Mechanisms underlying height loss-related cardiovascular risk: a narrative review

Background Recent studies have reported a positive association between height loss and cardiovascular disease. However, the underlying mechanism linking height loss to cardiovascular disease remains unclear. Impaired microcirculation may represent a common pathological pathway underlying both conditions. Therefore, several epidemiological studies have been conducted focusing on factors that contribute to the maintenance of microcirculatory function. Main body Previous epidemiological studies conducted by our research team have investigated the risk of height loss in relation to various factors affecting hemodynamics. In this review, I integrate and synthesize findings from these studies to provide insights into the mechanisms underlying the association between height loss and cardiovascular risk. Annual height decline was calculated using data from the longest observation period available for individuals who attended the relevant health check-up at least twice during follow-up. These values were subsequently categorized into tertiles, quartiles, or quintiles. Height loss was defined as membership in the category with the greatest annual decline in height (i.e., the third tertile, fourth quartile, or fifth quintile). The validity of this definition was supported by sensitivity analyses using alternative thresholds for height loss. For instance, when height loss was defined as the third tertile in the primary analysis, the fourth quartile was used in the sensitivity analysis, yielding consistent results. Height loss was positively associated with atherosclerosis, as assessed by carotid intima-media thickness, and hypertension, while being inversely associated with circulating CD34-positive cells, which play a key role in endothelial repair and the maintenance of microcirculation. Endothelial repair activity, as evaluated by platelet counts, showed an inverse association with height loss among individuals with hypertension. Furthermore, a novel mechanism involving hemoglobin levels, body mass index, and thyroid function may contribute to the increased cardiovascular risk associated with height loss. Conclusion By focusing on vascular remodeling associated with height loss, this review presents a novel conceptual framework for understanding the biological mechanisms linking height loss to cardiovascular disease risk. Although additional studies are needed to validate this hypothesis, the evidence reviewed here suggests that height loss assessment may provide a practical and accessible indicator of endothelial repair activity.