Arterial stiffness and the risk of cardiovascular mortality (a 13-year prospective cohort study)

Abstract

Background: Cardiovascular disease is the leading cause of death in Mongolia, and atherosclerosis is its main pathogenic factor. The cardio-ankle vascular index (CAVI) is a marker of arterial stiffness, and measuring it allows atherosclerosis to be detected before clinical symptoms appear. This study was based on the need to assess CVD risk in older adults and to plan prevention accordingly. Aim: To determine whether CAVI independently predicts CVD mortality in older adults. Materials and Methods: This prospective cohort study included 1,403 adults aged 55–95 years from five regions of Mongolia who had participated in the study “Factors Influencing Population Longevity,” (2011–2015). CAVI was measured with a VaSera VS-1000 device (Fukuda Denshi, Japan). Mortality data as of December 20, 2025 were obtained from the Center for Health Development by linking participants’ national registration numbers to the death registry. Deaths coded I00–I99 under the International Classification of Diseases, 10th revision, were classified as CVD deaths. Participants were divided into four equal groups by CAVI value (quartiles: Q1 <8.0, Q2 8.0–8.8, Q3 8.9–9.7, Q4 ≥9.8), and the cumulative incidence of CVD mortality was estimated with the Aalen–Johansen method. Cox regression analysis was adjusted for age, sex, hypertension, smoking, LDL cholesterol, HDL cholesterol and estimated glomerular filtration rate. A Fine–Gray sensitivity analysis was also performed. Results: The mean age of participants was 66.8±7.9 years. During follow-up (median 13.2 years), 121 CVD deaths (8.6%) and 127 deaths from other causes (9.1%) were recorded. The cumulative incidence of CVD mortality rose stepwise from 3.3% in Q1 to 6.0% in Q2, 9.3% in Q3 and 14.1% in Q4 (Gray’s test p<0.001). Compared with Q1, the hazard of CVD death was higher in Q3 (HR 2.03 [95% CI 1.04–3.98]) and Q4 (HR 2.42 [95% CI 1.23–4.76]) (p-trend=0.012). Per 1-unit increase in CAVI, the HRs were: crude: 1.42 [95% CI 1.24–1.63], ageand sex-adjusted: 1.19 [95% CI 1.03–1.38] and fully adjusted: 1.17 [95% CI 1.00–1.36], p=0.045. Hypertension was an independent risk factor for CVD mortality (HR 1.53 [95% CI 1.06–2.21]). Conclusion: In older adults, higher CAVI predicts CVD mortality independently of age, sex and traditional risk factors, and the risk of CVD death rises stepwise with higher CAVI quartiles.