Sex-Specific Determinants of Arterial Stiffness in Patients with Cardiovascular Risk Factors

Objectives: Arterial stiffness is a key marker of vascular aging and an independent predictor of cardiovascular morbidity and mortality.While its clinical significance is well recognized, sex-specific differences in the determinants of arterial stiffness remain underexplored.Methods: This retrospective observational study analyzed 11,767 adults (6,780 men and 4,987 women; mean age 60.8 years) with at least one cardiometabolic risk factor who underwent brachial-ankle pulse wave velocity (baPWV) measurement as a cardiovascular screening.Increased arterial stiffness, indicating a high-risk profile, was defined as baPWV ≥1,800 cm/s.Findings: Multivariable analysis showed that older age, elevated systolic blood pressure, increased heart rate, and diabetes mellitus were independently associated with increased arterial stiffness (baPWV ≥1,800 cm/s) in both men and women.In addition, lower body mass index (BMI) (<25 kg/m 2 ) and reduced renal function (estimated glomerular filtration rate <60 mL/min/1.73m 2 ) were independent predictors of arterial stiffness in men and women, respectively.Conclusions: While traditional risk factors such as age, blood pressure, and diabetes contribute to arterial stiffness in both sexes, differences in the impact of BMI and renal function suggest distinct underlying mechanisms.Incorporating sex-specific considerations into cardiovascular risk assessment may facilitate earlier detection and personalized management of subclinical vascular disease.