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Of 13,116 participants at baseline, the mean ± SD age was 59.6 ± 9.7 years and 47.6% were males (Table 1). The mean ± SD ePWV was 9.7 ± 2.0 m/s, and the mean ± SD ePWV of the four quartile groups was 7.5 ± 0.5 m/s, 8.8 ± 0.3 m/s, 10.0 ± 0.4 m/s, and 12.4 ± 1.3 m/s, respectively. Participants with a higher ePWV were more likely to be older, male, have a lower education level, smokers, alcohol drinkers, and more inclined to have a history of hypertension, dyslipidemia, diabetes, or CVD (P < 0.001).
Characteristic Total
(n = 13,116)First quartile
(n = 3,279)Second quartile
(n = 3,278)Third quartile
(n = 3,280)Fourth quartile
(n = 3,279)P value Age, years 59.6 ± 9.7 50.5 ± 4.4 55.8 ± 5.4 61.2 ± 6.1 70.7 ± 8.0 < 0.0001 Men, n (%) 6,241 (47.6) 1,414 (43.1) 1,557 (47.5) 1,681 (51.3) 1,589 (48.5) < 0.0001 Married, n (%) 11,389 (86.8) 3,125 (95.3) 3,051 (93.1) 2,882 (87.9) 2,331 (71.1) < 0.0001 Education level, n (%) < 0.0001 No formal education 3,769 (28.7) 596 (18.2) 802 (24.5) 915 (27.9) 1,456 (44.4) Formal education 9,347 (71.3) 2,683 (81.8) 2,476 (75.5) 2,365 (72.1) 1,823 (55.6) Smoking status, n (%) < 0.0001 Never 7,883 (60.1) 2,084 (63.6) 1,992 (60.8) 1,900 (57.9) 1,907 (58.2) Ever 5,233 (39.9) 1,195 (36.4) 1,286 (39.2) 1,380 (42.1) 1,372 (41.8) Drinking status, n (%) < 0.0001 Never 59,037 (68.9) 2,369 (72.2) 2,236 (68.2) 2,218 (67.6) 2,214 (67.5) Past 825 (6.3) 113 (3.4) 183 (5.6) 226 (6.9) 303 (9.2) Current 3,254 (24.8) 797 (24.3) 859 (26.2) 836 (25.5) 762 (23.2) History of chronic disease, n (%) Hypertension 5,371 (40.9) 224 (6.8) 864 (26.4) 1,741 (53.1) 2,542 (77.5) < 0.0001 Dyslipidemia 4,898 (37.3) 1,099 (33.5) 1,175 (35.8) 1,289 (39.3) 1,335 (40.7) < 0.0001 Diabetes 2,228 (17.0) 423 (12.9) 521 (15.9) 589 (18.0) 695 (21.2) < 0.0001 CVD 1,754 (13.4) 248 (7.6) 505 (15.4) 358 (10.9) 643 (19.6) < 0.0001 Cancer 131 (1.0) 36 (1.1) 42 (1.3) 30 (0.9) 23 (0.7) 0.1051 SBP, mmHg 130.8 ± 21.5 112.1 ± 9.9 124.1 ± 12.2 134.9 ± 16.1 152.2 ± 21.9 < 0.0001 DBP, mmHg 75.9 ± 12.1 67.4 ± 8.2 75.0 ± 9.6 78.9 ± 11.4 82.3 ± 13.2 < 0.0001 ePWV, m/s 9.7 ± 2.0 7.5 ± 0.5 8.8 ± 0.3 10.0 ± 0.4 12.4 ± 1.3 < 0.0001 BMI, kg/m2 23.4 ± 3.8 23.2 ± 3.4 23.7 ± 3.7 23.7 ± 3.9 23.2 ± 4.2 < 0.0001 Waist circumference, cm 85.3 ± 10.2 83.0 ± 9.2 85.2 ± 9.7 86.3 ± 10.4 86.6 ± 10.9 < 0.0001 Total cholesterol, mg/dL 193.3 ± 34.6 188.7 ± 33.0 193.7 ± 34.7 194.9 ± 35.5 196.0 ± 34.6 < 0.0001 Triglycerides,
mg/dL112.4
(78.8–160.2)105.7
(74.3–154.9)113.7
(78.8–162.3)115.9
(80.7–162.1)114.9
