Arterial stiffness: pathophysiology, risk factors and measurement techniques

ABSTRACT

Introduction: Arterial stiffness (AS) or inelasticity is the term used to describe the reduced viscoelastic properties of the vascular wall. In recent years, special emphasis has been placed on the role of AS in the occurrence of cardiovascular diseases while its assessment is increasingly used in clinical practice.

Purpose: The purpose of this paper is to investigate the literature and highlight some of the most common mechanisms that contribute to increased AS, the risk factors and measurement techniques.

Methodology: A literature review was performed in the online databases PubMed and Google Scholar, without setting a time limit. The inclusion criteria included articles written in Greek and English, either review or research.

Results: AS develops through a complex interplay between static and dynamic changes involving structural and cellular components of the vascular wall. These include the reduced elastin/collagen ratio, the production of worn elastin fibers, the deposition of weaker collagen on the vessel wall, vascular dysfunction, while the Renin Angiotensin Aldosterone system and inflammatory factors also play an important role. Risk factors include all those factors that affect the elastic specifications of the arteries.

The main method used to estimate AS is pulse wave velocity (PWV), while Carotid-femoral PWV has been characterized as a "gold method" as it is an easy, reproducible, economical, and non-invasive method, has the highest predictive value of cardiovascular events without being affected by other factors. The AIx obtained by pulse wave analysis (Pulse Wave Analysis PWA) is an indirect but reliable indicator of arterial stiffness and depends on the speed of the wave, on the heart rate and on the intensity of the reflection from the periphery of the wave.

Conclusions: Elevated AS has implications for cardiovascular health and likely accounts for a large proportion of cardiovascular disease years worldwide. AS can be easily measured in daily clinical practice and can contribute to the prediction of cardiovascular risk while understanding the pathophysiological mechanisms as well as risk factors can contribute to the design of effective treatments.

Keywords: arterial stiffness, pulse wave velocity, pulse wave analysis, pathophysiology, mechanisms,   risk factors, arterial stiffness measurement