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

Mehrdad Emami, Thomas A. Agbaedeng, Gijo Thomas, Melissa E. Middeldorp, Anand Thiyagarajah, Christopher X. Wong, Adrian D. Elliott, Celine Gallagher, Jeroen M.L. Hendriks, Dennis H. Lau, Prashanthan Sanders

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)


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) were included. In a pooled analysis of MI and LTL in a multivariate-adjusted model, 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 chronological age and traditional covariance, we showed a 28% increased risk 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 association between CV risk factors and LTL (n = 7) showed that diabetes mellitus 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, a marker of biological aging, and the risk of MI and CV death. Cardiometabolic risk factors contribute to telomere attrition and therefore accelerates biological aging.

Original languageEnglish
Pages (from-to)365-375
Number of pages11
JournalCanadian Journal of Cardiology
Issue number3
Publication statusPublished or Issued - Mar 2022
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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