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La disfunzione microcircolatoria nell'ipertensione arteriosa: dalla ricerca sperimentale all'evidenza clinica.
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Vascular ultrasound and cardiovascular risk assessment
Full text linkVascular ultrasound is able to detect endothelial dysfunction, arterial
structural remodeling and increased arterial stiffness. These alterations have
been shown to be associated with established and emerging cardiovascular risk
factors and with incident cardiovascular events. Therefore, vascular ultrasound
has been proposed to evaluate the role of different risk factors in the initiation
and progression of atherosclerotic process, to study vascular aging and
the relationship between arterial stiffness and atherosclerosis, to assess the
efficacy of life-style and therapeutic interventions, and to improve the estimation
of individual cardiovascular risk. The present paper provides a critical overview
of the clinical evidence appraising the association of flow-mediated dilation,
carotid and femoral intima-media thickness and plaque presence as well as
local arterial stiffness with cardiovascular risk factors and cardiovascular events
Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications
No full textArterial stiffness results from a degenerative process affecting mainly the extracellular matrix of elastic arteries under the effect of aging and risk factors. Changes in extracellular matrix proteins and in the mechanical properties of the vessel wall related to arterial stiffening may activate number of mechanisms involved also in the process of atherosclerosis. Several noninvasive methods are now available to estimate large artery stiffness in the clinical setting, including carotid-femoral pulse wave velocity, the reference for aortic stiffness estimate, and local distensibility measures of superficial arteries, namely carotid and femoral. An independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been established. Thus, arterial stiffness is emerging as an interesting tissue biomarker for cardiovascular risk stratification and estimation of the individual "biological age". This paper overviews the mechanisms accounting for development and progression of arterial stiffness and for associations between arterial stiffness, atherosclerotic burden and incident cardiovascular events, summarizes the evidence and caveat for clinical use of stiffness as surrogate marker of cardiovascular risk, and briefly outlines some emerging methods for large artery stiffness characterization
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