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Arterial stiffness and wave reflection: Biomarkers of cardiovascular risk
Artery Research volume 3, pages 56–64 (2009)
Summary
Arterial stiffness and excessive pressure pulsatility have emerged as important risk factors for cardiovascular disease. Arterial stiffness increases with age and in the presence of traditional cardiovascular disease risk factors, such as hypertension, diabetes and lipid disorders. Pathologic stiffening of large arteries with advancing age and risk factor exposure predominantly involves the elastic aorta and carotid arteries, whereas stiffness changes are relatively limited in muscular arteries. Aortic stiffening is associated with increased pulse wave velocity and pulse pressure, which are related but distinct measures of the pulsatile energy content of the pressure waveform. A dramatic increase in pulsatile energy content of pressure and flow waves in the arterial system places considerable pulsatile stress on the heart, large arteries and distal circulation. Large artery stiffening is associated with abnormalities in microvascular structure and function that may contribute to tissue damage, particularly in susceptible high flow organs such as the brain and kidneys. This brief review summarizes results of recent research on risk factors for and adverse effects of large artery stiffening.
References
Chae CU, Pfeffer MA, Glynn RJ, Mitchell GF, Taylor JO, Hennekens CH. Increased pulse pressure and risk of heart failure in the elderly. JAMA 1999;281:634–9.
Domanski MJ, Davis BR, Pfeffer MA, Kastantin M, Mitchell GF. Isolated systolic hypertension: prognostic information provided by pulse pressure. Hypertension 1999;34:375–80.
Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham Heart Study. Circulation 1999;100:354–60.
Mitchell GF, Moye LA, Braunwald E, Rouleau JL, Bernstein V, Geltman EM, et al. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and Ventricular Enlargement. Circulation 1997;96:4254–60.
Domanski M, Mitchell G, Pfeffer M, Neaton JD, Norman J, Svendsen K, et al. Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 2002;287:2677–83.
Mitchell GF, Vasan RS, Keyes MJ, Parise H, Wang TJ, Larson MG, et al. Pulse pressure and risk of new-onset atrial fibrillation. JAMA 2007;297:709–15.
Mitchell GF, Vita JA, Larson MG, Parise H, Keyes MJ, Warner E, et al. Cross-sectional relations of peripheral microvascular function, cardiovascular disease risk factors, and aortic stiffness: the Framingham Heart Study. Circulation 2005;112:3722–8.
Franklin SS, Jacobs MJ, Wong ND, L’Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. . Hypertension 2001;37:869–74.
Franklin SS, Pio JR, Wong ND, Larson MG, Leip EP, Vasan RS, et al. Predictors of new-onset diastolic and systolic hypertension: the Framingham Heart Study. Circulation 2005;111: 1121–7.
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588–605.
Mitchell GF, Pfeffer MA, Finn PV, Pfeffer JM. Equipotent anti-hypertensive agents variously affect pulsatile hemodynamics and regression of cardiac hypertrophy in spontaneously hypertensive rats. Circulation 1996;94:2923–9.
Mitchell GF, Lacourciere Y, Ouellet JP, Izzo Jr JL, Neutel J, Kerwin LJ, et al. Determinants of elevated pulse pressure in middle-aged and older subjects with uncomplicated systolic hypertension: the role of proximal aortic diameter and the aortic pressure-flow relationship. Circulation 2003;108: 1592–8.
O’Rourke MF, Nichols WW. Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension 2005;45:652–8.
Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framing-ham Heart Study. Hypertension 2004;43:1239–45.
McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft JR. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol 2005;46: 1753–60.
Mitchell GF, Guo CY, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Cross-sectional correlates of increased aortic stiffness in the community: the Framingham Heart Study. Circulation 2007;115:2628–36.
Segers P, Rietzschel ER, De Buyzere ML, Vermeersch SJ, De Bacquer D, Van Bortel LM, et al. Noninvasive (input) impedance, pulse wave velocity, and wave reflection in healthy middle-aged men and women. Hypertension 2007;49:1248–55.
