Role of arterial stiffness in cardiovascular disease

Propagation of the pressure wave along the arterial tree (pulse wave velocity [PWV]) is related to the intrinsic elasticity of the arterial wall. PWV is increased in stiffer arteries and, when measured over the aorta, is an independent predictor of cardiovascular morbidity and mortality. Given the predictive power of PWV, identifying strategies that prevent or reduce stiffening may be important in prevention of cardiovascular events. One view is that aortic stiffness occurs as a result of atherosclerosis along the aorta. However, there is little or no association between PWV and classical risk factors for atherosclerosis, other than age and blood pressure. Furthermore, PWV does not increase during early stages of atherosclerosis, as measured by intima-media thickness and noncalcified atheroma, but it does increase in the presence of aortic calcification that occurs within advanced atherosclerotic plaque. Age-related widening of pulse pressure is the major cause of age-related increase in prevalence of hypertension and has been attributed to arterial stiffening. This review summarizes the methods of measuring aortic stiffness in humans, the pathophysiological mechanisms leading to aortic stiffness, including its association with atherosclerosis, and the haemodynamic consequences of increased aortic stiffness.

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HABITUAL EXERCISE AND AGE-RELATED INCREASE IN ARTERIAL WALL INTIMA-MEDIA THICKNESS

Medicine & Science in Sports & Exercise ◽

10.1097/00005768-199905001-01138 ◽

1999 ◽

Vol 31 (Supplement) ◽

pp. S239

Author(s):

H. Tanaka ◽

F. A. Dinenno ◽

C. A. DeSouza ◽

D. R. Seals

Keyword(s):

Arterial Wall ◽

Intima Media Thickness ◽

Media Thickness ◽

Age Related ◽

Habitual Exercise ◽

Related Increase

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Normal Pregnancy Is Associated with Changes in Central Hemodynamics and Enhanced Recruitable, but Not Resting, Endothelial Function

International Journal of Reproductive Medicine ◽

10.1155/2015/250951 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Juan Torrado ◽

Yanina Zócalo ◽

Ignacio Farro ◽

Federico Farro ◽

Claudio Sosa ◽

...

Keyword(s):

Pulse Wave Velocity ◽

Endothelial Function ◽

Wave Velocity ◽

Aortic Stiffness ◽

Pulse Wave ◽

Reactive Hyperemia ◽

Intima Media Thickness ◽

Normal Pregnancy ◽

Low Flow ◽

Central Hemodynamics

Introduction.Flow-mediated dilation (FMD), low flow-mediated constriction (L-FMC), and reactive hyperemia-related changes in carotid-to-radial pulse wave velocity (ΔPWVcr%) could offer complementary information about both “recruitability” and “resting” endothelial function (EF). Carotid-to-femoral pulse wave velocity (PWVcf) and pulse wave analysis-derived parameters (i.e., AIx@75) are the gold standard methods for noninvasive evaluation of aortic stiffness and central hemodynamics. If healthy pregnancy is associated with both changes in resting and recruitable EF, as well as in several arterial parameters, it remains unknown and/or controversial.Objectives.To simultaneously and noninvasively assess in healthy pregnant (HP) and nonpregnant (NP) women central parameters in conjunction with “basal and recruitable” EF, employing new complementary approaches.Methods.HP (n=11, 34.2 ± 3.3 weeks of gestation) and age- and cardiovascular risk factors-matched NP (n=22) were included. Aortic blood pressure (BP), AIx@75, PWVcf, common carotid stiffness, and intima-media thickness, as well as FMD, L-FMC, and ΔPWVcr %, were measured.Results.Aortic BP, stiffness, and AIx@75 were reduced in HP. ΔPWVcr% and FMD were enhanced in HP in comparison to NP. No differences were found in L-FMC between groups.Conclusion.HP is associated with reduced aortic stiffness, central BP, wave reflections, and enhanced recruitable, but not resting, EF.

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Relationship of arterial wall parameters to cardiovascular risk factors and cardiovascular risk assessed by SCORE system

Medicina ◽

10.3390/medicina43070067 ◽

2007 ◽

Vol 43 (7) ◽

pp. 529 ◽

Cited By ~ 2

Author(s):

Milda Kovaitė ◽

Žaneta Petrulionienė ◽

Ligita Ryliškytė ◽

Jolita Badarienė ◽

Alma Čypienė ◽

...

