原发性高血压患者血压分级及危险因素分层与脉搏波速度关系的研究

目的 探讨原发性高血压患者血压分级以及危险因素分层与动脉脉搏波速度(PWV)的关系.方法 应用动脉脉搏速度自动测量系统测定入选的660例原发性高血压患者的PWV(330例测定颈-股动脉PWV值,330例测定肱动脉-踝动脉PWV值),并对患者进行危险因素分层,比较不同血压水平及危险程度患者的脉搏波速度.结果 1级与2级高血压患者的cfPWV与baPWV间差异无统计学意义[颈-股动脉PWV(10.24±1.9)m/s比(10.78±0.9)m/s,P=0.324;baPWV(1 638±160)cm/s比(1 720±170)cm/s,P=0.288];伴有一种以上心血管危险因素患者的PWV显著高于单纯高血压患者[颈-股动脉PWV(10.28±1.6)m/s比(12.16±1.4)m/s,P=0.001;baPWV(1 735±138)cm、s比(1 584±160)cm/s,P=0.001].结论 存在一种或一种以上心血管危险因素的高血压患者PWV值明显高于无危险因素的高血压患者,心血管危险因素对脉搏波速度的影响可能较大.     

嘉兴市南湖区1286例臂踝脉搏波传导速度调查分析

血管壁病变是各种心血管事件发生的基础,早期发现和干预亚临床期血管病变的进展是延缓和控制心血管事件的根本措施.脉搏波传导速度(以下简称PWV)是动脉弹性功能检测的主要方法,反映动脉僵硬度的早期敏感指标[1],及时检出人体动脉弹性功能减退,寻找出危险因子为干预血管壁病变的进展提供依据.嘉兴市南湖区国民体质监测中心1年来免费为区内职工精确安全地监测臂踝脉搏波传导速度(baPWV)1286例,检测结果显示高血压、年龄等因素是影响PWV的重要因素,分析如下.     

心血管病高危人群臂踝脉搏波速度的临床应用

目的观察心血管病高危人群臂踝脉搏波速度(baPWV)与心血管病危险因素和临床心脑血管事件的相关性。方法连续入选111例心血管病高危患者,进行baPWV、身高、体重、腰围、血压、心率测量,病史采集及血液生化检查。高危人群定义为既往发生过心脑血管事件(冠心病、缺血性脑卒中、短暂性脑缺血发作)或具有两种以上心血管危险因素(年龄≥50岁、吸烟、肥胖、高血压病、糖尿病、高脂血症)的人群。比较高baPWV组(≥1700cm/s)与低baPWV组(<1700cm/s)患者具有危险因素个数和临床心脑血管事件发生情况的差异。结果与低baPWV组相比,高baPWV组心脑血管事件发生率较高(分别为35.3%和60.5%,P<0.01),心血管危险因素数目较多[(3.9±1.2)和(4.4±0.9),P<0.05]。影响baPWV的因素主要为年龄(P<0.001)和收缩压(P<0.01)。结论在心血管病高危人群中,baPWV较高的患者心脑血管事件发生率高,心血管危险因素多。年龄和收缩压是影响baPWV的独立危险因素。     

联合运用多普勒探头与脉搏波传感器检测脉搏波传导速度的可行性

目的 探讨联合运用超声多普勒探头与脉搏波传感器检测脉搏波传导速度(PWV)方法的可行性.方法 纳入30名正常人,分别将超声多普勒探头与脉搏波传感器放置于受试者左侧颈总动脉起始段及左侧踝部胫后动脉,将两测量点间距离与测得动脉多普勒血流流速曲线的起点和动脉脉搏波曲线起点间的传播时间相比,以所得比值作为颈-踝动脉段的PWV(caPWV);并对检测结果与动脉硬化仪检测同一受试者肱-踝动脉段PWV(baPWV)的检测结果进行相关性分析.结果 将脉搏波传感器放置于颈总动脉、多普勒探头放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.657,P＜0.01).将多普勒探头放置于颈总动脉、脉搏波传感器放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.526,P＜0.01).结论 联合运用超声多普勒探头与脉搏波传感器检测PWV为检测PWV提供了一种新方法,具有一定临床实用价值,值得推广.     

