Estimated pulse wave velocity and risk of new-onset heart failure

Aims As a potential surrogate of carotid-femoral pulse wave velocity, estimated pulse wave velocity (ePWV) has been confirmed to independently predict the cardiovascular events, but the association between ePWV and heart failure has not been well confirmed. Therefore, we performed this cohort study to evaluate the association between ePWV and risk of new-onset heart failure. Methods and results A total of 98 269 employees (mean age: 51.77 +/- 12.56 years, male accounted for 79.9%) without prior heart failure who participated in the 2006-2007 health examination were selected as the observation cohort, with an average follow-up of 13.85 +/- 1.40 years. Area under the receiver operator characteristic curve (AUC) of ePWV was calculated in prediction of heart failure. The adjusted Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals. The category-free net reclassification index (NRI) was calculated to evaluate the reclassification performance of cardiovascular risk models after adding ePWV. The AUC of ePWV was 0.74 in prediction of heart failure. After adjusting for the traditional cardiovascular risk factors except for age and blood pressure, the risk of new-onset heart failure increased by 35% [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.33-1.37] for each 1 m/s increase in ePWV. Subgroup analysis showed that ePWV was significantly associated with incident heart failure regardless of THE presence (HR: 1.33, 95% CI: 1.31-1.36, P < 0.01) or absence (HR: 1.59, 95% CI: 1.46-1.73, P < 0.01) of cardiovascular risk factors, male (HR: 1.33, 95% CI: 1.31-1.36, P < 0.01) or female (HR: 1.44, 95% CI: 1.38-1.51, P < 0.01), young and middle-aged (<52 years) (HR: 1.50, 95% CI: 1.41-1.58, P < 0.01), or middle-aged and elderly (>= 52 years) (HR: 1.23, 95% CI: 1.21-1.26, P < 0.01). The addition of ePWV to the traditional cardiovascular risk model including age and mean arterial pressure could significantly improve the reclassification ability by 31.1% (category-free NRI = 0.311, P < 0.01). Conclusions ePWV was an independent predictor for new-onset heart failure.