Keyword(s):

Cardiovascular Risk ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Arterial Wall ◽

Pulse Wave ◽

Augmentation Index ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Media Thickness ◽

Flow Mediated Dilatation

Objective. To investigate the relationship of arterial wall parameters (flow-mediated dilatation of the brachial artery, augmentation index, pulse wave velocity, stiffness index, carotid intima-media thickness) to conventional cardiovascular risk factors and cardiovascular risk assessed by SCORE system. Material and methods. A total of 209 subjects aged 40–65 years without clinically overt cardiovascular disease were examined. Parameters of arterial stiffness were obtained by two methods: augmentation index and carotid-radial pulse wave velocity by applanation tonometry and stiffness index by the means of finger photoplethysmography. Flow-mediated dilatation of the brachial artery, reflecting endothelial function, and carotid intima-media thickness was determined using a high-resolution B-mode ultrasonography. Results. Age and the presence of diabetes strongly influenced all parameters of the arterial wall (diabetes was not independent predictor when evaluating augmentation index). Mean arterial pressure and gender were independent predictors for arterial stiffness parameters – carotid-radial pulse wave velocity and augmentation index. Flow-mediated dilatation was strongly dependent on the diameter of the brachial artery, age, and body mass index. Using logistic regression, it was found that pulse wave velocity (P=0.014), intima-media thickness (P=0.004), and flow-mediated dilatation (P=0.020) were important parameters dividing subjects to the groups of increased (³5%) and low (<5%) cardiovascular risk assessed by SCORE system. The cutoff values for intima-media thickness and pulse wave velocity were 0.078 cm and 8.95 m/s, respectively. Conclusions. Arterial wall parameters are closely associated with conventional risk factors; they are influenced by age and the presence of diabetes. Arterial stiffness parameters are also influenced by mean arterial pressure; high-density lipoprotein cholesterol has influence on carotid intima-media thickness. Cutoff values for carotid intima-media thickness and carotid-radial pulse wave velocity could help to discriminate patients with increased cardiovascular risk.

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4 Day in dry immersion reproduces partially the aging effect on the arteries as observed during 6 month spaceflight or confinement

npj Microgravity ◽

10.1038/s41526-021-00172-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Danielle Greaves ◽

Laurent Guillon ◽

Stephane Besnard ◽

Nastassia Navasiolava ◽

Philippe Arbeille

Keyword(s):

Arterial Wall ◽

Natural Aging ◽

Aging Effect ◽

Intima Media Thickness ◽

Arterial Tree ◽

Dry Immersion ◽

Arterial Aging ◽

Ventricle Volume ◽

Carotid Distensibility ◽

The Impact

AbstractThe objectives of this study were to determine whether 4 days of dry immersion (DI) induced similar arterial aging as spaceflight and to test the impact of thigh cuffs. Eighteen subjects underwent DI; nine wore thigh cuffs. Cardiac and arterial targets were assessed by ultrasound. No significant differences were found between the groups. The left ventricle volume, stroke volume (SV), and ejection fraction decreased with DI (p < 0.001). Carotid distensibility reduced (p < 0.05), carotid to femoral arterial tree became stiffer in 33% of the subjects, and femoral artery intima media thickness increased (p < 0.05). A reduction in plasma volume is likely to have caused the observed cardiac changes, whereas the arterial wall changes are probably best explained by hypokinesia and/or environmental stress. These changes are similar but lower in amplitude than those observed in spaceflight and mimic the natural aging effect on earth. The daytime-worn thigh cuffs had no acute or chronic impact on these arterial-focused measurements.

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Mitochondria-targeted antioxidant therapy with MitoQ ameliorates aortic stiffening in old mice

Journal of Applied Physiology ◽

10.1152/japplphysiol.00670.2017 ◽

2018 ◽

Vol 124 (5) ◽

pp. 1194-1202 ◽

Cited By ~ 38

Author(s):

Rachel A. Gioscia-Ryan ◽

Micah L. Battson ◽

Lauren M. Cuevas ◽

Jason S. Eng ◽

Michael P. Murphy ◽

...

