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Current Cardiology Reports

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07-09-2023 | Arterial Diseases | Global Cardiovascular Health (L Sperling and D Gaita, Section Editors)

Arterial Stiffness and its Impact on Cardiovascular Health

Authors: Rachel Anne Xuereb, Caroline J. Magri, Robert G. Xuereb

Published in: Current Cardiology Reports | Issue 10/2023

Abstract

Purpose of Review

Cardiovascular diseases are the leading cause of mortality globally. Identifying patients at risk is important to initiate preventive strategies. Over the last few decades, the role of the endothelium and its impact on arterial stiffness have been recognised as playing a pivotal role in cardiovascular disease. This review will focus on the effect of arterial stiffness in different patient cohorts with regard to cardiovascular morbidity and mortality, as well as its use in clinical practice.

Recent Findings

Arterial stiffness is associated with a range of cardiovascular risk factors and is an independent predictor of cardiovascular mortality. The gold standard for evaluating arterial stiffness is pulse wave velocity. Recently, cardio-ankle vascular index has been implemented as an easy and highly reproducible measure of arterial stiffness. Moreover, certain pharmacologic agents may modify arterial stiffness and alter progression of cardiovascular disease.

Summary

The endothelium plays an important role in cardiovascular disease. Implementing assessment of arterial stiffness in clinical practice will improve stratification of patients at risk of cardiovascular disease and help modify disease progression.

Liao J, Farmer J. Arterial stiffness as a risk factor for coronary artery disease. Current Atherosclerosis Reports. 2014;16(2). https://doi.org/10.1007/s11883-013-0387-8.

Langille BL. Remodeling of developing and mature arteries: endothelium, smooth muscle, and matrix. J Cardiovasc Pharmacol. 1993;21(1):11–7. https://doi.org/10.1097/00005344-199321001-00003.CrossRef

Gauthier-Bastien A, Ung R-V, Larivière R, Mac-Way F, Lebel M, Agharazii M. Vascular remodeling and media calcification increases arterial stiffness in chronic kidney disease. Clin Exp Hypertens. 2013;36(3):173–80. https://doi.org/10.3109/10641963.2013.804541.CrossRefPubMed

London GM, Cohn JN. Prognostic application of arterial stiffness: task forces. Am J Hypertens. 2002;15(8):754–8. 6. https://doi.org/10.1016/s0895-7061(02)02966-7.

de Souza F, Muxfeldt ES, Salles GF. Prognostic factors in resistant hypertension: implications for cardiovascular risk stratification and therapeutic management. Expert Rev Cardiovasc Ther. 2012;10(6):735–45. https://doi.org/10.1586/erc.12.58.CrossRefPubMed

Hooglugt A, Klatt O, Huveneers S. Vascular stiffening and endothelial dysfunction in atherosclerosis. Curr Opin Lipidol. 2022;33(6):353–63. https://doi.org/10.1097/MOL.0000000000000852.CrossRefPubMedPubMedCentral

Arribas SM, Hinek A, González MC. Elastic fibres and vascular structure in hypertension.Pharmacol Ther. 2006;111:771–791. https://doi.org/10.1016/j.pharmthera.2005.12.003.

Benetos A, Waeber B, Izzo J, Mitchell G, Lawrence R, Roland A, et al. Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness: clinical applications. Am J Hypertens. 2002;15:1101–8. https://doi.org/10.1016/s0895-7061(02)03029-7.CrossRefPubMed

•• Fantin F, Giani A, Trentin M, Rossi AP, Zoico E, Mazzali G, et al. The correlation of arterial stiffness parameters with aging and comorbidity burden. J Clin Med. 2022;11(19):5761. https://doi.org/10.3390/jcm11195761. Recent study suggesting that arterial stiffness parameters can complement the characterization of patients affected by a remarkable comorbidity burden.

10.

Bonarjee VVS. Arterial stiffness: a prognostic marker in coronary heart disease. Available methods and clinical application. Front Cardiovasc Med. 2018;5:64. https://doi.org/10.3389/fcvm.2018.00064.

11.

Ungvari Z, Gupte S, Recchia F, Batkai S, Pacher P. Role of oxidative-nitrosative stress and downstream pathways in various forms of cardiomyopathy and heart failure. Curr Vasc Pharmacol. 2005;3(3):221–9. https://doi.org/10.2174/1570161054368607.CrossRefPubMedPubMedCentral

12.

Chowienczyk PJ, Watts GF, Cockcroft JR, Ritter JM. Impaired endothelium-dependent vasodilation of forearm resistance vessels in hypercholesterolaemia. Lancet. 1992;340(8833):1430–2. https://doi.org/10.1016/0140-6736(92)92621-l.CrossRefPubMed

13.

