Towards applicability of measures of arterial stiffness in clinical routine

Abstract

This editorial refers to ‘Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: “establishing normal and reference values”’, by The Reference Values for Arterial Stiffness' Collaboration. doi:10.1093/eurheartj/ehq165 Cardiovascular risk is steadily increasing in Western countries. Thus, assessment of risk in individual subjects is becoming more and more important. Already 40 years ago it was recognized that individual risk of cardiovascular events is, in addition to age, dependent on various factors, such as high cholesterol, elevated blood pressure, diabetes, and smoking. These ‘traditional’ risk factors have been studied extensively and therapeutic approaches addressing these factors have shown, largely uniformly, reduction of cardiovascular risk. However, it was also recognized that these factors do not fully explain cardiovascular risk. Many other factors have been claimed to be of importance, but most of them were later found to be of little or no incremental value. On the other hand, it was recognized that consequences of risk factors vary significantly between individual patients, and this individual response may be detectable by measuring signs of organ damage or vascular alterations. In fact, a recent systematic review found that carotid–femoral pulse wave velocity (cfPWV), a measure of large artery stiffness, may even be unrelated to classic risk factors other than hypertension and reflect arterial ageing,1 although recent data suggest that exposure to risk factors over time, such as smoking, may well play an important additional role.2 Thus, it is not surprising that organ damage and vascular alterations were found to be of incremental prognostic value independently of ‘traditional’ risk factors.3 Furthermore, therapies reducing some of these factors such as left ventricular hypertrophy and microalbuminuria were found to be accompanied by a reduction of the risk of subsequent major cardiovascular events. Therefore, these signs of vascular and organ … *Corresponding author. Tel: +31 43 387 7097, Fax: +31 43 387 5104, Email: hp.brunnerlarocca{at}mumc.nl