(80.5–162.1)< 0.0001 HDL-C, mg/dL 51.1 ± 13.8 51.5 ± 13.4 50.8 ± 13.4 50.8 ± 14.2 51.5 ± 14.3 0.0054 LDL-C, mg/dL 116.1 ± 31.2 112.8 ± 29.6 116.2 ± 31.2 117.4 ± 32.1 118.0 ± 31.6 < 0.0001 FPG, mg/dL 110.2 ± 33.8 105.9 ± 28.6 109.6 ± 31.4 112.3 ± 39.4 113.0 ± 34.5 < 0.0001 HbA1c, % 5.3 ± 0.7 5.2 ± 0.6 5.3 ± 0.7 5.3 ± 0.8 5.3 ± 0.8 < 0.0001 Note. CVD: Cardiovascular disease; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ePWV: Estimated pulse wave velocity; BMI: Body mass index; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; FPG: Fasting plasma glucose; HbA1c: Hemoglobin A1c. As for continuous variables, data were presented as mean ± SD if normally distributed, and as median with interquartile range (25%–75%) if non-normally distributed. Categorical variables were expressed as frequency with percentages. Table 1. Baseline characteristics of study population according to estimated pulse wave velocity
There were 8,938 CHARLS participants included in the ΔePWV analysis. The mean ± SD age was 59.5 ± 9.2 years in wave 1 and 47.1% were male (Supplementary Table S1, available in www.besjournal.com). The median ΔePWV in the first quartile group was negative (−0.70 m/s); the other median ΔePWV values were positive in the 2nd−4th quartiles (0.08 m/s, 0.61 m/s, and 1.42 m/s, respectively). The proportion of males, alcohol drinkers, and patients with hypertension or dyslipidemia was higher among participants with a higher ΔePWV (Supplementary Table S2, available in www.besjournal.com).
Characteristic Total
(n = 8,938)First quartile
(n = 2,234)Second quartile
(n = 2,235)Third Quartile
(n = 2,234)Fourth quartile
(n = 2,235)P value Age, years 59.5 ± 9.2 59.5 ± 9.1 58.5 ± 9.0 58.9 ± 9.5 61.0 ± 9.2 < 0.0001 Men, n (%) 4,209 (47.1) 975 (43.6) 980 (43.8) 1,065 (47.7) 1,189 (53.2) < 0.0001 Married, n (%) 7,868 (88.0) 1,978 (88.5) 1,971 (88.2) 1,968 (88.1) 1,951 (87.3) 0.6223 Education level, n (%) 0.3634 No formal education 2,528 (28.3) 629 (28.2) 614 (27.5) 639 (28.6) 646 (28.9) Formal education 6,410 (71.7) 1,605 (71.8) 1,621 (72.5) 1,595 (71.4) 1,589 (71.1) Smoking status < 0.0001 Never 5,435 (60.8) 1,447 (64.8) 1,427 (64.0) 1,352 (60.5) 1,209 (54.1) Ever 3,498 (39.2) 787 (35.2) 804 (36.0) 881 (39.5) 1,026 (45.9) Drinking status < 0.0001 Never 6,162 (69.0) 1,607 (72.0) 1,561 (70.0) 1,558 (69.8) 1,436 (64.3) Past 558 (6.3) 120 (5.4) 134 (6.0) 140 (6.3) 164 (7.3) Current 2,206 (24.7) 506 (22.7) 534 (24.0) 533 (23.9) 633 (28.3) History of chronic disease, n (%) Hypertension 3,575 (40.0) 1,291 (57.8) 829 (37.1) 697 (31.2) 758 (33.9) < 0.0001 Dyslipidemia 3,364 (37.6) 977 (43.7) 819 (36.6) 769 (34.4) 799 (35.7) < 0.0001 Diabetes 1,460 (16.3) 406 (18.2) 354 (15.8) 328 (14.7) 372 (16.6) 0.0144 CVD 1,168 (13.1) 324 (14.5) 258 (11.6) 277 (12.4) 309 (13.8) 0.0144 Cancer 83 (0.9) 16 (0.7) 24 (1.1) 17 (0.8) 26 (1.2) 0.3042 