Aortic Stiffness May Predict Heart Risk and Death in Diabetes, Meta-Analysis Finds
China: A new systematic review and meta-analysis has identified aortic stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), as a significant predictor of cardiovascular events and all-cause mortality in individuals with diabetes. The study, led by Dr. Ziyue Zhang and colleagues from the Department of Cardiology at the Medical Center of Army (Daping Hospital), Army Medical University in Chongqing, China, was recently published in the Journal of Diabetes and its Complications.
The analysis evaluated whether cfPWV—a widely accepted measure of arterial stiffness—can reliably forecast future cardiovascular outcomes or mortality in diabetic populations, where the burden of cardiovascular disease remains disproportionately high.
The researchers conducted a comprehensive search across major databases, including PubMed, Embase, and the Cochrane Library up to June 11, 2024. A total of 12 observational studies were included, encompassing data from 9,160 individuals with diabetes who were followed for an average of 8 years. Each study reported associations between cfPWV values and cardiovascular or mortality outcomes. Quality assessments were performed using the Newcastle-Ottawa Scale, and statistical methods accounted for variability and potential publication bias.
The findings of the study were as follows:
- Elevated cfPWV is significantly associated with adverse clinical outcomes in individuals with diabetes.
- A 1 m/s increase in cfPWV was linked to a 7% higher risk of cardiovascular events (HR: 1.07), based on data from 3,132 participants.
- The risk of all-cause mortality also increased by 7% for every 1 m/s rise in cfPWV (HR: 1.07), according to findings from 1,700 subjects.
- Individuals with higher cfPWV values had a 71% increased risk of experiencing cardiovascular events compared to those with lower values (HR: 1.71).
The study’s authors emphasized that these associations were held even after accounting for variations in study designs and modeling approaches. While some degree of heterogeneity existed across studies, the overall evidence supports the utility of cfPWV as a non-invasive prognostic marker in clinical diabetes care.
“The meta-analysis confirms that aortic stiffness, as assessed by pulse wave velocity, has meaningful prognostic implications in people with diabetes,” the authors noted. “The consistent link with both cardiovascular events and all-cause mortality underlines the potential role of PWV in long-term risk stratification.”
Despite some limitations—including study heterogeneity and the absence of universally standardized PWV cut-off values—the researchers believe their findings pave the way for integrating PWV into routine cardiovascular risk assessment among diabetic patients. They also call for further research to define optimal PWV thresholds and to develop consensus-based guidelines for clinical application.
The authors concluded, "The study strengthens the evidence base for using pulse wave velocity as a predictive tool for identifying diabetic patients at greater risk of cardiovascular complications and early mortality."
Reference:
Zhang, Z., Yang, R., Wu, W., & Wang, Z. (2025). Association of aortic pulse wave velocity with cardiovascular outcomes and all-cause mortality in diabetes: A systematic review and meta-analysis. Journal of Diabetes and its Complications, 39(10), 109118. https://doi.org/10.1016/j.jdiacomp.2025.109118
