Arterial stiffness and cardiovascular disease

There has been much recent interest in the relationship between arterial stiffness and cardiovascular disease. Surrogate measures of arterial stiffness indicate that arterial stiffness increases both with age and in certain disease states that are themselves associated with increased cardiovascular risk, including hypertension, diabetes mellitus, hypercholesterolemia and end-stage renal failure.(1,2) As changes can be detected before the appearance of clinically apparent vascular disease, arterial stiffness may act either as a marker for the development of future atherosclerotic disease, or may be more directly involved of the process of atherosclerosis.(3)

Arterial stiffness may be measured using a variety of different techniques, although at present the majority of measurements are made for experimental and physiological studies rather than in clinical practice. It is certain that over the next few years measurement of arterial stiffness will become an increasingly important part of process of risk assessment, and may also improve the monitoring of therapy in patients with conditions of increased arterial stiffness as isolated systolic hypertension, in atherosclerotic cardiovascular disease.

The terminology used in the field of arterial stiffness can be confusing, because terms are oftenused interchangeably when in fact they have different meanings. Therefore the generic term “arterial stiffness” seems to be the most appropriate.

There are several different methods of assessing arterial stiffness, some of which are more widely applicable in the clinical settings than others. Several techniques give information on systemic arterial stiffness, while others only give information on local stiffness of the vessel being studied.(4)

Pulse pressure is simply the difference between systolic and diastolic pressures, and depends on cardiac output, large-artery stiffness and wave reflection. Pulse pressure alone is inadequate to assess arterial stiffness accurately, because pulse pressure measurement made in the periphery do not always accurately reflect the actual central pulse pressure.

One of the oldest techniques is pulse wave velocity, which is the speed at which the forward pressure is transmitted from the aorta through the vascular tree.

Ultrasound can be readily used to measure arterial stiffness, arterial distensibility and compliance, but its use is limited to the larger and more accessible arteries.

MRI- derived techniques have been used to measure vascular distensibility and compliance, but this technique in clinical practice is very doubtful and is mostly used in certain research.

More and more techniques using arterial waveform analysis is done either by systolic or diastolic pulse contour analysis. An applanation tonometer is used for the registration of the arterial wave forms.

In conclusion, arterial stiffness is now recognized as important in predicting cardiovascular disease. At present, measurements are being used in the research setting and also as a part of cardiovascular risk prediction clinics. There is scope for using these techniques to assess the response to different classes of medications. It is conceivable that measurement of arterial stiffness will become an important part of the routine assessment of patients in the cardiovascular practice.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.