SBP, mmHg 130.3 ± 21.2 143.1 ± 22.2 130.3 ± 19.3 125.2 ± 18.7 122.6 ± 18.0 < 0.0001 DBP, mmHg 75.6 ± 12.1 83.3 ± 11.5 76.2 ± 10.7 72.6 ± 10.9 70.2 ± 11.0 < 0.0001 ePWV, m/s 9.6 ± 1.8 10.3 ± 1.8 9.5 ± 1.8 9.3 ± 1.8 9.4 ± 1.7 < 0.0001 BMI, kg/m2 23.1 ± 3.8 23.5 ± 3.8 23.2 ± 3.7 23.0 ± 3.8 22.7 ± 4.0 0.8162 Waist circumference, cm 84.3 ± 12.2 85.2 ± 12.9 84.4 ± 11.6 84.0 ± 11.7 83.3 ± 12.5 < 0.0001 Total cholesterol, mg/dL 195.1 ± 36.7 196.1 ± 35.4 195.4 ± 35.9 193.3 ± 37.0 195.5 ± 38.6 0.1503 Triglycerides, mg/dL 114.6
(83.2–168.1)122.1
(86.7–176.1)115.9
(84.1–167.3)108.8
(81.4–161.1)112.4
(79.6–166.4)< 0.0001 HDL-C, mg/dL 51.7 ± 12.0 51.0 ± 11.8 51.8 ± 11.4 51.7 ± 12.1 52.3 ± 12.7 0.0231 LDL-C, mg/dL 112.9 ± 28.8 113.0 ± 28.4 113.2 ± 28.7 112.1 ± 28.2 113.1 ± 29.7 0.6856 FPG, mg/dL 103.7 ± 35.6 105.4 ± 38.6 102.2 ± 33.1 101.9 ± 30.4 105.3 ± 39.3 0.0026 HbA1c, % 5.2 ± 1.0 5.3 ± 1.1 5.2 ± 1.0 5.2 ± 1.0 5.2 ± 1.0 0.0297 Note. CVD: Cardiovascular disease; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ePWV: Estimated pulse wave velocity; BMI: Body mass index; HDL-C: High-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; FPG: fasting plasma glucose; HbA1c: Hemoglobin A1c. As for continuous variables, data were presented as mean ± SD if normally distributed, and as median with interquartile range (25%–75%) if non-normally distributed. Categorical variables were expressed as frequency with percentages. ΔePWV was defined as the difference of ePWV between Wave 2 and Wave 1. Table S1. Characteristics of study population at Wave1 according to ΔePWV quartiles.
Characteristic Total
(n = 8,938)First quartile
(n = 2,234)Second quartile
(n = 2,235)Third quartile
(n = 2,234)Fourth quartile (n = 2,235) P value Age, years 61.5 ± 9.2 61.5 ± 9.1 60.5 ± 9.0 60.9 ± 9.5 63.0 ± 9.2 < 0.0001 Men, n (%) 4,209 (47.1) 975 (43.6) 980 (43.8) 1,065 (47.7) 1,189 (53.2) < 0.0001 Married, n (%) 7,718 (86.4) 1,939 (86.8) 1,934 (86.5) 1,940 (86.8) 1,905 (85.2) 0.3545 Education level, n (%) 0.8561 No formal education 2,521 (28.2) 625 (28.0) 619 (27.7) 633 (28.3) 644 (28.8) Formal education 6,417 (71.8) 1,609 (72.0) 1,616 (72.3) 1,601 (71.7) 1,591 (71.2) Smoking status, n (%) 0.0664 Never 8,588 (96.1) 2,136 (95.6) 2,167 (97.0) 2,148 (96.2) 2,137 (95.6) Ever 350 (3.9) 98 (4.4) 68 (3.0) 86 (3.8) 98 (4.4) Drinking status, n (%) < 0.0001 Never 5,879 (65.8) 1,505 (67.4) 1,514 (67.7) 1,496 (67.0) 1,364 (61.0) Past 819 (9.2) 227 (10.2) 199 (8.9) 189 (8.5) 204 (9.1) Current 2,240 (25.1) 502 (22.5) 522 (23.4) 549 (24.6) 667 (29.8) History of chronic disease, n (%) Hypertension 3,804 (42.6) 825 (36.9) 710 (31.8) 833 (37.3) 1,436 (64.3) < 0.0001 Dyslipidemia 2,977 (33.3) 863 (38.6) 729 (32.6) 673 (30.1) 712 (31.9) < 0.0001 Diabetes 1,368 (15.3) 383 (17.1) 327 (14.6) 310 (13.9) 348 (15.6) 0.0165 CVD 1,168 (13.1) 324 (14.5) 258 (11.5) 277 (12.4) 309 (13.8) 0.0139 Cancer 68 (0.8) 13 (0.6) 17 (0.8) 18 (0.8) 20 (0.9) 0.6734 SBP, mmHg 131.5 ± 21.0 122.5 ± 17.5 126.6 ± 18.5 131.0 ± 18.6 145.8 ± 21.4 < 0.0001 DBP, mmHg 76.0 ± 11.9 70.7 ± 10.5 73.3 ± 10.5 76.2 ± 10.9 83.6 ± 11.9 < 0.0001 ePWV, m/s 10.0 ± 1.9 9.5 ± 1.7 9.6 ± 1.8 9.9 ± 1.8 11.0 ± 1.8 < 0.0001 BMI, kg/m2 23.7 ± 3.8 23.9 ± 3.8 23.7 ± 3.9 23.7 ± 3.7 23.5 ± 3.8 0.0065 Waist circumference, cm 86.8 ± 10.3 87.3 ± 10.4 86.3 ± 10.2 86.6 ± 10.2 87.1 ± 10.5 0.0178 Total cholesterol, mg/dL 193.6 ± 35.3 196.3 ± 34.8 194.2 ± 37.4 191.1 ± 33.8 193.0 ± 34.9 < 0.0001 Triglycerides, mg/dL 110.6
(77.0−157.5)116.8
(81.4−164.6)108.0
(74.3−156.6)109.7
(75.2−153.1)109.7
(77.9−155.4)< 0.0001 HDL-C, mg/dL 51.5 ± 14.2 50.6 ± 14.5 51.4 ± 13.7 51.7 ± 14.1 52.4 ± 14.6 0.0001 LDL-C, mg/dL 116.3 ± 31.7 117.5 ± 32.7 117.0 ± 32.7 114.9 ± 29.4 115.7 ± 32.0 0.0181 FPG, mg/dL 110.1 ± 33.4 111.3 ± 37.3 109.1 ± 30.7 109.2 ± 31.0 110.8 ± 34.2 0.3678 HbA1c, % 5.3 ± 0.8 5.3 ± 0.8 5.2 ± 0.7 5.2 ± 0.7 5.3 ± 0.8 0.3265 Note. CVD: Cardiovascular disease; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ePWV: Estimated pulse wave velocity; BMI: Body mass index; HDL-C: High-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; FPG: fasting plasma glucose; HbA1c: Hemoglobin A1c. As for continuous variables, data were presented as mean ± SD if normally distributed, and as median with interquartile range (25%–75%) if non-normally distributed. Categorical variables were expressed as frequency with percentages. ΔePWV was defined as the difference of ePWV between Wave 2 and Wave 1. Table S2. Characteristics of study population at Wave2 according to ΔePWV quartiles.
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As shown in Table 2, during a median follow-up period of 7.0 years, participants with a higher ePWV had a higher all-cause mortality rate. After adjustment for gender, smoking status, alcohol consumption status, histories of hypertension, dyslipidemia, diabetes, CVD, and cancer, and the BMI at baseline, the positive association between ePWV and all-cause mortality (P for trend < 0.001) was observed. The multivariate-adjusted hazard ratios (HRs, 95% CI) for all-cause mortality (vs. quartile 1) were 1.69 (1.31−2.18), 3.09 (2.44−3.91), and 8.54 (6.78−10.75) for participants in the 2nd, 3rd, and 4th ePWV quartiles, respectively. The HR (95% CI) per increase of ePWV for all-cause mortality was 2.32 (2.20−2.45) after full adjustment for confounders, which was consistent with the results considering ePWV as a categorical variable.
