Interrelations Between Arterial Stiffness, Target Organ Damage, and Cardiovascular Disease Outcomes

Ramachandran S. Vasan, Meghan I. Short, Teemu J. Niiranen, Vanessa Xanthakis, Charles DeCarli, Susan Cheng, Sudha Seshadri, Gary F. Mitchell

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


Background: Excess transmission of pressure pulsatility caused by increased arterial stiffness may incur microcirculatory damage in end organs (target organ damage [TOD]) and, in turn, elevate risk for cardiovascular disease (CVD) events. Methods and Results: We related arterial stiffness measures (carotid-femoral pulse wave velocity, mean arterial pressure, central pulse pressure) to the prevalence and incidence of TOD (defined as albuminuria and/or echocardiographic left ventricular hypertrophy) in up to 6203 Framingham Study participants (mean age 50±15 years, 54% women). We then related presence of TOD to incident CVD in multivariable Cox regression models without and with adjustment for arterial stiffness measures. Cross-sectionally, greater arterial stiffness was associated with a higher prevalence of TOD (adjusted odds ratios ranging from 1.23 to 1.54 per SD increment in arterial stiffness measure, P<0.01). Prospectively, increased carotid-femoral pulse wave velocity was associated with incident albuminuria (odds ratio per SD 1.28, 95% CI, 1.02–1.61; P<0.05), whereas higher mean arterial pressure and central pulse pressure were associated with incident left ventricular hypertrophy (odds ratio per SD 1.37 and 1.45, respectively; P<0.01). On follow-up, 297 of 5803 participants experienced a first CVD event. Presence of TOD was associated with a 33% greater hazard of incident CVD (95% CI, 0–77%; P<0.05), which was attenuated upon adjustment for baseline arterial stiffness measures by 5–21%. Conclusions: Elevated arterial stiffness is associated with presence of TOD and may partially mediate the relations of TOD with incident CVD. Our observations in a large community-based sample suggest that mitigating arterial stiffness may lower the burden of TOD and, in turn, clinical CVD.

Original languageEnglish (US)
Article numbere012141
JournalJournal of the American Heart Association
Issue number14
StatePublished - 2019


  • arterial stiffness
  • cardiovascular disease
  • epidemiology
  • pulse wave velocity
  • target organ damage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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