Arterial stiffness is associated with left ventricular diastolic dysfunction (DD), which can lead to heart failure with preserved ejection fraction. However, longitudinal data on their relationship in the general population are limited. This study aimed to evaluate the association between arterial stiffness, assessed by brachial-ankle pulse wave velocity (baPWV), and the prevalence and progression of DD, as well as long-term outcomes in a large, community-based cohort.

This retrospective cohort study enrolled 16 476 adults (≥ 18 years) who underwent health screening, including echocardiography and baPWV measurements, between 2010 and 2019. Participants were categorized into normal (< 1400cm/s), borderline (1400-1799cm/s), and elevated (≥ 1800cm/s) baPWV groups. Multivariable regression was conducted to analyze the association between baPWV, DD progression, and all-cause mortality during long-term follow-up.

At baseline, the prevalence of definite DD was significantly higher in the borderline baPWV group (PR, 1.73; 95%CI, 1.23-2.23) and the elevated baPWV group (PR, 3.25; 95%CI, 2.16-4.33) compared with the normal group. Participants with borderline or elevated baPWV had a faster increase in left ventricular filling pressure (E/e′) over a mean follow-up of 4 years. Elevated baPWV was independently associated with an increased risk of incident DD (HR, 2.61; 95%CI, 1.73-3.95) and higher all-cause mortality during follow-up (HR, 3.91; 95%CI, 1.68-9.10), even after adjustment for traditional cardiovascular risk factors.

Borderline and elevated baPWV were significantly associated with a higher prevalence and faster DD progression, as well as an increased mortality risk in the general population, suggesting that baPWV is an important factor in DD pathophysiology and a useful noninvasive tool for cardiovascular risk stratification.