Characteristic First
quartile
(n = 3,279)Second
quartile
(n = 3,278)Third
quartile
(n = 3,280)Fourth
quartile
(n = 3,279)P
trendper SD increase Person-years 21,767 21,623 21,292 19,494 Cases, n 95 160 300 801 Incidence rate (per 1,000 person-years) 4.4 7.4 14.1 41.1 Crude model, HR (95% CI) 1.00 (Ref) 1.69 (1.31–2.18) 3.21 (2.55–4.05) 9.37 (7.58–11.60) < 0.0001 2.27 (2.17–2.37) Adjusted model, HR (95% CI) 1.00 (Ref) 1.69 (1.31–2.18) 3.09 (2.44–3.91) 8.54 (6.78–10.75) < 0.0001 2.32 (2.20–2.45) Note. HR, hazard ratio; CI, confidence interval; SD, standard deviation; ePWV, estimated pulse wave velocity. Model was adjusted for baseline sex, smoking status, drinking status, history of hypertension, dyslipidemia, diabetes, CVD and cancer, and body mass index. Table 2. Hazard ratios of all-cause mortality associated with ePWV
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During a median follow-up of 5.0 years, 658 deaths were identified (Table 3). In the unadjusted analysis, by comparing quartiles 2 and 3 with quartile 1, the associations between ΔePWV and all-cause mortality did not reach statistical significance. In the quartile 4 group, however, the HR (95% CI) for all-cause mortality was 1.28 (1.04−1.57). After adjustment for sex, smoking status, alcohol consumption status, histories of hypertension, dyslipidemia, diabetes, CVD and cancer, BMI, and baseline ePWV, an increased ePWV was significantly associated with a higher risk of all-cause mortality (P for trend < 0.001), with a 43% (95% CI, 15%−79%) and 90% (95% CI, 52%−137%) increased risk of death for participants in quartiles 3 and 4, respectively. Furthermore, each SD increase in ΔePWV was significantly associated with a 1.28-fold increase (95% CI, 1.18−1.38) in all-cause mortality after multivariate adjustment.
Characteristic First
quartile
(n = 2,234)Second
quartile
(n = 2,235)Third
quartile
(n = 2,234)Fourth
quartile
(n = 2,235)P
trendper SD increase Person-years 10,463 10,595 10,636 10,473 Cases, n 162 131 157 208 Incidence rate (per 1,000 person-years) 15.5 12.4 14.8 19.9 Crude model, HR (95% CI) 1.00 (Ref) 0.80 (0.64–1.01) 0.95 (0.77–1.19) 1.28 (1.04–1.57) 0.0049 1.10 (1.02–1.19) Adjusted model, HR (95% CI) 1.00 (Ref) 1.13 (0.90–1.43) 1.43 (1.15–1.79) 1.90 (1.52–2.37) < 0.0001 1.28 (1.18–1.38) Note. HR, hazard ratio; CI, confidence interval; SD, standard deviation; ePWV, estimated pulse wave velocity. ΔePWV was defined as the difference of ePWV between Wave 2 and Wave 1. Model was adjusted for sex, smoking status, drinking status, history of hypertension, dyslipidemia, diabetes, CVD and cancer, body mass index, and baseline ePWV. Table 3. Hazard ratios of all-cause mortality associated with ΔePWV
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In subgroup analyses, the results did not substantially change when stratified by specific factors (Figures 2 and 3). The associations between ePWV and all-cause mortality were more pronounced among participants who were female (P for interaction = 0.0116), never smokers (P for interaction = 0.0065), or without diabetes (P for interaction = 0.0439) or cancer (P for interaction = 0.0428). The results of ΔePWV analyses were consistent, except when stratified by marital status (P for interaction = 0.0293). In sensitivity analyses, after excluding those who died during the 2 years of follow-up, the positive association between ePWV and all-cause mortality remained statistically significant. Similar results were also obtained when participants with a history of chronic diseases were excluded or when models were further adjusted for age and MBP (Supplementary Table S3, available in www.besjournal.com).
