Overlooked Factors Affecting Arterial Stiffness Beyond Simple Renal Cyst Which Is the New Cardiovascular Risk Predictor

Abstract

Nishibe et al. 1 proposed that simple renal cysts (SRC) were present in the majority of patients with abdominal aortic aneurysm (AAA). Also, the presence of SRC was an independent predictor of increased arterial stiffness like with increased age and hypertension. 1 Parameters of hypertension and high systolic blood pressure (>140 mmHg) were both included in the multivariable regression analysis. 1 As the two parameters are correlated and converge with each other, it could have been better to include only one of them in the regression model.Atrial fibrillation (AF) is the most common chronic arrhythmia and its prevalence increases with age. 2 Although it was reported that non-invasive measurement of arterial stiffness is reliable in patients with AF, it was demonstrated that pulse wave velocity reduced after cardioversion due to the decreased mean arterial pressure. 3 Mean arterial pressure may change beat to beat in AF, and therefore it may affect the results of arterial stiffness measurement. 4 As the study population is older and with a high burden of comorbidities, there must be a proportion of cases with AF. It would be useful to document if patients with AF were excluded or not.There is emerging evidence about the favorable effects of renin-angiotensin system (RAS) blockers on arterial stiffness. 5 Vasodilatory and anti-inflammatory properties of RAS blockers are the main mechanisms of reversing arterial stiffness. 5 Novel anti-diabetic agents like DPP-4 (dipeptidyl peptidase-4) inhibitors, GLP-1 (glucagon-like peptide-1) receptor agonists, and SGLT-2 (sodium-glucose cotransporter 2) inhibitors have favorable effects on arterial stiffness. 6,7 In the Nishibe et al. 1 study, the use of RAS blockers and oral antidiabetic agents was not assessed. These parameters might have influenced the results.