Arterial stiffness and stroke: de-stiffening strategy, a therapeutic target for stroke

Abstract

Stroke is the second leading cause of mortality and morbidity worldwide. Early intervention is of great importance in reducing disease burden. Since the conventional risk factors cannot fully account for the pathogenesis of stroke, it is extremely important to detect useful biomarkers of the vascular disorder for appropriate intervention. Arterial stiffness, a newly recognised reliable feature of arterial structure and function, is demonstrated to be associated with stroke onset and serve as an independent predictor of stroke incidence and poststroke functional outcomes. In this review article, different measurements of arterial stiffness, especially pressure wave velocity, were discussed. We explained the association between arterial stiffness and stroke occurrence by discussing the secondary haemodynamic changes. We reviewed clinical data that support the prediction role of arterial stiffness on stroke. Despite the lack of long-term randomised double-blind controlled therapeutic trials, it is high potential to reduce stroke prevalence through a significant reduction of arterial stiffness (which is called de-stiffening therapy). Pharmacological interventions or lifestyle modification that can influence blood pressure, arterial function or structure in either the short or long term are promising de-stiffening therapies. Here, we summarised different de-stiffening strategies including antihypertension drugs, antihyperlipidaemic agents, chemicals that target arterial remodelling and exercise training. Large and well-designed clinical trials on de-stiffening strategy are needed to testify the prevention effect for stroke. Novel techniques such as modern microscopic imaging and reliable animal models would facilitate the mechanistic analyses in pathophysiology, pharmacology and therapeutics.

Terminal end Variations and Common Pathological Abnormalities of the Basilar Artery among the Ugandan Population: a Human Autopsy Study

“…Multiple branching patterns of the terminal end of the basilar artery tend to alter the hemodynamics resulting in arterial remodeling secondary to hypertension; this in turn increases arterial rigidity, plaque depositions and atherosclerosis limiting brain perfusion. 21 Atheroma plaques were observed in 16 cases (14%) within the age range of 38-85 years from the current study. Those formed at the formation and termination ends were frequent among age groups of 38-50 and those that spread entirely across the arteries were among individuals with 50 and above years This could imply that atheroma plaques are most likely to commence at the basilar termination and formation points but spread as the person ages.…”

Evaluation of Arterial Stiffness in Patients with Bronchial Asthma and Co-Existent Chronic Obstructive Pulmonary Disease

“…Thus, in previous studies, there was found a relation between PWV and stroke development in hypertension. The increase in PWV by 1 m/s increased all-cause and cardiovascular mortality by 15% [11,13,35].…”

“…Increased vascular stiffness being one of the markers of subclinical atherosclerosis is associated with the development of cardiovascular complications (myocardial infarction, stroke, HF, kidney disease, and high rates of overall mortality) [8][9][10][11].…”

Potential Role of Antihypertensive Medications in Preventing Excessive Arterial Stiffening

“…These beneficial effects on arterial stiffness are independent of blood pressure lowering effects [52]. These findings suggest that reversibility of arterial stiffness by blood pressure independent effects may also be attributable to local remodeling effects of these drugs on large artery stiffening [62]. A combination of ACE inhibitors and AT-1R antagonists caused significant decrease in PWV in chronic kidney patients [63].…”