Arterial stiffness: A clinical index or a research tool?

Arterial stiffness: A clinical index or a research tool?Cardiovascular risk reduction and treatment of cardiovascular pathophysiology is essential for the management of subjects with multiple risk factors, impairment of vascular or hemodynamic physiology, or even overt cardiovascular disease (cardiomyopathy, atherosclerosis, peripheral arterial disease, stroke, or arterial hypertension) [1e3].(see Table 1)Arteriosclerosis is a disease caused primary by functional and structural changes in the media and is responsible for arterial stiffening, mainly of the large arteries [4e6].Although similar risk factors [7e9] affect both atherosclerosis (a disease of the intima) and arteriosclerosis, the two entities are distinct and should not be used interchangeably [10] (Fig. 1).The physiological event with most relevance is the stiffness of the aorta, and it is largely determined by the aortic structure, especially that of the tunica media, which contains the elastic components of the aortic wall (elastin fibers and collagen).A less distensible aorta cannot efficiently accommodate the blood volume ejected by the left ventricle, which results in high systolic pressure and decreased diastolic pressure.These pathophysiological changes may impair diastolic flow in the coronary arteries, thereby causing ischemia, especially in the hypertrophic myocardium.Importantly, arterial stiffening can be used as an excellent predictive tool with additive value in the general population [11], subjects with hypertension [12], subjects with diabetes mellitus [13], subjects with renal disease [14], etc., reclassifying intermediate-risk subjects in low-or high-risk categories.Moreover, several studies have shown that modification and treatment