Increased pulse wave velocity strongly related to age in apparently healthy people of high cardiovascular risk population
Authors: Zemtsovskaja G , Pilt K , Abina J , Meigas K , Viigimaa M 
Published: November 2020

Abstract

Introduction
Pulse wave velocity (PWV) as a measure of arterial stiffness is associated with CVD morbidity and mortality. CVD mortality rates show Estonia (capital Tallinn) as being among high cardiovascular (CV) risk countries.
Our study aimed to investigate the prevalence of increased PWV in Tallinn adults aged 20–65, apparently healthy (AH) at primary medical examination, and also to evaluate the association of increased PWV with age and biochemical cardiovascular risk factors at levels indicative of CV risk.

Methods
PWV measured by Arteriograph and biochemical CV risk factors by Cobas Roche 6000 analyzer were investigated in 805 responders of a cross-sectional population-based study of Tallinn adults aged 20–65, randomly selected from the Estonian Population Register by age decade and sex. Apparently healthy conditions were defined at primary visit as absence of hypertension (SBP &lt;140 and DBP &lt;90 mmHg), diabetes, obesity (BMI &lt;30 kg/m2), a history of known heart disease and medication usage against hyperlipidaemia. Statistical analysis was performed by MedCalc version 14.8.1.

Results
445 people (men=180, women=265) were in AH conditions with median values (95% central range) of SBP, DBP, and BMI: 115 (94–137) mmHg, 73 (55–87) mmHg, and 24 (18–29) kg/m2. 27.4% of AH adults were smokers.
Medians (95% central range) and indicative of CV risk level (with crude prevalence at this level) of other investigated CV risk factors were: PWV 6.2 (4.5–11.3), ≥9.7 m/s (24.7%); age 39 (23–62), ≥50 years (24.7%); total cholesterol 5.2 (3.7–7.2), &gt;5.0 mmol/L (57.1%); triglycerides 1.0 (0.5–2.7), ≥1.7 mmol/L (14.8%); apolipoprotein B 3.0 (1.7–4.7), &gt;2.6 /2.3 μmol/L for men/women (76.6%); HDL cholesterol 1.6 (1.0–2.6), &lt;1.0/1.3 mmol/L for men/women (7.0%); LDL cholesterol 3.2 (1.7–5.2), ≥3.0 mmol/L (82.7%); homocysteine 11.8 (7.1–20.2), ≥12.0 μmol/L (49%); lipoprotein (a) 0.1 (0.1–1.2), &gt;0.3 g/L (23.6%); high-sensitivity C-reactive protein 0.9 (0.2–6.8), &gt;3.0 mg/L (10.1%). Categorization of PWV values as indicative of CV risk (increased PWV) was made according to their interpretation by Arteriograph software as increased or abnormal.
Stepwise logistic regression analysis of increased PWV along with age and biochemical risk factors revealed statistically significant and strong association only with age ≥50. Overall model fit p was &lt;0.0001, c-statistic 0.838, odds ratio 29.3.

Conclusions
Despite total cholesterol, apolipoprotein B, LDL cholesterol and homocysteine being at indicative of CV risk level in over 50% of AH people, increased PWV was observed only in about 6% of them. The study showed that being 50 years of age or older in a high risk population means 29 times greater probability of increased arterial stiffness than in younger ages, even without having hypertension, diabetes or obesity. This knowledge is important for preventive CVD strategy in this population group.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Ministry of Education and Research under institutional research financing