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Global distributions of age- and sex-related arterial stiffness: systematic review and meta-analysis of 167 studies with 509,743 participants.
Pubmed ID: 37229905
Pubmed Central ID: PMC10327869
Journal: EBioMedicine
Publication Date: June 1, 2023
Affiliation: Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: raimund.pechlaner@i-med.ac.at.
MeSH Terms: Humans, Male, Female, Blood Pressure, Ankle Brachial Index, Vascular Stiffness, China, Pulse Wave Analysis
Grants: N01HC25195, HHSN268201500001I, HHSN268201500001C, 75N92019D00031, R01 HL060040, R01 HL070100
Authors: Aguilar D, Kavousi M, Kiechl S, Segers P, Benjamin EJ, Vasan RS, Lu Y, Nakamura M, Ninomiya T, Ferrières J, Mill JG, Rietzschel E, Koyama T, Wang J, Pereira AC, Kullo IJ, Bailey K, Meyer ML, Liu C, Poon AK, Chen CH, Urbina EM, Wong A, Kim HL, Scholz M, Quyyumi AA, Tomiyama H, Yamashina A, Diaz A, Cunha RS, Cheng HM, Kim MK, Stamatelopoulos K, Mitchell GF, Kiechl SJ, Xu Q, Pechlaner R, Al-Hashmi KM, Alvim RO, Al-Zakwani IS, Antza C, Cicero AFG, Avramovska M, Avramovski P, Baek HJ, Bäck M, Baldo MP, Batista RFL, Benetos A, Bia D, Borghi C, Roux SB, Breet Y, Burgner D, Cardoso VC, Cecelja M, Ceponiene I, Cheung M, Cho J, Chowienczyk P, Coelho EB, Cseprekal O, Silva ABD, Dallaire F, Ferreira AVL, Furuta Y, Gómez-Marcos MA, Gómez-Sánchez L, Halcox J, Hanis C, Herzig KH, Jaeggi E, Kiechl-Kohlendorfer U, Kim YM, Kis E, Knoflach M, Kotsis V, Kozakova M, Kruger R, Kweon SS, Lambrinoudaki I, Loeffler M, Logan JG, Maddock J, Magalhães P, Maldonado J, Mattace-Raso FUS, Messner A, Mi J, Mu JJ, Muhammad IF, Nairz J, Nakagomi A, Nilson PM, Palombo C, Pereira T, Capingana DP, Probst-Hensch N, Reusz GS, Rhee MY, Ribeiro CCC, Rocha PRH, Rodilla E, Rojek M, Ruidavets JB, Rutten JHW, Saijo Y, Salvi P, Schmidt-Trucksäss A, Shin MH, Strazhesko ID, Sugiura M, Tkacheva ON, van den Munckhof ICL, Wake MA, Wannamethee G, Yan Y, Zaniqueli D, Zhu F, Zócalo Y
Cite As: Lu Y, Kiechl SJ, Wang J, Xu Q, Kiechl S, Pechlaner R, Global Pulse Wave Velocity Study Group. Global distributions of age- and sex-related arterial stiffness: systematic review and meta-analysis of 167 studies with 509,743 participants. EBioMedicine 2023 Jun;92:104619. Epub 2023 May 23.
Studies:
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.