Predictive Value Of Arterial Stiffness Research Articles

THE ARTERIAL STIFFNESS AS RISK FACTOR FOR THE OCCURRENCE OF ARTERIAL HYPERTENSION IN POSTOPERATIVE CRITICALLY ILL PATIENTS

Objective: The aim of the present study is to investigate the predictive value of arterial stiffness in the occurrence of arterial hypertension in critically ill patients. Also, the study investigates the risk factors of arterial hypertension in ICU patients. Design and method: This is a prospective observational study. The study included postoperative patients who were admitted to the ICU. We collected demographic characteristics of the patients, their clinical characteristics (i.e. hemodynamic status), clinical severity (APACHE II, SOFA score), lifestyle data (i.e. smoking, alcohol, drugs), and medical history (diabetes mellitus, cardiovascular diseases). Arterial stiffness assessment is performed by recording and analyzing the pulse wave in postoperative patients during the first 24 hours of admission to the ICU. The Sphygmocor software was used for pulse wave analysis and IBM SPSS v.27.0 software was used for statistical analysis. Results: The sample of the study consisted of 74 patients. Most of them were males (70.3%) aged 59.3±18.6 yrs and the rest were females (29.7%) aged 63.3±16.9 yrs. Totally, 54.1% of patients had emergency surgery, 60.8% survived and discharged from ICU, 52.7% had arterial hypertension, 70.3% had diabetes mellitus, 58.1% were smoking, and 63.5% had hypercholesterolemia. The APACHE II score of patients was found 21.2±7.2 and the SOFA score 7.5±2.8 The value of peripheral systolic blood pressure (PSBP) was 138.7±19.4 mmHg, peripheral diastolic blood pressure (PDBP) was 67.1±13.2 mmHg, mean peripheral blood pressure (MPBP) was 90.7±14.6 mmHg, pulse pressure (PP) was 53.1±15.3 mmHg and AIX@75 was 22.3±13.1%. Older patients (69.1±14.9 vs. 52.7±17.3, p=0.001), patients with diabetes mellitus (92.3% vs. 7.7%, p=0.001), patients with hypercholesterolemia (92.3% vs. 7.7%, p=0.001), patients with higher value of Albumin (2.9±0.5 vs. 2.5±0.6, p=0.025), and patients with a higher value of AIX@75 (26.8±10.5 vs. 18.3±14.1, p=0.004) had statistically significant higher percentages of arterial hypertension. Higher AIX values are associated with a greater likelihood of arterial hypertension (OR: 1.027; 95%CI: 1.004-1.049, p=0.018). Conclusions: The arterial stiffness is an independent risk factor for arterial hypertension in postoperative critically ill patients.

The additive predictive value of arterial stiffness for outcome to endothelial glycocalyx and SCORE in middle age individuals: 6 years follow-up

Abstract Background/Aim Arterial stiffness is involved in the clinical course of atherogenesis. We have previously shown that PBR, a marker of glycocalyx integrity is predictor of cardiovascular events in patients without established cardiovascular disease. The purpose of this study was to investigate whether altered arterial properties of the vessels confers predictively and additively to estimation of cardiovascular risk. Methods Pulse wave velocity carotid-femoral (PWVc-f), the gold standard method to assess arterial stiffness, was measured non-invasively by Complior device. Increased PWV(c-f), especially above 10 m/s, indicates increased arterial stiffness. We measured baseline PWV(c-f) in 600 apparently healthy subjects (47.61±13.84 years old, 50.1% males), without established cardiovascular disease. We prospectively monitored the occurrence of major cardiovascular events (MACE-death, myocardial infarction, stroke and heart failure hospitalization) during a 6-year follow-up period using electronic records and clinic visits. Results Fifty-seven MACEs were documented during follow-up. In univariate analysis, subjects with increased PWV were found to exert greater risk for MACEs (hazard ratio (HR): 1.09, 95% CI: 1.02–1.17, p=0.01). In all subjects, PWV predicted higher risk for MACEs in a model including PBR, sex, age, hyperlipidemia, diabetes, hypertension, current smoking, family history of coronary artery disease and treatment with ACEi/ARBs or lipid lowering agents (HR: 1.12; 95% CI: 1.04–1.17, p=0.029,net reclassification improvement (NRI): 23%; C-statistic: from 0.644 to 0.697). However, only in participants older than 50 years old, PWV was an independent and additive predictor of outcome when added in a model including PBR, SCORE, those risk factors not included in SCORE (diabetes, family history of CAD) and medication (HR: 1.09; 95% CI: 1.02–1.13, NRI: 23.8%, C-statistic increase from 0.703 to 0.762, p<0.01). Conclusion Arterial stiffness is an independent and additive predictor to endothelial glycocalyx and SCORE for adverse outcome at 6 years follow-up in individuals over 50 years old. Funding Acknowledgement Type of funding sources: None.

