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Aortic stiffness as a cardiovascular risk predictor

BMJ 2015; 351 doi: (Published 14 July 2015) Cite this as: BMJ 2015;351:h3764
  1. Ian B Wilkinson, professor of therapeutics1,
  2. John R Cockcroft, professor of cardiology2,
  3. Carmel M McEniery, senior research associate1
  1. 1Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke’s Hospital, Box 98, Cambridge CB2 0QQ, UK
  2. 2Department of Cardiology, Wales Heart Research Institute, Cardiff, UK
  1. Correspondence to: I Wilkinson ibw20{at}

A promising biomarker likely to be most useful in younger adults with low to moderate risk

Cardiovascular disease remains the leading cause of death worldwide, despite highly effective preventive treatments. Most current guidelines recommend treatment based on arbitrary thresholds or the risk of a future event. Although the guidelines are effective at identifying those most at risk, in whom to start treatment, many individuals are categorised as moderate-low risk, denied treatment, and go on to have events. This has created considerable interest in refining risk prediction with novel biomarkers, such as C reactive protein and carotid intima-media thickness. Frustratingly, the majority of these add little to risk prediction based on traditional risk factors such as blood pressure, lipids, cigarette smoking, and diabetes.1

Doctors have used hardening of the arteries, or arteriosclerosis, as a surrogate measure of vascular health for centuries. It makes sense because large arteries have an important role in buffering the cyclical changes in blood pressure caused by intermittent left ventricular ejection. This elasticity keeps systolic pressure low and maintains diastolic pressure. Arterial stiffening raises systolic pressure, which leads to systolic hypertension—the most common form of hypertension in people over 50—and increases the workload of the …

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