Association between cumulative estimated pulse wave velocity and complete edentulism in middle-aged and older adults: a nationwide prospective cohort study

Complete edentulism significantly affects quality of life in middle-aged and older adults. Evidence regarding the long-term cumulative effect of arterial stiffness on complete edentulism remains limited. This study aimed to investigate the longitudinal association between cumulative estimated pulse wave velocity (ePWV) and complete edentulism. We conducted a prospective analysis using data from the China Health and Retirement Longitudinal Study (CHARLS). Data were collected across four waves: Wave 1 (2011–2012, baseline), Wave 2 (2013), Wave 3 (2015), and Wave 4 (2018). Cumulative ePWV was calculated as the product of the average ePWV from the 2012 and 2015 surveys and the time interval (3 years): (ePWV_2012 + ePWV_2015)/2 × (2015–2012). ePWV itself was derived from age and mean arterial pressure using the Greve equation. Complete edentulism was a self-reported measure. Multivariable Cox models were used, with adjustment for demographic factors (age, gender, marriage, residence, education), lifestyle factors (smoking, drinking), and health status (body mass index (BMI), hypertension, diabetes, dyslipidemia, and cardiovascular disease). Restricted cubic spline (RCS) analysis was used to examine nonlinearity, and subgroup analyses were performed. Among 5,142 participants, 321 complete edentulism cases were observed. Each unit increase in cumulative ePWV was associated with a 6.5% higher complete edentulism risk (HR = 1.065, 95%CI:1.043–1.087). The highest cumulative ePWV quartile was associated with a 3.273-fold greater risk than the lowest quartile (HR = 3.273, 95%CI:2.172–4.931). A nonlinear relationship was identified, with a significantly increased risk above 27.911 m/s ( P = 0.001). Subgroup analyses showed consistent associations. This prospective study establishes an independent association between cumulative ePWV and complete edentulism. The findings suggest that arterial stiffness assessment may help identify individuals at elevated risk. This finding may support the development of integrated cardiovascular–oral health strategies for aging populations.