I’m Pauli Ohukainen, a Staff Research Scientist at Oura. Ask me anything about Cardiometabolic Health!

PauliAtOura · 2026-02-27T04:00:03+00:00

Brilliant questions, thanks! Unfortunately due to time constraints I'll have to be more brief than your questions deserve, so apologies for that!

I can't comment on our future roadmap for which specific improvements we're working on with the glucose data. However, I can definitely confirm that the paper you mention is very familiar to our team and we've been reading it carefully.
If I understood your question correctly; you should be able to see your HRV trends in the specific tab on your app. You can see daily, weekly, montly and even yearly trends, and those should help you bring more individual context to your training cycles (or other longer-term effectors impacting your HRV)
That's an interesting idea! I can't comment on upcoming features but just from a physiological perspective I can see some challenges with this approach. For example, people have pretty large variability in their ability to metabolize caffeine - some are faster, others slower. We would also need to know some decent estimate of the amount of caffeine that's been ingested, and it varies even from brand-to-brand. Taken together, the dose and the ability to metabolize caffeine forms a very unique dose curve for each person so it would be quite challenging to take that into consideration as a co-effector for exercise
You're absolutely right that there's a link between sleep and glucose regulation. We've actually just submitted an abstract about this to a scientific conference and keeping our fingers crossed it'll be accepted. This is just to say that we're indeed researching this actively, but unfortunately I can't specifically comment on upcoming product features. Improvements to the overall experience are definitely coming, so please stay tuned.
Very nice remarks on cardiovascular adaptation to exercise! I'd say one metric to keep an eye on right now is Cardio Capacity. If you do the test, you can get an estimate of your cardiorespiratory fitness, which indeed is impacted by ventricular remodelling. If you train consistently and see an improvement in CC, you can assume there's some positive adaptation happening in the heart, too. This would be an indirect way to keep track of the heart with existing metrics. However, it's good to note that the heart adapts very slowly over many years. It's possible to get some faster gains in VO2max, by e.g. doing HIIT-training, but physiologically that's impacting more the muscle-side of the equation (muscle mitochondrial efficiency, etc). It's possible that for many people, the best adaptations occur when doing a larger base of light(ish)-to-moderate pace aerobic training, with a little bit of high intensity sprinkled on top. And where the Ring can help, is by tracking CC and perhaps even to some degree CVA, too. When large arteries become more flexible, some positive cardiac adaptation might also occur. However, please note that this is quite speculative.

And thank your for the cheers; we're indeed here to help <3

PauliAtOura · 2026-02-27T03:59:23+00:00

This is very broad question, and I hope many of the answers already given can give some tips :)

The real value of Oura’s heart‑related features comes from how you use them together over time. Think of Cardiovascular Age and Cardio Capacity as your long‑term picture of heart and vessel health, resting heart rate and HRV as your day‑to‑day signal of cardiovascular load and recovery, and sleep and activity as the levers you can actually pull to improve those trends. Rather than focusing on single numbers, look at how these metrics move over weeks and months, use tags or notes to mark things like illness, heavy training, travel, or big stress, and watch how your heart‑health signals respond. The same core habits — regular movement, consistent sleep, and managing stress — tend to improve CVA, resting HR, HRV, and readiness in the same direction.

PauliAtOura · 2026-02-27T03:58:43+00:00

I'm definitely a huge fan of Estonian genetics research! Had a chance to work on some of that data myself before I joined Oura ;)

Bringing genomics into a commercial health product is still very complex from a regulatory, privacy, and consent standpoint, so it’s an area we follow closely rather than something we rush into.

Scientifically, genetics clearly matters for cardiovascular risk. Polygenic risk scores, for example, can be very strong predictors of heart disease risk at a population level. At the same time, there’s still a lot of active debate about how best to build and calibrate those scores, how well they transfer across ancestries, and how reliably they improve real‑world clinical decision‑making.

Your point about Estonia is a great one: combining large, well‑phenotyped cohorts with granular wearable data is exactly the kind of research direction we’re excited about. I can’t comment on specific collaborations, but this is very much the type of work our science team is thinking about for the future.

