ARTERIAL STIFFNESS AS A RISK FACTOR FOR CEREBRAL VASCULAR LESIONS

Abstract

Increased arterial stiffness, a biomarker of vascular aging, is a recognized subclinical organ damage, and may thus serve as predictor of cardiovascular disease. The predictive value of arterial stiffness is higher in patients with higher baseline cardiovascular risk, such as in patients with hypertension. According to European Society of Hypertension, increased arterial stiffness should be recommended as a negative prognostic factor in the management of patients with hypertension. Arterial stiffness, an important determinant of transition of pulse wave energy from the heart into the periphery, could improve our understanding of the consequences of the hemodynamic-related vascular stress, especially in low-impedance organs, including the brain. Epidemiological studies have demonstrated arterial stiffness as a risk factor for silent cerebral lesions, stroke, and cognitive impairment. Arterial stiffness was found to be independently associated with all components of cerebral small vessel disease including silent lacunar infarcts, white matter hyperintensities, and microbleeds, although there are some methodological differences between the various surrogate markers. Arterial stiffness may be important also in recovery after ischemic stroke. Aortic stiffness was found to be an independent predictor of both short-term clinical improvement and long-term functional outcome after ischemic stroke. Furthermore, increased aortic stiffness has been shown to be linked to acute hypertensive response after ischemic stroke. However, the vascular, physiological, and metabolic roles of arterial stiffness in cerebrovascular diseases remain unclear. Better understanding of the hemodynamic consequences of arterial stiffness on brain damage is necessary, not only to select the most appropriate therapeutic management but also to optimize prevention, which should be started early in individuals at high risk of developing cerebral vascular lesions.