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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1153-1159. doi: 10.19723/j.issn.1671-167X.2025.06.020

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Association between indicators of arterial stiffness and all-cause mortality and cardiovascular deaths: A prospective cohort study

Meng FAN1, Mengying WANG1, Siyue WANG1, Hexiang PENG1, Xueheng WANG1, Huangda GUO1, Tianjiao HOU1, Xueying QIN1, Dafang CHEN1, Yonghua HU1, Jin LI1, Yiqun WU1, Tao WU1,2,*()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
  • Received:2023-03-02 Online:2025-12-18 Published:2025-11-07
  • Contact: Tao WU
  • Supported by:
    the National Natural Science Foundation of China(82204135); Beijing Municipal Natural Science Foundation(7232237); China Postdoctoral Science Foundation(BX2021021); China Postdoctoral Science Foundation(2022M710249)

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Abstract:

Objective: To assess the associations between brachial-ankle pulse wave velocity (baPWV), ankle brachial index (ABI) and all-cause and cardiovascular mortality in a rural population in north China. Methods: The current study utilized the baseline data of Beijing Fangshan family cohort study and the data of the death surveillance system of the Beijing Fangshan District Center for Disease Prevention and Control. The main outcomes were all-cause mortality and cardiovascular mortality. Cardiovascular deaths which included deaths from coronary heart disease (CHD), stroke, heart failure, sudden cardiac death and arrhythmia, were coded according to the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10). The R4.2.2 software was used for statistical analysis, and the adjusted hazard ratios (HR) for all-cause and CVD mortality associated with baPWV and ABI were calculated using Cox proportional hazards regressions with shared frailty models. Results: A total of 7 686 participants were followed up for a median of 6.35 years in Fangshan District, Beijing, China. Totally 576 deaths were identified, with a mortality density of 11.88/1 000 person-years, of which 335 deaths were from cardiovascular diseases. We found that baPWV (HR=1.40, 95%CI: 1.02-1.92) and ABI (HR=3.32, 95%CI: 2.57-4.28) were associated with all-cause mortality after adjusting for confounding factors. ABI was more strongly associated with cardiovascular mortality than baPWV. There was no significant difference in the risk of all-cause mortality among different subgroups. The risk of cardiovascular mortality was significantly increased in the participants with hypertension (HR=1.72, 95%CI: 1.30-2.27). Conclusion: baPWV and ABI were associated with all-cause and cardiovascular mortality in a rural population of north China. The association of ABI and cardiovascular mortality was more significant than that of baPWV. And abnormal baPWV or ABI was associated with cardiovascular mortality, especially in people with hypertension.

Key words: Arterial stiffness, Pulse wave velocity, Ankle brachial index, Mortality, Cohort studies

CLC Number: 

  • R181.32

Table 1

Baseline characteristics of the participants"

Variables First quartile group
(n=1 914)		 Second quartile group
(n=1 927)		 Third quartile group
(n=1 923)		 Fourth quartile group
(n=1 922)		 P value
Age/years, ${\bar x}$±s 50.51±10.15 56.82±8.73 58.12±9.60 63.96±8.65 < 0.001
Male, n(%) 892 (46.60) 977 (50.70) 982 (51.07) 859 (44.69) < 0.001
Education level, n(%) < 0.001
  Primary school or below 512 (26.75) 726 (37.68) 811 (42.17) 1 101 (57.28)
  Junior high school or more 1 402 (73.25) 1 201 (62.32) 1 112 (57.83) 821 (42.72)
Smoking status, n(%) < 0.001
  Never 1 139 (59.51) 1 049 (54.44) 1 003 (52.16) 1 040 (54.11)
  Former smoker 203 (10.61) 291 (15.10) 298 (15.50) 383 (19.93)
  Current smoker 572 (29.89) 587 (30.46) 622 (32.35) 499 (25.96)
Drinking status, n(%) < 0.001
  Never 1 268 (66.25) 1 209 (62.74) 1 243 (64.64) 1 271 (66.13)
  Former drinker 115 (6.01) 174 (9.03) 173 (9.00) 180 (9.37)
  Current drinker 531 (27.74) 544 (28.23) 507 (26.37) 471 (24.51)
Exercise status (regularly), n(%) 256 (13.38) 261 (13.54) 120 (6.24) 189 (9.83) < 0.001
BMI/(kg/m2), ${\bar x}$±s 26.22±3.72 26.34±3.61 26.26±3.58 25.73±3.46 0.004
LDL-C/(mmol/L), ${\bar x}$±s 2.21±0.80 2.24±0.92 2.60±0.88 2.30±0.97 < 0.001
HDL-C/(mmol/L), ${\bar x}$±s 0.98±0.32 0.92±0.33 1.19±0.47 0.93±0.33 < 0.001
TG/(mmol/L), M (P25, P75) 1.18 (0.77, 1.77) 1.26 (0.83, 1.87) 1.47 (0.94, 2.16) 1.31 (0.86, 2.02) < 0.001
Diabetes mellitus, n(%) 558 (29.15) 818 (42.45) 696 (36.19) 1 029 (53.54) < 0.001
Hypertension, n(%) 778 (40.65) 1 367 (70.94) 1 505 (78.26) 1 736 (90.32) < 0.001
CHD, n(%) 441 (23.04) 563 (29.22) 337 (17.52) 727 (37.83) < 0.001
Stroke, n(%) 387 (20.22) 669 (34.72) 694 (36.09% 901 (46.88) < 0.001