The predictive value of arterial stiffness for multivessel disease after acute coronary syndrome

Acute coronary syndrome (ACS) is a primary cause of morbidity and mortality in the world. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. To assess the association between markers of arterial stiffness and multivessel disease after ACS. This prospective study was conducted from April 2017 to March 2018 in a single cardiac center. A total of 275 patients who were referred for first ACS were enrolled. Arterial stiffness was assessed by carotid to femoral pulse wave velocity (cfPWV), central pulse pressure (cPP) and augmentation index using SphygmoCor®XCEL. The mean age was 56.4 ± 10.6 years. Tobacco smoking and diabetes were present in 56.4% and 41.8% of patients, respectively. ST segment elevation myocardial infarction was predominant (54.5%) and 47.6% of patients had multivessel disease. This study showed that cfPWV (OR = 1.272; 95%IC [1.090;1.483]; P = 0.002) and cPP (OR = 1.071; 95%IC [1.024;1.121]; P = 0.003) were the two independent predictors of multivessel disease. The cfVOP threshold for predicting multivessel disease was 12.65 m/s (sensitivity of 48.1% and specificity of 76.4%). Arterial stiffness measured by cfPWV and cPP may reflect the extent of coronary artery disease after ACS.

Pulse Wave Velocity and Machine Learning to Predict Cardiovascular Outcomes in Prediabetic and Diabetic Populations.

Few studies have addressed the predictive value of arterial stiffness determined by pulse wave velocity (PWV) in a high-risk population with no prevalent cardiovascular disease and with obesity, hypertension, hyperglycemia, and preserved kidney function. This longitudinal, retrospective study enrolled 88 high-risk patients and had a follow-up time of 12.4years. We collected clinical and laboratory data, as well as information on arterial stiffness parameters using arterial tonometry and measurements from ambulatory blood pressure monitoring. We considered nonfatal, incident cardiovascular events as the primary outcome. Given the small size of our dataset, we used survival analysis (i.e., Cox proportional hazards model) combined with a machine learning-based algorithm/penalization method to evaluate the data. Our predictive model, calculated with Cox regression and least absolute shrinkage and selection operator (LASSO), included body mass index, diabetes mellitus, gender (male), and PWV. We recorded 16 nonfatal cardiovascular events (5 myocardial infarctions, 5 episodes of heart failure, and 6 strokes). The adjusted hazard ratio for PWV was 1.199 (95% confidence interval: 1.09-1.37, p < 0.001). Arterial stiffness was a predictor of cardiovascular disease development, as determined by PWV in a high-risk population. Thus, in obese, hypertensive, hyperglycemic patients with preserved kidney function, PWV can serve as a prognostic factor for major adverse cardiac events.

Arterial stiffness evaluated by pulse wave velocity is not predictive of the improvement in hypertension after adrenal surgery for primary aldosteronism: A multicentre study from the French European Society of Hypertension Excellence Centres

Predictive factors associated with normal blood pressure (BP) after unilateral adrenalectomy for primary aldosteronism (PA) are not clearly identified. To evaluate the predictive value of arterial stiffness before surgery on BP after surgery. During 2009-2013, 96 patients with PA due to unilateral adrenal adenoma who underwent surgery were enrolled in a multicentre open-label, prospective study. Aortic pulse wave velocity (PWV) was assessed before surgery. Patients underwent ambulatory blood pressure monitoring (ABPM) before surgery and 6 and 12months after surgery. Twenty-four h SBP/DBP values were compared in subjects with PWV<vs. ≥10m/s. The primary outcome was 24-hour ABPM<130/80mmHg 6 months after adrenalectomy. BP and PWV were available for 82 patients (mean age 49±12years). Mean 24-hour systolic/diastolic BP (SBP/DBP) values decreased from 144±15/91±9 before surgery to 131±15/84±11mmHg 6months after surgery. At 6months, mean 24-hour SBP did not differ significantly between high versus low PWV groups (SBP-0.8mmHg, 95% confidence interval-6.9 to 5.2, P=0.79). A total of 42.3% of women versus 20.0% of men had 24-hour SBP/DBP<130/80mmHg at 6months (P=0.07) and 57.9% vs. 23.8% at 12months (P=0.03). Higher SBP/DBP was recorded for men versus women after 6months (P=0.01/0.001) and 1year (P=0.04/0.05). Preoperative arterial stiffness does not predict a beneficial effect of adrenalectomy on BP values.

