Accelerated Biological Aging Secondary to Cardiometabolic Risk Factors Is a Predictor of Cardiovascular Mortality: A Systematic Review and Meta-analysis

Background: Chronological aging is one of the major risk factors of cardiovascular (CV) disease (CVD); however, the effect of biological aging on CVD and outcomes remain poorly understood. Herein, we evaluated the association between leukocyte telomere length (LTL), a marker of biological age, and CV outcomes. Methods: We searched PubMed, Embase, Ovid Medline, and Web of Science Core Collection for the studies on the association between LTL and myocardial infarction (MI), CV death, and/or CVD risk factors from inception to July 2020. Extracted data were pooled in a random-effects meta-analysis and summarized as risk ratio (RR) and corresponding 95% confidence interval (CI) per LTL tertile. Results:A total of 32 studies (n=144,610 participants) wereincluded. In a pooled analysis of MI and LTL in a multivariate-adjustedmodel, the shortest LTL was associated with a 39% higher risk of MI(RR, 1.39; 95% CI, 1.16-1.67;P < 0.001). After adjusting for chro-nological age and traditional covariance, we showed a 28% increasedrisk of CV death in the shortest tertile of LTL (RR, 1.28; 95% CI, 1.05-1.56;P=0.01). Analysis of the studies that investigated the associ-ation between CV risk factors and LTL (n=7) showed that diabetesmellitus is associated with a 46% increased risk of LTL attrition (RR,1.46; 95% CI, 1.46-2.09;P=0.039). Conclusions:This study shows a strong association between LTL, amarker of biological aging, and the risk of MI and CV death. Car-diometabolic risk factors contribute to telomere attrition and thereforeaccelerates biological aging.

Automated summary

This study reveals a strong association between leukocyte telomere length (LTL), a marker of biological aging, and the risk of myocardial infarction (MI) and cardiovascular (CV) death. The shortest LTL is associated with an increased risk of MI and CV death. Cardiometabolic risk factors contribute to telomere attrition and accelerate biological aging.