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Noninvasive tests of vascular function are useful for assessing the severity of atherosclerosis and risk of cardiovascular events, understanding the pathophysiology of cardiometabolic disorders, and investigating the effects of therapeutic interventions on cardiovascular morbidity and mortality, all of which can provide additional information for the management of patients with cardiovascular risk factors or a history of cardiovascular disease. In 2023-2024, many excellent articles on vascular function were published in Hypertension Research and other major cardiovascular and hypertension journals, and we summarize the emerging evidence on vascular function in this review. We hope that this review will be helpful for the management of patients with cardiovascular risk factors in clinical practice and for future basic and clinical research on vascular function.

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PURPOSE: Aortic stiffness, assessed as estimated aortic pulse wave velocity (aPWV), and carotid intima-media thickness (cIMT) are markers of vascular age, and carotid plaques are a marker of early atherosclerosis. In this cross-sectional study we aimed to investigate the association between aPWV, cIMT and plaques across different age groups and in women and men, in a middle-aged healthy population. MATERIALS AND METHODS: Participants in the 6.5-year follow-up of the VIPVIZA trial who were aged 47, 57 and 67 underwent an oscillometric measurement which estimates aPWV between 2020 and 2023. Carotid ultrasound examinations were also performed. Linear and ordinal regression models were used to investigate how aPWV associates with cIMT and with carotid plaques, for the overall study group and stratified for age groups and sex. RESULTS: A total of 1046 subjects were included in the analyses. Linear associations between aPWV and cIMT (ß = 0.018, 95% CI: 0.006-0.030, p = 0.003), and between aPWV and plaques (OR: 1.19, 95% CI: 1.03-1.38, p = 0.018), were seen in the 57-year-olds. In the 47-year-olds a significant association was seen between aPWV and plaques (OR: 2.98 95% CI: 1.44-6.14, p = 0.003). No significant associations were seen in the 67-year-olds. For women, a significant association between aPWV and cIMT (ß = 0.011, 95% CI: 0.004-0.017, p = 0.002) was shown. CONCLUSION: Estimated aPWV was positively associated with increasing cIMT and the presence of carotid plaques in younger middle-aged individuals, and with cIMT in women, suggesting that measurement of estimated aPWV may improve cardiovascular risk assessment in younger middle-aged individuals and women.Clinical Trial Registration date 8 May 2013: URL: www.clinicaltrials.gov. Unique identifier: NCT01849575.

What is the context? Vascular ageing is a process where the arteries become stiff, leading to impaired function and organ damage. Stiff arteries increase the risk of cardiovascular disease. Aortic pulse wave velocity is a measurement of arterial stiffness and a marker of vascular age. Carotid intima-media thickness and carotid plaque presence are other markers of vascular age and early atherosclerosis. There are limited data on the association between aortic pulse wave velocity, carotid intima-media thickness and carotid plaques.What is new? We measured estimated aortic pulse wave velocity using an oscillometric device and performed carotid ultrasound examinations for assessment of carotid intima-media thickness and carotid plaques in healthy middle-aged individuals across three different age groups. The association between aortic pulse wave velocity, carotid intima-media thickness and carotid plaques was examined in the different age groups and in women and men separately.What is the impact? Estimated aortic pulse wave velocity was associated with carotid intima-media thickness and carotid plaques in younger middle-aged individuals and with carotid intima-media thickness in women. Suggesting that for these groups ­ healthy younger middle-aged people, and especially women ­ measurement of estimated aortic pulse wave velocity could improve evaluation of cardiovascular risk.