Mitchell GF, Gudnason V, Launer LJ, Aspelund T, Harris TB. Hemodynamics of increased pulse pressure in older women in the community-based Age, Gene/Environment Susceptibility-Reykjavik Study. Hypertension 2008;51:1123–8.
Mitchell GF, Conlin PR, Dunlap ME, Lacourciere Y, Arnold JM, Ogilvie RI, et al. Aortic diameter, wall stiffness, and wave reflection in systolic hypertension. Hypertension 2008;51: 105–11.
Dart AM, Kingwell BA, Gatzka CD, Willson K, Liang YL, Berry KL, et al. Smaller aortic dimensions do not fully account for the greater pulse pressure in elderly female hypertensives. Hypertension 2008;51:1129–34.
Farasat SM, Morrell CH, Scuteri A, Ting CT, Yin FC, Spurgeon HA, et al. Pulse pressure is inversely related to aortic root diameter implications for the pathogenesis of systolic hypertension. Hypertension 2008;51:196–202.
Peterson LH. The dynamics of pulsatile blood flow. Circ Res 1954;2:127–39.
Ben Driss A, Benessiano J, Poitevin P, Levy BI, Michel JB. Arterial expansive remodeling induced by high flow rates. Am J Physiol 1997;272:H851–8.
Xu C, Lee S, Shu C, Masuda H, Zarins CK. Expression of TGF-beta1 and beta3 but not apoptosis factors relates to flow-induced aortic enlargement. BMC Cardiovasc Disord 2002;2:11.
Nagashima J, Musha H, Takada H, Murayama M. New upper limit of physiologic cardiac hypertrophy in Japanese participants in the 100-km ultramarathon. J Am Coll Cardiol 2003;42: 1617–23.
Mitchell GF. Impedance progress: aortic diameter rears its head again? Hypertension 2007;49:1207–9.
Agmon Y, Khandheria BK, Meissner I, Schwartz GL, Sicks JD, Fought AJ, et al. Is aortic dilatation an atherosclerosis-related process? Clinical, laboratory, and transesophageal echocar-diographic correlates of thoracic aortic dimensions in the population with implications for thoracic aortic aneurysm formation. J Am Coll Cardiol 2003;42:1076–83.
Launer LJ, Masaki K, Petrovitch H, Foley D, Havlik RJ. The association between midlife blood pressure levels and late-life cognitive function. The Honolulu–Asia Aging Study. JAMA 1995;274:1846–51.
Launer LJ, Ross GW, Petrovitch H, Masaki K, Foley D, White LR, et al. Midlife blood pressure and dementia: the Honolulu–Asia aging study. Neurobiol Aging 2000;21:49–55.
Kivipelto M, Helkala EL, Laakso MP, Hanninen T, Hallikainen M, Alhainen K, et al. Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease. Ann Intern Med 2002;137:149–55.
Liao D, Cooper L, Cai J, Toole J, Bryan N, Burke G, et al. The prevalence and severity of white matter lesions, their relationship with age, ethnicity, gender, and cardiovascular disease risk factors: the ARIC Study. Neuroepidemiology 1997;16:149–62.
Duprez DA, De Buyzere ML, Van den Noortgate N, Simoens J, Achten E, Clement DL, et al. Relationship between peri-ventricular or deep white matter lesions and arterial elasticity indices in very old people. Age Ageing 2001;30: 325–30.
Klein R, Klein BE, Tomany SC, Cruickshanks KJ. The association of cardiovascular disease with the long-term incidence of age-related maculopathy: the Beaver Dam eye study. Ophthalmology 2003;110:636–43.
Safar ME, London GM, Plante GE. Arterial stiffness and kidney function. Hypertension 2004;43:163–8.
Mitchell GF. Increased aortic stiffness: an unfavorable car-diorenal connection. Hypertension 2004;43:151–3.
Levy BI, Ambrosio G, Pries AR, Struijker-Boudier HA. Microcir-culation in hypertension: a new target for treatment? Circulation 2001;104:735–40.
