Therapeutic modification of arterial stiffness: An update and comprehensive review

Table 1 Demographic, clinical, and lifestyle factors associated with arterial stiffness

Age[7]

Sex[110]

Established cardiovascular disease[3]

Potential risk factors for atherosclerosis

Hypertension[11]

Dyslipidemia[2]

Cigarette smoking[63]

Chronic obstructive pulmonary disease[111]

Diabetes[14]

Obesity[3]

Obstructive sleep apnea[106]

Menopause[110]

Polycystic ovarian syndrome[112]

Hypothyroidism[113]

Chronic kidney disease[23]

Endothelial dysfunction[27]

Systemic inflammation[99]

Cytomegalovirus infection[114]

Nutritional and lifestyle aspects

Caffeine[115]

Chronic alcohol consumption[116]

Sedentary lifestyle[58]

Resistance exercise training[61]

Genes variants

Genes of the Renin-Angiotensin-Aldosterone system[33]

Genes of the extracellular matrix proteins[33]

Table 2 A summary of the advantages and disadvantages of different measurements for evaluating arterial stiffness

	Advantage	Disadvantage
cfPWV[42-44]	Reflects the stiffness of the descending aorta The gold standard measure for arterial stiffness	Largely affected by the change of BP Overestimated for the inaccurate measurement in the distance between the carotid and the femoral arteries
baPWV[116]	Reflects the stiffness of both the descending aorta and the leg artery High association with CV risk factors Ease of use for large-scale population studies	Largely affected by the change of BP Underestimates arterial stiffness in hypertensive patients with a history of cardiovascular events
hfPWV[117]	Strongly correlated with cfPWV moderately correlated with baPWV	Require a high level of proficiency in order to obtain accurate results
faPWV[117]	Moderately correlated with baPWV	The predictive value to incident vascular events remains unknown
pAIx[110]	Assessed non-invasively and peripherally, e.g., carotid, and radial arteries Correlated well with the central AIx	Largely affected by the change of BP Not a valid surrogate of arterial compliance in the elderly and diabetic populations
The stiffness parameter β[53,54]	Independent of the change of BP	Assessing only a local segment of the artery Loss of the independence of BP for those with moderate to severe hypertension or hypotension
CAVI[118]	Independent of the change of BP A novel atherosclerotic index that incorporates PWV and BP measurements The coefficients of variation are small (< 4%), and does not require significant training	CAVI, as a cardiovascular risk marker has not to be investigated definitively in large prospective clinical trials

Ba: Brachial-ankle arteries; CAVI: Cardio-ankle vascular index; BP: Blood pressure; cf: Carotid-femoral arteries; fa: Femoral-ankle arteries; hf: Heart-femoral arteries; pAIx: Peripheral augmentation index; PWV: Pulse-wave velocity.