Modifiable factors associated with early vascular ageing in youth: a systematic review

Risk factors for cardiovascular disease (CVD) begin to develop in childhood. Measures of vascular ageing that capture vascular structural and functional degeneration, such as carotid-to-femoral pulse wave velocity (cfPWV), are independent predictors of CVD. Importantly, exposure to modifiable factors is known to be associated with early vascular ageing; however, this has not been thoroughly assessed in youth. This review aimed to identify modifiable factors of cfPWV in youth (≤19 years). Medline, Scopus and Embase online databases were searched from inception to March 2025. Seven thousand five hundred and sixty-seven articles were identified; 51 studies were included. Most studies investigated the relationship between adiposity factors (n = 31). In a meta-analysis, there was a significant association between BMI and cfPWV (0.013 m/s per kg/m2, P < 0.0001). This review identified various modifiable factors that are adversely associated with cfPWV in youth. Lifestyle interventions targeting these factors are likely to be beneficial for vascular health in youth.