Explaining Variance in Pulse Wave Velocity in Youth: The Youth Vascular Consortium

BACKGROUND: Cardiovascular disease is a leading cause of global mortality. Carotid-femoral pulse wave velocity (cfPWV) is the gold-standard noninvasive measure of arterial stiffness and is commonly used to assess early vascular aging, as it predicts future cardiovascular events. Although the influence of cardiovascular risk factors on cfPWV is well studied in adults, evidence in youth is limited. This study aimed to identify common cardiovascular risk factors that best explain variation in cfPWV among young people. METHODS: This study included 6763 participants aged 5 to 40 years with cfPWV measured using the SphygmoCor device, drawn from the Youth Vascular Consortium. Analyses were conducted across 5 subsets based on data completeness. Multiple linear regression models, stratified by sex and age (≤19 and >19 years), were developed to identify cardiovascular risk factors explaining cfPWV variation. Model selection was guided by Akaike information criterion and adjusted R 2 . RESULTS: Age and systolic blood pressure were consistent predictors, explaining <40% of cfPWV variance in cfPWV. Heart rate and waist circumference also emerged as key predictors of cfPWV, although lipids contributed modestly only in young adults. Waist circumference was the strongest anthropometric predictor in most groups. CONCLUSIONS: Age, systolic blood pressure, and heart rate were the strong contributors among traditional risk factors, yet explained <40% of variance in cfPWV in most groups. These findings highlight the role of hemodynamic load in shaping arterial stiffness even in childhood and adolescence, when structural changes are evolving. A large proportion of variance remains unexplained, suggesting that genetic, prenatal, environmental, and behavioral factors warrant investigation.