Brachial-ankle pulse wave velocity in the measurement of arterial stiffness: recent evidence and clinical applications.
TL;DR: Brachial-ankle pulse wave velocity (baPWV) is a unique measure of systemic arterial stiffness that is measured by brachial and tibial arterial wave analyses and the hypothesis that baPWVs-guided therapy could improve prognosis in high-risk patients is examined.
Abstract: Arterial stiffness is a vascular measure that has been reported to predict cardiovascular events. It is important to measure arterial stiffness in order to determine current vascular status and treatment strategy. Brachial-ankle pulse wave velocity (baPWV) is a unique measure of systemic arterial stiffness that is measured by brachial and tibial arterial wave analyses. Measurement of baPWV is easy and is reproducible. For more than a decade, this measure has been used broadly in East Asian countries. Meta-analysis of cohort studies conducted in the general population with hypertension, diabetes, or end-stage renal disease, and other high-risk individuals have shown that a 1 m/s increase in baPWV is associated with 12% increase in the risk of cardiovascular events. Thus, the Japanese Circulation Society has proposed that a baPWV of 1800 cm/s is a threshold for high-risk category. For baPWV to be clinically applicable, we must confirm that circulation of the lower limbs are normal by examining brachial ankle blood pressure index. In cases of peripheral arterial disease, the reliability of baPWV measurement is attenuated. To further confirm the clinical usefulness of this measure, we need to examine the hypothesis that baPWV-guided therapy could improve prognosis in high-risk patients.
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TL;DR: PWV is a significant risk factor for future CVD independent of well-known cardiovascular risk factors and may be a useful tool to select subjects at high risk of developing subclinical atherosclerosis or CVD especially in mass screening.
Abstract: Early detection of subclinical atherosclerosis is important to reduce patients' cardiovascular risk. However, current diagnostic strategy focusing on traditional risk factors or using risk scoring is not satisfactory. Non-invasive imaging tools also have limitations such as cost, time, radiation hazard, renal toxicity, and requirement for specialized techniques or instruments. There is a close interaction between arterial stiffness and atherosclerosis. Increased luminal pressure and shear stress by arterial stiffening causes endothelial dysfunction, accelerates the formation of atheroma, and stimulates excessive collagen production and deposition in the arterial wall, leading to the progression of atherosclerosis. Pulse wave velocity (PWV), the most widely used measure of arterial stiffness, has emerged as a useful tool for the diagnosis and risk stratification of cardiovascular disease (CVD). The measurement of PWV is simple, non-invasive, and reproducible. There have been many clinical studies and meta-analyses showing the association between PWV and coronary/cerebral/carotid atherosclerosis. More importantly, longitudinal studies have shown that PWV is a significant risk factor for future CVD independent of well-known cardiovascular risk factors. The measurement of PWV may be a useful tool to select subjects at high risk of developing subclinical atherosclerosis or CVD especially in mass screening.
216 citations
TL;DR: New physiological diagnostic criteria for vascular failure are proposed, according to the target vascular layers and areas, assessed by endothelial function and arterial stiffness (a marker integrating medial layer function) using universally available diagnostic tools.
Abstract: In 2006, Inoue and Node first proposed a novel clinical entity for vascular disease, Vascular Failure, which was defined as the integration of vascular endothelial dysfunction, smooth muscle dysfunction, and metabolic dysfunction. It is a highly integrated concept, which includes a broad spectrum of pathophysiology in vascular diseases. Importantly, vascular failure indicates an impairment of vascular function and structure, as well as a disturbed metabolic milieu that can alter vascular metabolism. The pathophysiological features of vascular failure range from a subclinical initial stage of vascular dysfunction to the clinical manifestations of advanced atherosclerosis. Vascular failure not only plays a central role in the pathogenesis of cardiometabolic disorders but also may contribute to a broad range of diseases that involve the systemic or local vasculature. Thus, vascular failure should be an important potential target of preventative and therapeutic strategies. However, the screening and diagnosis of vascular failure has not been appropriate, possibly because of its heterogeneous nature, lack of established systematic reference values, and absence of diagnostic criteria. This is especially true for the physiological function of the vascular endothelium and the medial layer, which includes other vascular components, such as vascular smooth muscle cells and connective tissue elements (eg, elastin and collagens) and is responsible for maintaining vascular tone. Therefore, systematic diagnostic criteria are needed to identify possible subjects with vascular failure in clinical settings. This may provide a comprehensive approach to vascular failure even in the subclinical stage, and criteria-guided intervention might improve prognosis. Furthermore, this may help to elucidate the role of vascular failure in the pathogenesis of cardiovascular diseases, as well as in other clinical areas, such as dementia and cancer. In this review, we propose new physiological diagnostic criteria for vascular failure, according to the target vascular layers and areas, assessed by endothelial function and arterial stiffness (a marker integrating medial layer function) using universally available diagnostic tools (Figure 1).
