LETTER
TO
THE
EDITOR
Arterial Stiffness in Patients With Peripheral Arterial Disease To the Editor: We read the article “Increased Aortic Stiffness and Related Factors in Patients With Peripheral Arterial Disease” written by Catalano and colleagues with interest.1 They aimed to investigate the factors associated with aortic stiffness in patients with peripheral arterial disease (PAD). They showed that aortic stiffness as assessed by aortic pulse wave velocity (aPWV) was higher in PAD patients as compared with control patients and that aPWV was independently associated with pulse pressure (PP). We believe that these findings will act as a guide for further information regarding arterial stiffness in PAD patients. PAD, a manifestation of atherosclerosis, is associated with a significant increase in cardiovascular morbidity and mortality. The early diagnosis of PAD and the initiation of conservative measures are not only related with a reduction in disease progression but also with numerous additional beneficial actions.2 Arterial stiffness represents vascular damage and is a measure of the degree of atherosclerosis.3 Arterial stiffness has received increased attention because of its role as an independent prognostic factor for hypertension, chronic kidney disease, diabetes, and heart failure. Increased arterial stiffness is a common indicator of atherosclerotic involvement of the vascular structure indicating coronary artery disease (CAD), cerebrovascular disease, and PAD.4,5 It can also be affected by atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, and older age.6 Additionally, some inflammatory disease such as psoriasis may influence arterial stiffness parameters.7 In this point of view, the authors did not mention some of the affecting factors of arterial stiffness in the present study, including alcohol consumption, hypercholesterolemia, heart failure, cerebrovascular disease, and inflammatory disease such as psoriasis. It would have been helpful for the authors to provide information about these factors. Hypothyroidism plays a key role in cardiovascular disease pathogenesis by increasing total peripheral vascular resistance and inflammatory condition.8 Previously, the authors showed increases in augmentation indexes and central aortic pressures of hypothyroid patients.9 When arterial stiffness parameters were investigated with respect to their relationships with other studied parameters in patients, central aortic pressure showed significant relationships with serum vitamin B12 and phosphorus levels while augmentation
indexes showed significant correlations with albumin and magnesium levels.3 In conclusion, arterial stiffness is an easy, low-cost, reliable, noninvasive, and widely available parameter among the tested tools and may help detect the presence of subclinical atherosclerosis. Besides arterial stiffness, several other markers/tests such as C-reactive protein and functional photoplethysmography technology using a noninvasive automated device may reflect the presence of PAD.10 Both have the advantage of being less operator-dependent, unlike the arterial stiffness. Future studies should evaluate the prognostic significance of these variables in patients with PAD as well as their ability to identify unrecognized PAD. Sevket Balta, MD; Mustafa Demir, MD; Sait Demirkol, MD; Murat Unlu, MD; Ugur Kucuk, MD; Zekeriya Arslan, MD From the Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey References 1. Catalano M, Scandale G, Carzaniga G, et al. Increased aortic stiffness and related factors in patients with peripheral arterial disease. J Clin Hypertens (Greenwich). 2013;15:712–716. 2. Balta S, Balta I, Demirkol S, et al. Subclinical peripheral arterial disease and ankle-brachial index. Angiology. 2013;64:395–396. 3. Altun B, Bulucu F, Demirbas S, et al. The relationship between some of the cardiovascular risk factors and arterial stiffness parameters in essentially hypertensive patients. Clin Exp Hypertens. 2012 Nov 29 [Epub ahead of print]. 4. Demirkol S, Balta S, Kucuk U, et al. Arterial stiffness relatively easy and favourable prognostic marker in heart failure patients. Clin Cardiol 2013; DOI: 10.1002/clc.22211. 5. Balta S, Cakar M, Demirkol S, et al. Arterial stiffness itself without other inflammatory markers may not provide information to clinicians. J Clin Hypertens (Greenwich). 2013;15:303. 6. Vyssoulis GP, Karpanou EA, Kyvelou S-MG, et al. Beneficial effect of angiotensin II type 1 receptor blocker antihypertensive treatment on arterial stiffness: the role of smoking. J Clin Hypertens (Greenwich). 2008;10:201–207. 7. Balta I, Balta S, Demirkol S, et al. Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris. Angiology. 2013 May 1[Epub ahead of print]. 8. Balta S, Demırkol S, Kucuk U, et al. Epicardial adipose tissue should be evaluated with other inflammatory markers in patients with subclinical hypothyroidism. Med Princ Pract. 2013 April 6[Epub ahead of print]. 9. Obuobie K, Smith J, Evans LM, et al. Increased central arterial stiffness in hypothyroidism. J Clin Endocrinol Metab 2002;87:4662– 4666. 10. Sarlak H, Cakar M, Balta S, et al. Peripheral arterial disease assessment with photoplethysmography and continuous-wave Doppler ultrasound in addition to ankle-brachial index may loss time and funds. Angiology. 2013;64:321.
DOI: 10.1111/jch.12195
938
The Journal of Clinical Hypertension
Vol 15 | No 12 | December 2013
Official Journal of the American Society of Hypertension, Inc.
