Abstract
The major pathophysiologic process of coronary atherosclerosis is a defect or injury of the arterial endothelial function. The rate of progression of coronary atherosclerosis is highly variable and mainly determined by risk contributors such as lipids, glucose, and smoking. Coronary plaque rupture is the precipitating factor for clot formation and acute coronary events. Measurement of arterial stiffness with different noninvasive techniques provides information about the functional and structural vascular changes at the level of the aorta, muscular conduit arteries, the peripheral branches, and the microvascular components. Arterial stiffness has been related to the Framingham and other cardiovascular risk scores. Large artery stiffness contributes to exercise-induced myocardial ischemia in patients with coronary artery disease. It can predict the outcome after coronary interventions. There is now evidence that arterial stiffness is a predictor for cardiovascular events in the general population, in patients with hypertension, end-stage renal disease, impaired glucose intolerance, and coronary artery disease. Future studies are warranted to demonstrate the value of follow-up of arterial stiffness as a marker of reduction of arterial wall damage during antihypertensive, antidiabetic, and lipid-lowering therapy. Promising study results show that measurement of arterial stiffness could become an important part of the routine assessment of patients in daily practice.
Similar content being viewed by others
References and Recommended Reading
Cohn JN: Arterial stiffness, vascular disease and risk of cardiovascular events. Circulation 2006, 113:601–603.
Duprez D, Cohn JN: Monitoring vascular health beyond blood pressure. Curr Hypertens Rep 2006, 287:287–291.
Safar ME, Levy BI, Struijker-Boudier: Current perpectives on arterial stiffness and pulse pressure in hypertension and cardiovascular disease. Hypertension 2003, 107:2864–2869.
Davies JI, Struthers AD: Pulse wave analysis and pulse wave velocity: a critical review of their strengths and weakness. J Hypertens 2003, 21:463–472.
McVeigh GE: Pulse waveform analysis and arterial wall properties. Hypertension 2003, 41:1010–1011.
O’Rourke MF, Staessen JA, Vlachopoulos C, et al.: Clinical applications of arterial stiffness, definitions and reference values. Am J Hypertens 2002, 15:426–444.
Duprez DA, Kaiser DR, Whitwam W, et al.: Determinants of radial artery pulse wave analysis in asymptomatic individuals. Am J Hypertens 2004, 17:647–653.
Laurent S, Cockroft J, Van Bortel L, et al.: Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006, 27:2588–2605.
Widlansky ME, Gokce N, Keaney JF Jr, Vita JA: The clinical implications of endothelial dysfunction J Am Coll Cardiol 2003, 42:1149–1160.
Okumura K, Yasue H, Matsuyama K, et al.: Effect of acetylcholine on the highly stenotic coronary artery: difference between the constrictor response of the infarct-related coronary artery and that of the noninfarct-related artery. J Am Coll Cardiol 1992, 19:752–758.
Ludmer PL, Selwyn AP, Shook TL, et al.: Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med 1986, 315:1046–1051.
Cox DA, Vita JA, Treasure CB, et al.: Atherosclerosis impairs flow-mediated dilation of coronary arteries in humans. Circulation 1989, 80:458–465.
Gilani M, Kaiser DR, Bratelli CW, et al.: Role of nitric oxide deficiency and its detection as a risk factor for prehypertension. J Am Soc Hypertens 2007, In press.
Nigam A, Mitchell GF, Lambert J, Tardif JC: Relation between conduit vessel stiffness (assessed by tonometry) and endothelial function (assessed by flow-mediated dilatation) in patients with and without coronary heart disease. Am J Cardiol 2003, 92:395–399.
Cohn JN, Duprez DA, Grandits GA: Arterial elasticity as part of a comprehensive assessment of cardiovascular risk and drug treatment. Hypertension 2005, 46:217–220.
Lind L, Fors N, Hall J, et al.: A comparison of three different methods to determine arterial compliance in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. J Hypertension 2006, 24:1083–1088.
Nurnberger J, Keflioglu-Scheiber A, Opazo Saez AM, et al.: Augmentation index is associated with cardiovascular risk. J Hypertension 2002, 20:2407–2414.
Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Eur Heart J 1998, 19:1434–1503.
Simons PC, Algra A, Bots ML, et al.: Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease). Circulation 1999, 100:951–957.
Hoes AW, Grobbee DE, Valkenburg HA, et al.: Cardiovascular risk and all-cause mortality; a 12 year follow-up study in The Netherlands. Eur J Epidemiol 1993, 9:285–292.