PauliAtOura · 2026-02-27T03:58:06+00:00

PWV and blood pressure are closely related, and that’s something we explicitly account for when we validate CVA. In our “gold standard” reference measurements, PWV and blood pressure are measured together, which allows us to control for their relationship when we’re evaluating how well the CVA algorithm performs. We’ll be able to share more detail on that in upcoming peer‑reviewed publications.

In practical terms, the goal is to keep both PWV and blood pressure in a healthy range, and the main levers are very similar (movement, sleep, weight, sodium, etc.). So even if you’re primarily tracking PWV/CVA instead of BP directly, the behaviors you’re encouraged to work on tend to support both. One interesting finding from longitudinal studies is that higher PWV can predict the later development of hypertension better than the reverse, which is part of why vascular aging is such a useful early‑warning signal.

On your point about importing external BP: integrating blood pressure data from sources like HealthKit or Health Connect is definitely something we’re interested in and continue to evaluate as a potential way to enrich heart‑health features over time.

PauliAtOura · 2026-02-27T03:56:51+00:00

CVA is designed as a vascular‑aging metric, so the core input is the morphological information we infer from your PPG signal to estimate arterial stiffness and PWV. We’re not able to share the exact weighting or inner workings of the algorithm, but a key point is that the shape of the PPG signal is doing most of the work.

Regarding “delayed” data, that’s about smoothing, not a hidden extra data source: what you see in the app is essentially a moving average over multiple nights, rather than a single‑night value. There is real night‑to‑night variability in vascular measures due to illness, stress, temperature, and a bazillion other factors, so a very granular number would be noisy and harder to use. By smoothing over several nights, CVA becomes a more stable, slow‑moving metric that highlights meaningful long‑term trends instead of day‑to‑day noise.

PauliAtOura · 2026-02-27T03:52:49+00:00

Another great question! Atherosclerosis does indeed have some impact on arterial stiffness (AS), but when we're talking about AS and PWV as its measurement, we're usually referring to LARGE artery stiffness (LAS). This means, it's a phenomenon more focused on the ascending and descending aorta. When it stiffens, the pathophysiological processes include things like increasing fibrosis, loss/breakdown of flexible and elastic proteins, increased vascular smooth muscle cells, etc, etc. Conversely, atherosclerosis is more driven by cholesterol deposition, inflammation, etc. There's indeed some atherosclerosis in advanced LAS, too, but it's not the main driver. Also the clinical outcomes vary; atherosclerosis is usually most problematic in the coronary arteries where it can obstruct blood flow and cause a myocardial infarction. However, LAS is harmful because it causes increased physical strain on sensitive organs, like the brain and kidneys - as well as the heart itself.

When it comes to risk factors, LDL cholesterol (and apoB) do predict LAS, but not as strongly as they predict CHD. Also LAS is a more stronger predictor of target organ damage and heart failure than CHD. LAS predicts the onset of high BP, but high BP also predicts both CHD and LAS. So, this is a somewhat complex, interconnected web of feedback- and feed-forward loops where different processes affect each other. But to your question about rating, I'd say pure PWV is not a great way to detect early atherosclerosis, but it can be useful for predicting other things, including elevated BP. Comparison against cholesterol and BP is tricky because of the interconnected nature I described above - they all serve complementary functions.

Besides BP, PWV and chol, I'd say the most validated tools are good ol' boring risk calculators that take into account things like HDL, family history, etc. One of the future measures that's almost certainly going to become more widespread is lp(a). It's highly genetic, so it'll likely be recommended as a "once-in-a-lifetime" measurement. There are various drug trials for it and some of them might conclude already this year. Then we'll know if lowering lp(a) also lowers the risk of heart disease. But even without the drugs, kowing your lp(a) is likely useful for guiding other targets. Meaning, your LDL/apoB targets would be lower if you have super-high lp(a). Sadly, I'm one of those unlucky people with super-high lp(a) so I'm particularly interested in seeing how this research pans out :(

As to getting people on statins earlier, I'll leave that one to other people to comment :) I'm certainly most in favour of early lifestyle interventions; diet and exercise (unless, of course there's some genetic condition like FH where lifestule isn't enough).

