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Arterial stiffness: a modifiable cardiovascular risk factor?

The subject of arterial stiffness as a modifiable risk factor is controversial and difficult to understand. The best approach here will be to assist readers to understand the issue and the basis of controversy. We also hope to show that the subject is not as overwhelming as it might appear. We believe that new blood is required in this field and that a basic understanding is necessary for researchers to be induced to take on such investigations. Our approach sets out a historic and pathophysiologic background on which modern studies can be based; describes measures and indices of arterial stiffness including pulse wave velocity, augmentation index, ambulatory arterial stiffness index, aortic impedance, and carotid elastic modulus; and finally, addresses the specifics of this interesting and important question. Although aortic stiffening with age is attributable to fracture of elastin lamellae and is largely irreversible, stiffening of muscular arteries can be modified by vasodilator drugs, and by improved endothelial function such as induced by exercise training.