Van Trijp MJ, Uiterwaal CS, Bos WJ, et al.: Noninvasive arterial measurements of vascular damage in healthy young adults: relation to coronary heart disease risk. Ann Epidemiol 2006, 16:71–77.
Kelly RP, Tunin R, Kass DA: Effect of reduced aortic compliance on cardiac efficiency and contractile function of in situ canine left ventricle. Circ Res 1992, 71:490–502.
Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y: Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993, 21:1497–1506.
Kass DA, Saeki A, Tunin RS, Recchia FA: Adverse influence of systemic vascular stiffening on cardiac dysfunction and adaptation to acute coronary occlusion. Circulation 1996, 93:1533–1541.
Kingwell BA, Waddell TK, Medley TL, et al.: Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol 2002, 40:773–779.
Domanski MJ, Sutton-Tyrrell K, Mitchell GF, et al.: Determinants and prognostic information provided by pulse pressure in patients with coronary artery disease undergoing revascularization. The Balloon Angioplasty Revascularization Trial (BARI). Am J Cardiol 2001, 87:675–679.
Nakayama Y, Tsumura K, Yamashita N, et al.: Pulsatility of the ascending aortic pressure waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. Circulation 2000, 101:470–472.
Ueda H, Nakayama Y, Tsumura K, et al.: Inflection point of ascending aortic waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. Am J Hypertens 2002, 15:823–826.
Weber T, Auer J, O’Rourke MF, et al.: Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J 2005, 26:2657–2663.
Chirinos JA, Zambrano JP, Chakko S, et al.: Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease. Hypertension 2005, 45:980–985.
Willum-Hansen T, Staessen JA, Torp-Pedersen C, et al.: Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006, 113:664–670.
Shokawa T, Imazu M, Yamamoto H, et al.: Pulse wave velocity predicts cardiovascular mortality: findings from the Hawaii-Los Angeles-Hiroshima study. Circ J 2005, 69:259–264.
Mattace-Raso FU, van der Cammen TJ, Hofman A, et al.: Arterial stiffness and risk of coronary heart disease and stroke. The Rotterdam Study. Circulation 2006, 113:657–663.
Sutton-Tyrrell K, Najjar SS, Boudreau RM, et al.: Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005, 111:3384–3390.
Meaume S, Benetos A, Henry OF, et al.: Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol 2001, 21:2046–2050.
Stefanadis C, Dernellis J, Tsiamis E, et al.: Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischaemic heart disease. Eur Heart J 2000, 21:390–396.
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, 37:1236–1241.
Boutouyrie P, Tropeano AI, Asmar R, et al.: Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 2002, 39:10–15.
Laurent S, Katsahian S, Fassot C, et al.: Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003, 34:1203–1206.
Williams B, Lacy PS, Thom SM, et al.: Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006, 113:1213–1225.
Cruickshank K, Riste L, Anderson SG, et al.: Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002, 106:2085–2090.
Blacher J, Guerin AP, Pannier B, et al.: Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999, 99:2434–2439.
Shoji T, Emoto M, Shinohara K, et al.: Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol 2001, 12:2117–2124.
Safar ME, Blacher J, Pannier B, et al.: Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002, 39:735–738.
London GM, Blacher J, Pannier B, et al.: Arterial wave reflections and survival in end-stage renal failure. Hypertension 2001, 38:434–438.
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 Hypertension 2003, 16:265–269.
Blacher J, Pannier B, Guerin AP, et al.: Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension 1998, 32:570–574.
Barenbrock M, Kosch M, Joster E, et al.: Reduced arterial distensibility is a predictor of cardiovascular disease in patients after renal transplantation. J Hypertens 2002, 20:79–84.
Dijk JM, Algra A, van der Graaf Y, et al.; SMART study group: Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study. Eur Heart J 2005, 26:1213–1220.
Dart AM, Gatzka CD, Kingwell BA, et al.: Brachial blood pressure but not carotid arterial waveforms predict cardiovascular events in elderly female hypertensives. Hypertension 2006, 47:785–790.
Guerin AP, Blacher J, Pannier B, et al.: Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation 2001, 103:987–992.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Duprez, D.A., Cohn, J.N. Arterial stiffness as a risk factor for coronary atherosclerosis. Curr Atheroscler Rep 9, 139–144 (2007). https://doi.org/10.1007/s11883-007-0010-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11883-007-0010-y