Currently there are over 16,000 published papers on PWV, this page is a short curated list of key papers in the medical literature
Pulse Wave Velocity Predicts Cardiovascular Risk
The ability of cfPWV to predict cardiovascular risk has been validated in large cohort studies in the US and Europe, including the Framingham Heart Study. The results showed that higher aortic stiffness assessed by PWV is associated with increased risk for a first cardiovascular event. PWV improved risk prediction when added to standard risk factors. An editorial in JACC summarized the data and concluded “aPWV has gone a long way and has come to an age of maturity. Given the evidence we now have, and after critical consideration, aPWV is justified to be included in clinical practice for risk prediction”.
- Arterial stiffness and cardiovascular events: The Framingham Heart Study. Gary F. Mitchell, Shih-Jen Hwang, Ramachandran S. Vasan, Martin G. Larson, Michael J. Pencina, Naomi M. Hamburg, Joseph A. Vita, Daniel Levy, and Emelia J. Benjamin. 2010 February 2; 121(4): 505–511. doi:10.1161/CIRCULATIONAHA.109.886655
- Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. Yoav Ben-Shlomo, Melissa Spears, Chris Boustred, et al. J Am Coll Cardiol. 2014 February 25; 63(7): 636–646. doi: 10.1016/j.jacc.2013.09.063.
- Aortic Stiffness for Cardiovascular Risk Prediction. Just Measure It, Just Do It! Charalambos Vlachopoulos, Konstantinos Aznaouridis. Journal of the American College of Cardiology. 2014 ; 63(7): 647-649. https://doi.org/10.1016/j.jacc.2013.10.040
- Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness. A Scientific Statement From the American Heart Association. Raymond R. Townsend, Ian B. Wilkinson, Ernesto L. Schiffrin, et. Al. on behalf of the American Heart Association Council on Hypertension. 2015; 66: 698-722. DOI: 10.1161/HYP.0000000000000033.
Arterial stiffness (as measured by PWV) is associated with multiple adverse health outcomes
In a 15 year follow-up study of participants in the Framingham Study, arterial stiffness (as measure by PWV) has been positively associated with the long term risk of multiple adverse health outcomes including hypertension, diabetes, chronic kidney disease, dementia, cardiovascular disease (including coronary heart disease, heart failure, transient ischemic attacks, stroke), and death.
- Arterial Stiffness and Long-Term Risk of Health Outcomes: The Framingham Heart Study. Ramachandran S. Vasan , Stephanie Pan, Vanessa Xanthakis , Alexa Beiser , Martin G. Larson, Sudha Seshadri, Gary F. Mitchell. 2022;79: 1045-1056. https://doi.org/10.1161/HYPERTENSIONAHA.121.18776
PWV can predict higher coronary artery calcium scores
PWV has been shown to be positively correlated with higher coronary artery calcium scores (CACS), and thus is a low-cost method to identify individuals for further testing for coronary artery calcium deposits.
- Association of arterial stiffness with coronary artery calcium score in the general-population: the Swedish CArdioPulmonary bioImage study. Iram Faqir Muhammad et al. J Hypertens. 2022; 40(5): 933-939. doi: 10.1097/HJH.0000000000003096.Epub 2022 Feb 9.
PWV can identify high risk individuals with resistant hypertension
PWV has been demonstrated to identify individuals with increased risk for cardiovascular events and mortality in resistant hypertension. Furthermore, there is evidence that selective drug treatment can reduce arterial stiffness independent of changes in blood pressure. Thus measurement of arterial stiffness in hypertension may provide evidence as to the mechanism of action of selective antihypertensive drugs.
- Prognostic Value of Changes in Aortic Stiffness for Cardiovascular Outcomes and Mortality in Resistant Hypertension: a Cohort Study. Claudia R L Cardoso et al. 2022 Feb; 79(2): 447-456. https://doi.org/10.1161/HYPERTENSIONAHA.121.18498
· Spironolactone Reduces Aortic Stiffness in Patients With Resistant Hypertension Independent of Blood Pressure Change. Sudeep R Aryal, et al. J Am Heart Assoc. 2021; 10(17): e019434. https://doi.org/10.1161/JAHA.120.019434
The measurement of PWV can predict metabolic risk and the development of hypertension in young adults.
- Pulse Wave Velocity Predicts the Progression of Blood Pressure and Development of Hypertension in Young Adults. Koivistoinen , et.al. Hypertension. 2018 Mar; 71(3): 451-456. doi: 10.1161/HYPERTENSIONAHA.117.10368.
- Arterial stiffness precedes hypertension and metabolic risks in youth: a review. Andrew O Agbaje. J Hypertens. 2022 Oct 1; 40(10): 1887-1896. doi: 10.1097/HJH.0000000000003239.
PWV as a measure of ‘vascular age’
PWV can be used to assess ‘vascular age’ in individuals. Higher PWV (compared to age matched controls free of CV disease) is an indication of early vascular aging, while lower PWV is an indication of healthy vascular aging.
- Characteristics of healthy vascular ageing in pooled population-based cohort studies: the global Metabolic syndrome and Artery REsearch Consortium. Peter M. Nilssona, et.al., and The Metabolic syndrome, Arteries REsearch (MARE) Consortium. J Hypertens. 2018 December; 36(12): 2340-2349. Doi: 10.1097/HJH.0000000000001824
- Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications. Carlo Palombo, Michaela Kozakova. Vascular Pharmacology. 2016; 77: 1–7. https://doi.org/10.1016/j.vph.2015.11.083.
