Estimated Pulse Wave Velocity for Stage‐Specific Mortality Risk Stratification in Cardiovascular–Kidney–Metabolic Syndrome: The NHANES Study

Objective This study aimed to evaluate the prognostic value of estimated pulse wave velocity (ePWV) for predicting all‐cause and cardiovascular mortality in patients with cardiovascular–kidney–metabolic (CKM) syndrome. Methods We analyzed data from 9735 adults with CKM syndrome in the National Health and Nutrition Examination Survey (NHANES, 1999–2018). ePWV was calculated using a validated formula based on age and blood pressure. Participants were categorized into ePWV quartiles (Q1: ≤ 6.44 m/s; Q2: 6.44–7.41 m/s; Q3: 7.41–8.96 m/s; and Q4: > 8.96 m/s). Mortality outcomes were assessed via linkage to the National Death Index. Cox proportional hazards models were employed to estimate hazard ratios, adjusting for demographic, clinical, and laboratory covariates. Results During a median follow‐up of 20 years, higher ePWV quartiles showed progressively increased mortality risks. In fully adjusted models, Q4 exhibited substantially elevated hazards for all‐cause mortality ( HR : 10.46, 95% CI : 5.38–20.33) and cardiovascular mortality ( HR : 14.02, 95% CI : 3.67–53.51) versus Q1. In the overall cohort, PWV showed a significant positive linear relationship with both cardiovascular and all‐cause mortality (overall p < 0.05; nonlinear p > 0.05). Subgroup analyses revealed stronger associations in nonadvanced CKM stages (Stages 0–2) and older adults ( p < 0.05). Conclusion ePWV is a robust, noninvasive predictor of mortality in CKM syndrome, with potential utility for risk stratification and therapeutic targeting. These findings support incorporating arterial stiffness assessment into CKM management protocols.