GW27-e0094 The Predictive Value of Arterial Stiffness on Major Adverse Cardiovascular Events in Individuals with Mild Impaired Renal Function

Despite growing evidence that arterial stiffness has important predictive value on cardiovascular diseases (CVD) for patients with advanced stages of chronic kidney disease, the predictive significance of arterial stiffness in individuals with mild impaired renal function has not been established.

PP.25.08] IS ARTERIAL STIFFNESS EVALUATED BY PULSE WAVE VELOCITY PREDICTIVE OF THE IMPROVEMENT OF HYPERTENSION AFTER ADRENAL SURGERY FOR PRIMARY ALDOSTERONISM?

Objective: Predictive factors associated with normal blood pressure (BP) values after unilateral adrenalectomy for primary aldosteronism are not clearly identified. Arterial stiffness could play a role in the persistence of hypertension. The aim was to evaluate the predictive value of arterial stiffness assessed before surgery on BP after surgery. Design and method: From 2009–2013, in a French multicentre open-labelled prospective study, 96 patients with primary aldosteronism due to unilateral adrenal adenoma with an indication for surgery were recruited (age 48 ± 12; 47.6% of women; SBP/DBP: 150 ± 21/91 ± 15 mmHg; kalemia: 3.4 ± 0.5). Plasma aldosterone concentration (PAC) was conventionally measured (Normal values: 40–175 ng/l), either direct renin concentration (DRC) (4.2–59.7 mU/l) or plasma renin activity (PRA) (>0.4 ng/ml/h). Aortic pulse wave velocity (PWV) was assessed before surgery (Complior ®) They underwent an ABPM before and 3 to 6 months after surgery (Spacelab's ®) Normal BP values were defined as mean 24-hour-SBP/DBP<130/80 mmHg between 3 to 6 months after adrenalectomy Results: BP and PWV were available for 82 patients. At baseline, mean PAC was 368 ± 244 pg/ml, DRC was 4.4 ± 4.2 mU/L (n = 58) and PRA was 0.19 ± 0.18 ng/ml/h. Six months after surgery, office SBP/DBP was 131/81 mmHg. Mean 24-hour-SBP/DBP decreased (from 144 ± 15/91 ± 9 before to 131 ± 15/84 ± 11 mmHg). 40 of them who underwent ABPM at 12 months had 24-hour-SBP/DBP 125 ± 15/81 ± 9 mmHg. No patient needed potassium supplementation after surgery (vs 56% before). 64.7% of women and 35.3% of men had 24h-SBP/DBP<130/80 mmHg at 6 months (p = 0.07) and 68.8% vs 31.3% at 12 months (n = 40) (p = 0.03). SBP/DBP was higher for men than for women after 6 months (p = 0.01/0.001) and 1 year (p = 0.04/0.05). Mean PWV was 10.5 ± 3.6 m/s among patients with mean 24h-SBP/DBP<130/80mmHg vs 10.3 ± 2.3 m/s for patients with 24h-SBP/DBP>130/80mmHg (p = 0.96). 52.9% of patients with PWV<10m/s (median value) and 47.1% of patients with PWV values>10 m/s had 24h-SBP/DBP<130/80 mmHg (p = 0.91). No significant association between initial PWV and SBP or DBP after surgery was found. Conclusions: In our multicentre study, arterial stiffness reflected by PWV measured pre-operatively does not predict a benefit of adrenalectomy on blood pressure values. More women than men had normal BP values after surgery.

The predictive value of arterial stiffness on major adverse cardiovascular events in individuals with mildly impaired renal function.