Britten MB, Zeiher AM, Volker Schächinger. Clinical importance of coronary endothelial vasodilator dysfunction and therapeutic options. J Intern Med. Wiley-Blackwell; 1999;245(4):315–27. https://doi.org/10.1046/j.1365-2796.1999.00449.x.

14.

Zeiher AM, Drexler H, Saurbier B, Just H. Endothelium-mediated coronary blood flow modulation in humans. Effects of age, atherosclerosis, hypercholesterolemia, and hypertension. J Clin Invest. 1993;92(2):652–62. https://doi.org/10.1172/JCI116634.

15.

Donato AJ, Morgan RG, Walker AE, Lesniewski LA. Cellular and molecular biology of aging endothelial cells. J Mol Cell Cardiol. 2015;89:122–35. https://doi.org/10.1016/j.yjmcc.2015.01.021.CrossRefPubMedPubMedCentral

16.

•• Hahad O, Arnold N, Prochaska JH, Panova-Noeva M, Schulz A, Lackner KJ, et al. Cigarette smoking is related to endothelial dysfunction of resistance, but not conduit arteries in the general population-results from the Gutenberg health study. Front Cardiovasc Med. 2021;8:674622. https://doi.org/10.3389/fcvm.2021.674622. Findings from this study suggest that cigarette smoking is associated with altered endothelial function of resistance.

17.

Lavi S, Prasad A, Yang EH, Mathew V, Simari RD, Rihal CS, et al. Smoking is associated with epicardial coronary endothelial dysfunction and elevated white blood cell count in patients with chest pain and early coronary artery disease. Circulation. 2007;115(20):2621–7. https://doi.org/10.1161/CIRCULATIONAHA.106.641654.CrossRefPubMed

18.

•• Yang Q, Wang P, Cai Y, Cui Y, Cui J, Du X, et al. Circulating microRNA-505 may serve as a prognostic biomarker for hypertension-associated endothelial dysfunction and inflammation. Front Cardiovasc Med. 2022;9:834121. https://doi.org/10.3389/fcvm.2022.834121. This study links for the first time miR-505 to endothelial dysfunction and inflammation under hypertensive conditions, supporting the translational value of miR-505 in prognosticating hypertension-associated endothelial impairment and inflammatory injuries in target organs such as the vessels and kidneys.

19.

Negro R. Endothelial effects of antihypertensive treatment: focus on irbesartan. Vasc Health Risk Manag. 2008;4(1):89–101. https://doi.org/10.2147/vhrm.2008.04.01.89.CrossRefPubMedPubMedCentral

20.

Williams SB, Cusco JA, Roddy MA, Johnstone MT, Creager MA. Impaired nitric oxide-mediated vasodilation in patients with non-insulin-dependent diabetes mellitus. J Am Coll Cardiol. 1996;27(3):567–74. https://doi.org/10.1016/0735-1097(95)00522-6.CrossRefPubMed

21.

Bridger T. Childhood obesity and cardiovascular disease. Paediatr Child Health. 2009;14(3):177–82. https://doi.org/10.1093/pch/14.3.177.CrossRefPubMedPubMedCentral

22.

Ziccardi P, Nappo F, Giugliano G, Esposito K, Marfella R, Cioffi M, et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation. 2002;105(7):804–9. https://doi.org/10.1161/hc0702.104279.CrossRefPubMed

23.

Anderson TJ. Arterial stiffness or endothelial dysfunction as a surrogate marker of vascular risk. Can J Cardiol. 2006;22:72–80. https://doi.org/10.1016/s0828-282x(06)70990-4.CrossRef

24.

Wilkinson IB, MacCallum H, Cockcroft JR, Webb DJ. Inhibition of basal nitric oxide synthesis increases aortic augmentation index and pulse wave velocity in vivo. Br J Clin Pharmacol. 2002;53(2):189–92. https://doi.org/10.1046/j.1365-2125.2002.1528adoc.x.CrossRefPubMedPubMedCentral

25.

McVeigh GE, Allen PB, Morgan DR, Hanratty CG, Silke B. Nitric oxide modulation of blood vessel tone identified by arterial waveform analysis. Clin Sci (Lond). 2001;100(4):387–93 PMID: 11256976.CrossRefPubMed

26.

Verma S, Buchanan MR, Anderson TJ. Endothelial function testing as a biomarker of vascular disease. Circulation. 2003;108(17):2054–9. https://doi.org/10.1161/01.CIR.0000089191.72957.ED.CrossRefPubMed

27.

