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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

2023; Elsevier BV; Volume: 92; Linguagem: Inglês

10.1016/j.ebiom.2023.104619

2352-3964

Yao Lu, Sophia J. Kiechl, Jie Wang, Qingbo Xu, Stefan Kiechl, Raimund Pechlaner, David Aguilar, Khamis Al-Hashmi, Rafael de Oliveira Alvim, Ibrahim Al‐Zakwani, Christina Antza, Arrigo F.G. Cicero, Maja Avramovska, Petar Avramovski, Hyun Jae Baek, Magnus Bäck, Kent R. Bailey, Marcelo Perim Baldo, Rosângela Fernandes Lucena Batista, Athanasios Benetos, Emelia J. Benjamin, Daniel Bia, Claudio Borghi, Shani Botha‐Le Roux, Yolandi Breet, David Burgner, Viviane Cunha Cardoso, Marina Cecelja, Indrė Čeponienė, Chen‐Huan Chen, Michael Cheung, Hao‐Min Cheng, Jaegeol Cho, Phil Chowienczyk, Eduardo Barbosa Coelho, Orsolya Cseprekál, Amilcar BT Da Silva, Frédéric Dallaire, Roberto de Sá Cunha, Alejandro Díaz, Albano Vicente Lopes Ferreira, Jean Ferrières, Yoshihiko Furuta, Manuel A. Gómez‐Marcos, Leticia Gómez‐Sánchez, Julian Halcox, Craig L. Hanis, Karl‐Heinz Herzig, Edgar Jaeggi, Maryam Kavousi, Ursula Kiechl‐Kohlendorfer, Hack‐Lyoung Kim, Mi Kyung Kim, Yu‐Mi Kim, Éva Kis, Michael Knoflach, Vasilios Kotsis, Teruhide Koyama, M. Kozàkovà, Ruan Kruger, Iftikhar J. Kullo, Sun‐Seog Kweon, Ιrene Lambrinoudaki, Chang Liu, Markus Loeffler, Jeongok G. Logan, Jane Maddock, Pedro Magalhães, João Maldonado, Francesco Mattace‐Raso, Alex Messner, Michelle L. Meyer, Jie Mi, José Geraldo Mill, Gary F. Mitchell, Jianjun Mu, Iram Faqir Muhammad, Johannes Nairz, Atsushi Nakagomi, Mieko Nakamura, Peter M. Nilson, Toshiharu Ninomiya, Carlo Palombo, Alexandre C. Pereira, Telmo Pereira, Daniel Pires Capingana, Anna K. Poon, Nicole Probst‐Hensch, Arshed A. Quyyumi, György Reusz, Moo‐Yong Rhee, Cecília Cláudia Costa Ribeiro, Ernst Rietzschel, Paulo Ricardo Higassiaraguti Rocha, Enrique Rodilla, Marta Rojek, Jean‐Bernard Ruidavets, Joost H.W. Rutten, Yasuaki Saijo, Paolo Salvi, Arno Schmidt‐Trucksäss, Markus Scholz, Min‐Ho Shin, Patrick Segers, Kimon Stamatelopoulos, И. Д. Стражеско, Minoru Sugiura, О. Н. Ткачева, Hirofumi Tomiyama, Elaine M. Urbina, Inge van den Munckhof, Ramachandran S. Vasan, Melissa Wake, S. Goya Wannamethee, Andrew Wong, Akira Yamashina, Yinkun Yan, Divanei Zaniqueli, Fang Zhu, Yanina Zócalo,

Cerebrovascular and Carotid Artery Diseases

BackgroundArterial 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).MethodsMeasurements 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.FindingsThe 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).InterpretationChina 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.FundingThis 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.