Estimated pulse wave velocity as a marker of major adverse cardiovascular events in essential thrombocythaemia and polycythaemia vera.

Estimated pulse wave velocity (ePWV), a simple surrogate of arterial stiffness, predicts cardiovascular events in general and oncology populations, but its relevance in myeloproliferative neoplasms (MPN) is unknown. We evaluated the association of baseline ePWV with major adverse cardiovascular events (MACE) and overall survival (OS) in 664 patients with essential thrombocythaemia (n = 477) or polycythaemia vera (n = 187). Median ePWV was 11.1 m/s (interquartile range [IQR], 9.2-12.9), and 72.1% met criteria for early vascular ageing (≥9.4 m/s). Over a median follow-up of 67.4 months, 58 first MACE (8.7%) and 58 deaths (8.7%) occurred. In multivariable cause-specific Cox models, each 1 m/s higher baseline ePWV was independently associated with MACE (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.02-1.32; p = 0.025). The adjusted HRs were 1.18 (95% CI 1.00-1.39; p = 0.054) for arterial thrombosis and 0.98 (95% CI 0.74-1.28; p = 0.860) for venous thromboembolism. For OS, ePWV lost significance after adjustment for age (HR 0.92, p = 0.670). Among JAK2-mutated patients, JAK2 V617F variant allele fraction showed a significant correlation with ePWV (ρ = 0.134; p = 0.022). These findings identify ePWV as a scalable marker of vascular ageing associated with cardiovascular risk in MPN, warranting prospective validation.