Hadi HA, Carr CS, Al SJ. Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome. Vasc Health Risk Manag. 2005;1(3):183–98 PMID: 17319104.PubMedPubMedCentral

28.

Wilkinson IB, Mäki-Petäjä KM, Mitchell GF. Uses of arterial stiffness in clinical practice. Arterioscler Thromb Vasc Biol. 2020;40(5):1063–7. https://doi.org/10.1161/atvbaha.120.313130.CrossRefPubMedPubMedCentral

29.

Verdecchia P, Angeli F, Taddei S. At the beginning of stiffening: endothelial dysfunction meets “pulsology.” Hypertension. 2006;48(4):541–2. https://doi.org/10.1161/01.HYP.0000239236.12524.d3.CrossRefPubMed

30.

Bonarjee VVS. Arterial stiffness: a prognostic marker in coronary heart disease. Available Methods and Clinical Application. Front Cardiovasc Med. 2018;5:64. https://doi.org/10.3389/fcvm.2018.00064.

31.

Segers P, Rietzschel ER, Chirinos JA. Brief review on how to measure arterial stiffness in humans. Arterioscler Thromb Vasc Biol. 2019;40:1034–43. https://doi.org/10.1161/ATVBAHA.119.313132.CrossRefPubMedPubMedCentral

32.

Agabiti-Rosei E, Mancia G, O’Rourke MF, Roman MJ, Safar ME, Smulyan H, Wang JG, Wilkinson IB, Williams B, Vlachopoulos C. Central blood pressure measurements and antihypertensive therapy: a consensus document. Hypertension. 2007;50(1):154–60. https://doi.org/10.1161/HYPERTENSIONAHA.107.090068.CrossRefPubMed

33.

Safar ME, Blacher J, Pannier B, Guerin AP, Marchais SJ, Guyonvarc’h PM, London GM. Central pulse pressure and mortality in end-stage renal disease. Hypertension. 2002;39(3):735–8. https://doi.org/10.1161/hy0202.098325.CrossRefPubMed

34.

Dolan E, Thijs L, Li Y, Atkins N, McCormack P, McClory S, et al. Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in the Dublin Outcome Study. Hypertension. 2006;47:365–70. https://doi.org/10.1161/01.HYP.0000200699.74641.c5.CrossRefPubMed

35.

Hansen TW, Li Y, Staessen JA, Jeppesen J, Rasmussen S, Wang JG, et al. Independent prognostic value of the ambulatory arterial stiffness index and aortic pulse wave velocity in a general population. J Hum Hypertens. 2008;22:214–6. https://doi.org/10.1038/sj.jhh.1002295.CrossRefPubMed

36.

Fantin F, Mattocks A, Bulpitt CJ, Banya W, Rajkumar C. Is augmentation index a good measure of vascular stiffness in the elderly? Age Ageing. 2007;36(1):43–8. https://doi.org/10.1093/ageing/afl115.CrossRefPubMed

37.

Chen CH, Ting CT, Nussbacher A, Nevo E, Kass DA, Pak P, et al. Validation of carotid artery tonometry as a means of estimating augmentation index of ascending aortic pressure. Hypertension. 1996;27(2):168–75. https://doi.org/10.1161/01.hyp.27.2.168.CrossRefPubMed

38.

Franklin SS. Ageing and hypertension: the assessment of blood pressure indices in predicting coronary heart disease. J Hypertens Suppl. 1999;17(5):S29-36 PMID: 10706323.PubMed

39.

Pauca AL, O’Rourke MF, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension. 2001;38(4):932–7. https://doi.org/10.1161/hy1001.096106.CrossRefPubMed

40.

Hayashi T, Nakayama Y, Tsumura K, Yoshimaru K, Ueda H. Reflection in the arterial system and the risk of coronary heart disease. Am J Hypertens. 2002;15(5):405–9. https://doi.org/10.1016/s0895-7061(02)02260-4.CrossRefPubMed

41.

Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236–41. https://doi.org/10.1161/01.hyp.37.5.1236.CrossRefPubMed

42.

Weber T, Auer J, O’rourke MF, Kvas E, Lassnig E, Lamm G, et al. Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J. 2005;26(24):2657–63. https://doi.org/10.1093/eurheartj/ehi504.CrossRefPubMed

43.

London GM, Blacher J, Pannier B, Guérin AP, Marchais SJ, Safar ME. Arterial wave reflections and survival in end-stage renal failure. Hypertension. 2001;38(3):434–8. https://doi.org/10.1161/01.hyp.38.3.434.CrossRefPubMed

44.

Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension. 1999;33(5):1111–7. https://doi.org/10.1161/01.hyp.33.5.1111.CrossRefPubMed

45.

Kim HL, Kim SH. Pulse wave velocity in atherosclerosis. Front Cardiovasc Med. 2019;6:41. https://doi.org/10.3389/fcvm.2019.00041.CrossRefPubMedPubMedCentral

46.

Niiranen TJ, Kalesan B, Mitchell GF, Vasan RS. Relative contributions of pulse pressure and arterial stiffness to cardiovascular disease. Hypertension. 2019;73(3):712–7. https://doi.org/10.1161/HYPERTENSIONAHA.118.12289.CrossRefPubMed

47.

Bramwell JC, Hill AV. The velocity of pulse wave in man. Proceedings of the Royal Society of London. Series B, Containing Papers of a Biological Character. 1922;93(652):298–306.

48.

Cheng HM, Chen CH. Measuring arterial stiffness in clinical practice: moving one step forward. J Clin Hypertens. 2020;22:1824–6. https://doi.org/10.1111/jch.13965.CrossRef

49.

• Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension. 2004;43(6):1239–45. https://doi.org/10.1161/01.HYP.0000128420.01881.aa. Findings from this study suggest that in a healthy cohort with a minimal burden of cardiovascular disease risk factors, an age-related increase in aortic stiffness, as compared with peripheral arterial stiffness, is associated with increasing forward wave amplitude and pulse pressure and reversal of the arterial stiffness gradient.

50.

• Mendis S. The contribution of the Framingham Heart Study to the prevention of cardiovascular disease: a global perspective. Prog Cardiovasc Dis. 2010;53(1):10–4. https://doi.org/10.1016/j.pcad.2010.01.001. The Framingham Heart Study has also been in the forefront of the development of cardiovascular risk prediction equations for assessment of absolute risk. The Framingham Study provided insights into the prevalence, incidence, prognosis, predisposing factors and determinants of CVD.

51.

Hasegawa M. Fundamental research on human aortic pulse wave velocity. Jikei Med J. 1970;85:742–60.

52.

Emoto M, Nishizawa Y, Kawagishi T, Maekawa K, Hiura Y, Kanda H, et al. Stiffness indexes beta of the common carotid and femoral arteries are associated with insulin resistance in NIDDM. Diabetes Care. 1998;21(7):1178–82. https://doi.org/10.2337/diacare.21.7.1178.CrossRefPubMed

53.

Shirai K, Utino J, Otsuka K, Takata M. A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb. 2006;13:101–7. https://doi.org/10.5551/jat.13.101.CrossRefPubMed

54.

Wohlfahrt P, Cífková R, Movsisyan N, Kunzová Š, Lešovský J, Homolka M, et al. Reference values of cardio-ankle vascular index in a random sample of a white population. J Hypertens. 2017;35:2238–44. https://doi.org/10.1097/HJH.0000000000001437.CrossRefPubMed

55.

Miyoshi T, Ito H. Assessment of arterial stiffness using the cardio-ankle vascular index. Pulse. 2016;4(1):11–23. https://doi.org/10.1159/000445214.CrossRefPubMedPubMedCentral

56.

Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. European network for non-invasive investigation of large arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–2605. https://doi.org/10.1093/eurheartj/ehl254.

57.

Dobsak P, Soska V, Sochor O, Jarkovsky J, Novakova M, Homolka M, et al. Increased cardio-ankle vascular index in hyperlipidemic patients without diabetes or hypertension. J Atheroscler Thromb. 2015;22(3):272–83. https://doi.org/10.5551/jat.24851.CrossRefPubMed

58.

Nagayama D, Watanabe Y, Saiki A, Shirai K, Tatsuno I. Lipid parameters are independently associated with cardio-ankle vascular index (CAVI) in healthy Japanese subjects. J Atheroscler Thromb. 2018;25(7):621–33. https://doi.org/10.5551/jat.42291.CrossRefPubMedPubMedCentral

59.

Nakamura K, Tomaru T, Yamamura S, Miyashita Y, Shirai K, Noike H. Cardio-ankle vascular index is a candidate predictor of coronary atherosclerosis. Circ J. 2008;72(4):598–604. https://doi.org/10.1253/circj.72.598.CrossRefPubMed

60.

Satoh N, Shimatsu A, Kato Y, Araki R, Koyama K, Okajima T, et al. Evaluation of the cardio-ankle vascular index, a new indicator of arterial stiffness independent of blood pressure, in obesity and metabolic syndrome. Hypertens Res. 2008;31(10):1921–30. https://doi.org/10.1291/hypres.31.1921.CrossRefPubMed

61.

