Current Cardiovascular Risk Reports

, Volume 5, Issue 2, pp 187–195 | Cite as

The Global Burden of Cardiovascular Disease: The Role of Endothelial Function and Arterial Elasticity in Cardiovascular Disease as Novel and Emerging Biomarkers

Article

Abstract

Some consider the measurements of arterial elasticity and flow-mediated dilation to be an indirect “biomarker” of endothelial dysfunction. As such, we describe the various uses of these techniques in the evaluation of the natural history of vascular disease. These measures are potential markers of disease, as abnormalities reflect changes in the integrity of vascular structure but occur prior to the manifestation of symptomatic cardiovascular events. In this review, the natural history of arterial elasticity is discussed, and the effects of aging and inflammation are reviewed. The role that arterial elasticity and flow-mediated dilation have in predicting future cardiovascular disease, and the effects of pharmacologic agents on these measures, is also reviewed.

Keywords

Arterial elasticity Arterial stiffness Flow-mediated dilation 

Notes

Disclosure

Stephen P. Glasser reports no potential conflict of interest relevant to this article. Tanja Dudenbostel reports no potential conflict of interest relevant to this article.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Lee R, Kamm R., Vascular mechanics for the cardiologist. J Am Coll Cardiol, 1994. 23(6): p. 1289–95.PubMedCrossRefGoogle Scholar
  2. 2.
    Zimlichman R, Boaz M, Duprez D, et al., The Seven European Sites Study of Arterial Elasticity - Using the Blood Pressure Wave Form Analysis - Reliability, Repeatability and Establishment of Normal Values for Healthy European Population with Comparison to Healthy U.S. Population. American Journal of Hypertension, 2003. 16(No. 5, Part 2): p. P315.Google Scholar
  3. 3.
    Arnett DK, Glasser SP, McVeigh G, et al., Blood pressure and arterial compliance in young adults: the Minnesota Children’s Blood Pressure Study. Am J Hypertens, 2001. 14(3): p. 200–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Bhuiyan AR, Li S, Li H, et al., Distribution and correlates of arterial compliance measures in asymptomatic young adults: the Bogalusa Heart Study. Am J Hypertens, 2005. 18(5 Pt 1): p. 684–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Valappil NI, Jacobs DR, Gross MD, et al., Correlates of Arterial Compliance in Young Adults: The CARDIA Study. The Journal of Clinical Hypertension Supplement, 2007. 9(5): p. A10.Google Scholar
  6. 6.
    Glasser SP, Arnett DK, McVeigh GE, et al., Vascular compliance and cardiovascular disease: a risk factor or a marker? Am J Hypertens, 1997. 10(10 Pt 1): p. 1175–89.PubMedCrossRefGoogle Scholar
  7. 7.
    Liao D, Arnett DK, Herman A, et al., Arterial stiffness and the development of hypertension. The ARIC study. Hypertension, 1999. 34(2): p. 201–6.PubMedGoogle Scholar
  8. 8.
    Julius S, Nesbitt SD, Egan BM, et al., Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med, 2006. 354(16): p. 1685–97.PubMedCrossRefGoogle Scholar
  9. 9.
    Glasser, S.P., On Arterial Physiology, Pathophysiology of Vascular Compliance, and Cardiovascular Disease. Heart Disease, 2000. 2: p. 375–379.PubMedGoogle Scholar
  10. 10.
    Cohn, J.N., Vascular wall function as a risk marker for cardiovascular disease. J Hypertens Suppl, 1999. 17(5): p. S41–4.PubMedGoogle Scholar
  11. 11.
    •• Najjar SS, Scuteri A, Shetty V, et al., Pulse Wave Velocity is an Independent Predictor of the Longitudinal Increase in Systolic Glood Pressure and of Incident Hypertension in the Baltimore Longitudinal Study of Aging. J Am Coll Cardiol, 2008. 51: p. 1377–1383. This article presents evidence that links many biochemical, enzymatic, and cellular alterations, as well as their modulating signals, to accelerated vascular aging and the pathogenesis and progression of arterial diseases.PubMedCrossRefGoogle Scholar