Keyword(s):

Pulse Wave Velocity ◽

Wave Velocity ◽

Aortic Stiffness ◽

Pulse Wave ◽

Therapeutic Strategies ◽

Elastin Degradation ◽

Age Related ◽

Clinical Disorders ◽

Aortic Stiffening ◽

Old Mice

Aortic stiffening is a major independent risk factor for cardiovascular diseases, cognitive dysfunction, and other chronic disorders of aging. Mitochondria-derived reactive oxygen species are a key source of arterial oxidative stress, which may contribute to arterial stiffening by promoting adverse structural changes—including collagen overabundance and elastin degradation—and enhancing inflammation, but the potential for mitochondria-targeted therapeutic strategies to ameliorate aortic stiffening with primary aging is unknown. We assessed aortic stiffness [pulse-wave velocity (aPWV)], ex vivo aortic intrinsic mechanical properties [elastic modulus (EM) of collagen and elastin regions], and aortic protein expression in young (~6 mo) and old (~27 mo) male C57BL/6 mice consuming normal drinking water (YC and OC) or water containing mitochondria-targeted antioxidant MitoQ (250 µM; YMQ and OMQ) for 4 wk. Both baseline and postintervention aPWV values were higher in OC vs. YC (post: 482 ± 21 vs. 420 ± 5 cm/s, P < 0.05). MitoQ had no effect in young mice but decreased aPWV in old mice (OMQ, 426 ± 20, P < 0.05 vs. OC). MitoQ did not affect age-associated increases in aortic collagen-region EM, collagen expression, or proinflammatory cytokine expression, but partially attenuated age-associated decreases in elastin region EM and elastin expression. Our results demonstrate that MitoQ reverses in vivo aortic stiffness in old mice and suggest that mitochondria-targeted antioxidants may represent a novel, promising therapeutic strategy for decreasing aortic stiffness with primary aging and, possibly, age-related clinical disorders in humans. The destiffening effects of MitoQ treatment may be at least partially mediated by attenuation/reversal of age-related aortic elastin degradation. NEW & NOTEWORTHY We show that 4 wk of treatment with the mitochondria-specific antioxidant MitoQ in mice completely reverses the age-associated elevation in aortic stiffness, assessed as aortic pulse-wave velocity. The destiffening effects of MitoQ treatment may be at least partially mediated by attenuation of age-related aortic elastin degradation. Our results suggest that mitochondria-targeted therapeutic strategies may hold promise for decreasing arterial stiffening with aging in humans, possibly decreasing the risk of many chronic age-related clinical disorders.

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Cardiovascular Risk Assessment Using Ultrasonographic Surrogate Markers of Atherosclerosis and Arterial Stiffness in Patients With Chronic Renal Impairment: A Narrative Review of the Evidence and a Critical View of Their Utility in Clinical Practice

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120954939 ◽

2020 ◽

Vol 7 ◽

pp. 205435812095493

Author(s):

Andreas Kousios ◽

Panayiotis Kouis ◽

Alexandros Hadjivasilis ◽

Andrie Panayiotou

Keyword(s):

Risk Assessment ◽

Cardiovascular Risk ◽

Risk Stratification ◽

Pulse Wave ◽

Management Strategies ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Routine Practice ◽

Surrogate Markers

Purpose of the review: Validated tools to improve cardiovascular disease (CVD) risk assessment and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are lacking. Noninvasive measures of arteriosclerosis and subclinical atherosclerosis such as pulse wave velocity (PWV) and carotid intima-media thickness (cIMT), respectively, have emerged as promising risk stratification tools and potential modifiable biomarkers. Their wide use as surrogate markers in clinical research studies is based on the strong pathophysiological links with CVD. However, whether their effect as risk stratification or intervention targets is superior to established clinical approaches is uncertain. In this review, we examine the evidence on the utility of PWV, cIMT, and plaque assessment in routine practice and highlight unanswered questions from the clinician’s perspective. Sources of information: Electronic databases PubMed and Google Scholar were searched until February 2020. Methods: This narrative review is based on peer-reviewed meta-analyses, national and international societies’ guidelines, and on focused critical review of recent original studies and landmark studies in the field. Key findings: Although patients with CKD are considered in the high-risk CVD groups, there is still need for tools to improve risk stratification and individualized management strategies within this group of patients. Carotid intima-media thickness is associated with all-cause mortality, CVD mortality, and events in CKD and hemodialysis cohorts. However, the evidence that measurement of cIMT has a clinically meaningful role over and above existing risk scores and management strategies is limited. Plaque assessment is a better predictor than cIMT in non-CKD populations and it has been incorporated in recent nonrenal-specific guidelines. In the CKD population, one large observational study provided evidence for a potential role of plaque assessment in CKD similar to the non-CKD studies; however, whether it improves prediction and outcomes in CKD is largely understudied. Pulse wave velocity as a marker of arterial stiffness has a strong pathophysiological link with CVD in CKD and numerous observational studies demonstrated associations with increased cardiovascular risk. However, PWV did not improve CVD reclassification of dialysis patients when added to common risk factors in a reanalysis of ESRD cohorts with available PWV data. Therapeutic strategies to regress PWV, independently from blood pressure reduction, have not been studied in well-conducted randomized trials. Limitations: This study provides a comprehensive review based on extensive literature search and critical appraisal of included studies. Nevertheless, formal systematic literature review and quality assessment were not performed and the possibility of selection bias cannot be excluded. Implications: Larger, prospective, randomized studies with homogeneous approach, designed to answer specific clinical questions and taking into consideration special characteristics of CKD and dialysis, are needed to study the potentially beneficial role of cIMT/plaque assessment and PWV in routine practice.

