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Better Management of Cardiovascular Diseases by Pulse Wave Velocity: Combining Clinical Practice with Clinical Research using Evidence-Based Medicine

Ali R. Khoshdel, MD, Department of Nephrology, John Hunter Hospital, Faculty of Health, The University of Newcastle, Australia
Shane L. Carney, MD, PhD, FRACP, Department of Nephrology, John Hunter Hospital, Faculty of Health, The University of Newcastle, Australia
Balakrishnan R. Nair, MD, PhD, FRACP, Centre of Clinical Epidemiology and Biostatistics (CCEB), The University of Newcastle, Australia
Alastair Gillies, MD, PhD, FRACP, Department of Nephrology, John Hunter Hospital, Faculty of Health, The University of Newcastle, Australia

Reprint Requests: Ali Reza Khoshdel, MD, Department of Nephrology, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre NSW 2310, Tel.: (02) 4921 4321, Fax: (02) 4921 4339, Email: Alireza.Khoshdel{at}hnehealth.nsw.gov.au

Arterial stiffness measured by pulse wave velocity (PWV) is an accepted strong, independent predictor of cardiovascular events and mortality. However, lack of a reliable reference range has limited its use in clinical practice. In this evidence-based review, we applied published data to develop a PWV risk stratification model and demonstrated its impact on the management of common clinical scenarios. After reviewing 97 studies where PWV was measured, 5 end-stage renal disease patients, 5 hypertensives, 2 diabetics, and 2 elderly studies were selected. Pooling the data by the "fixed-effect model" demonstrated that the mortality and cardiovascular event risk ratio for one level increment in PWV was 2.41 (1.81–3.20) or 1.69 (1.35–2.11), respectively. There was a significant difference in PWV between survived and deceased groups, both in the low and high risk populations. Furthermore, risk comparison demonstrated that 1 standard deviation increment in PWV is equivalent to 10 years of aging, or 1.5 to 2 times the risk of a 10 mmHg increase in systolic blood pressure. Evidence shows that PWV can be beneficially used in clinical practice for cardiovascular risk stratification. Furthermore, the above risk estimates could be incorporated into currently used cardiac risk scores to improve their predictive power and facilitate the clinical application of PWV.

Key Words: Arterial stiffness • Cardiovascular risk • Evidence-based medicine