32	129.83±20.94	142.50±20.25	0.00
DBP (mmHg)	76.11±11.61	74.3±10.53	83.62±12.22	0.00
Laboratory tests
TC (mmol/l)	5.19±0.96	5.09±0.92	5.34±0.96	0.00
TG (mmol/l)	1.78±1.34	1.60±1.21	2.01±1.29	0.00
HDL-C (mmol/l)	1.31±0.32	1.36±0.32	1.25±0.31	0.00
LDL-C (mmol/l)	3.13±1.09	3.04±1.08	3.24±0.87	0.00
FPG (mmol/l)	5.41±1.29	5.14±0.91	5.77±1.33	0.00
HbA1C (%)	5.93±0.97	5.71±0.68	6.21±1.18	0.00
baPWV (m/s)	15.03 (13.35,17.39)	13.96 (12.71,15.42)	17.07 (15.02,19.55)	0.00
ABI	1.11±0.08	1.09±0.07	1.12±0.08	0.00
BNP (pg/mL)	52 (31, 85)	47 (28, 73)	59 (35, 108.5)	0.00
HCY (umol/l)	11 (9, 14)	11 (8, 13)	12 (10, 15)	0.00
hsCRP (mg/l)	1.19 (0.59, 2.24)	1.01 (0.47, 1.91)	1.39 (0.81, 2.78)	0.00
Echocardiography
LVEF (%)	64.93±3.26	65.36±3.30	64.38±3.15	0.00
LVMI (g/m^2)	74.77 (64.83,86.17)	71.52 (62.84,82.80)	78.64 (69.04,90.05)	0.00
E/A ratio	1.14±0.68	1.25±0.68	1.00±0.60	0.00
E/e’ ratio	8 (7, 11)	8.5 (7, 12)	7 (6, 10)	0.00
LAD (mm)	34.07±4.50	33.27±4.31	35.33±5.19	0.00
LVIDd (mm)	46.73±4.12	28.66±3.93	29.41±4.38	0.00
PVWT (mm)	7.9±1.08	7.84±1.09	8.14±1.08	0.00
IVST (mm)	8.53±2.37	8.39±2.92	8.71±1.37	0.00

Notes: The variables with skewed distribution were described as median (inter-quartile range), whereas others with normal distribution were expressed as the mean±SD. P values are obtained by univariate analysis between groups.

Abbreviations: BMI, body mass index; CBP, central blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, total triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; FPG, fasting plasma glucose; HbA1C, glaciated hemoglobin; baPWV, brachial-ankle pulse wave velocity; ABI, ankle-brachial index; BNP, B-type natriuretic peptide; HCY, homocysteine; hsCRP, high-sensitivity C-reactive protein; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; E, peak early diastolic flow velocity; A, peak flow velocity of atrial contraction; e’, velocity of mitral annulus early diastolic motion; LAD, left atrium diameter; LVIDd, left ventricular internal diameter at end-diastole; PVWT, posterior left ventricular wall thickness; IVST, interventricular septal thickness.

Table 3 Threshold Effect Analysis of Baseline baPWV on the Risk of 10-Year ASCVD Risk Using Piecewise Linear Regression Model (Unadjusted)

Model	Result [β*(95% CI)]	P-value
Model I one-line	0.95 (0.88–1.01)	<0.0001
Model II turning point: 14 m/s
Slope 1: baPWV≤14 m/s	0.60 (0.32–0.88)	<0.0001
Slope 2: baPWV>14 m/s	1.01 (0.93–1.10)	<0.0001
Slope 2 - Slope 1	0.41 (0.09–0.73)	0.0128
A log likelihood ratio test		0.013

Note: *Adjusted for nothing.

Table 4 Threshold Effect Analysis of Baseline baPWV on the Risk of 10-Year ASCVD Risk Using Piecewise Linear Regression Model (Adjusted)

Model	Result [β*(95% CI)]	P-value
Model I one-line	0.16 (0.11–0.21)	<0.0001
Model II turning point: 16 m/s
Slope 1: baPWV≤16 m/s	−0.08 (−0.18–0.02)	0.1330
Slope 2: baPWV>16 m/s	0.28 (0.21–0.34)	<0.0001
Slope 2 – Slope 1	0.35 (0.23–0.48)	<0.0001
A log likelihood ratio test		<0.001

Notes: *Adjusted for age, gender, diabetes mellitus, smoking, TC, HDL-C, SBP, anti-hypertensive medicine.

Table 5 Logistic-Regression Analysis of Relevant Factors

Predictors	Crude OR (95% CI)	P-value	Adjusted OR (95% CI)	P-value
LDL-C (mmol/l)	1.20 (1.06–1.36)	0.00	1.02 (0.51–2.02)	0.95
TG (mmol/l)	1.16 (1.07–1.26)	0.00	1.12 (0.82–1.54)	0.46
BMI	1.06 (1.03–1.10)	0.00	0.92 (0.84–1.01)	0.06
HCY (umol/l)	1.03 (1.02–1.05)	0.00	1.02 (0.99–1.06)	0.19
ABI
>0.9	Reference	–	Reference	–
≤0.9	1.64 (0.44, 6.10)	0.46	5.28 (1.20–12.23)	0.03
BNP (pg/mL)^a
<100	Reference	–	Reference	–
≥100	2.13 (1.59–2.86)	0.00	1.088 (0.56–2.13)	0.80
baPWV (cm/s)
<1400	Reference	–	Reference	–
1400–1600	2.84 (2.14–3.76)	0.00	2.37 (1.77–3.18)	0.00
≥1600	12.92 (9.86–16.95)	0.00	9.09 (6.84–12.07)	0.00
HbA1c (%)^b
<5.7	Reference	–	Reference	–
5.7–6.1	1.73 (1.33–2.24)	0.00	1.33 (0.76–2.34)	0.32
≥6.1	2.82 (2.10–3.78)	0.00	1.64 (0.70–2.79)	0.54
hsCRP (mg/l)
<1	Reference	–	Reference	–
1–3	1.22 (0.95–1.58)	0.13	0.92 (0.84–1.21)	0.11
≥3	1.45 (1.04–2.02)	0.03	1.01 (0.94–1.47)	0.35

Notes: ^aBNP cut-off point of 100 pg/mL was identified according to the European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. ^bHbA1c cut-off point of 5.7% has a higher positive predictive value for identifying people at risk for developing diabetes.

Figure 1 Smooth curve of the trend of the relationship between baPWV and 10-year ASCVD risk. (A) Adjusted for nothing. (B) Adjusted for age, gender, diabetes mellitus, smoking, TC, HDL-C, SBP, anti-hypertensive medicine.

Figure 2 The Receiver operating characteristic curve for baPWV for predicting 10-year ASCVD risk.