Age-Dependent Lipid–Cardiovascular Interplay in Patients at High and Very High Cardiovascular Risk

<b>Objectives:</b> This study aimed to investigate the associations between serum lipid biomarkers and pulse wave analysis (PWA) variables in patients at high and very high cardiovascular risk, with particular emphasis on age-related differences. <b>Methods:</b> Seventy-six patients at high or very high cardiovascular risk were enrolled and stratified into middle-aged (Group 1) and elderly (Group 2). All participants underwent PWA, and multiple serum lipid biomarkers were measured, including composite lipid indices. <b>Results:</b> In both age groups, PWA parameters showed significant correlations with serum lipid biomarkers. Systolic blood pressure (SBP) was an independent determinant of the lipid balance index (LBI), while pulse wave velocity (PWV) and SBP were independent determinants of the triglyceride-glucose (TyG) index. PWV correlated with age in both groups and was higher in Group 2 for comparable blood pressure values. In middle-aged patients, diastolic blood pressure (DBP) showed significant, independent associations with triglycerides and TyG, indicating a close link between peripheral vascular resistance and metabolic dysfunction in earlier stages of cardiovascular risk. In elderly patients, SBP and pulse pressure were predominantly associated with lipid-derived indices, reflecting the increasing contribution of large-artery stiffness and lipid-driven vascular remodeling with advancing age. Systematic Coronary Risk Estimation 2 (SCORE2) correlated significantly with PWV, the lipid index (LI), and the LBI. <b>Conclusions:</b> Serum lipid biomarkers and PWA-derived hemodynamic variables exhibit a significant, age-dependent interplay in patients with high and very high cardiovascular risk. These findings underscore the importance of age-specific evaluation of lipid-hemodynamic interactions to improve early identification and targeted management of high-risk individuals.