Key result
High ePWV trajectory is linked to ~161% higher all-cause mortality in CKM stages 0-3.
Why the study?
The prognostic significance of longitudinal estimated pulse wave velocity trajectories in individuals with cardiovascular-kidney-metabolic syndrome remains unclear.
Do higher estimated pulse wave velocity (ePWV) trajectories increase all-cause mortality in middle-aged and older Chinese adults with CKM syndrome stages 0-3?
Cohort (n=4,123)
Yes
Do higher estimated pulse wave velocity (ePWV) trajectories increase all-cause mortality in middle-aged and older Chinese adults with CKM syndrome stages 0-3?
Hazard Ratio: 2.61 (95% CI 1.19–5.72)
p-value: p=0.016
Higher longitudinal trajectories of estimated pulse wave velocity are independently associated with a graded increase in all-cause mortality risk among adults with early-stage cardiovascular-kidney-metabolic syndrome.
May aid mortality risk stratification via ePWV trajectories in CKM syndrome; leaves open whether modifying trajectories improves outcomes.
Pulse wave velocity (PWV), a marker of arterial stiffness, is a well-established predictor of cardiovascular outcomes. Estimated PWV (ePWV), derived from blood pressure and age, provides a convenient alternative to direct PWV measurement. However, the prognostic significance of longitudinal ePWV trajectories in individuals with cardiovascular–kidney–metabolic (CKM) syndrome remains unclear. This study investigated the associations between ePWV trajectories and all-cause mortality among middle-aged and older Chinese adults with CKM syndrome stages 0–3. This prospective cohort study included 4,123 participants aged ≥ 45 years with CKM syndrome stages 0–3 from the China Health and Retirement Longitudinal Study. ePWV was calculated using blood pressure and age across three survey waves (2011–2015), and distinct trajectories were identified using group-based trajectory modeling. Mortality outcomes were ascertained over a 5-year follow-up period (2015–2020). Cox proportional hazards models were used to evaluate the associations between ePWV trajectories and mortality, with adjustment for demographic characteristics, lifestyle factors, and clinical conditions. Four ePWV trajectories were identified: Low (25.61%), Moderate-low (36.89%), Moderate-high (24.89%), and High (12.61%). During the follow-up period, 318 deaths (7.71%) occurred, with survival curves showing progressive separation across trajectory groups (log-rank P < 0.001). After full adjustment, compared with the Low trajectory, the hazard ratios (HRs) for all-cause mortality were 1.47 (95% confidence interval [CI], 0.83–2.60) for the Moderate-low trajectory, 2.24 (95% CI, 1.18–4.25; P = 0.014) for the Moderate-high trajectory, and 2.61 (95% CI, 1.19–5.72; P = 0.016) for the High trajectory (P for trend = 0.010). These associations were consistent across subgroups stratified by age, sex, lifestyle factors, cardiometabolic conditions, and CKM stage (all P for interaction > 0.05), and were supported by sensitivity analyses. Higher ePWV trajectories were independently associated with an increased risk of all-cause mortality in a graded manner among individuals with CKM syndrome stages 0–3.
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Zhang et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 (n=4,123). High estimated pulse wave velocity (ePWV) trajectory vs. Low ePWV trajectory was evaluated on All-cause mortality (HR 2.61, 95% CI 1.19-5.72, p=0.016). A high estimated pulse wave velocity trajectory was independently associated with a significantly increased risk of all-cause mortality (HR 2.61) compared to a low trajectory in adults with CKM syndrome stages 0-3.
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