Tanaka H, DeSouza CA, Seals DR. Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol. 1998;18(1):127–32. https://doi.org/10.1161/01.atv.18.1.127.CrossRefPubMed

62.

Kaess BM, Rong J, Larson MG, Hamburg N, Vita J, Levy D, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012;308(9):875–81. https://doi.org/10.1001/2012.jama.10503.CrossRefPubMedPubMedCentral

63.

Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37:1236–41. https://doi.org/10.1161/01.hyp.37.5.1236.CrossRefPubMed

64.

Benetos A, Adamopoulos C, Bureau JM, Temmar M, Labat C, Bean K, et al. Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period. Circulation. 2002;105(10):1202–7. https://doi.org/10.1161/hc1002.105135.CrossRefPubMed

65.

Wilkinson IB, Prasad K, Hall IR, Thomas A, MacCallum H, Webb DJ, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol. 2002;39(6):1005–11. https://doi.org/10.1016/s0735-1097(02)01723-0.CrossRefPubMed

66.

• Mitchell GF, Guo CY, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, Vasan RS, Levy D. Cross-sectional correlates of increased aortic stiffness in the community: the Framingham Heart Study. Circulation. 2007;115(20):2628–36. https://doi.org/10.1161/CIRCULATIONAHA.106.667733. Findings from this study suggest that the prevalence of abnormal aortic stiffness increases steeply with advancing age, especially in the presence of obesity or diabetes.

67.

Stefanadis C, Tsiamis E, Vlachopoulos C, Stratos C, Toutouzas K, Pitsavos C, Marakas S, Boudoulas H, Toutouzas P. Unfavorable effect of smoking on the elastic properties of the human aorta. Circulation. 1997;95(1):31–8. https://doi.org/10.1161/01.cir.95.1.31.CrossRefPubMed

68.

Salomaa V, Riley W, Kark JD, Nardo C, Folsom AR. Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC Study. Atherosclerosis Risk in Communities Study. Circulation. 1995;91(5):1432–43. https://doi.org/10.1161/01.cir.91.5.1432.

69.

Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106(16):2085–90. https://doi.org/10.1161/01.cir.0000033824.02722.f7.CrossRefPubMed

70.

Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113(5):664–70. https://doi.org/10.1161/CIRCULATIONAHA.105.579342.CrossRefPubMed

71.

Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, et al. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation. 2005;111(25):3384–90. https://doi.org/10.1161/CIRCULATIONAHA.104.483628.CrossRefPubMed

72.

Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113(5):657–63. https://doi.org/10.1161/CIRCULATIONAHA.105.555235.CrossRefPubMed

73.

Shokawa T, Imazu M, Yamamoto H, Toyofuku M, Tasaki N, Okimoto T, et al. Pulse wave velocity predicts cardiovascular mortality: findings from the Hawaii-Los Angeles-Hiroshima study. Circ J. 2005;69(3):259–64. https://doi.org/10.1253/circj.69.259.CrossRefPubMed

74.

Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002;39(1):10–5. https://doi.org/10.1161/hy0102.099031.CrossRefPubMed

75.

• Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study Circulation. 1999;100(4):354–60. https://doi.org/10.1161/01.cir.100.4.354. Findings from this study suggest that higher pulse pressure is an important component of cardiovascular risk.

76.

• Benjamin EJ, Larson MG, Keyes MJ, Mitchell GF, Vasan RS, Keaney JF Jr, et al. Clinical correlates and heritability of flow-mediated dilation in the community: the Framingham Heart Study. Circulation. 2004;109(5):613–9. https://doi.org/10.1161/01.CIR.0000112565.60887.1E. Findings from this study suggest that increasing age, systolic blood pressure, and smoking are associated with lower flow-mediated dilation, whereas prior exercise and increasing heart rate were associated with higher flow-mediated dilation.

77.

• Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113(5):657–63. https://doi.org/10.1161/CIRCULATIONAHA.105.555235. This study concluded that aortic pulse wave velocity is an independent predictor of coronary heart disease and stroke in healthy individuals.

78.

Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318–27. https://doi.org/10.1016/j.jacc.2009.10.061.CrossRefPubMed

79.

Liao J, Farmer J. Arterial stiffness as a risk factor for coronary artery disease. Curr Atheroscler Rep. 2014;16(2):387. https://doi.org/10.1007/s11883-013-0387-8.CrossRefPubMed

80.

Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434–9. https://doi.org/10.1161/01.cir.99.18.2434.CrossRefPubMed

81.

