Sex- and age-specific associations between metabolic phenotypes and brachial-ankle pulse wave velocity in adults: a cross-sectional study

Objective To examine age- and sex-stratified associations between metabolic phenotypes and brachial-ankle pulse wave velocity (baPWV) in adults undergoing routine health examinations. Methods This cross-sectional study included 9,981 Chinese adults classified as metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically obese normal weight (MONW), or metabolically unhealthy obesity (MUO) according to body mass index, homeostasis model assessment of insulin resistance, and metabolic syndrome status. Elevated baPWV was defined as mean bilateral baPWV >1700cm/s. Logistic regression analyses were stratified by sex and age (<50 and ≥50 years) and adjusted for age, smoking, and alcohol consumption. False discovery rate correction, phenotype-by-sex interaction testing, Firth logistic regression, and continuous-baPWV sensitivity analyses were performed. Results Elevated baPWV was present in 7.5% of participants. Compared with MHNW, MONW (adjusted OR range, 2.58–7.68) and MUO (adjusted OR range, 2.34–6.60) were associated with higher odds of elevated baPWV in all four sex-age strata, with associations remaining significant after false discovery rate correction. MHO was not significantly associated with elevated baPWV. The adjusted phenotype-by-sex interaction was not significant ( P = 0.495). Firth and continuous-baPWV sensitivity analyses yielded concordant findings, although estimates in women aged <50 years were imprecise because of sparse events. Conclusion MONW and MUO, but not MHO, were consistently associated with less favorable baPWV profiles across sex and age strata. Assessing metabolic health alongside body mass index may provide additional information for vascular risk characterization. Longitudinal multicenter studies are needed to confirm temporal and clinical significance.