Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet
This review critiques the literature supporting clinical assessment and management of cardiovascular disease and cardiovascular disease risk stratification with brachial-ankle pulse wave velocity (baPWV). First, we outline what baPWV actually measures—arterial stiffness of both large central elastic arteries and medium-sized muscular peripheral arteries of the lower limb. Second, we argue that baPWV is not a surrogate for carotid-femoral pulse wave velocity. While both measures are dependent on the properties of the aorta, baPWV is also strongly dependent on the muscular arteries of the lower extremities. Increased lower-extremity arterial stiffness amplifies and hastens wave reflections at the level of the aorta, widens pulse pressure, increases afterload, and reduces coronary perfusion. Third, we used an established evaluation framework to identify the value of baPWV as an independent vascular biomarker. There is sufficient evidence to support (1) proof of concept; (2) prospective validation; (3) incremental value; and (4) clinical utility. However, there is limited or no evidence to support (5) clinical outcomes; (6) cost-effectiveness; (7) methodological consensus; or (8) reference values. Fourth, we address future research requirements. The majority of the evaluation criteria ([1] proof of concept, [2] prospective validation, [3] incremental value, [4] clinical utility, and [9] reference values) can be supported using existing cohort datasets, whereas the (5) clinical outcomes and (6) cost-effectiveness criteria require prospective investigation. The (8) methodological consensus criteria will require an expert consensus statement. Finally, we finish this review by providing an example of a future clinical practice model.
History
Publisher
American Heart AssociationVersion
- AM (Accepted Manuscript)
Citation
Stone, K., Veerasingam, D., Meyer, M.L., Heffernan, K.S., Higgins, S., Maria Bruno, R., Bueno, C.A., Döerr, M., Schmidt-Trucksäss, A., Terentes-Printzios, D., Voicehovska, J. et al. (2023) 'Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet', Hypertension. doi: 10.1161/HYPERTENSIONAHA.123.21314Print ISSN
0194-911XElectronic ISSN
1524-4563Cardiff Met Affiliation
- Cardiff School of Sport and Health Sciences
Cardiff Met Authors
Keeron StoneCardiff Met Research Centre/Group
- Cardiovascular Physiology
Copyright Holder
- © The Publisher
Language
- en