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Introduction: Obesity in adults is a known risk factor for cardiovascular events and is associated with a decline in arterial elasticity. This study aims to evaluate the utility of pulse wave analysis (PWA) parameters in routine clinical practice for the primary prevention of cardiovascular events by developing a prediction model for arterial stiffness among obese and overweight individuals. Methods: The study enrolled 84 adult patients, aged 18 to 85 years, with varying degrees of weight status, including optimal weight, overweight, and obesity. The lifestyle habits, the personal and family history of cardiometabolic diseases, as well the clinical evaluation that included BMI (body mass index), WHR (waist-to-hip ratio), WC (waist circumferance) were performed. PWA evaluation was conducted using the Mobil-O-Graph device, assessing the following parameters: pulse wave velocity (PWV), augmentation index (AIx), heart rate (HR), central pulse pressure (cPP), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP). Body composition analysis was performed using the TANITA BC-418 body analyzer. Laboratory results from the past 3 months were also collected during initial nutritional consultations for each patient. Results: Family history of cardiovascular events showed positive correlations with all PWA parameters, while diabetes history only with PWV and family history of obesity with PWV, DBP, and cSBP. Insufficient sleep duration showed positive associations with all arterial stiffness parameters except cDBP. Smoking status correlated with significantly elevated PWV and Aix values, while insufficient physical activity was associated solely with PWV. Positive correlations were showed between current weight and PWV, while WC demonstrated positive associations with PWV, SBP, and cSBP. Body composition analysis revealed significant associations between trunk adipose tissue mass (%) and PWV, SBP, and cSBP. Hydration status (%) emerged as an independent predictor for PWV, exhibiting an inverse relationship. HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) showed a strong positive correlation with PWV. Negative associations were observed with HDL-c and vitamin D. Threshold values for age, cDBP and Cardiac Index providing positive diagnostic for vascular impairment. Conclusion: The assessment of arterial stiffness can be considered a reliable approach to prevent obesity-related cardiovascular events and facilitate the comprehensive management of such pathologies.

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BACKGROUND: As the pulmonary system and cardiovascular system are intimately linked, patients with chronic obstructive pulmonary disease (COPD) and asthma have high risk for developing cardiovascular diseases (CVDs) and altered central hemodynamic. OBJECTIVE: We aim to assess the central aortic blood pressure (CABP) indices, pulse wave velocity (PWV) and other indicators of arterial stiffness in Indian patients with COPD and bronchial asthma. METHODS: This is a single-center, cross-sectional study conducted in outpatients diagnosed with either chronic stable phase of COPD or bronchial asthma. CABP indices, vascular age, arterial stiffness and central hemodynamics were measured in patients. RESULTS: Of 193 patients with obstructive airway disease who were enrolled, (n = 81 had COPD and n = 112 had partially-controlled bronchial asthma) the proportion of male patients was higher in both groups. The PWV, augmentation index (AI) and vascular age (VA) were significantly higher in patients with COPD compared to those with bronchial asthma (all, p < 0.05). CONCLUSION: The study showed that PWV, AI and VA were higher in patients with stable COPD without any cardiac comorbidities compared to bronchial asthma.

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The present cross-sectional study aimed to compare climacteric symptoms and arterial stiffness indices between perimenopausal and postmenopausal women. The study sample comprised 70 healthy female participants, including 27 perimenopausal (49.8 ± 3.8 years) and 43 postmenopausal (55.7 ± 4 years) individuals. Validated methods were used to assess physical activity level, quality of life, climacteric symptoms, and anthropometric data. Arterial stiffness parameters were measured using Mobil-O-Graph. Pulse wave velocity (PWV) had a higher mean in the postmenopausal group than in the perimenopause group [8.04 m/s (SD 0.79) vs 7.01 m/s (SD 0.78), p < .001). PWV was strongly correlated with peripheral (r = 0.619) and central (r = 0.632) Systolic Blood Pressure (SBP) in postmenopausal group and an even stronger correlation was observed in perimenopausal group (r = 0.779 pSBP and 0.782 cSBP). BMI was a risk predictor in the perimenopausal group contributing positively to increase Pulse Pressure Amplification (PPA) (0.458, p < .05). In postmenopausal women, heart rate (HR) was a stronger predictor for central SBP, cardiac output, and total vascular resistance, whereas perimenopausal women HR influenced central diastolic blood pressure and PPA. Vascular changes initiating during perimenopause may contribute to the development of cardiovascular pathologies in the postmenopausal period. Further research with larger, representative samples is warranted to corroborate these findings.

