Is recovery or exercise estimated pulse wave velocity superior to traditional resting measures in association with all-cause mortality among young and middle-aged adults? Evidence from the national health and nutrition examination survey

Objectives: Estimated pulse wave velocity (ePWV) is a useful indicator for arterial stiffness assessment. However, traditional ePWV calculation only utilizes resting blood pressure (BP) values, and the association between ePWV based on exercise BP readings and clinical outcomes remains unclear. This study aims to explore whether ePWV calculated by BP derived from cardiopulmonary exercise test (CPET) is superior to traditional ePWV in the relationship with all-cause mortality. Methods: A total of 2272 young and middle-aged adults without cardiovascular disease in the National Health and Nutrition Examination Survey (1999–2002) were included. Traditional ePWV was calculated using resting BP. Moreover, using CPET as protocol, exercise BP and recovery BP were used for ePWV calculation as well. Cox proportional hazards models were applied to assess the association between different types of ePWV and all-cause mortality, with hazard ratio with 95% confidence intervals (95% CIs) estimated. Restricted cubic spline analysis was performed to examine the nonlinear correlation between ePWV and outcomes, and subgroup analyses were conducted. Results: After adjustment for potential confounders, a linear relationship was observed between all types of ePWV and outcomes, and only recovery ePWV showed a significant association with all-cause mortality (hazard ratio: 1.67, 95% CI: 1.26–2.21). Subgroup analysis showed that recovery ePWV was significantly associated with all-cause mortality in certain groups, including different age ranges, moderate cardiopulmonary health status, absence of hypertension, lower education levels, and current smokers. However, no significant interactions were found across subgroups. Conclusion: Recovery ePWV, derived from postexercise BP measurements, demonstrated superior prognostic value for all-cause mortality compared to traditional resting or exercise ePWV in young and middle-aged adults. This finding suggests that incorporating dynamic BP assessments may provide additional prognostic information.