To explore the influencing factors of longitudinal trajectory of cardio-ankle vascular index (CAVI) in middle-aged and elderly community populations and its correlation with new-onset major adverse cardiovascular events (MACEs), so as to provide a basis for the early intervention of arterial stiffness and dynamic management of cardiovascular risk.

Eligible subjects were selected from the longitudinal data management cohort of health check-ups (2020~2023) at Jinding Street Community Health Management Center in Shijingshan District, Beijing. A group-based trajectory model (GBTM) was used to construct and classify CAVI change trajectory models. Repeated-measures analysis of variance was applied to describe the model characteristics; unordered multinomial Logistic regression was used to analyze the influencing factors of different trajectory groups; and Cox regression model was employed to explore the correlation between different trajectory groups and new-onset MACEs.

A total of 883 subjects were included. GBTM classified the longitudinal trajectory of CAVI into three groups: low-level fluctuation group (17.89%), medium-level fluctuation group (62.85%), and high-level fluctuation group (19.25%). Repeated-measures analysis of variance showed that there were statistically significant differences in CAVI across different time points and different groups (P＜0.05). Taking the low-level fluctuation group as the reference, unordered multinomial Logistic regression revealed that subjects with advanced age, high systolic blood pressure, high levels of homocysteine (HCY) and serum creatinine (Scr), current alcohol consumption, or hyperlipidemia were more likely to be classified into the medium-level fluctuation group, while subjects with advanced age, male gender, high systolic blood pressure, high levels of fasting blood glucose (FBG), HCY, blood urea nitrogen (BUN), Scr and glycated hemoglobin (HbA1c), smoking history, current alcohol consumption, hypertension, diabetes mellitus, or hyperlipidemia were more likely to be classified into the high-level fluctuation group. Cox regression analysis indicated that compared with the low-level fluctuation group, the risk of new-onset MACEs was significantly increased in the medium-level fluctuation group (hazard ratio [HR]=9.71, 95% confidence interval [CI]: 1.33~70.97, P=0.025) and the high-level fluctuation group (HR=18.33, 95%CI: 2.45~136.94, P=0.005).

There are three distinct patterns of CAVI longitudinal trajectory in middle-aged and elderly community populations, and the population characteristics differ among different trajectory groups. Both the medium-level and high-level CAVI fluctuation groups are associated with an increased risk of new-onset MACEs, so targeted intervention for high-risk populations should be strengthened.