Association between pulse wave velocity and coronary artery calcification: a systematic review and meta-analysis

Cardiovascular diseases are the leading cause of mortality and morbidity combined worldwide. Traditional risk factors may underestimate risk in individuals with subclinical atherosclerosis, prompting the development of novel markers. Coronary artery calcium assessment has been proposed as a promising marker of subclinical atherosclerosis, although it involves exposure to ionizing radiation. This systematic review and meta-analysis aimed to explore the association between a noninvasive marker, pulse wave velocity (PWV), and coronary calcification, as well as the factors influencing this association. A systematic review and meta-analysis were conducted via the PubMed, Scopus, and Web of Science databases in accordance with the MOOSE and PRISMA guidelines. Data extraction, quality assessment, and statistical analyses were carried out on the basis of preestablished criteria. Twenty-six studies involving 103 222 individuals were included. Higher central PWV in the unadjusted and adjusted models [pooled odds ratio (p-OR) = 3.11, 95% confidence interval (CI): 2.07-4.67 and p-OR = 1.51, 95% CI: 1.26-1.81, respectively] and higher peripheral PWV in the unadjusted and adjusted models (p-OR = 2.49, 95% CI: 1.97-3.14 and p-OR = 1.68, 95% CI: 1.38-2.05, respectively) were associated with greater coronary calcification, with considerable heterogeneity. The percentage of women, total cholesterol, body mass index and diastolic blood pressure were related to the p-OR. The adjusted model for peripheral PWV showed publication bias. Our meta-analysis underscores a significant association between arterial stiffness and coronary calcification, highlighting PWV as a promising noninvasive biomarker. Its integration into clinical practice could enhance cardiovascular risk stratification, enabling earlier interventions. To maximize its clinical utility, standardization and further research are imperative.