Arterial Stiffness in Patients with Ischemic Attack

Abstract

Dear Editor, we read the article ‘Aortic stiffness measurement improves the prediction of asymptomatic coronary artery disease (CAD) in stroke/transient ischemic attack patients’ by Calvet and coworkers with a great interest (1). They investigated the predictive value of aortic stiffness for >50% asymptomatic CAD in a stroke/transient ischemic attack population. They concluded that in stroke/ transient ischemic attack patients, aortic pulse wave velocity improves the prediction of >50% asymptomatic CAD beyond classical risk factors. We believe that these findings will be guides for further studies about the effect of inflammation on arterial stiffness parameters in patients with stroke/transient ischemic attack. Endothelial dysfunction is the critical early step in the process of atherogenesis, and it is commonly investigated by measuring arterial stiffness (2,3). Increased arterial stiffness is a common indicator of atherosclerotic involvement of the vascular structure indicating CAD, cerebrovascular disease, peripheral arterial disease, and hypertension. Also, arterial stiffness parameters can reflect the inflammatory diseases. In a previous study, we investigated the relationship between arterial stiffness and highsensitivity C-reactive protein (hsCRP) in patients with psoriasis. We concluded that arterial stiffness parameters were higher and correlated positively with age, gender, body mass index, diastolic blood pressure, and hsCRP level in patients with psoriasis (4). Furthermore, some medications such as antihypertensive treatment, including angiotensin-converting enzyme inhibitors, angiotensin receptor blocker, statins used, may influence arterial stiffness parameters. However, the authors of the present study did not mention some factors affecting arterial stiffness parameters. Arterial stiffness parameters can also be affected by the atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, hypothyroidism, and older age. Smoking is a modifiable one among the cardiovascular risk factors. In a previous study the authors conducted in 554 hypertensive patients, including active smokers, quitters, and never smoked individuals, the effect of smoking on arterial stiffness were investigated and they showed that arterial stiffness parameters were significantly higher in the smoking patients compared with those of the nonsmokers (5). Hypothyroidism plays a key role in cardiovascular disease pathogenesis by increasing total peripheral vascular resistance and inflammatory condition (6). Previously, the authors demonstrated increases in arterial stiffness parameters in hypothyroid patients (7). The fact is that arterial stiffness is a noninvasive method to assess endothelial dysfunction in clinical practice and that without other inflammatory markers, arterial stiffness alone may not provide information to clinicians about the predictive asymptomatic CAD in patients with stroke/transient ischemic attack. It would have been better if these factors were included in the paper.