Association between pulse wave velocity and extracoronary arterial calcification: a systematic review and...

Cardiovascular diseases remain the leading cause of mortality worldwide. Their increasing prevalence has focused attention on new promising biomarkers such as vascular calcification, although its assessment involves radiation exposure. Thus, this systematic review and meta-analysis aimed to examine the association between arterial stiffness, assessed through pulse wave velocity (PWV) and extracoronary arterial calcification (ECC), in addition to identifying possible factors influencing this relationship. A systematic search was conducted in PubMed, Scopus, and Web of Science according to PRISMA and MOOSE guidelines. Data extraction, quality assessment, and statistical analyses were performed according to predefined criteria. A total of 41 studies with 19 300 participants were included. Higher central PWV was associated with higher presence of ECC in both unadjusted and adjusted models (p-OR = 2.84; 95% CI: 2.25-3.59; and p-OR = 2.27; 95% CI: 1.66-3.11, respectively). Similarly, peripheral PWV was associated with ECC in both unadjusted and adjusted models (p-OR = 3.73; 95% CI: 2.76-5.05; and p-OR = 1.49, 95% CI: 1.26-1.75, respectively), though with considerable heterogeneity. Age, diabetes, low-density lipoprotein cholesterol, total cholesterol, pulse pressure, and body mass index were related to p-OR. Publication bias was identified in all models except the adjusted peripheral model. This meta-analysis highlights a significant association between central arterial stiffness and ECC, supporting PWV as a promising noninvasive biomarker. Given the cross-sectional nature of the available evidence and the observed heterogeneity, further prospective studies are needed to confirm these findings, clarify their clinical relevance, standardize measurement methods, and to strengthen the overall evidence base.