Associação entre o risco cardiovascular e velocidade de onda de pulso em pacientes idosos: Estudo EVOPIU

Abstract

Introduction: Carotid-femoral Pulse Wave Velocity (c-fPWV) is a noninvasive indirect measure of central arterial stiffness, considered a predictor of cardiovascular events. However, it is not included in any cardiovascular risk calculator, such as the pooled risk equation for atherosclerotic cardiovascular disease (ASCVD) risk estimation. Objective: To evaluate the association between c-fPWV and cardiovascular risk (CVR) CVR in older individuals as determined by ASCVD Risk Estimator. Materials and Methods: EVOPIU is a longitudinal study where c-fPWV and ASCVD risk were evaluated in 927 patients aged 60 or older. We measured c-fPWV with the SphygmoCor XCEL model EM4C device (AtCor Medical, Sydney, NSW, Australia). We calculated 10-year ASCVD risk using the pooled equation risk calculator that integrates information on age, gender, systolic BP (and treatment with statin, total and HDL cholesterol, and history of DM. The primary outcomes considered were death, acute myocardial infarction and stroke during follow-up. Results: Average age was 67.8 ± 5.2 years, 38% male, 13% diabetic; 56% hypertensive; total cholesterol 202 ± 37 mg/dl; HDL-cholesterol 52 ± 14 mg/dl, and LDL 119 ± 33 mg /dl. Baseline cfPWV was 9.33 ±0.9 m/s. The average ASCVD risk was 21.9%. There was a direct correlation between cfPWV and ASCVD risk (Spearman’s σ = 0.74 p<0.0001. A total of 87 deaths events occurred during a median follow-up of 4 years. Survival analysis showed that CVR+c-fPWV detected higher number of deaths in the largest tertiles of the PVW e ASCVD (chi2: 8.3; p = 0.002). Grouping CVR + c-fPWV change the prediction capacity of the ASCVD risk estimator for death for cardiovascular cause. The area under the curve was 0.86, with 77.4% sensitivity and 77.3% specificity with c-fPWV cutoff = 9.6 m / s. Conclusion: There is a positive association between c-fPWV and ASCVD risk. Grouping CVR + c-fPWV change the prediction capacity of the ASCVD risk estimator for death for all causes. The c-fPWV measurement could complement the ASCVD risk estimator for the elderly