How Age and Gender Influence Arterial Stiffness in Chinese Population
Isolated indicators on your medical report—slightly high blood pressure, a slightly larger waistline, borderline blood sugar—are quietly weaving a web of health risks.
Have you ever thought that a few "slightly abnormal" indicators on your medical report are nothing to worry about? New research suggests that these seemingly isolated metabolic issues may be working together to accelerate your vascular aging.
In China, cardiovascular disease mortality ranks first, and metabolic syndrome is becoming a core driver of this health crisis. A landmark study in Chinese population reveals the complex and subtle connections between metabolic syndrome components and subclinical arterial stiffness, connections that vary by age and gender2 .
Metabolic syndrome is not a single disease but a cluster of metabolic abnormalities that together significantly increase the risk of cardiovascular disease and type 2 diabetes.
According to the International Diabetes Federation 2005 definition, diagnosing metabolic syndrome requires central obesity plus at least two of the following four factors:
How do these components interact to damage our blood vessels? The key lies in how they collectively promote a subclinical vascular pathology called "arterial stiffness".
Arterial stiffness is a core marker of vascular aging, referring to the reduced elasticity and increased hardening of arterial walls4 .
When arteries stiffen, the resistance the heart faces when pumping blood increases, placing greater strain on the heart. Simultaneously, stiffened vessels cannot effectively cushion the impact of blood flow, which directly damages end organs, especially the brain and kidneys4 .
Carotid-Femoral Pulse Wave Velocity (cfPWV)
Researchers precisely assess arterial stiffness by measuring carotid-femoral pulse wave velocity. This indicator is considered the "gold standard" for measuring arterial stiffness4 .
The principle is simple: the pulse wave generated by the heartbeat propagates through the arterial system at a certain speed—the stiffer the artery, the faster the pulse wave travels. Normally, cfPWV values should be below 10 m/s, while values above this indicate increased arterial stiffness3 .
Elastic walls efficiently expand and contract with each heartbeat, maintaining optimal blood flow.
Arterial walls begin to lose elasticity, pulse wave velocity increases slightly.
Reduced elasticity increases cardiac workload, cfPWV > 7 m/s.
Significantly hardened arteries, cfPWV > 10 m/s, high cardiovascular risk.
A pioneering study by the research team at The First Affiliated Hospital of Fujian Medical University revealed how the relationship between metabolic syndrome and arterial stiffness varies by age and gender in the Chinese population3 .
This cross-sectional study analyzed clinical data from 3,355 individuals who underwent carotid-femoral pulse wave velocity checks between February 2016 and December 20193 .
The research team divided participants into four groups based on metabolic health status and body mass index:
The results challenge conventional wisdom—metabolically healthy obesity is not truly "healthy," but this harm highly depends on age.
The study also revealed clear gender differences. Although specific data weren't detailed in the provided content, the authors explicitly stated these associations varied by gender.
This suggests men and women may need to pay special attention to different components of metabolic syndrome.
To understand how such research is conducted, let's explore a similar study design by a Peking University team, who assessed dynamic changes in arterial stiffness through estimated pulse wave velocity (ePWV) trajectories2 .
Participants meeting CKM 0-3 stages were screened from the China Health and Retirement Longitudinal Study (CHARLS) cohort.
Demographic data, anthropometric measurements (height, weight, waist circumference) and blood pressure measurements were collected.
Estimated pulse wave velocity was calculated using specific formulas based on age and mean arterial pressure.
Group-based trajectory modeling (GBTM) was used to identify different ePWV trajectory groups.
Cox proportional hazards models analyzed associations between ePWV trajectories and cardiovascular disease risk.
| Category | Specific Items | Function/Significance |
|---|---|---|
| Anthropometric Tools | Body Mass Index (BMI), Waist Circumference | Assess obesity degree and type |
| Blood Pressure Monitoring | Electronic Sphygmomanometer, Arterial Stiffness Detection Device | Measure blood pressure and arterial stiffness |
| Biochemical Testing | Lipid Profile, Fasting Blood Glucose, Insulin Levels | Evaluate metabolic status |
| Vascular Function Assessment | Carotid-Femoral Pulse Wave Velocity (cfPWV), Estimated Pulse Wave Velocity (ePWV) | Directly or indirectly assess arterial stiffness |
| Statistical Methods | Group-Based Trajectory Modeling (GBTM), Cox Proportional Hazards Model | Analyze data trends and risk associations |
The Peking University research team, through long-term tracking of 6,788 Chinese individuals aged 45 and above, found a clear dose-response relationship between ePWV trajectories and cardiovascular disease risk2 .
| ePWV Trajectory Group | Hazard Ratio (HR) | 95% Confidence Interval |
|---|---|---|
| Low Trajectory Group | 1.000 (Reference) | - |
| Medium-Low Trajectory Group | 1.287 | Not provided |
| Medium-High Trajectory Group | 1.891 | Not provided |
| High Trajectory Group | 2.400 | 1.660-3.469 |
This data clearly shows that the progression speed of arterial stiffness directly correlates with cardiovascular risk. The highest trajectory group had 2.4 times the cardiovascular disease risk of the low trajectory group.
Fujian Medical University's research, through multifactorial logistic regression analysis, revealed the association strength between various metabolic abnormalities and arterial stiffness across different age groups3 :
| Age Group | Metabolic Status | Association with Increased Arterial Stiffness (OR value) |
|---|---|---|
| Middle-aged & Young | Metabolically Unhealthy | 1.856 (1.413-2.440) |
| Middle-aged & Young | Metabolically Healthy Obese | 2.249 (1.481-3.414) |
| Elderly | Metabolically Unhealthy | 1.519 (1.088-2.122) |
| Elderly | Metabolically Healthy Obese | No significant association |
This finding has important implications for prevention strategies: middle age may be the critical window for intervening in metabolically healthy obesity.
Low Risk
Medium-Low
Medium-High
High Risk
Based on these research findings, we can take targeted measures to protect vascular health:
Reduce high-sugar beverages and processed foods, increase dietary fiber
Break sedentary lifestyle, at least 150 minutes of moderate-intensity aerobic exercise weekly
Chronic stress promotes metabolic syndrome by disrupting the HPA axis
Especially for high-risk individuals with family history of metabolic syndrome
Peking University researchers emphasize that incorporating ePWV trajectories into routine monitoring may help early identification of high-risk individuals, having special value in primary prevention, especially in resource-limited areas2 .
Fujian Medical University's research brings a glimmer of hope: intervening in metabolically healthy obesity during middle age can effectively delay the progression of arterial hardening3 .
As one researcher noted, monitoring arterial stiffness trajectories is like observing a "barometer" of vascular health, capable of issuing the earliest warning signals while we still feel healthy2 .