EXPRESS: Associations between lifestyle behaviours and vascular parameters in women: an umbrella review (the MUJER-EVA Project)

Cardiovascular disease is the leading cause of death in women, who also experience worse outcomes after a cardiovascular event. Lifestyle factors such as diet, physical activity, and smoking influence the process of vascular aging. Therefore, the aim of this study was to examine the associations between lifestyle behaviors and various vascular parameters in women. A systematic search was conducted in different databases (PubMed, Scopus, Cochrane, and Web of Science) from their inception to April 2025. Standardised mean differences and their corresponding 95% confidence intervals for each outcome are presented in forest plots to assess the relationships between lifestyle behaviours and vascular parameters in women. All the statistical analyses were conducted via STATA 15 software. Twenty studies were included in the umbrella review. Flow-mediated dilation significantly improved following dietary and physical exercise interventions, particularly aerobic exercise and high-intensity interval training, whereas tobacco use was associated with a marked reduction. No significant effects were observed in terms of the relationship between physical exercise and the intima-media thickness. In contrast, various types of physical activity resulted in significant reductions in pulse wave velocity. This umbrella review demonstrates that lifestyle behaviours influence vascular parameters such as flow-mediated dilation and pulse wave velocity in women. However, further research is needed to provide more specific findings.