ObjectivesDespite growing evidence that arterial stiffness has important predictive value for cardiovascular disease in patients with advanced stages of chronic kidney disease, the predictive significance of arterial stiffness in individuals with mildly impaired renal function has not been established. The aim of this study was to evaluate the predictive value of arterial stiffness on cardiovascular disease in this specific population.Materials and methodsWe analyzed measurements of arterial stiffness (carotid–femoral pulse-wave velocity [cf-PWV]) and the incidence of major adverse cardiovascular events (MACEs) in 1,499 subjects from a 4.8-year longitudinal study.ResultsA multivariate Cox proportional-hazard regression analysis showed that in individuals with normal renal function (estimated glomerular filtration rate [eGFR] ≥90 mL/min/1.73 m2), the baseline cf-PWV was not associated with occurrence of MACEs (hazard ratio 1.398, 95% confidence interval 0.748–2.613; P=0.293). In individuals with mildly impaired renal function (eGFR <90 mL/min/1.73 m2), a higher baseline cf-PWV level was associated with a higher risk of MACEs (hazard ratio 2.334, 95% confidence interval 1.082–5.036; P=0.031).ConclusionArterial stiffness is a moderate and independent predictive factor for MACEs in individuals with mildly impaired renal function (eGFR <90 mL/min/1.73 m2).

Predictive Value of Arterial Stiffness and Subclinical Carotid Atherosclerosis for Cardiovascular Disease in Patients with Rheumatoid Arthritis

We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD. In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses. Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline. CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.

Carotid-femoral pulse wave velocity in the elderly.

Predictive value of arterial stiffness in cardiovascular disease has been recognized for many decades. Carotid-femoral pulse wave velocity (cfPWV), as a noninvasive measurement, has been recommended as a gold standard of arterial stiffness, and we believe that this surrogate of arterial stiffness has been refined to the point that its utility in routine clinical practice need to be recommended. Considering the worldwide aging population and aging itself as a major cause of arterial stiffness, we would focus in this article, from a practical point of view, on cfPWV in the elderly, and review the current knowledge on the effect of arterial aging on cfPWV measurements, as well as the significance of its clinical application in the elderly.

Arterial stiffness predicts risk for long-term recurrence in patients with type 2 diabetes admitted for acute coronary event

Objectivesto investigate the predictive value of arterial stiffness (AS) estimation for long-term recurrences in patients with type 2 diabetes (DM2) following acute coronary event. Patients and methodsprospective observational study involving 119 DM2 patients without history of coronary heart disease admitted with ST-segment elevation myocardial infarction (STEMI). Medical history, anthropometrics, smoking, HbA1c, lipid profile, troponine-I levels, and left ventricular ejection fraction (LVEF) were recorded. Carotid-femoral pulse wave velocity (cf-PWV) was measured 1 month after discharge. Patients were followed up for 36 months or to reach an end-point: cardiovascular death, acute coronary event, angioplasty or hospitalization for acute heart failure. To facilitate analysis, patients were divided into two groups according to cf-PWV, using the accepted cut-off value of 12m/s. Resultsoverall, 34 patients had a recurrence. In Kaplan–Meier analysis patients with cf-PWV>12m/s had mean time-to-event 353±43 days compared to 505±115 days for patients with cf-PWV≤12m/s, log rank=0.0252. In multivariate analysis factors independently associated with recurrence were age (66.53±6.87 vs. 61.54±10.77 years, p=0.015), LVEF (41.66±8.21 vs. 47.58±8.11%, p=0.001) and cf-PWV (13.94±2.91 vs. 12.35±2.77m/s, p=0.008). ConclusionsAS estimation in patients with DM2 after STEMI discriminate patients at higher risk for 3-year recurrence, and maybe valuable for distinguishing patients likely to require a more rigorous therapeutic intervention.

