Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications

Vascul Pharmacol. 2016 Feb:77:1-7. doi: 10.1016/j.vph.2015.11.083. Epub 2015 Nov 28.


Arterial stiffness results from a degenerative process affecting mainly the extracellular matrix of elastic arteries under the effect of aging and risk factors. Changes in extracellular matrix proteins and in the mechanical properties of the vessel wall related to arterial stiffening may activate number of mechanisms involved also in the process of atherosclerosis. Several noninvasive methods are now available to estimate large artery stiffness in the clinical setting, including carotid-femoral pulse wave velocity, the reference for aortic stiffness estimate, and local distensibility measures of superficial arteries, namely carotid and femoral. An independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been established. Thus, arterial stiffness is emerging as an interesting tissue biomarker for cardiovascular risk stratification and estimation of the individual "biological age". This paper overviews the mechanisms accounting for development and progression of arterial stiffness and for associations between arterial stiffness, atherosclerotic burden and incident cardiovascular events, summarizes the evidence and caveat for clinical use of stiffness as surrogate marker of cardiovascular risk, and briefly outlines some emerging methods for large artery stiffness characterization.

Keywords: Arterial stiffness; Atherosclerosis; Cardiovascular risk; Carotid-femoral pulse wave velocity; Local distensibility; Tissue biomarker; Vascular aging.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Atherosclerosis / complications*
  • Atherosclerosis / metabolism
  • Atherosclerosis / physiopathology
  • Biomarkers / metabolism
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / metabolism
  • Cardiovascular Diseases / physiopathology
  • Cerebrovascular Disorders / etiology*
  • Cerebrovascular Disorders / metabolism
  • Cerebrovascular Disorders / physiopathology
  • Endothelium, Vascular / metabolism
  • Endothelium, Vascular / physiopathology
  • Extracellular Matrix / metabolism
  • Extracellular Matrix Proteins / metabolism
  • Heart Failure / etiology*
  • Heart Failure / metabolism
  • Heart Failure / physiopathology
  • Hemodynamics / physiology
  • Humans
  • Myocardial Ischemia / etiology*
  • Myocardial Ischemia / metabolism
  • Myocardial Ischemia / physiopathology
  • Risk Factors
  • Vascular Stiffness / physiology*


  • Biomarkers
  • Extracellular Matrix Proteins