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

BACKGROUND/OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.