Arterial Stiffness in Cancer Survivors: The Prognostic Value of Estimated Pulse Wave Velocity in US Cancer Population From the National Health and Nutrition Examination Survey 2009 to 2018

Background Estimated pulse wave velocity (ePWV), a marker of arterial stiffness, is strongly associated with cardiovascular events and all‐cause death in the general population. This study evaluates the association of arterial stiffness, defined by the ePWV equation, with all‐cause and cardiovascular death and identifies an optimal ePWV threshold for risk stratification in cancer survivors. Methods Using data from the National Health and Nutrition Examination Survey (2009–2018), we analyzed a cohort representing more than 105 million US cancer survivors. Multivariable Cox regression and Kaplan–Meier analyses assessed the association between ePWV and outcomes. Dose‐dependent relationships were explored, and an optimal ePWV threshold was determined through maximally selected rank statistics. Results During a median follow‐up of 59 months, a total of 105 869 670 weighted cancer survivors (2234 unweighted) were analyzed, recording 435 all‐cause and 91 cardiovascular deaths. Early vascular aging (ePWV ≥9.4 m/s) was present in 54.6% of participants. Each 1 m/s increase in ePWV was associated with higher risks of all‐cause death (29%) and cardiovascular death (46%) (hazard ratio [HR], 1.29 [95% CI, 1.19–1.40] and 1.46 [95% CI, 1.20–1.76], respectively, both P <0.001). Those with ePWV ≥12.05 m/s demonstrated higher risks of all‐cause and cardiovascular death (HR, 1.70 [95% CI, 1.35–2.13] and 2.53 [95% CI, 1.56–4.12], respectively, both P <0.001). Conclusions Arterial stiffness, assessed by ePWV, demonstrates prognostic utility in cancer survivors, showing a nonlinear association with all‐cause and cardiovascular death, independent of demographic, socioeconomic, traditional cardiovascular risk factors not included in the ePWV equation, and baseline cardiovascular disease.