脉搏波传导速度与代谢综合征的相关性探讨

目的研究脉搏波传导速度(pulse wave velocity,PWV)与代谢综合征(metabolic syndrome,MS)的相关性。方法对153例MS患者和153例体格检查的健康人进行PWV检测,并检测血压、血糖、血脂等指标。结果MS组动脉弹性指标PWV平均值(11.3±2.85)显著高于对照组(9.6±3.28,P0.05);MS组血压、脉压、体重指数、血糖、血脂均明显高于对照组(P0.05)。结论PWV升高是MS患者心血管事件的重要危险因素,对MS高危人群发生心血管事件的预测有一定价值。     

超声与动脉硬化仪检测肱-踝动脉脉搏波传导速度的相关性研究

目的通过联合运用多普勒超声探头及脉搏波传感器检测肱-踝动脉段血管的脉搏波传导速度(pulse wave velocity,PWV),并将检测结果与动脉硬化仪检测该动脉段的结果进行相关性分析,探讨联合运用超声多普勒探头与脉搏波传感器检测肱-踝动脉段脉搏波传导速度(brachial ankle pulse wave velocity,baPWV)方法的可行性。方法纳入30例正常人,分别将超声多普勒探头与脉搏波传感器放置于受试者左侧肘部肱动脉及左侧踝部胫后动脉,将受试者左侧肘部肱动脉及左侧踝部胫后动脉间的距离与动脉多普勒血流流速曲线的起点与动脉脉搏波起点间的传播时间相比,得出的比值作为肱-踝动脉段的PWV。并将检测结果与动脉硬化仪检测同组受试者该段动脉脉搏波传导速度的检测结果进行相关性分析。结果将脉搏波传感器放置于肱动脉,多普勒探头放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.584,P<0.01)。将多普勒探头放置于肱动脉,脉搏波传感器放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.703,P<0.01)。结论联合运用超声多普勒探头与脉搏波传感器检测肱-踝动脉段脉搏波传导速度为脉搏波传导速度的检测提供了一种新的检测方法,具有一定的临床实用价值,值得进一步推广。     

14929份baPWV/ABI检测结果的分析及影响因素与动脉血管弹性降低的相关性研究

目的通过对我院14929份踝臂脉搏波传导速度(baPWV)/踝臂血压指数(ABI)检测结果的分析,探讨影响因素与动脉血管弹性降低的相关性。方法选择2007-01—2010-07在我院健康体检的人员进行检测,分析其baPWV的变化。结果人群中动脉硬化潜在危险普遍存在,对体检者的baPWV与各项指标进行相关性分析,发现年龄与baPWV呈正相关,收缩压、舒张压、血糖、尿酸均与脉搏波传导速度大小呈高度相关性,差异有统计学意义(P0.05)。结论 baPWV异常提示可能具有重要的预警意义。在健康体检中定期检测baPWV与ABI,可对防治心血管疾病起到提前预警作用。     

老年人踝臂指数和脉搏波速度与心血管危险因素的关系研究

国内老年人心血管疾病发病率越来越高。查阅近年来国内外心血管疾病危险因素研究资料及文献,踝臂指数（ankle-brachial index,ABI）和脉搏波速度（pulse wave velocity,PWV）在评估、预测心血管病变风险等方面已成为判别老年人心血管危险因素的重要指标,并日益受到重视。通过对老年人ABI和PWV特点及与心血管危险因素关系的论述、分析,探讨其在临床的应用价值。     

