Independent association of estimated pulse-wave velocity with all-cause mortality in individuals with type 2 diabetes

Background: Estimated pulse-wave velocity (ePWV), a surrogate measure of arterial stiffness, was shown to independently predict morbidity and mortality from cardiovascular disease and other causes in both the general population and high-risk individuals. However, in people with type 2 diabetes, it is unknown whether ePWV adds prognostic information beyond the parameters used for calculating it. Aims: To assess the independent association of ePWV with all-cause mortality in individuals with type 2 diabetes. Design: Prospective cohort study that enrolled 15 773 patients in 19 Italian centres in 2006-08. Methods: ePWV was calculated from a regression equation using age and mean blood pressure (BP). All-cause mortality was retrieved for 15 656 patients in 2015. Results: Percentage and rate of deaths, Kaplan-Meier estimates and unadjusted hazard ratios increased from Quartile I to Quartile IV of ePWV. After adjustment for age, sex, BP levels and anti-hypertensive treatment, the strength of association decreased but mortality risk remained significantly higher for Quartiles II ( 34%), III ( 82%) and IV ( 181%) vs. Quartile I and was virtually unchanged when further adjusting for other cardiovascular risk factors and complications/comorbidities. Each m s-1 increase in ePWV was associated with an increased adjusted risk of death in the whole cohort ( 53%) and in participants with ( 52%) and without ( 65%) cardiorenal complications. Moreover, ePWV significantly improved prediction of mortality risk over cardiovascular risk factors and complications/comorbidities, though the net increase was modest. Conclusions: These findings suggest that ePWV may represent a simple and inexpensive tool for providing prognostic information beyond traditional cardiovascular risk factors.