Shoji T, Emoto M, Shinohara K, Kakiya R, Tsujimoto Y, Kishimoto H, et al. Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol. 2001;12(10):2117–24. https://doi.org/10.1681/ASN.V12102117.CrossRefPubMed

82.

•• Wang N, Guo Y, Li X, Dong Y, Liu Q, Wang G, et al. Association between cardio-ankle vascular index and masked uncontrolled hypertension in hypertensive patients: a cross-sectional study. J Atheroscler Thromb. 2022;2022(2):1–8. https://doi.org/10.1155/2022/3167518. Findings of this study support, for the first time, the novel notion that cardio-ankle vascular index, as an arterial stiffness parameter, is an independent risk factor for masked uncontrolled hypertension.

83.

Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation. 2001;103(7):987–92. https://doi.org/10.1161/01.cir.103.7.987.CrossRefPubMed

84.

Muhammad IF, Borné Y, Östling G, Kennbäck C, Gottsäter M, Persson M, et al. Arterial stiffness and incidence of diabetes: a population-based cohort study. Diabetes Care. 2017;40(12):1739–45. https://doi.org/10.2337/dc17-1071.CrossRefPubMed

85.

Kimoto E, Shoji T, Shinohara K, Inaba M, Okuno Y, Miki T, et al. Preferential stiffening of central over peripheral arteries in type 2 diabetes. Diabetes. 2003;52(2):448–52. https://doi.org/10.2337/diabetes.52.2.448.CrossRefPubMed

86.

Smith A, Karalliedde J, De Angelis L, Goldsmith D, Viberti G. Aortic pulse wave velocity and albuminuria in patients with type 2 diabetes. J Am Soc Nephrol. 2005;16(4):1069–75. https://doi.org/10.1681/ASN.2004090769.CrossRefPubMed

87.

Cardoso CR, Moran CB, Marinho FS, Ferreira MT, Salles GF. Increased aortic stiffness predicts future development and progression of peripheral neuropathy in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study. Diabetologia. 2015;58(9):2161–8. https://doi.org/10.1007/s00125-015-3658-9.CrossRefPubMed

88.

Mansour AS, Yannoutsos A, Majahalme N, Agnoletti D, Safar ME, Ouerdane S, et al. Aortic stiffness and cardiovascular risk in type 2 diabetes. J Hypertens. 2013;31(8):1584–92. https://doi.org/10.1097/HJH.0b013e3283613074.CrossRefPubMed

89.

Wijkman M, Länne T, Östgren CJ, Nystrom FH. Aortic pulse wave velocity predicts incident cardiovascular events in patients with type 2 diabetes treated in primary care. J Diabetes Complications. 2016;30(7):1223–8. https://doi.org/10.1016/j.jdiacomp.2016.06.008.CrossRefPubMed

90.

•• Mavraganis G, Dimopoulou MA, Delialis D, Bampatsias D, Patras R, Sianis A, Maneta E, Stamatelopoulos K, Georgiopoulos G. Clinical implications of vascular dysfunction in acute and convalescent COVID-19: a systematic review. Eur J Clin Invest. 2022;52(11):e13859. https://doi.org/10.1111/eci.13859. Recent study, suggesting a detrimental effect of COVID‐19 on markers of endothelial function and arterial stiffness that could persist for months after the resolution of the infection.

91.

•• Schnaubelt S, Oppenauer J, Tihanyi D, et al. Arterial stiffness in acute COVID-19 and potential associations with clinical outcome. J Intern Med. 2021;290(2):437–43. https://doi.org/10.1111/joim.13275. Findings from this study suggest that COVID‐19 is related to enhanced pulse wave velocity, reflecting an increase in arterial stiffness.

92.

•• Ratchford SM, Stickford JL, Province VM, et al. Vascular alterations among young adults with SARS‐CoV‐2. Am J Physiol Heart Circ Physiol. 2021;320(1):404‐410. https://doi.org/10.1152/ajpheart.00897. This study was the first to investigate the vascular implications of contracting SARS-CoV-2 among young, otherwise healthy adults. The main findings from this study are a strikingly lower vascular function and a higher arterial stiffness compared with healthy controls. This suggests significant vascular effects seen weeks after contracting SARS-CoV-2 in young adults.

93.

•• Jud P, Gressenberger P, Muster V, et al. Evaluation of endothelial dysfunction and inflammatory vasculopathy after SARS‐CoV‐2 infection‐a cross‐sectional study. Front Cardiovasc Med. 2021;8:750887. https://doi.org/10.3389/fcvm.2021.750887. Recent study suggesting that COVID-19 affects arterial stiffness, capillary morphology and selected parameters of arginine, kynurenine and homocysteine metabolism.

