Associations of estimated pulse wave velocity with cardiovascular-kidney-metabolic syndrome in U.S. adults: the role of sex and ethnicity (NHANES 1999-2018)

Abstract

Aim: Estimated pulse wave velocity (ePWV) is a surrogate marker of arterial stiffness and has been reported as an important risk factor for cardiovascular, kidney, and metabolic disorders. However, the associations of ePWV with cardiovascular-kidney-metabolic (CKM) multimorbidity are limited. We aim to examine the association between ePWV and CKM stages among adults in the United States (US).

Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. CKM multimorbidity was defined as the concurrent presence of subclinical or clinical cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic disorders. Participants were classified into five CKM stages according to the clinical severity of these coexisting conditions. ePWV was calculated using a validated formula based on age and blood pressure. All analyses incorporated survey weights, strata, and primary sampling units to account for NHANES’s complex multistage sampling design. Survey-weighted multinomial logistic regression models were applied to evaluate the associations between ePWV and CKM stages.

Results: A total of 21,397 adults from the US aged 20 years or older were included in the analysis. Overall, 17.9% of participants (n = 5,406) had an ePWV ≥ 10 m/s. Higher ePWV was associated with more advanced CKM stages. In fully adjusted models, each 1 m/s increase in ePWV was associated with higher odds of CKM stage 1 [odds ratios (ORs) 1.50, 95% confidence interval (CI) 1.36-1.66], stage 2 (OR 3.04, 95% CI 2.73-3.38), stage 3 (OR 8.08, 95% CI 7.12-9.16), and stage 4 (OR 4.49, 95% CI 4.01-5.03), compared with CKM stage 0. Significant interactions by sex and ethnicity were observed. The associations between ePWV and advanced CKM stages (stages 3-4) were stronger in males than in females, and Black individuals had higher odds of advanced CKM stages compared with White or Mexican individuals (all P for interaction < 0.05).

Conclusions: Greater arterial stiffness, as indicated by higher ePWV, was associated with an increased risk of CKM multimorbidity after adjustment for sociodemographic characteristics, lifestyle factors, and CKM-related risk factors.

Keywords

Cardiovascular-kidney-metabolic syndrome / cardiovascular disease / ePWV / NHANES / risk factors