Abstract P3009: Stenostiffness Approach for Cardiovascular Disease Risk Assessment in Primary Prevention

Abstract

Background: The Japan Brachial-Ankle pulse wave VELocity individual participant data meta-analysis of prospective studies (J-BAVEL) studies are a series of individual participant data meta-analyses carried out to demonstrate the predictive ability, individually, of the inter-arm blood pressure difference (IAD), ankle-brachial pressure index (ABI), and brachial-ankle pulse wave velocity (brachia-ankle PWV) for the prediction of cardiovascular events in Japanese subjects. Purposes: Based on the findings of the J-BAVEL study series, we discuss here a strategy for integrating IAD, ABI, and brachial-ankle PWV (i.e., steno-stiffness approach) with the conventional cardiovascular disease (CVD) risk prediction model to improve the accuracy of CVD risk prediction in primary prevention. Methods and Results: The data of 1,1726 subjects without a past history of cardiovascular disease (CVD) in J-BAVEL study were re-analyzed. The IAD > 15 mm Hg (IAD15) was associated with a significant Cox stratified adjusted hazard ratio (HR) for subsequent stroke [2.42; 95% confidence interval (CI), 1.27-4.60; P <0.01]. The adjusted odds ratio of IAD10 for ABI ≤0.90 in the binary logistic regression analysis was 3.42 (95% CI 2.13-5.50; P < 0.001). Furthermore, among 10,512 subjects of J-BAVEL study cohort, subjects having either ABI ≤0.90 {n = 123 (1.2%)} or brachial-ankle PWV ≥15.9 m/sec {n = 3,837 (36.5%)} were defined as abnormal steno-stiffness markers. The addition of abnormal steno-stiffness marker to a model including the FRS improved the accuracy of prediction of the development of CVD (category-free net reclassification improvement: 0.391 [95% CI, 0.266-0.517], P < 0.001; integrated discrimination index: 0.0021 [95% CI, 0.0004-0.0038], P = 0.02). Conclusion: Steno-stiffness approach (i.e., IAD, ABI, and brachial-ankle PWV) to CVD risk assessment in primary prevention may be efficient. The IAD is a simply measured useful physiological marker of subclinical PAD (IAD10) or stroke (IAD15). Furthermore, the ABI ≤0.90 or brachial-ankle PWV > 15.9 m/sec may be efficient for the improvement of CVD risk assessment by conventional risk prediction model in primary prevention.