Baron AD, Brechtel-Hook G, Johnson A, Hardin D. Skeletal muscle blood flow. A possible link between insulin resistance and blood pressure. Hypertension 1993;21:129–35.
Bonadonna RC, Saccomani MP, Del Prato S, Bonora E, DeFronzo RA, Cobelli C. Role of tissue-specific blood flow and tissue recruitment in insulin-mediated glucose uptake of human skeletal muscle. Circulation 1998;98:234–41.
Serne EH, Stehouwer CD, ter Maaten JC, ter Wee PM, Rauwerda JA, Donker AJ, et al. Microvascular function relates to insulin sensitivity and blood pressure in normal subjects. Circulation 1999;99:896–902.
Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol 2008;105:1652–60.
Baumbach GL, Siems JE, Heistad DD. Effects of local reduction in pressure on distensibility and composition of cerebral arte-rioles. Circ Res 1991;68:338–51.
Loutzenhiser R, Bidani A, Chilton L. Renal myogenic response: kinetic attributes and physiological role. Circ Res 2002;90: 1316–24.
Gokce N, Duffy SJ, Hunter LM, Keaney JF, Vita JA. Acute hypertriglyceridemia is associated with peripheral vasodilation and increased basal flow in healthy young adults. Am J Cardiol 2001;88:153–9.
Polak K, Schmetterer L, Luksch A, Gruber S, Polska E, Peternell V, et al. Free fatty acids/triglycerides increase ocular and subcutaneous blood flow. Am J Physiol Regul Integr Comp Physiol 2001;280:R56–61.
Raitakari OT, Lai N, Griffiths K, McCredie R, Sullivan D, Celermajer DS. Enhanced peripheral vasodilation in humans after a fatty meal. J Am Coll Cardiol 2000;36:417–22.
Heeschen C, Jang JJ, Weis M, Pathak A, Kaji S, Hu RS, et al. Nicotine stimulates angiogenesis and promotes tumor growth and atherosclerosis. Nat Med 2001;7:833–9.
Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 2002;39:10–5.
Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37:1236–41.
Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B, et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003;34: 1203–6.
Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006;113:657–63.
Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, et al. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005;111: 3384–90.
Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006;113:664–70.
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007;14 (Suppl. 2):S1–113.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007;25:1751–62.
Agabiti-Rosei E, Mancia G, O’Rourke MF, Roman MJ, Safar ME, Smulyan H, et al. Central blood pressure measurements and antihypertensive therapy: a consensus document. Hypertension 2007;50:154–60.
Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension 2007;50:197–203.
Kelly R, Daley J, Avolio A, O’Rourke M. Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension. Hypertension 1989;14:14–21.
Kelly RP, Gibbs HH, O’Rourke MF, Daley JE, Mang K, Morgan JJ, et al. Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery. Eur Heart J 1990;11:138–44.
Vyas M, Izzo Jr JL, Lacourciere Y, Arnold JM, Dunlap ME, Amato JL, et al. Augmentation index and central aortic stiffness in middle-aged to elderly individuals. Am J Hypertens 2007;20:642–7.
Schnabel R, Larson MG, Dupuis J, Lunetta KL, Lipinska I, Meigs JB, et al. Relations of inflammatory biomarkers and common genetic variants with arterial stiffness and wave reflection. Hypertension 2008;51:1651–7.
Farrar DJ, Bond MG, Riley WA, Sawyer JK. Anatomic correlates of aortic pulse wave velocity and carotid artery elasticity during atherosclerosis progression and regression in monkeys. Circulation 1991;83:1754–63.
Mitchell GF, Izzo Jr JL, Lacourciere Y, Ouellet JP, Neutel J, Qian C, et al. Omapatrilat reduces pulse pressure and proximal aortic stiffness in patients with systolic hypertension: results of the conduit hemodynamics of omapatrilat international research study. Circulation 2002;105:2955–61.
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Mitchell, G.F. Arterial stiffness and wave reflection: Biomarkers of cardiovascular risk. Artery Res 3, 56–64 (2009). https://doi.org/10.1016/j.artres.2009.02.002
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DOI: https://doi.org/10.1016/j.artres.2009.02.002