Age-specific reference values for pulse wave velocity in paediatric populations: a systematic review with...

Arterial stiffness, assessed by pulse wave velocity (PWV), is a key marker of vascular aging and an independent predictor of cardiovascular morbidity and mortality. Age is the primary determinant of PWV; however, age-specific and sex-specific reference values in healthy paediatric populations are not yet well defined. Therefore, this study aimed to establish reference values for PWV in healthy children.

A systematic review and meta-analysis of observational studies reporting age-stratified PWV values in healthy children was conducted. Pooled mean estimates and 95% confidence intervals (95% CIs) were calculated using random effects models. Additional sex-stratified analyses were performed, and percentile distributions were examined to enhance clinical applicability.

Ten studies were included in the quantitative synthesis. A nonlinear pattern was observed: PWV was greater in the 0-5-year age group (5.33 m/s) than in the 6-8-year age group (4.93 m/s), followed by a progressive increase up to 15-18 years (5.80 m/s). This trend was consistent across sexes. Substantial heterogeneity between studies was detected, and Egger's test suggested the presence of publication bias across several age groups, both in sex-stratified analyses and in the overall population.

Age is the primary determinant of arterial stiffness during childhood and is influenced by physiological processes such as arterial wall maturation early in life and puberty. Establishing age-specific reference values for PWV provides an essential clinical tool for the early detection of accelerated vascular aging and cardiovascular risk stratification from early stages of life.