Global distributions of age- and sex-related arterial stiffness: systematic review and meta-analysis of 167 studies with 509,743 participants

Yao, Lu and Sophia, Kiechl and Global PWV, group and Avramovska, Maja and Avramovski, Petar (2023) Global distributions of age- and sex-related arterial stiffness: systematic review and meta-analysis of 167 studies with 509,743 participants. eBioMedicine, 92 (104619). pp. 1-15. ISSN 2352-3964

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Abstract

Background Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse
vascular pathologies and mortality. We investigated age and sex trajectories, regional differences, and global reference
values of arterial stiffness as assessed by pulse wave velocity (PWV).
Methods Measurements of brachial-ankle or carotid-femoral PWV (baPWV or cfPWV) in generally healthy
participants published in three electronic databases between database inception and August 24th, 2020 were
included, either as individual participant-level or summary data received from collaborators (n = 248,196) or by
extraction from published reports (n = 274,629). Quality was appraised using the Joanna Briggs Instrument.
Variation in PWV was estimated using mixed-effects meta-regression and Generalized Additive Models for
Location, Scale, and Shape.
Findings The search yielded 8920 studies, and 167 studies with 509,743 participants from 34 countries were included.
PWV depended on age, sex, and country. Global age-standardised means were 12.5 m/s (95% confidence interval:
12.1–12.8 m/s) for baPWV and 7.45 m/s (95% CI: 7.11–7.79 m/s) for cfPWV. Males had higher global levels than
females of 0.77 m/s for baPWV (95% CI: 0.75–0.78 m/s) and 0.35 m/s for cfPWV (95% CI: 0.33–0.37 m/s), but
sex differences in baPWV diminished with advancing age. Compared to Europe, baPWV was substantially higher
in the Asian region (+1.83 m/s, P = 0.0014), whereas cfPWV was higher in the African region (+0.41 m/s,
P < 0.0001) and differed more by country (highest in Poland, Russia, Iceland, France, and China; lowest in Spain,
Belgium, Canada, Finland, and Argentina). High vs. other country income was associated with lower baPWV
(−0.55 m/s, P = 0.048) and cfPWV (−0.41 m/s, P < 0.0001).
Interpretation China and other Asian countries featured high PWV, which by known associations with central blood
pressure and pulse pressure may partly explain higher Asian risk for intracerebral haemorrhage and small vessel
stroke. Reference values provided may facilitate use of PWV as a marker of vascular ageing, for prediction of vascular
risk and death, and for designing future therapeutic interventions.
Funding This study was supported by the excellence initiative VASCage funded by the Austrian Research Promotion
Agency, by the National Science Foundation of China, and the Science and Technology Planning Project of Hunan
Province. Detailed funding information is provided as part of the Acknowledgments after the main text.

Item Type:	Article
Subjects:	Scientific Fields (Frascati) > Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Veterinary Medicine
Depositing User:	D-r Petar Avramovski
Date Deposited:	09 Jun 2023 10:49
Last Modified:	09 Jun 2023 10:49
URI:	https://eprints.uklo.edu.mk/id/eprint/8432

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