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BACKGROUND: There are currently no specialized risk-scoring systems for critically ill patients with coronary heart disease (CHD). Arterial stiffness, as measured by estimated pulse wave velocity (ePWV), has emerged as a potential indicator of mortality or adverse cardiovascular events in individuals with CHD. This study aimed to evaluate the association between ePWV and all-cause mortality among critically ill patients with CHD beyond traditional risk scores. METHODS: This study included 11 001 participants with CHD from the Medical Information Mart for Intensive Care IV, with a one-year follow-up. The primary endpoint was one-year all-cause mortality, and the secondary endpoint was in-hospital mortality. RESULTS: Elevated ePWV was significantly associated with higher risks of in-hospital (OR 1.15, 95% CI 1.12-1.17, p < 0.001) and one-year (HR 1.21, 95% CI 1.20-1.23, p < 0.001) mortality. These associations remained consistent when adjusted for traditional risk scores and potential confounders. When ePWV was integrated into traditional risk scoring models (OASIS, SOFA score, APSIII, SIRS score, SAPS II, and LODS score), the predictive accuracy (area under the curve: 64.55 to 70.56, 64.32 to 72.51, 72.35 to 75.80, 55.58 to 67.68, 71.27 to 73.53, 67.24 to 73.40, p < 0.001) and reclassification (net reclassification index: 0.230, 0.268, 0.257, 0.255, 0.221, 0.254; integrated discrimination improvement: 0.049, 0.072, 0.054, 0.068, 0.037, 0.061, p < 0.001) of these models significantly improved for one-year mortality. Similar results were also found for in-hospital mortality. CONCLUSIONS: ePWV is a strong independent predictor of both short- and long-term mortality in critically ill patients with CHD. Importantly, integrating ePWV into traditional risk scores significantly boosts the predictive accuracy for one-year and in-hospital all-cause mortality.

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BACKGROUND: Different types of exercise, performed acutely or chronically, have different repercussions on central hemodynamics, arterial stiffness, and cardiac function. In this study, we aim to compare the effects of acute elbow flexion (EFlex) and knee extension (KExt) exercises on vascular and hemodynamic parameters and arterial stiffness indices in healthy young adults. METHODS: Young adults (20 to 39 years) underwent randomized muscle strength tests to obtain 1 repetition maximum (1RM) for elbow flexion (EFlex) and knee extension (KExt). After a minimum interval of 48 h, cardiovascular parameters were assessed using Mobil-O-Graph® (Mobil-O-Graph, IEM, Germany) at three-time points: at baseline (before exercise), immediately after elbow flexion or knee extension exercises with a load corresponding to 50% of 1RM (T0) and after 15 min of rest (T15). RESULTS: Immediately after exercise (T0), peripheral systolic blood pressure, peripheral pulse pressure, central systolic blood pressure, and central pulse pressure were significantly higher in KExt than EFlex (Δ 3.13; Δ 3.06; Δ 5.65; Δ 5.61 mmHg, respectively). Systolic volume, cardiac output, and cardiac index were significantly higher immediately after KExt when compared with EFlex (Δ 4.2 ml; Δ 0.27 ml/min and 0.14 l/min*1/m2, respectively). The reflection coefficient and the pulse wave velocity were also significantly higher at T0 in KExt compared to EFlex ( Δ 8.59 and Δ 0.12 m/sec, respectively). CONCLUSION: Our results show differential contribution of muscle mass in vascular and hemodynamic parameters evaluated immediately after EFlex and KExt. In addition, our study showed for the first time that the reflection coefficient, an index that evaluates the magnitude of the reflected waves from the periphery, was only affected by KExt.