新疆维吾尔族健康及冠心病人群中体质指数、腰围与动脉僵硬程度相关性研究

目的研究新疆地区维吾尔族健康及冠心病人群中体质指数(BMI)、腰围与动脉僵硬程度相关性。方法本研究纳入新疆地区冠心病患者113例,健康人92人。测量其体质指数、腰围、臂踝脉搏波传导速度(PWV)及各项生化指标。分别在健康人群与冠心病人群中,用体质指数、腰围与PWV做线性相关性分析,并对PWV的影响因素进行校正。结果在健康人群中,PWV与BMI无相关性(r=0.076,P>0.05),PWV与腰围呈正相关(r=0.218,P<0.05)。在冠心病患者中,PWV与BMI存在正相关(r=0.232,P<0.05),PWV与腰围呈正相关(r=0.256,P<0.01)。经过对年龄,性别及其他心血管危险因素的校正,在冠心病人群中,BMI每增加1 kg/m2可能会伴随着PWV增加0.053 m/s,腰围每增加1 cm可能伴随着PWV增加0.027 m/s。结论无论在维吾尔族冠心病患者中或健康人群中,腹部肥胖的测量指标(腰围)、全身肥胖的测量指标(BMI)与PWV所反映的动脉僵硬程度呈正相关。     

高血压患者心血管危险分层与脉搏波速度的关系研究

目的研究高血压患者心血管危险分层与脉搏波速度（pulse wave velocity,PWV）的关系。方法应用康普乐全自动动脉硬化检测系统对确诊为原发性高血压465例患者进行颈动脉-股动脉脉搏波速度（Carotid-femoralPWV,CF-PWV）的检测,并按照全国高等学校教材内科学（第6版）的心血管危险分层标准将高血压患者分为低危、中危、高危、极高危4组。比较各组的CF-PWV值。结果低危组、中危组、高危组和极高危组的CF-PWV值分别为（8.52±1.50）、（9.75±1.76）（、10.81±2.01）（、11.53±2.58）m/s,两两比较均具有显著性差异（均P〈0.01）。结论高血压患者PWV随着心血管危险分层增加而增高;心血管危险因素对动脉硬化的影响可能较大。     

Better management of cardiovascular diseases by pulse wave velocity: combining clinical practice with clinical research using evidence-based medicine

Arterial stiffness measured by pulse wave velocity (PWV) is an accepted strong, independent predictor of cardiovascular events and mortality. However, lack of a reliable reference range has limited its use in clinical practice. In this evidence-based review, we applied published data to develop a PWV risk stratification model and demonstrated its impact on the management of common clinical scenarios. After reviewing 97 studies where PWV was measured, 5 end-stage renal disease patients, 5 hypertensives, 2 diabetics, and 2 elderly studies were selected. Pooling the data by the "fixed-effect model" demonstrated that the mortality and cardiovascular event risk ratio for one level increment in PWV was 2.41 (1.81-3.20) or 1.69 (1.35-2.11), respectively. There was a significant difference in PWV between survived and deceased groups, both in the low and high risk populations. Furthermore, risk comparison demonstrated that 1 standard deviation increment in PWV is equivalent to 10 years of aging, or 1.5 to 2 times the risk of a 10 mmHg increase in systolic blood pressure. Evidence shows that PWV can be beneficially used in clinical practice for cardiovascular risk stratification. Furthermore, the above risk estimates could be incorporated into currently used cardiac risk scores to improve their predictive power and facilitate the clinical application of PWV.     

Estimated pulse wave velocity (ePWV) as a potential gatekeeper for MRI-assessed PWV: a linear and deep neural network based approach in 2254 participants of the Netherlands Epidemiology of Obesity study

The International Journal of Cardiovascular Imaging - Pulse wave velocity (PWV) assessed by magnetic resonance imaging (MRI) is a prognostic marker for cardiovascular events. Prediction modelling...     

