Aims: Carotid-femoral pulse wave velocity (PWV) is considered the gold standard measure of arterial stiffness, representing mainly aortic stiffness. As compared to the elastic carotid and aorta, the more muscular femoral artery may be differently associated with cardiovascular risk factors (CV-RFs), or provide additional predictive information beyond carotid-femoral PWV. Still, clinical application is hampered by the absence of reference values. Therefore, our aim was (1) to establish age- and sex-specific reference values for femoral artery stiffness in healthy subjects and (2) investigate the associations with CV-RFs.

Methods: femoral artery distensibility coefficient (DC), the inverse of stiffness, was calculated as the ratio of relative diastolic-systolic distension (obtained from ultrasound echo-tracking) and pulse pressure among 5,069 individuals (49.5% men, age range: 15–87 year). Individuals without cardiovascular disease (CVD), CV-RFs and medication use (n=1,489; 43% men) constituted a healthy sub-population used to establish sex-specific equations for percentiles of femoral artery DC across age.

Results: In the total population, femoral artery DC Z-scores were independently associated with body mass index (BMI), mean arterial pressure (MAP), and total-to-HDL cholesterol ratio. Standardized βs, in men and women respectively, were −0.18 (95% CI: −0.23;−0.13) and −0.19 (−0.23; −0.14) for BMI; −0.13 (−0.18; −0.08) and −0.05 (−0.10; −0.01) for MAP; and −0.07 (−0.11; −0.02) and −0.16 (−0.20; −0.11) for total-to-HDL cholesterol ratio.

Conclusion: In young and middle-aged men and women, normal femoral artery stiffness does not change substantially with age up to the 6th decade. CV-RFs related to metabolic disease are associated with increased femoral artery stiffness.