Association between estimated pulse wave velocity and impaired fasting glucose: a multicenter retrospective cohort study in China

Background Prediabetes, primarily impaired fasting glucose (IFG), represents a critical window for preventing diabetes and its vascular sequelae. Estimated pulse wave velocity (ePWV) is a noninvasive marker of aortic stiffness and a predictor of cardiovascular events. Although arterial stiffness is linked to early glucose metabolism abnormalities, the independent association of ePWV with incident IFG remains unclear. This study aimed to elucidate this relationship in a multi-province Chinese cohort and to identify potential risk thresholds. Methods We performed a retrospective analysis of 184,291 Chinese adults with normal baseline fasting plasma glucose from the Rich Healthcare Group. Participants were stratified into four quartiles according to their ePWV values. Kaplan-Meier (K-M) survival analysis and Cox proportional hazards regression models were subsequently employed to evaluate the relationship between ePWV and the incidence of IFG. Restricted cubic spline (RCS) analysis was employed to explore potential non-linear relationships and identify inflection points. To evaluate the robustness of the results, sensitivity and subgroup analyses were performed. Results During a median follow-up period of 3.0 years, 11.28% of participants (n=20,783) developed incident IFG. Following multivariable adjustment for gender, BMI, FPG, blood lipids, liver and renal function, and behavioral factors, each 1 m/s increase in ePWV was associated with a hazard ratio (HR) of 1.19 (95% CI: 1.18-1.2) for developing IFG. Furthermore, K-M survival analysis revealed that the incidence of IFG demonstrated a progressive rise in tandem with increasing levels of ePWV quartiles. RCS revealed a nonlinear association was observed, characterized by a threshold was identified at 8.365 m/s, below which the relationship exhibited a distinct change in trend, each 1 m/s rise conferred a 33% higher risk. The positive association between elevated ePWV and IFG risk remained robust across all subgroups examined. Conclusions In this large retrospective cohort study, elevated ePWV was independently associated with an increased risk of incident IFG, exhibiting a nonlinear relationship with a more pronounced risk gradient below 8.365 m/s. These findings suggest ePWV may serve as a simple, non-invasive marker for early identification of individuals at high risk for IFG.