Impact of Arterial Stiffness on Adverse Cardiovascular Outcomes and Mortality in Peritoneal Dialysis Patients

Cardiovascular (CV) disease is a major cause of morbidity and mortality in patients with end-stage renal disease. In recent years, arterial stiffness has taken on great importance in the pathophysiology of CV diseases. The independent predictive value of arterial stiffness for CV events and for all-cause and CV mortality has been demonstrated in the general population and in hemodialysis patients. Our aim in this study was to determine the relationship of arterial stiffness with mortality and fatal and nonfatal CV events in peritoneal dialysis (PD) patients. In this prospective observational cohort study with 2 years of follow-up, we studied a cohort of 156 PD patients with a mean follow-up of 19.2 ± 6.4 months. At baseline, echocardiography and standard clinical and biochemical analyses were performed in all patients and in 28 healthy subjects. Aortic stiffness index beta (ASIβ, a surrogate marker of arterial stiffness) was calculated as follows: ASIβ = ln (systolic blood pressure / diastolic blood pressure) / [(systolic diameter – diastolic diameter) / diastolic diameter]. During the follow-up period, 25 of the patients (16.0%) died, and 10 of those deaths had CV causes. Nonfatal CV events occurred in 15 patients. The median ASIβ was greater in PD patients than in control subjects (4.2 vs. 3.5; interquartile range: 3.2 - 5.5 vs. 2.5 - 4.8; p = 0.028]. In the fully adjusted multivariate Cox regression analysis (co-variates: age, sex, albumin, hemoglobin, diabetes mellitus, comorbid CV disease, left ventricular mass index, residual glomerular filtration rate, dialysate-to-plasma ratio of creatinine, Kt/V urea, left ventricular ejection fraction, duration of dialysis, smoking), ASIβ independently predicted fatal and nonfatal CV events (hazard ratio: 1.239; 95% confidence interval: 1.103 to 1.392), but not all-cause mortality. Our results provide the first direct evidence that arterial stiffness is an independent risk predictor of adverse CV outcome in PD patients.

Genetic Variants of Inflammatory Markers and Arterial Stiffness

Atherosclerotic disease is a primary cause of cardiovascular morbidity and mortality. This disease is generally undiagnosed before the onset of symptoms or complications. Experimental and clinical evidence indicate that inflammation is central to the initiation and progression of atherosclerosis.1 Therefore, vascular inflammation may serve as a potential marker of the disease process itself. Although potentially useful in risk stratification, the current systemic markers of inflammation lack sufficient disease specificity to be used satisfactory as screening tools in cardiovascular disease. The inaccuracy of current inflammatory markers may reflect the fact that these markers are neither derived primarily from the vascular wall nor produced primarily by cells involved in the vascular inflammatory process. Furthermore they may signal inflammation in a number of different organs and tissues, which may or may not have direct implications for the vasculature. Because of heterogeneity of the disease phenotype in the population, a single marker may not provide sufficient biological information for an acute assessment of vascular damage, and, therefore, it may be more interesting to look into a cluster of inflammatory markers. Human studies support an association between inflammatory gene polymorphisms and subclinical and clinical cardiovascular disease.2 The predictive value of arterial stiffness or 1:elasticity for cardiovascular morbidity and mortality has now been very well established.3 Arterial …

New techniques for assessing arterial stiffness

Arterial stiffness is now included in the guidelines of the European Society of Hypertension. In this paper, we review the evidence for the predictive value of arterial stiffness. More than 11 longitudinal trials have proven the predictive value of aortic stiffness measured through carotid to femoral pulse wave velocity, beyond and above classical risk factors. Such evidence is scarcer for central pressure and local arterial stiffness. If we add this evidence to the easiness of performing such measure, carotid to femoral pulse wave velocity is the reference technique for assessing arterial stiffness. Its place in the investigation of patients remains to be precised.

Recent Advances in Arterial Stiffness and Wave Reflection in Human Hypertension

In recent years, great emphasis has been placed on the role of arterial stiffness and wave reflection in the development of cardiovascular (CV) diseases. Arterial stiffness and wave reflections, which are now well accepted as the most important determinants of increasing systolic and pulse pressures in aging societies, are increasingly used in the clinical assessment of patients with hypertension and various CV risk factors.1,2 This review addresses recent advances in our understanding of the role played by arterial stiffness and wave reflection in the pathophysiology and treatment of human hypertension. According to the editorial rules for “Hypertension Highlights”, and to better focus on recent research, apart from large clinical trials, only articles published during the last 2 years are quoted in this review. Research on the molecular determinants of arterial stiffness has focused for years on the structure and amount of the main load bearing proteins: elastin and collagens.3 Indeed, aging and blood pressure, the two major determinants of arterial stiffness, are associated with a number of molecular changes of the load-bearing media of elastic arteries: the orderly arrangement of elastic fibers and laminae is gradually lost over time, and thinning, splitting, fraying, and fragmentation are observed. The degeneration of elastic fibers is associated with an increase in collagenous material and in ground substance, often accompanied by calcium deposition in ground substance and in degenerate elastic fibers.4 However, quantitative changes in elastin and collagen may not explain, by themselves, paradoxical observations. For instance, the changes in arterial wall material which accompany arterial hypertrophy in animal models of essential hypertension (SHRs and SHR-SPs) and in middle-age hypertensive patients are not necessarily associated with an increased isobaric stiffness.5 We suggested5 that adaptive mechanisms may include a rearrangement of the arterial wall material through cell–matrix connections, with a …

