Estimated pulse wave velocity and progression to advanced cardiovascular–kidney–metabolic syndrome: a population-based longitudinal study with supportive external cross-sectional evidence

Background Cardiovascular–kidney–metabolic (CKM) syndrome captures the interconnected burden of metabolic risk factors, chronic kidney disease, and cardiovascular disease. Evidence remains limited regarding simple and clinically accessible markers that may help identify individuals at risk of progression to advanced CKM syndrome. We evaluated whether estimated pulse wave velocity (ePWV), an easily calculated marker of arterial stiffness, was associated with progression to advanced CKM syndrome. Methods We analyzed longitudinal data from the China Health and Retirement Longitudinal Study, with baseline assessment in 2011 and follow-up assessments in 2013 and 2015. Multivariable logistic regression examined associations of baseline ePWV, longitudinal changes in ePWV, and ePWV trajectories with progression to advanced CKM syndrome. Subgroup, inverse probability weighting, restricted cubic spline, and receiver operating characteristic analyses were performed. We also assessed cross-sectional associations in an independent hospital-based cohort. Results The longitudinal analysis included 5,810 participants. In fully adjusted models, higher baseline ePWV was associated with greater odds of progression to advanced CKM syndrome. Compared with participants in the lowest ePWV tertile, those in the highest tertile had significantly higher odds of CKM progression [odds ratio [OR] = 2.630; 95% confidence interval [CI]: 2.004–3.451; P for trend <0.001]. The association was generally consistent across subgroups, and inverse probability weighting analyses supported the robustness of the findings after accounting for loss to follow-up. Each 1 m/s increase in change in ePWV was associated with 115.3% higher odds of CKM progression (OR = 2.153; 95% CI: 1.960–2.364), and a persistently high ePWV trajectory was also associated with greater odds of CKM progression. Restricted cubic spline analysis showed a nonlinear association, and baseline ePWV showed moderate discriminatory performance. The association between higher ePWV and advanced CKM syndrome was also supported by the independent hospital-based cross-sectional cohort. Conclusions Higher baseline ePWV, greater longitudinal increases in ePWV, and a persistently higher ePWV trajectory were associated with progression to advanced CKM syndrome. ePWV may serve as a convenient adjunctive marker for early CKM risk stratification, while its interpretation should consider its dependence on age and blood pressure.