Pulse wave velocity reference values in healthy adults aged 26-75 years

The stiffening of arteries is associated with various cardiovascular diseases. Arterial stiffening can be studied utilizing arterial pulse wave velocity (PWV), but the absence of reliable reference values for PWV has limited its use in clinical practice. The aim of this study was to establish a range of reference values for PWV. PWV was examined by measuring the time difference of systolic pulse waves in arteries from the aortic arch to the popliteal artery using whole-body impedance cardiography (ICG). The study population consisted of 799 individuals (age range 25-76 years), 283 of whom had no evidence of cardiovascular disease, and a low burden of risk factors was selected to represent an apparently healthy population. In healthy study population, PWV was higher in males (8 x 9 +/- 1 x 8 m s(-1)) than females (8 x 1 +/- 2 x 0 m s(-1), P<0 x 001). Young males had lower PWV values than old males. Correspondingly, young females also had lower PWV values than old females. PWV was clearly associated with age, and PWV was higher in young and middle-aged males than in females. There was no statistically significant difference between old males and females in PWV. In conclusion, whole-body ICG provides a practical method for PWV measurement. Reference values can be useful in the clinical management of patients, especially in detecting early vascular disease or an increased risk of cardiovascular complications.     

Arteriosclerosis and pulse wave velocity

Impairment of the arterial compliance or loss of Windkessel effect of elastic arteries causes increased afterload to the heart and increased pulsatile flow to the peripheral vasculatures. The former induces left ventricular hypertrophy or dysfunction and the latter induces small vessel damage or end organ dysfunction. Thus, the arterial compliance plays important roles in the course of hypertension. Therefore; it is worthwhile to measure the elastic properties of aortoarterial system in patient with hypertension. The velocity of the pressure wave along an arterial system, known as pulse wave velocity(PWV), is related to the average stiffness of an arterial segment between measurement sites. The measurement of PWV is inversely related to arterial wall distensibility, which offers a simple and potential approach. There are numerous reports which PWV is a forceful marker and predictor of the cardiovascular risk in hypertensive or other arteriosclerotic disorders. Thus, PWV measurement is recommended in patients with hypertension for early detection of organ damages or estimation of the cardiovascular risk, as well as for the evaluation of the effectiveness of the treatment as a surrogate marker.     

Assessment of regional aortic stiffness with cardiac magnetic resonance imaging in a healthy Asian population

The aim of this study was to determine the normal values for aortic pulse wave velocity (PWV) and distensibility using cine and phase contrast cardiac magnetic resonance imaging (CMRI) in patients without cardiovascular risk factors. PWV and distensibility are indispensible predictors of global and regional cardiovascular risk. Regional heterogeneity in aortic stiffness plays an important role in the pathogenesis of cardiovascular disease. Contrary to global estimates of aortic PWV that are commonly measured with tonometry, CMRI has emerged as an important method for estimating regional PWV and distensibility. A total of 124 Korean patients, aged 20–79 years and free of cardiovascular risk factors, were categorized by age decade. Using cine and phase contrast sequences, the cross-sectional area for distensibility and average blood flow were measured at four aortic levels: the ascending, upper descending thoracic, lower thoracic and abdominal aorta. Regional PWV was determined in four aortic segments: proximal, descending thoracic, abdominal aorta and across the entire aorta. Distensibility at the four levels of the aorta from the ascending to distal (4.4 ± 2.5, 4.0 ± 1.6, 5.2 ± 1.9, and 3.3 ± 1.7 × 10^?3 mm/Hg, respectively) was higher in women (P < 0.001) and decreased with age. The regional PWV was highest in the descending thoracic aorta and increased with age. The present study is the first to show the heterogeneity in aortic PWV and distensibility, as well to provide normal values for these parameters using CMRI in an Asian sample.     

Regional in vivo transit time measurements of aortic pulse wave velocity in mice with high-field CMR at 17.6 Tesla

Background

Transgenic mouse models are increasingly used to study the pathophysiology of human cardiovascular diseases. The aortic pulse wave velocity (PWV) is an indirect measure for vascular stiffness and a marker for cardiovascular risk.

