Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Background Vascular aging results in stiffer arteries and may have a role in the development of cardiovascular disease ( CVD ). Arterial stiffness index ( ASI ), measured by finger photoplethysmography, and pulse pressure ( PP ) are 2 independent vascular aging indices. We investigated whether ASI or PP predict new‐onset CVD and mortality in a large community‐based population. Methods and Results We studied 169 613 UK Biobank participants (mean age 56.8 years; 45.8% males) who underwent ASI measurement and blood pressure measurement for PP calculation. Mean± SD ASI was 9.30±3.1 m/s and mean± SD PP was 50.98±13.2 mm Hg. During a median disease follow‐up of 2.8 years (interquartile range 1.4–4.0), 18 190 participants developed CVD , of which 1587 myocardial infarction ( MI ), 4326 coronary heart disease, 1192 heart failure, and 1319 stroke. During a median mortality follow‐up of 6.1 years (interquartile range 5.8–6.3), 3678 participants died, of which 1180 of CVD . Higher ASI was associated with increased risk of overall CVD (unadjusted hazard ratio 1.27; 95% confidence interval [ CI ], 1.25–1.28), myocardial infarction (1.38; 95% CI , 1.32–1.44), coronary heart disease (1.31; 95% CI , 1.27–1.34), and heart failure (1.31; 95% CI 1.24–1.37). ASI also predicted mortality (all‐cause, CVD , other). Higher PP was associated with overall CVD (1.57; 95% CI , 1.55–1.59), myocardial infarction (1.48; 95% CI , 1.42–1.54), coronary heart disease (1.47; 95% CI , 1.43–1.50), heart failure (1.47; 95% CI , 1.40–1.55), and CVD mortality (1.47; 95% CI , 1.40–1.55). PP improved risk reclassification of CVD in a non–laboratory‐based Framingham Risk Score by 5.4%, ASI by 2.3%. Conclusions ASI and PP are independent predictors of CVD and mortality outcomes. Although both improved risk prediction for new‐onset disease, PP appears to have a larger clinical value than ASI .