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PURPOSE: Brachial blood pressure (BP) is the current gold standard for BP assessment; however, measures of pulse wave velocity (PWV) and central blood pressure (CBP) may contribute uniquely to assessment of cardiovascular health status. As of yet, standards for assessment of CBP and PWV have not addressed the impact of hydration status on proper measurement. To understand the impact of hydration, PWV and CBP should be measured in a euhydrated and hypohydrated state. METHODS: Forty-three young, healthy participants (21 ± 2 years) completed a dehydration protocol utilizing moderate aerobic activity until they lost 1%-2% of their body weight. PWV and CBP were measured before and following the dehydration protocol. Linear regression was utilized to assess change in hydration status and change in PWV and CBP. RESULTS: No significant relationships were observed between the change in hydration status (% body weight lost) and PWV (ß = 0.05, p = 0.78) or central diastolic BP (ß = -3.8, p = 0.10), however, a significant relationship was observed with central systolic BP (ß = -5.0, p = 0.03). DISCUSSION: In conclusion, the assessment of hydration status before measurement of CBP or PWV may not be necessary in young, healthy individuals.

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Background: Cardiovascular diseases (CVD) account for approximately one-third of all deaths worldwide. The incidence of cardiovascular events such as myocardial infraction has been reported to be progressively increasing with age, especially with existing comorbidities such as hypertension, diabetes and obesity. Assessing arterial stiffness indices may serve as a screening tool in identification of population at risk of cardiovascular diseases and assist in implementation of preventive measures and early treatment in this population. Objectives: To measure and compare the arterial stiffness indices in healthy adults with diabetes, hypertension and obesity. Methods: A total of 184 adults in the age group of 30-50 years were included in the study who were divided into 4 groups: Group I (n = 64) (diabetic), group II (n = 40) (hypertensives), group III (n = 40) (obese) and group IV (n = 40) (control). The arterial stiffness indices were measured by using a certified oscillometric device in all the participants. Results: The arterial stiffness indices were assessed by using a certified oscillometric device in all the participants. The mean values of right baPWV and left baPWV are found to be significantly higher in hypertensive subjects compared with obese, diabetic and healthy controls. Conclusion: The pulse wave velocity, ASI and pulse pressure serve as independent predictors of cardiovascular mortality and outcomes in hypertension, diabetes and obesity as well as healthy individuals.

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Severe acute coronavirus-2 (SARS-CoV-2) infection has been associated with endothelial damage, and impaired nitric oxide production, which results in arterial stiffness and increased risk of cardiovascular disease. Long COVID is a term used to describe the persistence or the development of new symptoms that can occur after an acute infection. Little is known about the association between arterial stiffness and Long COVID. An observational, cross-sectional study in which arterial stiffness was measured with pulse wave velocity (PWV) was carried out in 74 participants between 19 and 40 years old (53 with Long COVID, 21 age and gender-matched controls). Data was collected from participants between 1 and 9 months after acute COVID-19 infection using the Complior analyze unit protocol. The Long COVID group had higher carotid-radial-PWV (crPWV) than controls (10 m/s interquartile range [IQR] 8.5-11.2 m/s) versus 8.8 m/s (IQR 7.7-9.2 m/s) as was their carotid-radial-arterial stiffness index (crASI) (2.26 cm/ms (IQR 1.9-2.56 cm/ms) vs. 2.01 cm/ms (IQR 1.82-2.27 cm/ms); p < 0.05) in both. They also had more type-A waveforms, indicating increased arterial stiffening. Peripheral arterial stiffness was higher in adults with Long COVID than in controls who were never infected with SARS-CoV-2 as noted by the elevated levels of crPWV and crASI among adults with Long COVID.

