Arterial Stiffness in Cancer Survivors: The Prognostic Value of Estimated Pulse Wave Velocity in US Cancer Population From the National Health and Nutrition Examination Survey 2009 to 2018.

Background: Estimated pulse wave velocity (ePWV), a marker of arterial stiffness, is strongly associated with cardiovascular events and all-cause death in the general population. This study evaluates the association of arterial stiffness, defined by the ePWV equation, with all-cause and cardiovascular death and identifies an optimal ePWV threshold for risk stratification in cancer survivors.

Methods: Using data from the National Health and Nutrition Examination Survey (2009-2018), we analyzed a cohort representing more than 105 million US cancer survivors. Multivariable Cox regression and Kaplan-Meier analyses assessed the association between ePWV and outcomes. Dose-dependent relationships were explored, and an optimal ePWV threshold was determined through maximally selected rank statistics.

Results: During a median follow-up of 59 months, a total of 105 869 670 weighted cancer survivors (2234 unweighted) were analyzed, recording 435 all-cause and 91 cardiovascular deaths. Early vascular aging (ePWV ≥9.4 m/s) was present in 54.6% of participants. Each 1 m/s increase in ePWV was associated with higher risks of all-cause death (29%) and cardiovascular death (46%) (hazard ratio [HR], 1.29 [95% CI, 1.19-1.40] and 1.46 [95% CI, 1.20-1.76], respectively, both P<0.001). Those with ePWV ≥12.05 m/s demonstrated higher risks of all-cause and cardiovascular death (HR, 1.70 [95% CI, 1.35-2.13] and 2.53 [95% CI, 1.56-4.12], respectively, both P<0.001).

Conclusions: Arterial stiffness, assessed by ePWV, demonstrates prognostic utility in cancer survivors, showing a nonlinear association with all-cause and cardiovascular death, independent of demographic, socioeconomic, traditional cardiovascular risk factors not included in the ePWV equation, and baseline cardiovascular disease.