Figure 2. Hazard ratios (95% CI) of all-cause mortality associated with ePWV stratified by different factors. CI: confidence interval; ePWV: estimated pulse wave velocity; CVD: cardiovascular disease; BMI: body mass index. Model was adjusted for baseline sex, smoking status, drinking status, history of hypertension, dyslipidemia, diabetes, CVD and cancer, and body mass index.
Figure 3. Hazard Ratios (95% CI) of all-cause mortality associated with ΔePWV stratified by different factors. CI: confidence interval; ePWV: estimated pulse wave velocity; CVD: cardiovascular disease; BMI: body mass index. ΔePWV was defined as the difference of ePWV between wave 2 and wave 1. Model was adjusted for sex, smoking status, drinking status, history of hypertension, dyslipidemia, diabetes, CVD and cancer, body mass index, and baseline ePWV.
Characteristic Person-years Cases, n Incidence rate (per 1,000 person-years) HR (95% CI) ePWV Excluding cases occurred during the first 2 years of follow-up First quartile 21,346 80 3.7 1.00 (Ref) Second quartile 21,358 121 5.7 1.50 (1.13−1.99) Third quartile 21,153 234 11.0 2.85 (2.19−3.70) Fourth quartile 20,003 628 31.4 7.77 (6.03−10.00) P trend < 0.0001 per SD increase 1.52 (1.48−1.57) Excluding cases with history of chronic disease First quartile 10,681 38 3.5 1.00 (Ref) Second quartile 10,655 58 5.4 1.51 (1.00−2.28) Third quartile 10,591 121 11.4 3.18 (2.19−4.60) Fourth quartile 9,641 372 38.6 9.99 (7.00−14.26) P trend < 0.0001 per SD increase 2.37 (2.19−2.56) Model further adjusted for age and MBP First quartile 21,767 95 4.4 1.00 (Ref) Second quartile 21,623 160 7.4 0.95 (0.73, 1.24) Third quartile 21,292 300 14.1 0.99 (0.76, 1,29) Fourth quartile 19,494 801 41.1 1.05 (0.75, 1.47) P trend 0.4482 per SD increase 1.59 (1.25, 2.00) ΔePWV Excluding cases with history of chronic disease First quartile 5,483 82 15.0 1.00 (Ref) Second quartile 5,574 63 11.3 1.08 (0.78−1.50) Third quartile 5,609 70 12.5 1.31 (0.95−1.81) Fourth quartile 5,527 96 17.4 1.63 (1.21−2.21) P trend 0.0082 per SD increase 1.16 (1.04-1.30) Model further adjusted for age and MBP First quartile 10,463 162 15.5 1.00 (Ref) Second quartile 10,595 131 12.4 1.01 (0.78, 1.31) Third quartile 10,636 157 14.8 1.20 (0.90, 1.60) Fourth quartile 10,473 208 19.9 1.45 (1.00, 2.08) P trend 0.0306 per SD increase 1.24 (1.04, 1.48) Note. HR: Hazard ratio; CI: Confidence interval; ePWV: Estimated pulse wave velocity. ΔePWV was defined as the difference of ePWV between Wave 2 and Wave 1. Model of ePWV analyses was adjusted for baseline sex, smoking status, drinking status, history of hypertension, dyslipidemia, diabetes, CVD and cancer, body mass index. Model of ΔePWV analyses was adjusted for the aforementioned covariates using Wave 2 data as well as baseline ePWV. Table S3. Hazard ratios (HRs) (95% CI) of all-cause mortality associated with ePWV and ΔePWV in sensitivity analyses
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Characteristics of the Study Population by ePWV or ΔePWV
Association of ePWV with All-cause Mortality
Association of ΔePWV with All-cause Mortality
Subgroup and Sensitivity Analyses
22155Supplementary Materials.pdf |