The Association Between Estimated Pulse Wave Velocity and Cancer Risk in Middle-Aged and Older Adults

Objective This study aimed to investigate the association between arterial stiffness, as characterised by estimated pulse wave velocity (ePWV), and the risk of cancer in middle-aged and older adults. Subgroup analyses were conducted to assess the role of ePWV in predicting cancer risk across different subgroups. We also explored the association between ePWV and the risk of cancer across different organ systems. Methods A cohort study design was employed. We enrolled 11,648 middle-aged and older adults aged 45 years and above, newly recruited to the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015. Cancer incidence during the 2013–2018 follow-up period was defined as the outcome event. The median follow-up duration was 7.00 years. Using X-tile software, ePWV was categorised into two groups: Low-level (Low, < 8.84) and High-level (High, ≥ 8.84). Descriptive analysis was used to compare baseline characteristics. Univariate and multivariate Cox proportional hazards models were employed to analyse the association between ePWV and cancer risk. Subgroup analyses assessed effect differences across populations, and explored the association between ePWV and cancers of different organ systems. Results There were 215 cancer cases during follow-up. Cancer incidence was significantly higher in the high ePWV group than in the low ePWV group (68.84% vs 31.16%, P = 0.010). After adjusting for age, sex and other confounders in the multivariable Cox regression model, high ePWV was independently associated with an increased cancer risk (HR = 1.48, 95% CI: 1.07–2.06, P = 0.020). All variables had variance inflation factors (VIF) < 5, indicating no multicollinearity. Subgroup analysis showed high ePWV was a significant risk factor for increased cancer incidence in individuals aged < 65 years, males, rural residents, alcohol consumers, those sleeping ≥ 6 hours per night, those with a BMI < 24 kg/m², and those with a comorbidity index ≤ 2. Site-specific analysis indicated high ePWV was associated with head cancer (HR = 3.77, 95% CI: 1.31–10.84, P = 0.014), respiratory cancers (HR = 2.67, 95% CI: 1.07–6.65, P = 0.035), and cancers of other systems (HR = 2.27, 95% CI: 1.04–4.95, P = 0.040). Conclusion This study demonstrates that arterial stiffness, as characterised by ePWV, is significantly associated with increased cancer risk in middle-aged and older adults. This association is more pronounced in certain subgroups. Furthermore, ePWV is closely associated with the risk of head, respiratory, and other system cancers, and may serve as a potential indicator for identifying high-risk groups for cancer in middle-aged and older adults.