  12. 12.
    McVeigh GE, Bratteli CW, Morgan DJ, et al., Age-related abnormalities in arterial compliance identified by pressure pulse contour analysis: aging and arterial compliance. Hypertension, 1999. 33(6): p. 1392–8.PubMedGoogle Scholar
  13. 13.
    Gilani M, Alinder C, Kaiser D, et al., Differences in Large and Small Artery Response to Acute Inhibition of Nitric Oxide Synthase in Human Subjects. Am J Hypertens, 2000. 13(4 (part 2) Abstract No. B003).Google Scholar
  14. 14.
    McVeigh GE, Allen PB, Morgan DR, et al., Nitric oxide modulation of blood vessel tone identified by arterial waveform analysis. Clin Sci (Lond), 2001. 100(4): p. 387–93.CrossRefGoogle Scholar
  15. 15.
    Weinberger MH, Fineberg NS, Weinberg M, et al., The Relationships Between Age, Gender and Blood Pressure and Vascular Compliance and Resistance in Normal and Hypertensive Humans. American Journal of Hypertension, 2001. 14(4 Part 2 Orals No. O16).Google Scholar
  16. 16.
    Takeuchi K, Zhang B, Ideishi M, et al., Influence of age and hypertension on the association between small artery compliance and coronary artery disease. Am J Hypertens, 2004. 17(12 Pt 1): p. 1188–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Duprez DA, Somasundaram PE, Sigurdsson G, et al., Relationship between C-reactive protein and arterial stiffness in an asymptomatic population. J Human Hypet, 2005. 19: p. 515–519.CrossRefGoogle Scholar
  18. 18.
    • Saijo Y, Utsugi M, Yoshioka E, et al., The relationship of gamma-glutamyltransferase to C-reactive protein and arterial stiffness. Nutr Metab Cardiovasc Dis, 2008. 18(3): p. 211–9. This article discusses the role of inflammatory markers and vascular disease.PubMedCrossRefGoogle Scholar
  19. 19.
    Mahmud A, Feely J, Arterial stiffness is related to systemic inflammation in essential hypertension. Hypertension, 2005. 46(5): p. 1118–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Kim JS, Kang TS, Kim JB, et al., Significant association of C-reactive protein with arterial stiffness in treated non-diabetic hypertensive patients. Atherosclerosis, 2007. 192(2): p. 401–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Booth AD, Wallace S, McEniery CM, et al., Inflammation and Arterial Stiffness in systemic Vasculitis A model of Vascular Inflammation. Arthritis & Rheumatism, 2004. 50: p. 581–588.CrossRefGoogle Scholar
  22. 22.
    Vlachopoulos C, Dima I, Aznaouridis K, et al., Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals. Circulation, 2005. 112(14): p. 2193–200.PubMedCrossRefGoogle Scholar
  23. 23.
    •• Tuttolomondo A, Di Raimondo D, Pecoraro R., et al, Immune-inflammatory markers and arterial stiffness indexes in subjects with acute ischemic stroke. Atherosclerosis, 2010. 213(1): p. 311–318. This is one of the first studies evaluating the relationship between arterial elasticity and immune inflammatory markers in acute cerebrovascular disease.PubMedCrossRefGoogle Scholar
  24. 24.
    •• Mitchell GF, Hwang S, Vasan RS, et al., Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation, 2010. 121(4): p. 505–11. This analysis of 2232 participants from the Framingham Heart Study focuses on aortic PVW as a potential novel biomarker of cardiovascular risk.PubMedCrossRefGoogle Scholar
  25. 25.
    Laurent S, Boutouyrie P, Asmar R, et al., Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension, 2001. 37(5): p. 1236–41.PubMedGoogle Scholar
  26. 26.
