Large Artery Stiffness: A Companion to the 2015 AHA Science Statement on Arterial Stiffness

Abstract

Large artery stiffness (LAS) has proven to be an independent risk factor for cardiovascular disease and mortality. Nevertheless, the position of current hypertension guidelines regarding the usefulness of assessing LAS differs across different continents. In general, European Guidelines recognize pulse wave velocity (PWV) as a marker of target organ damage but do not recommend its systematic use in general population. Asian guidelines consider PWV as a recommended test at diagnosis of hypertension, in contrast to North American guidelines that do not state any position about its usefulness. However, PWV predicts cardiovascular events, and several studies have shown that it improves risk classification adjusting for established risk factors especially for intermediate-risk patients. Finally, some advances have been made related to treatments affecting LAS. Dietary interventions such as sodium restriction and exercise-based interventions have a modest effect in reducing LAS. Pharmacological interventions, such as statins, or more recent advances with mineralocorticoid blocker seem to have a beneficial effect. Last, controversial effects of renal denervation on LAS have been found. Our goal here is to update the reader on LAS on these areas since the 2015 American Heart Association Scientific Statement.

Cellular Senescence Contributes to Large Elastic Artery Stiffening and Endothelial Dysfunction With Aging: Amelioration With Senolytic Treatment

“…Stiffening of the aorta occurs with advancing age, as indicated by an increase in aortic PWV, 55 and is a major independent risk factor for age-associated CV events, clinical CVD, 56 kidney dysfunction, 57 and cognitive impairment. 58 It is important to understand the mechanism(s) mediating arterial stiffening with aging, as these mechanism(s) could serve as viable therapeutic targets for treatments.…”

The Prolonged Effect of Shift Work and the Impact of Reducing the Number of Nightshifts on Arterial Stiffness—A 4-Year Follow-Up Study

“…Studies suggest, on a general basis, that arterial stiffness could be mitigated by sodium restriction, exercise-based intervention, weight reduction, smoking cessation, and BP and statin treatment [ 10 , 11 , 13 ]. At baseline in the present cohort-study, self-reported PA, with a high degree of intensity, was associated with lower values of PWV [ 15 ].…”

“…Arterial stiffness is regarded as one of the earliest manifestations of vascular damage [ 10 , 11 ], and represents a cause of hypertension [ 12 ], as well as coronary heart disease, stroke and other cardiovascular events and is linked to high levels of pulse wave velocity (PWV) [ 13 ].…”

Expert Consensus on the Clinical Use of Pulse Wave Velocity in Asia

“…Although its impact on outcomes has been widely studied and suggested as a clinical aid for primary and secondary CV prevention [ 6 ], there are still large hurdles in applying the concept of PWV in clinical use. Hypertension guidelines pay minimal attention to the clinical use of PWV and with many methods available there is no standard method for measuring PWV [ 7 , 8 ]. Currently, the main tool of measuring vascular aging is PWV, but there are differences in measurement methods.…”