Results

This study presents a cardiovascular magnetic resonance (CMR) transit time (TT) method that allows the determination of the PWV in the descending murine aorta by analyzing blood flow waveforms. Systolic flow pulses were recorded with a temporal resolution of 1 ms applying phase velocity encoding. In a first step, the CMR method was validated by pressure waveform measurements on a pulsatile elastic vessel phantom. In a second step, the CMR method was applied to measure PWVs in a group of five eight-month-old apolipoprotein E deficient (ApoE^(-/-)) mice and an age matched group of four C57Bl/6J mice. The ApoE^(-/-) group had a higher mean PWV (PWV = 3.0 ± 0.6 m/s) than the C57Bl/6J group (PWV = 2.4 ± 0.4 m/s). The difference was statistically significant (p = 0.014).

Conclusions

The findings of this study demonstrate that high field CMR is applicable to non-invasively determine and distinguish PWVs in the arterial system of healthy and diseased groups of mice.     

Measurement of pulse wave velocity using pulse wave Doppler ultrasound: comparison with arterial tonometry

Pulse wave velocity (PWV), the speed of propagation of arterial pressure waves through the arterial tree, is related to arterial stiffness and is an important prognostic marker for cardiovascular events. In clinical practice PWV is commonly determined by arterial tonometry, with a noninvasive pressure sensor applied sequentially over carotid and femoral arteries. The electrocardiogram (ECG) is used as a timing reference to determine the time delay or "transit time" between the upstroke of carotid and femoral pulse waveforms. Commercially available vascular ultrasound scanners provide a pulsed wave (PW) Doppler velocity signal, which should allow determination of carotid-femoral transit time and hence PWV. We compared carotid-femoral PWV measured by tonometry and by PW Doppler ultrasound (Seimens, Apsen scanner with 7 MHz linear transducer) in asymptomatic subjects (n = 62, 26 male, aged 21 to 72 y). To test for intra-subject and inter-observer variation, ten subjects were scanned by one observer on two occasions 2 wk apart and by two observers on same day. PWV by tonometry ranged from 5.3 to 15.0 m/s. There was no significant difference between mean values of PWV obtained by the two techniques (mean difference: 0.3 m/s, standard deviation of difference: 1.5 m/s), which were closely correlated (r = 0.83). The coefficient of variation for repeated measures on the same subject by the same observer was 10.1% and the inter-observer coefficient of variation was 5.8%. These results suggest a commercial ultrasound scanner can be used to measure PWV, giving results that are reproducible and closely correlated with those obtained by arterial tonometry. (E-mail: ben_yu.jiang@kcl.ac.uk).     

Noninvasive ultrasonic measurement of regional and local pulse-wave velocity in mice

Mouse models of human disease are increasingly used to study the nature of cardiovascular diseases such as atherosclerosis. The pulse wave velocity (PWV) provides an indirect measure of arterial stiffness and can be useful for characterizing disease progression. In this study, the PWV was measured noninvasively in the left common carotid artery of seven young mice using two image-guided approaches: a regional transit-time (TT) method and a local flow-area (QA) method. The QA approach measures the cross-sectional area and volume flow through the vessel using high frame-rate retrospective colour flow imaging. The QA method was found to correlate well with the TT method (r2=0.80, p<0.001). The mean difference between methods was 0.05+/-0.21 m/s. This study demonstrates the feasibility of measuring both regional and local PWV in mice using image-based high-frequency ultrasound methodologies.     

Carotid-Femoral Pulse Wave Velocity Is Associated With Cerebral White Matter Lesions in Type 2 Diabetes

OBJECTIVE

Patients with type 2 diabetes have a high incidence of cardiovascular events including stroke. Increased arterial stiffness (AS) predicts cardiovascular events in the general population. Cerebral white matter lesions (WMLs) are associated with an increased risk of stroke. It is unknown whether AS in patients with type 2 diabetes is associated with WMLs.

RESEARCH DESIGN AND METHODS

We examined 89 patients recently diagnosed with type 2 diabetes (<5 years) and 89 sex- and age-matched controls. AS was assessed with carotid-femoral pulse wave velocity (PWV). WMLs were identified using magnetic resonance imaging and graded qualitatively with the Breteler scale (no/slight changes = 0, moderate changes = 1, severe changes = 2) and semiquantitatively.