Aortic stiffness, as measure by PWV, has been demonstrated to predict the incidence of mild cognitive impairment and dementia.
- Aortic Stiffness and the Risk of Incident Mild Cognitive Impairment and Dementia. Matthew P. Pase, Alexa Beiser, Jayandra J. Himali, Connie Tsao, Claudia L. Satizabal, Ramachandran S. Vasan, Sudha Seshadri, Gary F. Mitchell. 2016; 47: 2256-2261. DOI: 10.1161/STROKEAHA.116.013508
Recent key papers on Pulse Wave Velocity (PWV)
January 30, 2023
This paper is a review of 51 studies of the effects of different forms of exercise on arterial stiffness (as measure by PWV) in healthy young (18-24 yrs), middle aged (25-49 yrs), and older 50 and above) women. The conclusion is that exercise, particularly aerobic exercise, is an effective way to improve arterial stiffness. The review also examined the effects major determinants of the effects on arterial stiffness.
- Lan YS, Khong TK, and Yusof A. Effects of Exercise on Arterial Stiffness in Healthy Young, Middle-Aged and Older Women: A Systematic Review. Nutrients 2023;15:308-25. https://doi.org/10.3390/nu15020308
This study examines the longitudinal relationship between arterial stiffness (as measured by PWV) and blood pressure in a cohort of over 900 participants in the UK Twin Study. It demonstrated that one measure of arterial stiffness can predict the trajectory of blood pressure measurements over time. In contrast, the prediction of progression of arterial stiffness over time cannot be accomplished by measuring blood pressure at one point in time, but requires the measurement of the longitudinal progression of blood pressure. This study is further evidence of the importance of measuring arterial stiffness in predicting subsequent changes in blood pressure.
- Keehn L, Mangino M, Spector T, Chowienczyk P, and Cecelja M. Relation of Pulse Wave Velocity to Contemporaneous and Historical Blood Pressure in Female Twins. Hypertension 2023;80: 361-369. DOI: 10.1161/HYPERTENSIONAHA.122.1931
This study examined the cardiovascular pathophysiology of infection with Covid 19. This is important because of the increased risk of cardiovascular disease 1 year after infection. The study examined 19 Covid-19 survivors and 19 well-matched controls, and examined vascular function as assessed by assessing arterial stiffness by measuring carotid femoral pulse wave velocity. The results demonstrated that arterial stiffness was increased in Covid-19 survivors compared with controls at 1 year. This study concludes that longitudinal followup of arterial stiffness and other CV measures in warranted in Covid-19 survivors to assess cardiovascular risk.
- Faria D, Moll-Bernardes RJ, et al. Sympathetic Neural Overdrive, Aortic Stiffening, Endothelial Dysfunction, and Impaired Exercise Capacity in Severe COVID-19 Survivors: A Mid-Term Study of Cardiovascular Sequelae. Hypertension. 2023;80:470–481. DOI: 10.1161/HYPERTENSIONAHA.122.19958.
This study demonstrates the usefulness of measuring PWV in studies of the efficacy of different therapies in mitigating vascular dysfunction. Adolescents (n=34) with Type1 diabetes were enrolled in a 8 week in duration placebo-controlled cross-over study of bromocriptine and vascular health. The results demonstrated that bromocriptine improved PWV, supporting the need for longer-term studies.
- Bromocriptine Improves Central Aortic Stiffness in Adolescents With Type 1 Diabetes: Arterial Health Results From the BCQR-T1D Study. Schafer M, Browne LP, etc. Hypertension 2023,80(2):482-491. DOI: 10.1161/HYPERTENSIONAHA.122.1954.
June 22, 2022
An article published in the JAMA Network Open evaluated the association between progression of arterial stiffness, as measured by PWV and statin medication use in Chinese adults. The cohort study found that statin use was associated with slower progression of arterial stiffness in Chinese adults with high atherosclerotic risk.
- Association Between Statin Use and Progression of Arterial Stiffness Among Adults With High Atherosclerotic Risk https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2793490/zhou_2022_oi_220529_1654814835.17565.pdf
May 30, 2022
This editorial from the Journal of the American Heart Association discusses how different methods of non-invasively measuring or estimating pulse wave velocity (PWV) are important to measure aortic stiffness as an indicator of generalized vascular vulnerability. Due to the importance of this measure, and the current measurement techniques being too demanding for general clinical use, investigators have been searching for alternative shortcuts to estimate cfPWV. The author concludes that estimating is not measuring, and recommends prudence in using estimated measures. He states “Estimating is not measuring; we hope that each time a pilot lands an aircraft, he/she measures speed and altitude for a safe landing, rather than estimate from charts. We expect a similar rigor from doctors when evaluating their patient’s risk.”
- Estimating Is Not Measuring: The Lessons About Estimated Pulse Wave Velocity, Pierre Boutouyrie, MD, PhD J Am Heart Assoc. 2022;11:e025830. DOI: 10.1161/JAHA.122.025830
The PhysioWave Pro™ provides a measured cfPWV in less than a minute as a digital biomarker, while standing on the device like a scale. It also provides weight, heart rate and body composition.
Feb 16, 2022
This article published in in the May 2022 issue of Hypertension studied the predictive value of pulse wave velocity over a median of 15 years and followed 7283 Framingham Study participants. Participants with increased pulse wave velocity had demonstrated increased risks of hypertension, diabetes, chronic kidney disease, dementia, and cardiovascular disease (CVD, and it’s components: Coronary heart disease, transient ischemic attack/stroke, and death)
- Arterial Stiffness and Long-Term risk of Health Outcomes: The Framingham Heart Study https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.18776