Associations between estimated pulse wave velocity trajectories and all-cause mortality in participants with cardiovascular-kidney-metabolic syndrome stages 0–3

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.