Baseline estimated pulse wave velocity (ePWV) and its longitudinal change are associated with incident frailty in older Chinese adults: a prospective cohort study

This study aimed to examine the longitudinal associations of estimated pulse wave velocity (ePWV) and its longitudinal change with incident frailty in older adults. A total of 2,016 older adults (≥60 years, baseline non-frail) were included in baseline analysis, selected from an initial cohort of 4,129. Of these, 1,137 had repeated ePWV data for change analysis. Arterial stiffness was measured using ePWV, and its longitudinal change from baseline to follow-up was defined as ΔePWV. Frailty was assessed using a frailty index (FI), analyzed as both continuous and binary outcome (FI ≥ 0.25). Multivariable regression models evaluated associations of baseline ePWV and ΔePWV with incident frailty. After a mean follow-up of 7 years, 394 of 2,016 participants (19.5%) developed frailty. Each 1 m/s increase in baseline ePWV was associated with higher frailty risk (OR = 1.21, 95% CI: 1.10–1.33); the highest quartile had more than twice the risk of the lowest (OR = 2.11, 95% CI: 1.36–3.28). Among 1,137 participants with repeated measures, each 1 m/s increase in ΔePWV was associated with 21.4% higher frailty odds (OR = 1.21, 95% CI: 1.03–1.43), and rapid increase group had higher risk than decline/stable group (OR = 1.91, 95% CI: 1.13–3.23). Results were consistent in continuous FI and most sensitivity analyses. However, after excluding hypertension and cardiovascular disease from the FI, the associations were attenuated and no longer statistically significant. These findings indicate that higher baseline ePWV and increases in ePWV over follow-up were associated with an increased risk of incident frailty, although part of this association may be related to the cardiovascular components within the FI. ePWV may serve as a useful indicator for identifying individuals at elevated risk of frailty.