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We introduce a new computational framework that utilises Pulse Wave Velocity (PWV) extracted directly from 4D flow MRI (4DMRI) to inform patient-specific compliant computational fluid dynamics (CFD) simulations of a Type-B aortic dissection (TBAD), post-thoracic endovascular aortic repair (TEVAR). The thoracic aortic geometry, a 3D inlet velocity profile (IVP) and dynamic outlet boundary conditions are derived from 4DMRI and brachial pressure patient data. A moving boundary method (MBM) is applied to simulate aortic wall displacement. The aortic wall stiffness is estimated through two methods: one relying on area-based distensibility and the other utilising regional pulse wave velocity (RPWV) distensibility, further fine-tuned to align with in vivo values. Predicted pressures and outlet flow rates were within 2.3 % of target values. RPWV-based simulations were more accurate in replicating in vivo hemodynamics than the area-based ones. RPWVs were closely predicted in most regions, except the endograft. Systolic flow reversal ratios (SFRR) were accurately captured, while differences above 60 % in in-plane rotational flow (IRF) between the simulations were observed. Significant disparities in predicted wall shear stress (WSS)-based indices were observed between the two approaches, especially the endothelial cell activation potential (ECAP). At the isthmus, the RPWV-driven simulation indicated a mean ECAP>1.4 Pa-1 (critical threshold), indicating areas potentially prone to thrombosis, not captured by the area-based simulation. RPWV-driven simulation results agree well with 4DMRI measurements, validating the proposed pipeline and facilitating a comprehensive assessment of surgical decision-making scenarios and potential complications, such as thrombosis and aortic growth.

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BACKGROUND: This study aimed to assess the efficacy of estimated preoperative aortic pulse wave velocity (AoPWV) to discriminate between low and high 6 min walk test (6MWT) distance in patients awaiting major non-cardiac surgery. METHODS: Prospective observational study in 133 patients undergoing non cardiac surgery. AoPWV and the distance walked during a 6MWT were assessed. Receiver operating characteristic (ROC) curve analysis was used to determine two different AoPWV cut-points for predicting a distance of 427 m in the 6MWT. We also calculated lower and upper AoPWV cut-points (probability ≥ 0.75) for predicting a distance of < 427 m, ≥427 m, and also 563 m in the 6MWT. RESULTS: The ROC curve analysis for the < 427 m distance revealed an area under the curve (AUC) of 0.68 (95% confidence interval 0.56-0.79) and an AUC of 0.72 (95% confidence interval 0.61-0.83) for >563 m. Patients with AoPWV > 10.97 m/s should be considered high risk, while those with <9.42 m/s can be considered low risk. CONCLUSIONS: AoPWV is a simple, non-invasive, useful clinical tool for identifying and stratifying patients awaiting major non-cardiac surgery. In situations of clinical uncertainty, additional measures should be taken to assess the risk.

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Background: A potential independent association between arterial stiffness (AS) and the development of new-onset chronic kidney disease (CKD) has not been thoroughly examined. Patients and methods: A total of 6929 participants were collected from the Kailuan study. All participants were free of CKD at the baseline. The participants were divided into four groups based on their brachial-ankle pulse wave velocity (baPWV) values. Cox regression models were used to analyze the relationship between baPWV values and the risk of new-onset CKD. Results: Over the course of a 10.06-year follow-up period, a total of 962 cases of new-onset CKD were documented. Cox proportional hazards analyses showed that a higher baPWV quartile was linked to an increased risk of new-onset CKD. Conclusions: Brachial-ankle pulse wave velocity has a strong correlation with the development of new-onset CKD. Therefore, baPWV can be considered an innovative indicator for predicting the occurrence of new-onset CKD.

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BACKGROUND: There are numerous cross-sectional studies showing an association between arterial stiffness and diabetes, but the temporality of the association is unclear. OBJECTIVE: To investigate the temporal relationship between arterial stiffness and diabetes. METHODS: We searched MEDLINE and Embase from inception to 31 August 2023, to identify cohort studies that assessed whether arterial stiffness, as measured by pulse wave velocity (PWV), was predictive of the development of diabetes and vice versa. We summarised study data, and where possible undertook meta-analysis. RESULTS: We identified 19 studies that included people with type 1, type 2 and gestational diabetes. All 11 studies investigating arterial stiffness as a predictor of diabetes found a significant relationship. Six of those studies were suitable for meta-analysis. The risk of developing diabetes was greater in people with higher PWV at baseline than lower PWV (RR = 2.14, 95%CI 1.65 to 2.79, p < 0.00001) and the mean difference in baseline PWV was higher in people who developed diabetes than those who did not (mean difference: 0.77 m/s, 95%CI 0.47 to 1.06, p < 0.00001). Of 8 studies investigating diabetes as a predictor of arterial stiffness, 7 found a significant relationship. CONCLUSION: There is evidence of a bidirectional relationship between arterial stiffness and diabetes. Arterial stiffness may provide a causal link between diabetes and future cardiovascular disease.