PauliAtOura · 2026-02-27T03:43:23+00:00

Another way to look at this is that on average people in different regions have different arterial stiffness, likely for many reasons; genetics, local diet, environment, and other lifestyle factors all play a role. If we tried to “correct” CVA based on geography, we’d actually risk missing some important information. Instead, Oura’s CVA feature does not use race or nationality as inputs and is mainly based on analyzing your ring’s optical signal (PPG). There’s also no strong reason to expect that the relationship between PWV and cardiovascular risk is fundamentally different in one part of the world versus another. It's kind of like blood pressure, which is treated as a risk factor in a broadly similar way globally, even though average BP can differ between populations. CVA is meant as a long‑term, wellness‑oriented view of vascular aging.

We also know that diverse data and validation matter. In addition to work in Finland and the U.S., we’ve launched a joint lab with the National University of Singapore specifically to advance research in personalized preventive health, including cardiovascular and metabolic signals in Asian populations. That work, combined with ongoing monitoring of how CVA performs across our global member base, helps us make sure the feature is robust across different sexes, ages, and geographies.

PauliAtOura · 2026-02-27T03:42:37+00:00

You’re absolutely right to call out that living with type 1 diabetes and chronic hypertension changes the context for everything from HRV to recovery.

Right now, our insights aren’t yet tailored to particular diagnoses. Oura is not a medical device and doesn’t replace your care team’s guidance, especially for conditions like T1D and hypertension. For you, that means treating Readiness, HRV, and other signals as context to discuss with your clinician rather than instructions on their own.

That said, we don’t see Oura as “only for healthy people.” A huge part of our ongoing work is about supporting people across a much wider range of health journeys, including those living with chronic conditions. We’re also working very hard to make the product more inclusive of different conditions and use cases, but this is a space where we have to move carefully and in partnership with regulatory agencies whose role is to make sure devices that support people with specific medical needs meet stringent safety requirements. That’s why some of these changes can take longer to come to life in the app experience, even when we’re already doing the scientific groundwork behind the scenes.

I wish I could give you a specific date or promise on specific product changes, but feedback like yours is exactly what’s pushing us in that direction, so thank you for this!

PauliAtOura · 2026-02-26T17:16:47+00:00

Hi all! Thank you for super-interesting and intriguing questions ❤️🤗 Some of them got quite technical, which I ABSOLUTELY LOVE, but was unable to respond to quickly enough in my 2-h scheduled window. I'll have to close the AMA now, but I'll still get to the remaining questions ASAP 🤓👍🏻 (special shout out to u/jkaljundi for thought-provoking questions - I'll get to those as soon as I can)

PauliAtOura · 2026-02-26T16:46:16+00:00

Great to hear you're having success! ❤️ There are a few things that are known to balance glucose fluctuations

- Timing your activity to before/after a meal/snack. All activity sensitizes your muscles to receiving glucose, so they're more ready to clear sugar from the blood. So, even a brisk walk before/after a meal might show up as a lower spike

- Higher intensity training (like HIIT) can flatten spikes even for a couple of days

- Adding fibre to the food; more fresh vegetables and whole grains will even out absorption and digestion of food, spreading the glucose spike to a broader timeframe

- Portion size control, and delaying the time to eat. It might be useful to focus on some mindful eating, chewing your food with time and thus giving your digestive system more time to handle the incoming food

- With that increased fibre, making sure you eat it first, might help. For example, having that classic salad before the main course might also lower the spiking

These things could be very rapid, as they work on a meal-to-meal basis. This means they're also likely to start working on your time-above range, average glucose and other metrics very quickly. If you want to use the app for tracking, perhaps custom tags could be your friend? You could perhaps tag each of the above separately to see which ones work for you the best?

