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).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.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).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.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.
