Arterial Elasticity in Chinese Youth: References and the Role of Muscle

BACKGROUND: Arterial elasticity, noninvasively assessed by carotid-femoral pulse wave velocity (cfPWV), is an important determinant of cardiovascular health, yet reference values are lacking for Chinese youth. Moreover, the interplay between adiposity, skeletal muscle mass, and blood pressure regarding cfPWV remains unclear. METHODS: We analyzed 2077 Chinese children and adolescents aged 6 to 14 years from a cross-sectional survey. Among them, 1382 nonobese, normotensive, and metabolically healthy participants were selected as the reference population to derive sex-, age-, and height-specific cfPWV centiles, from which cfPWV Z scores were calculated in the overall population to examine potential correlates. RESULTS: In the reference population, cfPWV increased with age and height in both sexes, with a steeper rise after the age of 10 years. In the overall population, higher fat mass index and systolic blood pressure were independently associated with higher cfPWV Z scores, whereas higher appendicular skeletal muscle mass index was associated with lower cfPWV Z scores in both boys (β=−0.123, P =0.018) and girls (β=−0.135, P =0.027). Although excess adiposity was associated with impaired arterial elasticity (odds ratio, 1.99 [95% CI, 1.06–3.74]) in boys with low-to-medium muscle mass, this association was attenuated among those with high muscle mass (odds ratio, 1.32 [95% CI, 0.65–2.65]). These patterns were not clearly observed in girls. CONCLUSIONS: This study establishes the first growth-specific cfPWV reference standards for Chinese youth. The favorable association of muscle mass with arterial elasticity suggests that muscle-building strategies could be considered alongside weight management in early pediatric cardiovascular prevention.