94.

•• Szeghy RE, Province VM, Stute NL, et al. Carotid stiffness, intima‐media thickness and aortic augmentation index among adults with SARS‐CoV‐2. Exp Physiol. 2022;107(7):694‐707. https://doi.org/10.1113/ep089481. This study found that carotid stiffness and aortic augmentation index were greater in young adults who tested positive for SARS-CoV-2 compared with healthy young adults. These findings provide additional evidence for detrimental effects of SARS-CoV-2 on young adult vasculature, which might have implications for cardiovascular health.

95.

•• Zanoli L, Gaudio A, Mikhailidis DP, et al. Vascular dysfunction of COVID‐19 is partially reverted in the long‐term. Circ Res. 2022;130(9):1276‐1285. https://doi.org/10.1161/circresaha.121.320460. Recent study suggesting that COVID-19-related arterial stiffening involves several arterial tree portions and is partially resolved in the long-term.

96.

•• Evans PC, Rainger GE, Mason JC, Guzik TJ, Osto E, Stamataki Z, Neil D, Hoefer IE, Fragiadaki M, Waltenberger J, Weber C, Bochaton-Piallat ML, Bäck M. Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science. Cardiovasc Res. 2020;116(14):2177–2184. https://doi.org/10.1093/cvr/cvaa230. The Working Group on Atherosclerosis and Vascular Biology together with the Council of Basic Cardiovascular Science of the European Society of Cardiology provide a Position Statement on the importance of the endothelium in the underlying pathophysiology behind the clinical presentation in COVID-19 and identify key questions for future research to address. This position paper proposes that endothelial biomarkers and tests of function should be evaluated for their usefulness in the risk stratification of COVID-19 patients.

97.

Poulter NR, Wedel H, Dahlöf B, Sever PS, Beevers DG, Caulfield M, et al. Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA). Lancet. 2005;366(9489):907–13. https://doi.org/10.1016/S0140-6736(05)67186-3.CrossRefPubMed

98.

Williams B, Lacy PS; CAFE and the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Investigators. Impact of heart rate on central aortic pressures and hemodynamics: analysis from the CAFE (Conduit Artery Function Evaluation) study: CAFE-Heart Rate. J Am Coll Cardiol. 2009;54(8):705–13. https://doi.org/10.1016/j.jacc.2009.02.088.

99.

Mallareddy M, Parikh CR, Peixoto AJ. Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2006;8(6):398–403. https://doi.org/10.1111/j.1076-7460.2006.05418.x.CrossRefPubMed

100.

Asmar RG, London GM, O'Rourke ME, Safar ME; REASON Project Coordinators and Investigators. Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient: a comparison with atenolol. Hypertension. 2001;38(4):922–6.https://doi.org/10.1161/hy1001.095774.

101.

•• Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–323. https://doi.org/10.1093/eurheartj/ehz486. The emphasis in these guidelines is to provide information on the current state of the art in how to prevent and manage the effects of diabetes mellitus on the heart and vasculature.

102.

Adam CA, Anghel R, Marcu DTM, Mitu O, Roca M, Mitu F. Impact of sodium–glucose cotransporter 2 (SGLT2) inhibitors on arterial stiffness and vascular aging—what do we know so far? (a narrative review). Life. 2022;12:803. https://doi.org/10.3390/life12060803.CrossRefPubMedPubMedCentral

103.

•• Patoulias D, Papadopoulos C, Stavropoulos K, Zografou I, Doumas M, Karagiannis A. Prognostic value of arterial stiffness measurements in cardiovascular disease, diabetes, and its complications: The potential role of sodium-glucose co-transporter-2 inhibitors. The Journal of Clinical Hypertension. 2020;22(4):562–71. https://doi.org/10.1111/jch.13831. This paper summarised knowledge regarding the prognostic role of arterial stiffness in type 2 diabetes mellitus, along with the presentation of retrieved data on the potential role of sodium‐glucose co‐transporter‐2 inhibitors.CrossRefPubMedPubMedCentral

104.

Chilton R, Tikkanen I, Cannon CP, Crowe S, Woerle HJ, Broedl UC, et al. Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes. Diabetes Obes Metab. 2015;17(12):1180–93. https://doi.org/10.1111/dom.12572.CrossRefPubMedPubMedCentral

105.

