Arterial Windkessel function of lifelong Japanese female pearl divers revealed by carotid arterial waveform analyses

The arterial Windkessel function is a critical determinant of cardiovascular health as it reflects the buffering and cushioning capacity of the cardiothoracic arteries. Identifying populations that maintain superior Windkessel function associated with reduced arterial stiffness across the lifespan provides an opportunity to understand potential lifestyle factors and physiological mechanisms that preserve vascular elasticity. Japanese female pearl divers, called “Ama,” exhibit lower arterial stiffness, possibly as an adaptation to lifelong repeated breath-hold diving that begins in adolescence. Such vascular adaptation may be observed in Ama of later life as well as in young-to-middle age. In the present study, we investigated whether enhanced Windkessel function contributes to the favorable arterial profile observed in this group of women. A total of 66 female pearl divers (younger group, n=26, 54±9 years; older group, n=40, 73±4 years) and 97 non-diver females (younger group, n=54, 54±9 years; older group, n=43, 74±5 years) participated in this study. Participants were categorized into younger and older groups using a cutoff age of 65 years. Cardio-ankle vascular index was assessed as an index of arterial stiffness. The blood velocity waveform in the common carotid artery was measured using Doppler ultrasound. The diastolic velocity-time integral was calculated as an index of diastolic perfusion from the carotid velocity waveform. Systolic flow augmentation was calculated as the ratio of late- to early-systolic velocity amplitude from end-diastolic velocity. Pearl divers had lower cardio-ankle vascular index and higher diastolic velocity-time integrals compared with non-divers in both age groups (main effect of divers: both P< 0.05). Systolic flow augmentation was greater in older than in younger groups in non-divers (P< 0.01). However, such an age-related difference was absent in pearl divers (P=0.14). Additionally, pearl divers showed lower systolic flow augmentation than non-divers in the older age groups (P=0.02). These results suggest that female pearl divers across young to older adulthood demonstrate enhanced arterial Windkessel function, thereby promoting diastolic perfusion and attenuating systolic flow augmentation. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.