Carotid-femoral pulse wave velocity in a healthy adult sample: The ELSA-Brasil study Marcelo Perim Baldo a,1 , Roberto S. Cunha b,1 , Maria del Carmen B. Molina c,1 , Dora Chór d,1 , Rosane H. Griep e,1 , Bruce B. Duncan f,1 , Maria Inês Schmidt f,1 , Antonio L.P. Ribeiro g,1 , Sandhi M. Barreto g,1 , Paulo A. Lotufo h,1 , Isabela M. Bensenor h,1 , Alexandre C. Pereira i,1 , José Geraldo Mill b, ⁎ ,1 a Department of Pathophysiology, Montes Claros State University, Montes Claros, MG, Brazil b Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil c Post Graduate Programme in Public Health, Federal University of Espírito Santo, Brazil d Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil e Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil f Faculdade de Medicina and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul,Brazil g Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil h Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil i Heart Institute, University of Sao Paulo, São Paulo, Brazil abstract article info Article history: Received 10 August 2017 Received in revised form 23 September 2017 Accepted 18 October 2017 Available online 22 October 2017 Background: Aging declines essential physiological functions, and the vascular system is strongly affected by artery stiffening. We intended to define the age- and sex-specific reference values for carotid-to-femoral pulse wave velocity (cf-PWV) in a sample free of major risk factors. Methods and results: The ELSA-Brasil study enrolled 15,105 participants aged 35–74 years. The healthy sample was achieved by excluding diabetics, those over the optimal and normal blood pressure levels, body mass index ≤ 18.5 or ≥ 25 kg/m 2 , current and former smokers, and those with self-report of previous cardiovascular disease. After exclusions, the sample consisted of 2158 healthy adults (1412 women). Although cf-PWV predic- tors were similar between sex (age, mean arterial pressure (MAP) and heart rate), cf-PWV was higher in men (8.74 ± 1.15 vs. 8.31 ± 1.13 m/s; adjusted for age and MAP, P b 0.001) for all age intervals. When divided by MAP categories, cf-PWV was significantly higher in those which MAP ≥ 85 mm Hg, regardless of sex, and for all age intervals. Risk factors for arterial stiffening in the entire ELSA-Brasil population (n = 15,105) increased by twice the age-related slope of cf-PWV growth, regardless of sex (0.0919 ± 0.182 vs. 0.0504 ± 0.153 m/s per year for men, 0.0960 ± 0.173 vs. 0.0606 ± 0.139 m/s per year for women). Conclusions: cf-PWV is different between men and women and even in an optimal and normal range of MAP and free of other classical risk factors for arterial stiffness, reference values for cf-PWV should take into account MAP levels. Also, the presence of major risk factors in the general population doubles the age-related rise in cf-PWV. © 2017 Elsevier B.V. All rights reserved. Keywords: Arterial stiffness Reference value Healthy sample Sex differences Risk factors 1. Introduction The aging process can be defined as the progressive decline in body functions affecting all systems in the body [1]. Cardiac and vascular structures are substantially affected, being aging the major risk factor for cardiovascular diseases. Some hemodynamic changes are associated with aging progress and are primarily attributable to central arterial stiffening. Indeed, the vascular system is strongly affected by aging consequent to molecular and structural remodeling of the vascular wall [2] characterized by replacement of elastic fibers by collagenous tissue and the consequent loss of arterial distensibility. The arterial stiff- ening raises systolic blood pressure (SBP), increasing the risk of cardio- vascular diseases [3,4]. Carotid-to-femoral pulse wave velocity (cf-PWV) has been used as the most reliable surrogate for arterial stiffness [5]. Cf-PWV is obtained by measuring the pulse transit time and the distance traveled by the pulse between the carotid and femoral arteries. Arterial stiffness expressed by cf-PWV is a strong and independent predictor of future cardiovascular events and all-cause mortality [6,7]. Based on this affirmative, identification of individuals at high risk for cardiovascular diseases and possible subclinical cardiovascular disease becomes an important clinical goal in clinical settings [8]. International Journal of Cardiology 251 (2018) 90–95 ⁎ Corresponding author at: Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil. E-mail address: josegmill@gmail.com (J.G. Mill). 1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. https://doi.org/10.1016/j.ijcard.2017.10.075 0167-5273/© 2017 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard