Increased arterial stiffness is independently related to cerebrovascular disease and aneurysms of the abdominal aorta: the Second Manifestations of Arterial Disease (SMART) Study

Arterial stiffness is a risk factor for stroke and myocardial infarction. We investigated whether carotid arterial stiffness is related to other localizations of manifest arterial disease. Carotid artery stiffness was measured by ultrasonography as the change in diameter in systole relative to the diastolic diameter in patients enrolled in the Second Manifestations of Arterial Disease (SMART) Study, a cohort study among patients with manifest cardiovascular disease or cardiovascular risk factors. The first consecutive 1561 patients with manifest cardiovascular disease were classified in 4 categories: cerebrovascular disease, coronary artery disease, peripheral artery disease, or aneurysm of the abdominal aorta (AAA). Differences in arterial stiffness among the categories were studied by linear regression analyses. Patients with coronary artery disease as single diagnosis (n=482) served as reference group. Patients with cerebrovascular disease (arterial distension -42.0 microm [95% CI, -57.2 to -26.8]) and those with an AAA (-64.4 microm [95% CI, -84.8 to -44.0]) had an increased carotid stiffness compared with the reference group. Adjustment for confounders attenuated the relations, which remained statistically significant (-34.2 microm [95% CI, -47.8 to -20.7] and -33.2 microm [95% CI, -51.8 to -14.6], respectively). Our study suggests that increased arterial stiffness is important in the pathophysiology of especially cerebrovascular disease and AAA. That the differences in arterial stiffness between disease categories attenuated after adjustment for important risk factors but remained significant suggests that besides being an element in the causal pathway, arterial stiffness is also a risk factor for cardiovascular disease itself