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Increased arterial stiffening and thickening in the paretic lower limb in patients with hemiparesis

Clinical Science ◽

10.1042/cs20030387 ◽

2004 ◽

Vol 106 (6) ◽

pp. 613-618 ◽

Cited By ~ 15

Author(s):

Reiko OKABE ◽

Masaaki INABA ◽

Shinrei SAKAI ◽

Eiji ISHIMURA ◽

Atsushi MORIGUCHI ◽

...

Keyword(s):

Muscle Mass ◽

Lower Limb ◽

Mineral Content ◽

Arterial Wall ◽

Pulse Wave ◽

Intima Media Thickness ◽

Lower Limbs ◽

Arterial Stiffening ◽

X Ray ◽

Paretic Side

Atherosclerosis has two key components, thickening and stiffening of arterial wall. These parameters are quantified ultrasonographically by IMT (intima-media thickness) and PWV (pulse wave velocity). In the present study, we determined the FA IMT (IMT of the bilateral femoral artery) and PWV of femoral–ankle (PWV fa) and brachial–ankle (PWV ba) segments in order to examine whether the degree of atherosclerosis is different between paretic and non-paretic lower limbs in 24 patients with hemiparesis. The values of PWV fa, PWV ba and FA IMT were all significantly greater on the paretic than the non-paretic side. Furthermore, significant decreases in masses of muscle, bone and fat, determined by dual-energy X-ray absorptiometry, were observed in paretic lower limbs compared with the non-paretic side. PWV fa correlated significantly and negatively with muscle mass (r=-0.488, P=0.0004) and tended to correlate negatively with BMC (bone mineral content; r=-0.264, P=0.069) when statistical analyses were performed with the paretic and non-paretic sides together. Multiple regression analysis elucidated that the muscle mass was associated significantly with PWV fa and PWV ba, independent of age, duration after cerebrovascular accident, gender, bone and fat mass and FA IMT. The muscle mass was still associated with increased PWV fa and PWV ba when multivariate analysis was conducted independently in the paretic and non-paretic sides. In summary, our results indicated that arterial thickening and stiffening were greater on the paretic than the non-paretic side and suggested that a decrease of muscle mass might be associated with increased arterial stiffening in the paretic lower limb.

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Beneficial Effect of Statin Therapy on Arterial Stiffness

BioMed Research International ◽

10.1155/2021/5548310 ◽

2021 ◽

Vol 2021 ◽

pp. 1-19

Author(s):

Mona Alidadi ◽

Fabrizio Montecucco ◽

Tannaz Jamialahmadi ◽

Khalid Al-Rasadi ◽

Thomas P. Johnston ◽

...

Keyword(s):

Cardiovascular Disease ◽

Arterial Stiffness ◽

Statin Therapy ◽

Arterial Wall ◽

Pulse Wave ◽

Lipid Lowering ◽

Biological Aging ◽

Arterial Elasticity ◽

Myocardial Remodeling ◽

Cardiovascular Morbidity And Mortality

Arterial stiffness describes the increased rigidity of the arterial wall that occurs as a consequence of biological aging and several diseases. Numerous studies have demonstrated that parameters to assess arterial stiffness, especially pulse-wave velocity, are predictive of those individuals that will suffer cardiovascular morbidity and mortality. Statin therapy may be a pharmacological strategy to improve arterial elasticity. It has been shown that the positive benefits of statin therapy on cardiovascular disease is attributable not only to their lipid-lowering capacity but also to various pleiotropic effects, such as their anti-inflammatory, antiproliferative, antioxidant, and antithrombotic properties. Additionally, statins reduce endothelial dysfunction, improve vascular and myocardial remodeling, and stabilize atherosclerotic plaque. The aim of the present review was to summarize the evidence from human studies showing the effects of statins on arterial stiffness.

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