Association Between Cumulative Estimated Pulse Wave Velocity and the Risk of Major Adverse Cardiovascular Events in Adults over 45 Years of Age: A Longitudinal Study Based on the CHARLS and Kailuan Cohorts

Estimated pulse wave velocity (ePWV) is a widely used metric for assessing arterial stiffness, a key pathophysiological mechanism contributing to major adverse cardiovascular events (MACEs). While cross-sectional and short-term associations of ePWV with cardiovascular risk are recognized, the long-term impact of cumulative exposure to elevated ePWV levels on the risk of developing MACEs remains poorly understood, particularly in middle-aged and older adults. This longitudinal study analyzed data from two large prospective cohorts: the Kailuan Study (n = 3568; 65% male) and the China Health and Retirement Longitudinal Study (CHARLS) (n = 4831; 48% male). Individual ePWV was calculated based on age and mean arterial pressure. Cumulative ePWV exposure was quantified as the summed area under the curve between serial measurements. The primary outcome was the incidence of MACEs. Cox regression revealed significant positive associations between cumulative ePWV and MACEs risk, with the highest ePWV quartile showing substantially elevated risk compared to the lowest quartile in both the Kailuan (HR = 2.01; 95% CI: 1.34-3.01) and CHARLS cohorts (HR = 1.73; 95% CI: 1.03-2.91). Subgroup analyses demonstrated similar positive associations across key demographic and clinical strata. Long-term cumulative exposure to elevated ePWV independently predicts MACEs in adults aged ≥45 years. Critically, this association persists after rigorous adjustment for baseline ePWV and key confounders, highlighting the unique prognostic value of tracking arterial stiffness burden over time.