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INTRODUCTION: Significant kidney function may be lost before CKD is diagnosed. Arterial stiffness may be a risk factor for CKD and the relationship may be bi-directional. A systematic review of cohort studies was undertaken to ascertain the temporal relationship of arterial stiffness and CKD. METHODS: MEDLINE and Embase were searched to 4 October 2023 to identify studies that investigated whether arterial stiffness, as estimated by pulse wave velocity, was predictive of the development or progression of CKD, rapid decline in kidney function, and vice versa. The characteristics and outcomes of the included studies were set out in a qualitative summary. The review protocol is registered with PROSPERO (CRD42019129563). RESULTS: Forty-two studies were included, all of which were high quality with respect to bias. Thirteen of seventeen studies that investigated arterial stiffness as a predictor of incident CKD found a positive association (p < 0.05). Of the 10 studies that controlled for CKD risk factors, 6 found a positive association. Eight of seventeen studies that investigated arterial stiffness as a predictor of progression of CKD, and five out of eight studies, which investigated rapid kidney decline, found a positive association. One study of six found kidney function was able to predict future elevated arterial stiffness. CONCLUSION: Arterial stiffness may predict incident CKD and a rapid decline in CKD. It is uncertain if arterial stiffness is associated with CKD progression or whether reduced kidney function is predictive of increased arterial stiffness. Further longitudinal research is required.

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Although whole grains have well-recognized protective effects against the development of cardiometabolic diseases, whole grain foods are poorly consumed by the general population. The aim of our study was to establish, at a population level, the vascular impact of a low intake of whole grain foods. From the initial cohort of the Brisighella Heart Study, we identified a population sample of 1503 individuals-including 720 men (47.9%) and 783 women (52.1%)-who overall largely consumed refined grain products. Diet quality was estimated by the Short Healthy Eating Index (sHEI), and women were found to have an eating pattern that was overall healthier than men (44.1 ± 8.5 vs. 36.3 ± 8.1, p < 0.001). The development of an age- and blood pressure (BP)-adjusted multiple linear regression model found that carotid-femoral pulse wave velocity (cfPWV) was significantly predicted by the estimated glomerular filtration rate (eGFR, B = -0.148, 95% Confidence Interval (CI) -0.259--0.038, p < 0.001), serum uric acid (SUA, B = 0.220, 95%CI 0.095-0.320, p = 0.001) and sHEI (B = -0.231, 95%CI -327--0.089, p < 0.001) in men, and by eGFR (B = -0.152, 95%CI -0.266--0.052, p < 0.001), body mass index (BMI, B = 0.174, 95%CI 0.111-0.331, p = 0.002), SUA (B = 0.278, 95%CI 0.158-0.354, p < 0.001) and sHEI (B = -0.218, 95%CI -308--0.115, p < 0.001) in women. Ultimately, a low sHEI score was a significant predictor of arterial stiffness also in a population cohort with a high consumption of refined grain products.

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Vascular aging, a common pathogenesis of senile chronic diseases, significantly increases morbidity and mortality in older adults; its intricate cellular and molecular mechanisms necessitate further investigation. Lumican (LUM) and integrin α2ß1(ITGα2ß1) are profibrotic extracellular matrix proteins and vital cell regulatory receptors, respectively. However, their roles in vascular aging remain unclear. This study sought to elucidate the connection between LUM and vascular aging as well as the biological mechanism of LUM/ITGα2ß1 in this process. Using an enzyme-linked immunosorbent assay, we discovered that plasma LUM was elevated in vascular aging individuals and was positively correlated with brachial-ankle pulse wave velocity. Additionally, immunohistochemical and western blot analyses confirmed LUM upregulation in arteries of older adults and aged mice, as well as in senescent vascular smooth cells (VSMCs). Wild-type and LUM semiknockout (Lum-/+) mice, along with primary VSMCs extracted from these mice, were exposed to angiotensin II (Ang II) to induce stress-induced senescence model. LUM semiknockout mitigated Ang Ⅱ-induced arteriosclerosis, hypertension, vascular aging and remodeling in mice. Both in vitro and in vivo studies revealed that LUM deficiency suppressed p53, p21, collagen 1 and collagen 3 upregulation and synthetic phenotype formation in VSMCs stimulated by Ang Ⅱ. Treating VSMCs with a ITGα2ß1 antagonist reversed the aforementioned changes triggered by LUM proteins. Briefly, LUM functions as a potential marker and risk factor for vascular aging and promotes pathological changes by affecting ITGα2ß1 in VSMCs. This study introduces a novel molecular target for the early diagnosis and treatment of vascular aging and age-related vascular diseases.