    Williams B, O’Rourke M, The Conduit Artery Functional Endpoint (CAFE) study in ASCOT. J Hum Hypertens, 2001. 15 Suppl 1: p. S69–73.PubMedGoogle Scholar
  27. 27.
    •• Duprez DA, Jacobs Jr DR, Lutseyl P, et al., Small Artery but not Large Artery Elasticity Coronary Heart Disease Events Beyond Coronary Calcium Score and Carotid Intima Media Thickness in an Asymptomatic Population, in ACC International Meeting. 2009. The potential value of techniques that differentiate smaller from larger vessel elasticity is suggested in this study.Google Scholar
  28. 28.
    Duprez DA, Jacobs Jr DR, Luseyl P, et al., Large and Small Artery elasticity, but not Coronary Calcium Score and Carotid Intima Media Thickness, Predict Incident Congestive Heart Failure Events in an Asymptomatic Population: Results of the Multi-Ethnic Study of Atherosclerosis, in Acc International Meeting. 2009.Google Scholar
  29. 29.
    Bhuiyan AR, Srinivasan SR, Chen W, et al., Correlates of vascular structure and function measures in asymptomatic young adults: the Bogalusa Heart Study. Atherosclerosis, 2006. 189(1): p. 1–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Cohn JN, Duprez DA, Grandits GA, Arterial elasticity as part of a comprehensive assessment of cardiovascular risk and drug treatment. Hypertension, 2005. 46(1): p. 217–20.PubMedCrossRefGoogle Scholar
  31. 31.
    •• Weiss SA, Blumenthal RS, Sharrett AR, et al., Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulation, 2010. 121(19): p. 2109–16. Vascular elasticity is a determinate of the BP response to exercise, and its ability to predict future CVD events in asymptomatic subjects is suggested by this study.PubMedCrossRefGoogle Scholar
  32. 32.
    Duprez D, DeBuyzere M, Van Den Noortgate N, et al., Relationship Between Periventricular or Deep White Matter Lesions and Arterial Elasticity Indices in Very Old People. Age and Ageing, 2001. 30: p. 325–330.PubMedCrossRefGoogle Scholar
  33. 33.
    Duprez D, DeBuyzere ML, DeBruyne L, et al., Small and Large Artery Elasticity Indices in Peripheral Arterial Occlusive Disease (PAOD). Vascular Medicine, 2001. 6: p. 211–214.PubMedCrossRefGoogle Scholar
  34. 34.
    Beltran A, McVeigh G, Morgan D, et al., Arterial compliance abnormalities in isolated systolic hypertension. Am J Hypertens, 2001. 14(10): p. 1007–11.PubMedCrossRefGoogle Scholar
  35. 35.
    Grey E, Bratteli C, Glasser SP, et al., Reduced small artery but not large artery elasticity is an independent risk marker for cardiovascular events. Am J Hypertens, 2003. 16(4): p. 265–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Glasser SP, Arnett DK, McVeigh GE, et al., The importance of arterial compliance in cardiovascular drug therapy. J Clin Pharmacol, 1998. 38(3): p. 202–12.PubMedGoogle Scholar
  37. 37.
    • Cohn JN, Goldman JM, Establishing a new option for target-organ protection: rationale for ARB plus ACE inhibitor combination therapy. Am J Hypertens, 2008. 21(3): p. 248–56. The fact that different drugs impact arterial elasticity differentially is emphasized in this study.PubMedCrossRefGoogle Scholar
  38. 38.
    Bratteli CW, Alinder CM, Cohn JN, Contrasting Arterial Compliance Effects of Enalapril and amlodipine in Normotensive Elderly Subjects. American Journal of Hypertension, 1999. 12(4 part 2 Abstract No B015).Google Scholar
  39. 39.
    Resnick LM, Lester MH, and Chesney CF, Differential Effects of Antihypertensive Drug Therapy on Arterial Compliance, in 15th Scientific Meeting of the American Society of Hypertension. 2000, American Journal of Hypertension. p. 20A.Google Scholar
  40. 40.
    Corretti MC, Anderson TJ, Benjamin EJ, et al., Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol, 2002. 39(2): p. 257–65.PubMedCrossRefGoogle Scholar
