Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study

Background Hypertension guidelines underline the
importance of quantification of total cardiovascular risk; an
extensive evaluation of target organ damage (TOD) may
increase the number of patients classified at high-added
cardiovascular risk.
Objective To assess the effect of the evaluation of different
forms of TOD, in addition to ‘routine’ workup, on
cardiovascular risk stratification in a general population
sample in Northern Italy.
Methods In 385 patients (age 57W10 years, 44% men, 64% hypertensives, 32% treated), left ventricular and carotid artery structure and carotid–femoral pulse wave velocity (PWV) were measured. All patients underwent laboratory examinations. Patients were divided into risk categories according to European Society of Hypertension/European Society of Cardiology guidelines before and after TOD evaluation.
Results After routine workup, patients were classified as
follows: 6% at average cardiovascular risk, 35% at low
cardiovascular risk, 25% at moderate cardiovascular risk,
33% at high cardiovascular risk and 1% at very high
cardiovascular risk. The proportion of patients at low or
moderate cardiovascular risk reclassified at high
cardiovascular risk were 5, 14, 30 and 14% after
echocardiography, measurement of albuminuria and
estimated glomerular filtration rate, carotid ultrasound
and PWV, respectively (x2 P<0.001 for all vs. routine).
Assessment of PWV in addition to echocardiography
led to an increase of the proportion of patients at high risk (from 5 to 15%, P<0.001), as for PWV in addition to
albuminuria, estimated glomerular filtration rate or both
(from 14 to 31%, P<0.01), but did not affect risk
stratification in addition to carotid ultrasound (from 30 to
34%, PUNS).
Conclusion Our data suggest that measurement of PWV
may significantly change cardiovascular risk stratification in
addition to echocardiography and to detection of
albuminuria and/or of a reduction of estimated glomerular
filtration rate, but not after carotid ultrasound. Our results
confirm that evaluation of different forms of TOD is useful
for a more accurate assessment of global cardiovascular
risk.