Arterial stiffness independently predicts cardiovascular events in an elderly community — Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110–1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300–2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns.

Arterial Stiffness and Stroke in Hypertension

Stroke is the second leading cause of mortality worldwide, and the leading cause of death in China and Japan. Its prevention represents a major goal. Identification of primary stroke risk, particularly through newly individualised risk factors including biomarkers of large artery damage such as arterial stiffening, is necessary for determining the appropriate level of intervention. The purpose of this review is to focus on the pathophysiology of arterial stiffness, its predictive value for stroke and the therapeutic implications of this risk factor for stroke prevention. The predictive value of arterial stiffness for stroke was demonstrated in a longitudinal study that included 1715 patients with essential hypertension and measurements of carotid-femoral pulse wave velocity (PWV) [an indicator of arterial stiffness] at entry. Over a mean follow-up period of 7.9 years, during which 25 fatal strokes occurred, PWV significantly predicted stroke (relative risk = 1.39 [(95% CI 1.08, 1.72]; p = 0.02 for each 4 m/sec increase) independently of classical cardiovascular risk factors, including age, cholesterol level, diabetes mellitus, smoking and mean blood pressure. Additional longitudinal studies are needed to confirm the predictive value of aortic stiffness on primary and secondary events, in low- and high-risk populations, in various countries, and using different methodologies of arterial stiffness measurement. Drug treatment could prevent stroke through a reduction in arterial stiffness in parallel with correction of cardiovascular risk factors such as hypertension, dyslipidaemia, diabetes mellitus and smoking, all of which are associated with arterial stiffening. In view of the important local actions of angiotensin II on arterial stiffening, drugs interfering with the renin-angiotensin-aldosterone system should be particularly effective. Promising therapeutic strategies to reduce arterial stiffness include taking advantage of the non-lipid-lowering effects of statins and directly targeting the molecular events leading to arterial stiffening, such as formation of advanced glycation end products.

Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study.

Arterial stiffness may predict coronary heart disease beyond classic risk factors. In a longitudinal study, we assessed the predictive value of arterial stiffness on coronary heart disease in patients with essential hypertension and without known clinical cardiovascular disease. Aortic stiffness was determined from carotid-femoral pulse wave velocity at baseline in 1045 hypertensives. The risk assessment of coronary heart disease was made by calculating the Framingham risk score according to the categories of gender, age, blood pressure, cholesterol, diabetes, and smoking. Mean age at entry was 51 years, and mean follow-up was 5.7 years. Coronary events (fatal and nonfatal myocardial infarction, coronary revascularization, and angina pectoris) and all cardiovascular events served as outcome variables in Cox proportional-hazard regression models. Fifty-three coronary events and 97 total cardiovascular events occurred. In univariate analysis, the relative risk of follow-up coronary event or any cardiovascular event increased with increasing level of pulse wave velocity; for 1 SD, ie, 3.5 m/s, relatives risks were 1.42 (95% confidence interval [CI], 1.10 to 1.82; P<0.01) and 1.41 (95% CI, 1.17 to 1.70; P<0.001), respectively. Framingham score significantly predicted the occurrence of coronary and all cardiovascular events in this population (P<0.01 and P<0.0001, respectively). In multivariate analysis, pulse wave velocity remained significantly associated with the occurrence of coronary event after adjustment either of Framingham score (for 3.5 m/s: relative risk, 1.34; 95% CI, 1.01 to 1.79; P=0.039) or classic risk factors (for 3.5 m/s: relative risk, 1.39; 95% CI, 1.08 to 1.79; P=0.01). Parallel results were observed for all cardiovascular events. This study provides the first direct evidence in a longitudinal study that aortic stiffness is an independent predictor of primary coronary events in patients with essential hypertension.