Pulse Wave Velocity and Vitamin D: A Narrative Review

Abstract

Pulse Wave Velocity (PWV) is a well-established, noninvasive biomarker of arterial stiffness and an independent predictor of cardiovascular morbidity and mortality. Emerging evidence suggests that vitamin D deficiency, prevalent worldwide, may adversely influence vascular function through mechanisms involving endothelial dysfunction, inflammation, and altered calcium homeostasis. However, the extent and consistency of this association remain under active investigation. This narrative review aims to critically examine the existing literature exploring the relationship between vitamin D status and arterial stiffness, as measured by PWV, and to elucidate potential physiological and clinical mechanisms underlying this interaction. A comprehensive literature search was performed using PubMed, Scopus, and Embase databases. Studies evaluating serum 25-hydroxyvitamin D [25(OH)D] levels in relation to PWV in adult populations were included. Both interventional and observational studies were reviewed, emphasizing methodological quality, confounding control, and population diversity. Most observational studies demonstrate an inverse association between serum 25(OH)D levels and PWV, suggesting that vitamin D deficiency is correlated with increased arterial stiffness. Interventional trials assessing vitamin D supplementation yield heterogeneous findings; improvements in PWV are more evident in vitamin D-deficient cohorts and those with elevated baseline cardiovascular risk. Mechanistically, vitamin D may modulate arterial stiffness through suppression of renin-angiotensin-aldosterone system activity, attenuation of vascular smooth muscle cell proliferation, and enhancement of nitric oxide bioavailability. Current evidence supports a biologically plausible link between low vitamin D status and increased PWV, though causality remains inconclusive due to inconsistent intervention outcomes and population heterogeneity. Further large-scale, randomized controlled trials with standardized vitamin D dosing regimens and longitudinal PWV assessments are warranted to establish therapeutic relevance. Understanding this relationship could refine cardiovascular risk stratification and inform preventive strategies targeting vascular health.