Arterial Stiffness

Arterial stiffness increases with age, and with conditions such as hypertension, diabetes, and obesity.

Arterial stiffness

Normal risk – compliant artery

Arterial stiffness test

Elevated risk – stiff artery

Pulse Wave Velocity (PWV)

Pulse wave velocity (PWV) has been validated as a measure of arterial stiffness[2]. In particular, stiffness of the aorta, the central artery in the chest, provides an independent measure of the risk of suffering a cardiovascular event such as a myocardial infarction or stroke. PWV is the speed at which the pressure wave generated by the contraction of the heart travels down the aorta. It is expressed in meters per second, and represents a simple number for clinical interpretation of risks.

Pulse Wave Velocity (PWV)

PWV is a simple number to assess risk

CV Risk Tablet
5-year probability Framingham Heart Study

Improvement in risk stratification by adding PWV

PWV Graph

Source: Journal of the American College of Cardiology, 63(7), 2014[1,3]

When PWV is added to the standard risk factors for predicting mortality and cardiovascular events (as per the American College of Cardiology/American Heart Association recommendations), risk for both all-cause and cardiovascular mortality increases, as does the risk for suffering a cardiovascular or coronary event. This results in the reclassification of some individuals from low to moderate risk, and from moderate to high risk.

For instance, in a meta-analysis of more than 17,000 individuals, it was shown that addition of PWV to the FRS led to a five-year risk reclassification of 14% of individuals initially characterized as intermediate risk for a cardiovascular disease[1].

Elevated PWV equals added risk

The American Heart Association (AHA)[2] and the European Societies of Hypertension/Cardiology[4] have published scientific statements indicating that PWV provides additional information beyond traditional risk assessments to predict future cardiovascular events.

The incorporation of PWV into cardiovascular risk assessment may change the individual goals for risk factor control, including more rigorous control of cholesterol and blood pressure.

Decades of clinical research

Decades of clinical research have led to over 7,000 scientific papers that include measurement of PWV. The value of PWV in assessing cardiovascular risk has been demonstrated in a number of studies.  For instance, the Framingham Heart Study[5] demonstrated that the measurement of PWV alone has the same raw predictive power to assess cardiovascular risk as using the entire Framingham Risk Score (FRS), which includes blood pressure, blood cholesterol, age, sex, family history, and smoking.

Through multiple longitudinal studies, meta-analyses, and now recommendations from major societies, PWV has been shown to fulfill the criteria of a clinically useful risk marker[3].

We invite you to learn more about PWV from these professional societies and from key investigators in the field of PWV and cardiovascular risk assessment.

Key scientific evidence

  1. “Aortic Pulse Wave Velocity Improves Cardiovascular Event Prediction: An Individual Participant Meta‑Analysis of Prospective Observational Data From 17,635 Subjects, ” Y. Ben‑Schlomo et al., Journal of the American College of Cardiology, 63(7), 2014
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  2. “Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness. A Scientific Statement From the American Heart Association,”  R.R. Townsend et al. on behalf of the American Heart Association Council on Hypertension, Hypertension, 66, 698-722, 2015
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  3. Editorial: “Aortic Stiffness for Cardiovascular Risk Prediction: Just Measure It, Just Do It!,”
    Journal of the American College of Cardiology, 63(7), 2014
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  4. Guidelines: “2013 ESH/ESC Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC),” 
    Journal of Hypertension, 31:1281-1357, 2013
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  5. “Arterial Stiffness and Cardiovascular Events: The Framingham Heart Study,”
    G.F. Mitchell et al., Circulation, 121:505-511, 2010
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