  41. 41.
    Celermajer DS, Sorensen KE, Gooch VM, et al., Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet, 1992. 340(8828): p. 1111–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Celermajer DS, Adams MR, Clarkson P, et al., Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adults. N Engl J Med, 1996. 334(3): p. 150–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Gokce N, Holbrook M, Duffy SJ, et al., Effects of race and hypertension on flow-mediated and nitroglycerin-mediated dilation of the brachial artery. Hypertension, 2001. 38(6): p. 1349–54.PubMedCrossRefGoogle Scholar
  44. 44.
    Koh KK, Han SH, Chung WJ, et al., Comparison of effects of losartan, irbesartan, and candesartan on flow-mediated brachial artery dilation and on inflammatory and thrombolytic markers in patients with systemic hypertension. Am J Cardiol, 2004. 93(11): p. 1432–5, A10.Google Scholar
  45. 45.
    Rajagopalan SR, Kariisa M, Dellegrottaglie S, et al., Angiotensin Receptor Blockade Imporves Vascular Compliance in Healthy Normotensive elderly Individuals: Results from a Randomized Double-Blind Placebo-Controlled Trial. The Journal of Clinical Hypertension, 2006. 8(11): p. 783–790.PubMedCrossRefGoogle Scholar
  46. 46.
    Yilmaz MI, Carrero JJ, Martin-Ventura JL, et al., Combined therapy with renin-angiotensin system and calcium channel blockers in type 2 diabetic hypertensive patients with proteinuria: effects on soluble TWEAK, PTX3, and flow-mediated dilation. Clin J Am Soc Nephrol, 2010. 5(7): p. 1174–81.PubMedCrossRefGoogle Scholar
  47. 47.
    Yilmaz MI, Axelsson J, Sonmez A, et al., Effect of renin angiotensin system blockade on pentraxin 3 levels in type-2 diabetic patients with proteinuria. Clin J Am Soc Nephrol, 2009. 4(3): p. 535–41.PubMedCrossRefGoogle Scholar
  48. 48.
    Pasini AF, Garbin U, Stranieri, et al., Nebivolol treatment reduces serum levels of asymmetric dimethylarginine and improves endothelial dysfunction in essential hypertensive patients. Am J Hypertens, 2008. 21(11): p. 1251–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Merchant N, Searles CD, Pandian A, et al., Nebivolol in high-risk, obese African Americans with stage 1 hypertension: effects on blood pressure, vascular compliance, and endothelial function. J Clin Hypertens (Greenwich), 2009. 11(12): p. 720–5.CrossRefGoogle Scholar
  50. 50.
    Ghiadoni L, Magagna A, Versari D, et al., Different effect of antihypertensive drugs on conduit artery endothelial function. Hypertension, 2003. 41(6): p. 1281–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Souza-Barbosa L, Ferreira-Melo SE, Ubaid-Girioli S, et al., Endothelial Vascular Function in Hypertensive Patients After Renin—Angiotensin System Blockade. The Journal of Clinical Hypertension. 2006;8: 803–811.PubMedCrossRefGoogle Scholar
  52. 52.
    Nishizaka MK, Zaman MA, Green SA, et al., Impaired endothelium-dependent flow-mediated vasodilation in hypertensive subjects with hyperaldosteronism. Circulation, 2004. 109(23): p. 2857–61.PubMedCrossRefGoogle Scholar
  53. 53.
    Singh TP, Groehn H, Kazmers A, Vascular function and carotid intimal-medial thickness in children with insulin-dependent diabetes mellitus. J Am Coll Cardiol, 2003. 41(4): p. 661–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Suwaidi JA, Hamasaki S, Higano ST, et al., Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation, 2000. 101(9): p. 948–54.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Preventive Medicine and Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Vascular Biology and Hypertension ProgramUniversity of Alabama at BirminghamBirminghamUSA

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