Soares RN, Ramirez-Perez FI, Cabral-Amador FJ, Morales-Quinones M, Foote C, Ghiarone T, et al. SGLT2 inhibition attenuates arterial dysfunction and decreases vascular F-actin content and expression of proteins associated with oxidative stress in aged mice. GeroScience. 2022;44:1657–75. https://doi.org/10.1007/s11357-022-00563-x.CrossRefPubMedPubMedCentral

106.

Muramatsu J, Kobayashi A, Hasegawa N, Yokouchi S. Hemodynamic changes associated with reduction in total cholesterol by treatment with the HMG-CoA reductase inhibitor pravastatin. Atherosclerosis. 1997;130(1–2):179–82. https://doi.org/10.1016/s0021-9150(96)06024-8.CrossRefPubMed

107.

Yokoyama H, Kawasaki M, Ito Y, Minatoguchi S, Fujiwara H. Effects of fluvastatin on the carotid arterial media as assessed by integrated backscatter ultrasound compared with pulse-wave velocity. J Am Coll Cardiol. 2005;46(11):2031–7. https://doi.org/10.1016/j.jacc.2005.06.084.CrossRefPubMed

108.

Laufs U, Marra D, Node K, Liao JK. 3-Hydroxy-3-methylglutaryl-CoA reductase inhibitors attenuate vascular smooth muscle proliferation by preventing rho GTPase-induced down-regulation of p27(Kip1). J Biol Chem. 1999;274(31):21926–31. https://doi.org/10.1074/jbc.274.31.21926.CrossRefPubMed

109.

Yang Z, Kozai T, van der Loo B, Viswambharan H, Lachat M, Turina MI, et al. HMG-CoA reductase inhibition improves endothelial cell function and inhibits smooth muscle cell proliferation in human saphenous veins. J Am Coll Cardiol. 2000;36(5):1691–7. https://doi.org/10.1016/s0735-1097(00)00924-4.CrossRefPubMed

110.

Van Doornum S, McColl G, Wicks IP. Atorvastatin reduces arterial stiffness in patients with rheumatoid arthritis. Ann Rheum Dis. 2004;63(12):1571–5. https://doi.org/10.1136/ard.2003.018333.CrossRefPubMedPubMedCentral

111.

Ferrier KE, Muhlmann MH, Baguet JP, Cameron JD, Jennings GL, Dart AM, Kingwell BA. Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension. J Am Coll Cardiol. 2002;39(6):1020–5. https://doi.org/10.1016/s0735-1097(02)01717-5.CrossRefPubMed

112.

Adams SP, Sekhon SS, Tsang M, Wright JM. Fluvastatin for lowering lipids. Cochrane Database Syst Rev. 2018;3(3):CD012282. https://doi.org/10.1002/14651858.CD012282.pub2.

113.

Efrati S, Averbukh M, Dishy V, Faygenzo M, Friedensohn L, Golik A. The effect of simvastatin, ezetimibe and their combination on the lipid profile, arterial stiffness and inflammatory markers. Eur J Clin Pharmacol. 2007;63(2):113–21. https://doi.org/10.1007/s00228-006-0238-4.CrossRefPubMed

114.

Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Endothelial function, arterial stiffness and lipid lowering drugs. Expert Opin Ther Targets. 2007;11(9):1143–60. https://doi.org/10.1517/14728222.11.9.1143.CrossRefPubMed

115.

Mandraffino G, Scicali R, Rodríguez-Carrio J, Savarino F, Mamone F, Scuruchi M, et al. Arterial stiffness improvement after adding on PCSK9 inhibitors or ezetimibe to high-intensity statins in patients with familial hypercholesterolemia: A Two-Lipid Center Real-World Experience. J Clin Lipidol. 2020;14(2):231–40. https://doi.org/10.1016/j.jacl.2020.01.015.CrossRefPubMed

116.

Van Bortel LM, Duprez D, Starmans-Kool MJ, Safar ME, Giannattasio C, Cockcroft J, et al. Clinical applications of arterial stiffness, Task Force III: recommendations for user procedures. Am J Hypertens. 2002;15(5):445–52. https://doi.org/10.1016/s0895-7061(01)02326-3.CrossRefPubMed

Title: Arterial Stiffness and its Impact on Cardiovascular Health
Authors: Rachel Anne Xuereb
Caroline J. Magri
Robert G. Xuereb
Publication date: 07-09-2023
Publisher: Springer US
Keywords: Arterial Diseases
Hypertension
Coronary Heart Disease
Published in: Current Cardiology Reports / Issue 10/2023
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-023-01951-1

2024 ASCO Annual Meeting

Springer Medicine

Arterial Stiffness and its Impact on Cardiovascular Health

Abstract

Purpose of Review

Recent Findings

Summary

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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