TO
THE
EDITOR
Arterial Stiffness in Patients With Peripheral Arterial Disease To the Editor: We read the article “Increased Aortic Stiffness and Related Factors in Patients With Peripheral Arterial Disease” written by Catalano and colleagues with interest.1 They aimed to investigate the factors associated with aortic stiffness in patients with peripheral arterial disease (PAD). They showed that aortic stiffness as assessed by aortic pulse wave velocity (aPWV) was higher in PAD patients as compared with control patients and that aPWV was independently associated with pulse pressure (PP). We believe that these findings will act as a guide for further information regarding arterial stiffness in PAD patients. PAD, a manifestation of atherosclerosis, is associated with a significant increase in cardiovascular morbidity and mortality. The early diagnosis of PAD and the initiation of conservative measures are not only related with a reduction in disease progression but also with numerous additional beneficial actions.2 Arterial stiffness represents vascular damage and is a measure of the degree of atherosclerosis.3 Arterial stiffness has received increased attention because of its role as an independent prognostic factor for hypertension, chronic kidney disease, diabetes, and heart failure. Increased arterial stiffness is a common indicator of atherosclerotic involvement of the vascular structure indicating coronary artery disease (CAD), cerebrovascular disease, and PAD.4,5 It can also be affected by atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, and older age.6 Additionally, some inflammatory disease such as psoriasis may influence arterial stiffness parameters.7 In this point of view, the authors did not mention some of the affecting factors of arterial stiffness in the present study, including alcohol consumption, hypercholesterolemia, heart failure, cerebrovascular disease, and inflammatory disease such as psoriasis. It would have been helpful for the authors to provide information about these factors. Hypothyroidism plays a key role in cardiovascular disease pathogenesis by increasing total peripheral vascular resistance and inflammatory condition.8 Previously, the authors showed increases in augmentation indexes and central aortic pressures of hypothyroid patients.9 When arterial stiffness parameters were investigated with respect to their relationships with other studied parameters in patients, central aortic pressure showed significant relationships with serum vitamin B12 and phosphorus levels while augmentation
indexes showed significant correlations with albumin and magnesium levels.3 In conclusion, arterial stiffness is an easy, low-cost, reliable, noninvasive, and widely available parameter among the tested tools and may help detect the presence of subclinical atherosclerosis. Besides arterial stiffness, several other markers/tests such as C-reactive protein and functional photoplethysmography technology using a noninvasive automated device may reflect the presence of PAD.10 Both have the advantage of being less operator-dependent, unlike the arterial stiffness. Future studies should evaluate the prognostic significance of these variables in patients with PAD as well as their ability to identify unrecognized PAD. Sevket Balta, MD; Mustafa Demir, MD; Sait Demirkol, MD; Murat Unlu, MD; Ugur Kucuk, MD; Zekeriya Arslan, MD From the Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey References 1. Catalano M, Scandale G, Carzaniga G, et al. Increased aortic stiffness and related factors in patients with peripheral arterial disease. J Clin Hypertens (Greenwich). 2013;15:712–716. 2. Balta S, Balta I, Demirkol S, et al. Subclinical peripheral arterial disease and ankle-brachial index. Angiology. 2013;64:395–396. 3. Altun B, Bulucu F, Demirbas S, et al. The relationship between some of the cardiovascular risk factors and arterial stiffness parameters in essentially hypertensive patients. Clin Exp Hypertens. 2012 Nov 29 [Epub ahead of print]. 4. Demirkol S, Balta S, Kucuk U, et al. Arterial stiffness relatively easy and favourable prognostic marker in heart failure patients. Clin Cardiol 2013; DOI: 10.1002/clc.22211. 5. Balta S, Cakar M, Demirkol S, et al. Arterial stiffness itself without other inflammatory markers may not provide information to clinicians. J Clin Hypertens (Greenwich). 2013;15:303. 6. Vyssoulis GP, Karpanou EA, Kyvelou S-MG, et al. Beneficial effect of angiotensin II type 1 receptor blocker antihypertensive treatment on arterial stiffness: the role of smoking. J Clin Hypertens (Greenwich). 2008;10:201–207. 7. Balta I, Balta S, Demirkol S, et al. Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris. Angiology. 2013 May 1[Epub ahead of print]. 8. Balta S, Demırkol S, Kucuk U, et al. Epicardial adipose tissue should be evaluated with other inflammatory markers in patients with subclinical hypothyroidism. Med Princ Pract. 2013 April 6[Epub ahead of print]. 9. Obuobie K, Smith J, Evans LM, et al. Increased central arterial stiffness in hypothyroidism. J Clin Endocrinol Metab 2002;87:4662– 4666. 10. Sarlak H, Cakar M, Balta S, et al. Peripheral arterial disease assessment with photoplethysmography and continuous-wave Doppler ultrasound in addition to ankle-brachial index may loss time and funds. Angiology. 2013;64:321.
DOI: 10.1111/jch.12195
938
The Journal of Clinical Hypertension
Vol 15 | No 12 | December 2013
Official Journal of the American Society of Hypertension, Inc.
