Arterial Stiffness Itself Without Other Inflammatory Markers May Not Provide Information to Clinicians


To the Editor:

We read the article “Association of Arterial Stiffness With Obesity in Australian Women: A Pilot Study” written by Pal and colleagues[1] with interest. The authors investigated the arterial stiffness status in overweight/obese Australian women compared with their lean counterparts. They concluded that increased arterial stiffness existed in overweight patients compared with lean patients, as well as with a positive association of augmentation index with measurements of body composition and blood pressure (BP). These data suggest that greater cardiovascular risk in overweight/obese women may be related to increased arterial stiffness, as well as increased BP and cholesterol. We believe that these findings will act as a guide for further information regarding obesity and cardiovascular disease risk factors related to body composition.

Arterial stiffness indicates the viscoelastic properties of the vessel wall. Arterial stiffness represents vascular damage and is a measure of the degree of atherosclerosis.[2] 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 peripheral arterial disease.[3, 4] It can also be affected by atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, hypothyroidism, and older age.[5] In this point of view, in the present study, the authors did not mention some of the affecting factors of arterial stiffness, including smoking, alcohol consumption, hypercholesterolemia, hypothyroidism, heart failure, cerebrovascular disease, and peripheral arterial disease. It would have been useful had the authors provided information about these factors.

Furthermore, some medications such as antihypertensive treatment including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins may influence arterial stiffness paremeters.[3, 4, 6] Had the authors described these factors, it would have been beneficial to the readers and the results may have been different.

In addition, the authors did not clearly define that obesity is independently associated with arterial stiffness paremeters. A multivariate regression analysis would have been valuable and adjusted for other related factors (such as hypertension, diabetes mellitus, smoking, hypercholesterolemia, and medications).

Finally, arterial stiffness is a noninvasive method to assess endothelial dysfunction in clinical practice and can be affected by many factors. Arterial stiffness itself without other inflammatory markers may not provide information to clinicians about the endothelial inflammation. Therefore, we think that it should be evaluated together with other serum inflammatory markers.