SummaryBackgroundArterial 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 the10.13039/501100004955Austrian Research
Promotion Agency, by the10.13039/501100001809National Science
Foundation of China, and theScience and Technology Planning Project of Hunan
Province. Detailed funding information is provided as
part of the Acknowledgments after the main text.