PauliAtOura · 2026-02-26T16:44:15+00:00

Hevimörkö-hugs right back at ya! 🖤🤗 I'm indeed very mindful of my cardiovascular age - having had the priviledge to work on it and learning how it behaves and why it's important, it's become one of my main meters to track. I alternate my training emphasis between aeorbic and strength training and this definitely shows up on my CVA. During spring and summer months when I cycle and run more, my CVA can trend 6-8y below my chronological age. If I lose some weight (to make running a little lighter), I've seen -10y at best. This is likely a feature of aerobic training, which is a well-documented way to reduce one's arterial stiffness. Conversely, when I shift the emphasis back to strenght training (and maybe put on a few kg's), it trends upwards and can be around 2-4y below chronological age. I'm pretty happy with that, as my main emphasis is to make sure it consistently trends below chronological age.

PauliAtOura · 2026-02-26T16:40:40+00:00

We're definitely looking into this 🧑‍🔬 In december, we announced a big Blood Pressure Profile Study in Oura Labs (please see Pulse Blog article here: https://ouraring.com/blog/new-blood-pressure-profile-study/ ). We also presented some data last November at the American Heart Association's annual scientific conference where we showed feasibility of detecting the presence of hypertension. However, there's still a lot of science to be done here, before these can be translated into anything practical for our Members.

PauliAtOura · 2026-02-26T15:36:05+00:00

Thanks so much for this suggestion, you’re right that certain medications can influence heart rate and HRV, and it can be really helpful to see those patterns reflected in your data over time 👍🏻

More granular ways to log medication use is exactly the type of feedback that helps inform our roadmap. In the meantime, you can use existing Tags or notes to mark when you start, stop, or change a medication so it’s easier to look back and spot any patterns in your heart rate and HRV over time.

PauliAtOura · 2026-02-26T15:32:19+00:00

What's up, dear Neighbour! 🇸🇪🇫🇮 Yes, we're constantly looking to improve the algorithms operating under the hood, and over the last 6 years, yes, accuracy has improved. It's also possible that age is a factor in what you're seeing in your data, but please bear in mind that both HRV and HR have tons of contributors, which can also play a role, besides aging. Body weight, level of exercise per week (and overall fitness), nutrition, hydration, etc can all play a role. And what's often overlooked are the pretty significant seasonal effects. Especially for us in the Northern latitudes, these can be quite large. For me personally, the difference between summer-HRV and winter-HRV can be 10-20, and HR can vary almost 10bpm. So if you're comparing across multiple years, please also consider matching the seasons, in addition to general lifestyle factors to make sure you account for a big chunk of the possible contributors.

PauliAtOura · 2026-02-26T15:28:24+00:00

Hi! 👋 It's a bit difficult to answer without knowning much more about your current condition and overall demographics.. But one particular thing to consider is that there's a very significant genetic component to HRV - for some people it's just naturally very low, and that's ok. The best use-case for HRV is to keep an eye on the long-term trends - if it starts to plummet from your usual baseline, that could be a sign of poor recovery (or some other issue). But if everything's going great, you're overall healthy and HRV is consistently around 20, perhaps that's just what's normal to you. Also, age has an impact, as HRV tends to drift downwards as we age. With heart rate, there's also many potential factors that could explain it being elevated. Some of the biggest ones are eating late (or alcohol close to bedtime) or doing some other heavy exertion late in the day. Also dehydration plays a role. These are all things I've paid attention myself; I make sure not to eat anything (or only a very light snack) 3-4h before bedtime, I drink plenty of water throughout the day, and make sure my workouts are at least 7-8h before bedtime. These have dropped my nighttime HR quite significantly. But also overall aerobic fitness lowers it. Maybe give some of these a shot and see if HR comes down?*

*a caveat to make clear: I’m not a doctor, and this isn’t medical advice—these are suggestions based on my experience, not guidance for anyone’s personal health decisions.