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Background: Recent studies have demonstrated an association between pulse wave velocity (PWV), cerebral small vessel disease (SVD), and cognitive impairment such as Alzheimer's disease. However, the association between brachial-ankle PWV and enlarged perivascular spaces (EPVS), one component of cerebral SVD remains controversial. Objective: To investigate the relationship between brachial-ankle PWV and EPVS severity in participants without dementia. Methods: We performed a cross-sectional study of data of 74 participants from sub-analysis of ongoing research. We assessed cognitive function, brachial-ankle PWV, and brain magnetic resonance imaging (MRI) features. Using brain MRI, EPVS were separately assessed as basal ganglia (BG)-EPVS or centrum semiovale (CSO)-EPVS on the basis of their location. The relationship between EPVS severity and brachial-ankle PWV was evaluated using multivariable ordinal logistic regression analyses. Results: We analyzed 74 participants (women: 47%, mean age: 73 years, mild cognitive impairment [MCI]: 74%). Compared with participants with normal cognition, those with MCI were more likely to have both severe BG-EPVS and severe CSO-EPVS. In multivariable analyses, high brachial-ankle PWV and age were independently associated with BG-EPVS severity (odds ratio [95% confidence interval]: 1.19 [1.02-1.38], 1.09 [1.01-1.17], respectively), whereas only age was independently associated with CSO-EPVS severity. A causal mediation analysis under a counterfactual approach revealed a significant pure natural indirect effect of brachial-ankle PWV on MCI that was mediated by BG-EPVS (estimate: 1.04, 95% CI: 1.01-1.12, p = 0.006). Conclusions: Brachial-ankle PWV was associated with BG-EPVS severity. High PWV may cause cerebrovascular pulsatility, which accelerates BG-EPVS and may worsen cognitive impairment.

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Pulse wave velocity (PWV) has been established as a promising biomarker in cardiovascular diagnostics, providing deep insights into vascular health and cardiovascular risk. Defined as the velocity at which the mechanical wave propagates along the arterial wall, PWV represents a useful surrogate marker for arterial vessel stiffness. PWV has garnered clinical attention, particularly in monitoring patients suffering from vascular diseases such as hypertension and diabetes mellitus. Its utility extends to preventive cardiology, aiding in identifying and stratifying cardiovascular risk. Despite the development of various measurement techniques, direct or indirect tonometry, Doppler ultrasound, oscillometric analysis, and magnetic resonance imaging (MRI), methodological variability and lack of standardization lead to inconsistencies in PWV assessment. In addition, PWV can be estimated through surrogate parameters, such as pulse arrival or pulse transit times, although this heterogeneity limits standardization and, therefore, its clinical use. Furthermore, confounding factors, such as variations in sympathetic tone, strongly influence PWV readings, thereby necessitating careful control during assessments. The bidirectional relationship between heart rate variability (HRV) and PWV underscores the interplay between cardiac autonomic function and vascular health, suggesting that alterations in one could directly influence the other. Future research should prioritize the standardization and increase comparability of PWV measurement techniques and explore the complex physiological variables influencing PWV. Integrating multiple physiological parameters such as PWV and HRV into algorithms based on artificial intelligence holds immense promise for advancing personalized vascular health assessments and cardiovascular care.