Association of Estimated Pulse Wave Velocity and Metabolic Markers With Cognitive Impairment Risk in Diabetes

Background Type 2 diabetes mellitus (T2DM) is a major modifiable risk factor for dementia, yet cost-effective, scalable methods for early identification of cognitively at-risk individuals remain limited. Objective To evaluate the predictive value of estimated pulse wave velocity (ePWV), alone and in combination with metabolic markers, for incident cognitive impairment (CI) in adults with diabetes. Methods Using data from 893 participants with T2DM in the China Health and Retirement Longitudinal Study (CHARLS), we prospectively assessed the association of ePWV—calculated from routine blood pressure and age—with CI over a 9-year follow-up. Metabolic indicators, including the triglyceride–glucose (TyG) index and glycated hemoglobin (HbA1c), were integrated into Cox regression and restricted cubic spline analyses. Results Higher ePWV was independently associated with an increased risk of CI, even after adjusting for conventional vascular and metabolic covariates. Models combining ePWV with TyG index and HbA1c demonstrated superior predictive discrimination compared with ePWV alone. Conclusions ePWV, obtainable from routine clinical measurements, is a practical and scalable tool to identify diabetic individuals at elevated risk for CI. Combining vascular stiffness and metabolic metrics enhances risk stratification, highlighting dual targets for early preventive intervention. These findings support the integration of cardiovascular–metabolic monitoring into dementia prevention strategies for high-risk populations.