157 citations
TL;DR: This review summarizes the current literature on sex differences in vascular stiffness induced by aging, obesity, hypertension, and sex‐specific risk factors as well as the impact of hormonal status, diet, and exercise on vascular stiffness in males and females.
Abstract: Arterial stiffness progressively increases with aging and is an independent predictor of cardiovascular disease (CVD) risk. Evidence supports that there are sex differences in the time course of aging-related arterial stiffness and the associated CVD risk, which increases disproportionately in postmenopausal women. The association between arterial stiffness and mortality is almost twofold higher in women versus men. The differential clinical characteristics of the development of arterial stiffness between men and women indicate the involvement of sex-specific mechanisms. This review summarizes the current literature on sex differences in vascular stiffness induced by aging, obesity, hypertension, and sex-specific risk factors as well as the impact of hormonal status, diet, and exercise on vascular stiffness in males and females. An understanding of the mechanisms driving sex differences in vascular stiffness has the potential to identify novel sex-specific therapies to lessen CVD risk, the leading cause of death in males and females. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
125 citations
Cites methods from "Brachial-ankle pulse wave velocity ..."
...and tibial arterial waveforms are used for the analysis (Munakata, 2014)....
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...Brachial‐ankle PWV is another method of PWV measurement, in which the brachial and tibial arterial waveforms are used for the analysis (Munakata, 2014)....
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04 Jun 2015
TL;DR: This review addresses the most frequently mentioned questions and concerns regarding baPWV to shed some light on this simple and easy arterial stiffness measurement.
Abstract: A variety of techniques to evaluate central arterial stiffness have been developed and introduced. None of these techniques, however, have been implemented widely in regular clinical settings, except for brachial-ankle pulse wave velocity (baPWV). The most prominent procedural advantage of baPWV is its ease of use, since it only requires the wrapping of blood pressure cuffs on the 4 extremities. There is mounting evidence indicating the ability of baPWV to predict the risk of future cardiovascular events and total mortality. Additionally, the guidelines for the management of hypertension in Japan recommended the measurement of baPWV be included in the assessment of subclinical target organ damage. However, baPWV has not been fully accepted worldwide due to perceived theoretical and methodological issues. In this review, we address the most frequently mentioned questions and concerns regarding baPWV to shed some light on this simple and easy arterial stiffness measurement.
86 citations
05 Feb 2016
TL;DR: Brachial-ankle PWV has the potential to become a measure of arterial stiffness worldwide, and a meta-analysis of cohort studies including various levels of risk has shown that a 1 m/s increase is associated with a 12% increase in the risk of cardiovascular events.
Abstract: Background: The populations of many developed countries are becoming progressively older. In aged societies, assessment of total vascular risk is critically important, because old age is usually associated with multiple risks. In this regard, pulse wave velocity (PWV) could be a global cardiovascular marker, since it increases with advancing age, high blood pressure, hyperglycaemia, and other traditional risks, summating cardiovascular risks. Carotid-femoral PWV has been widely applied in Western countries and has been used as a gold-standard PWV measure. However, this measure has never been implemented by general practitioners in Japan, possibly because of methodological difficulties. The life expectancy of Japanese people is now the highest in the world, and the establishment of an adequate total vascular risk measure is an urgent need. Against this background, brachial-ankle PWV was developed at the beginning of this century. Summary: Measurement of this parameter is easy, and its reproducibility is good. Moreover, the generality of the methodology is guaranteed. Brachial-ankle PWV has been reported to consistently increase with most traditional cardiovascular risk factors except dyslipidaemia. A meta-analysis of cohort studies including various levels of risk has shown that a 1 m/s increase in brachial-ankle PWV is associated with a 12% increase in the risk of cardiovascular events. Moreover, simultaneous evaluation of the ankle-brachial index could allow further risk stratification of high-risk individuals, who are common in aged societies. This unique feature is indispensable for the management of aged populations, who usually are exposed to multiple risks and have polyvascular diseases. This evidence, however, is chiefly derived from East Asian countries. The collection of data from Caucasian populations, therefore, remains a task for the future. Key Message: Brachial-ankle PWV has the potential to become a measure of arterial stiffness worldwide.
86 citations