Arterial Stiffness, Vascular Disease, and Risk of Cardiovascular Events

Most cardiovascular morbid events are the consequence of a progressive vascular disease called atherosclerosis. This disease begins at an early age, probably initially with a defect or injury of the arterial endothelial protective function, and progresses with structural remodeling in the microcirculation and cellular and lipid accumulation in conduit arteries complicated by calcification, plaque formation, and, ultimately, plaque rupture as a precipitating factor for clot formation and acute morbid events.1 The rate of progression of this process is highly variable but may extend over many decades. Furthermore, aging changes, pressure effects, and atherosclerotic changes become inextricably intertwined. Articles pp 657 and 664 Because it is now possible to slow progression of this vascular disease with a number of pharmacological agents and possibly with lifestyle alterations, the discovery of markers that can identify the disease in asymptomatic individuals could facilitate appropriate intervention. The wall of the artery is the primary site of the disease process and has therefore become an attractive target for demonstrating functional or structural alterations that may precede the morbid events. Noninvasive assessment of the arterial vasculature suitable for screening has been practiced since the development of the blood pressure cuff. Unfortunately, the ease of blood pressure measurement and the demonstration of its correlation with morbid events inhibited for many years the development of methods to more directly assess the arteries. Recently, there has been growing recognition that the disease of interest is in the arteries and that elevated blood pressure, although it may serve as a crude surrogate for arterial disease, is neither a sensitive nor a specific guide to its presence.2 Therefore, a number of noninvasive methods have been introduced to gain better insight into the abnormalities in the wall of the artery that can define the atherosclerotic process. It is important to begin …