Table 2

Cox regression analysis of the relationship between baPWV and the risk of death"

Variables First quartile group Second quartile group Third quartile group Fourth quartile group Continuous
All-cause
  Model 1 Reference 0.78 (0.56-1.10) 1.17 (0.86-1.60) 1.78 (1.32-2.40) 0.74 (0.70-0.79)
  Model 2 Reference 0.78 (0.55-1.09) 1.14 (0.83-1.55) 1.77 (1.31-2.39) 0.75 (0.71-0.79)
  Model 3 Reference 0.67 (0.48-0.96) 1.05 (0.76-1.46) 1.40 (1.02-1.92) 0.77 (0.72-0.81)
CVD
  Model 1 Reference 0.96 (0.61-1.51) 1.42 (0.93-2.15) 1.77 (1.17-2.67) 0.67 (0.62-0.72)
  Model 2 Reference 0.94 (0.59-1.48) 1.33 (0.87-2.03) 1.74 (1.15-2.64) 0.67 (0.62-0.72)
  Model 3 Reference 0.76 (0.47-1.21) 1.10 (0.71-1.72) 1.22 (0.79-1.88) 0.69 (0.64-0.75)

Table 3

Cox regression analysis of the relationship between ABI and the risk of death"

Variables Group 1 Group 2 Group 3 Continuous
All-cause
  Model 1 Reference 1.45 (1.07-1.99) 3.82 (2.99-4.88) 0.74 (0.70-0.79)
  Model 2 Reference 1.44 (1.05-1.97) 3.72 (2.90-4.77) 0.75 (0.71-0.79)
  Model 3 Reference 1.39 (1.02-1.91) 3.32 (2.57-4.28) 0.77 (0.72-0.81)
CVD
  Model 1 Reference 1.60 (1.06-2.40) 5.16 (3.77-7.06) 0.67 (0.62-0.72)
  Model 2 Reference 1.56 (1.03-2.36) 4.91 (3.58-6.74) 0.67 (0.62-0.72)
  Model 3 Reference 1.50 (0.99-2.28) 4.29 (3.09-5.94) 0.69 (0.64-0.75)

Table 4

Cox regression analysis of the relationship between the combined values of baPWV and ABI and the risk of death"

Variables ABI≥0.91 ABI≤0.90
All-cause
  baPWV < 1 800 cm/s Reference 3.67 (2.53-5.31)
  baPWV≥1 800 cm/s 1.62 (1.31-2.00) 4.76 (3.39-6.68)
CVD
  baPWV < 1 800 cm/s Reference 4.95 (3.14-7.79)
  baPWV≥1 800 cm/s 1.29 (0.97-1.72) 4.68 (2.97-7.36)

Table 5

The association between abnormal baPWV or ABI in different subgroups and the risk of death"

Variables All-cause mortality CVD mortality
HR (95%CI) P for interaction HR (95%CI) P for interaction
Age 0.489 0.734
   < 60 years 2.41 (1.67-3.48) 2.28 (1.43-3.64)
  ≥60 years 2.19 (1.75-2.75) 1.98 (1.47-2.66)
Sex 0.225 0.541
  Female 1.71 (1.25-2.33) 1.47 (0.96-2.23)
  Male 1.97 (1.53-2.55) 1.79 (1.28-2.49)
Smoking 0.568 0.415
  Never 2.22 (1.63-3.02) 1.85 (1.22-2.82)
  Former+Current 1.67 (1.31-2.14) 1.56 (1.10-2.19)
Drinking 0.138 0.512
  Never 1.96 (1.51-2.56) 1.85 (1.32-2.61)
  Former+Current 1.75 (1.30-2.37) 1.37 (0.91-2.07)
Obesity (BMI≥28 kg/m2) 0.417 0.434
  No 1.95 (1.56-2.44) 1.70 (1.26-2.30)
  Yes 1.90 (1.26-2.87) 1.66 (0.99-2.80)
Hypertension 0.193 0.505
  No 1.96 (1.17-3.27) 1.75 (0.85-3.59)
  Yes 1.90 (1.54-2.35) 1.72 (1.30-2.27)
Diabetes mellitus 0.256 0.481
  No 2.01 (1.54-2.61) 1.92 (1.31-2.81)
  Yes 1.84 (1.39-2.45) 2.53 (1.06-2.20)
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