Objectives To determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular (CVD) events beyond conventional risk factors. Background Several studies have shown that aPWV may be a useful risk factor for predicting CVD but have been underpowered to examine whether this is true for different sub-groups. Methods We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with cardiovascular outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. Results Of 17,635 participants, 1,785 (10%) had a cardiovascular (CVD) event. The pooled age- and sex-adjusted hazard ratio [95% CI] per SD change in loge aPWV was 1.35 [1.22, 1.50, p<0.001] for coronary heart disease (CHD), 1.54 [1.34, 1.78, p<0.001] for stroke, and 1.45 [1.30, 1.61, p<0.001) for CVD. Associations stratified by sex, diabetes and hypertension were similar, but decreased with age (1.89, 1.77, 1.36 and 1.23 for ≤50, 51–60, 61–70 and >70 years respectively, pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor: CHD 1.23, [1.11, 1.35 p<0.001]; stroke 1.28, [1.16, 1.42 p<0.001]; cardiovascular events 1.30 [1.18, 1.43, p<0.001]. Reclassification indices showed the addition of aPWV improved risk prediction (13% for 10 year CVD risk for intermediate risk) for some sub-groups. Conclusions Consideration of aPWV improves model fit and reclassifies risk for future cardiovascular events in models that include standard risk factors. aPWV may enable better identification of high-risk populations who may benefit from more aggressive cardiovascular risk factor management.

Intensive cholesterol reduction may be beneficial in the treatment of patients with ISH and normal lipid levels, through a reduction in large artery stiffness.

Abstract-Aerobic exercise training increases arterial compliance and reduces systolic blood pressure, but the effects of muscular strength training on arterial mechanical properties are unknown. We compared blood pressure, whole body arterial compliance, aortic impedance, aortic stiffness (measured by ␤-index and carotid pulse pressure divided by normalized systolic expansion Femoral-dorsalis pedis pulse wave velocity was also higher in the athletes, but carotid-femoral pulse wave velocity was not different. Furthermore, both carotid (56Ϯ3 versus 44Ϯ2 mm Hg; PϽ0.001) and brachial (60Ϯ3 versus 50Ϯ2 mm Hg; PϽ0.01) pulse pressures were higher in the athletes, but mean arterial pressure and resting heart rate did not differ between groups. These data indicate that both the proximal aorta and the leg arteries are stiffer in strength-trained individuals and contribute to a higher cardiac afterload. (Hypertension. 1999;33:1385-1391.) Key Words: mechanical properties, arterial Ⅲ stiffness Ⅲ compliance Ⅲ exercise A rterial compliance plays a role in determining both arterial systolic and diastolic pressure and therefore, in a clinical context, influences left ventricular size and function, coronary blood flow, and the risk of cerebrovascular accidents. [1][2][3] In the past, measures of arterial compliance in humans have been invasive, and therefore surrogate measures such as peripheral pulse pressure have been applied to investigate potential relationships with clinical outcomes. Pulse pressure correlates closely with serious cardiovascular outcomes such as myocardial infarction, 4 thus highlighting arterial compliance as a potential target for risk reduction therapy.Arterial compliance decreases with increasing age, 5-8 in atherosclerosis and coronary artery disease, 5,9 -12 and in hypertensive individuals. [13][14][15] Aerobic exercise has welldocumented efficacy for cardiovascular risk reduction, and it appears that at least part of its benefit derives from modification of arterial properties. In cross-sectional studies, aerobically trained athletes have a higher arterial compliance than sedentary individuals. 6,16,17 Furthermore, arterial compliance is elevated independently of blood pressure reduction in previously sedentary males after a 4-week program of moderate-intensity aerobic exercise training. 18 These data suggest that aerobic exercise structurally modifies the large arteries, a postulate supported by studies of ex vivo aortic properties in rats, after 16 weeks of spontaneous running. 19,20 While aerobic exercise is widely recommended as a preventative and therapeutic strategy, resistance-style training is becoming more popular, although it is less well studied with respect to its effects on blood pressure, and no previous study has examined arterial mechanical properties in this context. High-level resistance training is associated with abrupt and large pressor responses 21 and in the long term leads to a concentric ventricular hypertrophy. [22][23][24][25] We hypothesize that arterial mechanical modifica...

The increased SAC and decreased PWV in women receiving hormonal therapy suggest that such therapy may decrease stiffness of the aorta and large arteries in postmenopausal women, with potential benefit for age-related cardiovascular disorders. The reduction of arterial compliance with age appears to be altered with hormonal therapy.