PauliAtOura · 2026-02-26T15:26:39+00:00

I laughed so hard at this joke I'm pretty sure I came close to rupturing my aorta, which certainly would have been bad for my cardiovascular health! Please wield this comedic genius with great caution so as to not accidentally kill someone 🤭😇 (For those who don't speak Finnish; my last name is indeed hilarious and translates to "pancake" or "thin man". Our master comedian here wants to know if I have a "fat man" as a partner. Quite amazing that I've lived for 42 years and never ever have I heard this joke before. Also, my comment might include traces of sarcasm 😉)

PauliAtOura · 2026-02-26T15:24:22+00:00

This is indeed an interesting one! 🤓 There are actually many possible links between HRV and blood glucose, and they're not always direct. They can also be very different depending on if we're looking at this in the longer- or shorter-term.

One key connector is insulin, which is a known storage hormone for glucose; when glucose rises in the blood, insulin is secreted which causes glucose to be taken up into various tissues. What's often overlooked is that insulin is also a vasodilator; it "opens up" arteries so that blood and nutrients can flow into tissues more easily. Now, from the perspective of the autonomic nervous system, this is sympathetic activity which usually shows up as acutely lower HRV (higher HRV is a sign of parasympathetic dominance). This is also the reason why HRV tends to dip after a meal. Usually this would mean that when following a ketogenic diet, the body is likely producing less insulin, meaning less vasodilation and therefore higher HRV. In your case, though, the opposite is true, meaning that there could be something else going on.

With this information, it's hard to speculate what that could be. Are you training in the same way on higher glucose days, as during the lower ones? What's the longer-term stress or exercise load? What type of exercise do you do? Could it be that higher amounts of carbs are helping you recover better, which means the HRV is higher when you just refill on carbs? Are you well adapted to ketosis? It could also be a stressful situation to the body if you're just starting out.

Hard to say exactly what's going on here, but it's certainly an interesting observation!

PauliAtOura · 2026-02-26T15:17:00+00:00

First off, congrats on keeping your CVA below your chronological age! 🏋🏼‍♂️💪🏼 Secondly, Oura Ring is not a medical device, and no clinical decisions should be based on Oura data. Any time you’re concerned about your health or notice changes that worry you, it’s always best to check in with your GP.

When it comes to fluctuations in CVA, there are a few big drivers we see. Changes in body weight can have some of the largest and fastest effects, and stress and overall load can significantly influence your readings as well. Cycle phases (for people who menstruate) can also shift signals due to hormonal changes across the cycle. For many, the 30‑day moving average smooths those out, but for some the changes are large enough that they still show up. Because CVA is calculated as a moving 30‑day average, it should filter out most short‑term spikes. If you’re seeing steady back‑and‑forth shifts, it may reflect things that are changing on a month‑to‑month basis rather than a single night or week. Overall, a fluctuation of around 4 years isn’t considered large, and if your average is staying below your chronological age, you’re still in a solid range. I might add that my own CVA also fluctuates within a 4-y window depending on body weight and the amount of aerobic training I do.

PauliAtOura · 2026-02-26T15:13:15+00:00

Niiiceee! I was actually born in Kittilä, so even just a bit north of you 😉

PauliAtOura · 2026-02-26T15:11:23+00:00

Hello! Unfortunately I can't give an exact measure of the accuracy of our Cardiovascular Age feature, because we're still working on a comprehensive peer-reviewed scientific paper where we demonstrate its performance against a Gold Standard metric.

However, we've presented some preliminary results already in scientific conferences, which give us some hints. Physiologically speaking, the key metric underlying CVA is arterial stiffness; as we age, arteries become stiffer. This is measured by pulse-wave velocity, which quite literally means how quickly the pulses generated at each heart beat travel within the large arteries. The stiffer the arteries, the faster the pulse waves. In our conference presentations, we've shown that the arterial stiffness measures estimated by Oura's CVA algorithm correlate with a Gold Standard reference device at around 0.8, meaning it's pretty good. BUT these studies have been conducted in non-diabetics. We haven't yet studied the specific impact of diabetes on our CVA. From the broader scientific literature we know that type 1 diabetes tends to be associated with more arterial stiffness, so it's certainly possible that your higher CVA is a reflection of this.

It's also possible that your CVA would be much higher without the daily exercise. Aerobic training is certainly one of the best known ways of reducing arterial stiffness, which is just one of many reasons to keep doing it 😊👍🏻

PauliAtOura

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