RESULTS

The diabetic population had excellent glycemic control (HbA_1c, 6.5% [6.2–6.8]; median [interquartile range {IQR}]) and had, compared with the controls, lower office blood pressure (BP) (127 ± 12/79 ± 8 vs. 132 ± 14/84 ± 10 mmHg) and total cholesterol (4.3[3.9–4.7] vs. 5.6 [5.1–6.4]; mmol/L; median [IQR]), (P < 0.01 for all). Despite this, PWV was higher in the patients with diabetes compared with controls (9.3 ± 2.0 vs. 8.0 ± 1.6 m/s; P < 0.0001). PWV was associated with Breteler score (OR 1.36 [95% CI 1.17–1.58]; P < 0.001) and WML volume (OR 1.32 [95% CI 1.16–1.51]; P < 0.001) per 1 m/s increase in PWV. These associations remained significant when adjusted for age, sex, diabetes, 24-h mean arterial BP, BMI, heart rate, and use of antihypertensives and statins (Breteler score: OR 1.28 [95% CI 1.03–1.60]; P < 0.05 and WML volume: OR 1.30 [95% CI 1.06–1.58]; P < 0.05).

CONCLUSIONS

PWV was higher among patients with well-controlled type 2 diabetes compared with controls and was independently associated with WMLs. PWV may represent a clinically relevant parameter in the evaluation of cerebrovascular disease risk in type 2 diabetes.Despite intensified treatment, patients with type 2 diabetes have a significantly higher incidence of cardiovascular events, including stroke, compared with patients without diabetes (1–3). Identifying new risk factors for incident cardiovascular disease, which add prognostic information to established risk factors, is important to improve risk stratification and enable timely initiation of individually tailored preventive measures in this high-risk population (4). Increased arterial stiffness, as indicated by increased pulse wave velocity (PWV), is an independent predictor of cardiovascular morbidity and mortality and total mortality in various nondiabetic populations (5–11). In patients with diabetes, PWV independently predicts cardiovascular and total mortality (12). Several studies have found cerebral white matter lesions (WMLs) to be associated with the risk of stroke (13). Nevertheless, it remains unknown whether PWV in patients with type 2 diabetes is associated with the severity of WMLs. In this study of a sample of patients with recently diagnosed type 2 diabetes and a sex- and age-matched control group, our aims were to 1) compare PWV and established cardiovascular risk factors and 2) study the association between PWV and WMLs.     

Prognostic Impact of Aortic Stiffness in High-Risk Type 2 Diabetic Patients: The Rio de Janeiro Type 2 Diabetes Cohort Study

OBJECTIVE

The prognostic importance of carotid-femoral pulse wave velocity (PWV), the gold standard measure of aortic stiffness, has been scarcely investigated in type 2 diabetes and never after full adjustment for potential confounders. The aim was to evaluate the prognostic impact of carotid-femoral PWV for cardiovascular morbidity and all-cause mortality in a cohort of 565 high-risk type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

Clinical, laboratory, ambulatory blood pressure (BP) monitoring, and carotid-femoral PWV data were obtained at baseline. The primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause mortality. Multiple Cox survival analysis was used to assess the associations between carotid-femoral PWV, as a continuous variable and categorized at 10 m/s, and the end points.

RESULTS

After a median follow-up of 5.75 years, 88 total cardiovascular events and 72 all-cause deaths occurred. After adjustments for potential cardiovascular risk factors, including micro- and macrovascular complications, ambulatory BP, and metabolic control, carotid-femoral PWV was predictive of the composite end point but not of all-cause mortality both as a continuous variable (hazard ratio 1.13 [95% CI 1.03–1.23], P = 0.009 for increments of 1 m/s) and as categorized at 10 m/s (1.92 [1.16–3.18], P = 0.012). On sensitivity analysis, carotid-femoral PWV was a better predictor of cardiovascular events in younger patients (<65 years), in those with microvascular complications, and in those with poorer glycemic control (HbA_1c ≥7.5% [58.5 mmol/mol]).

CONCLUSIONS

Carotid-femoral PWV provides cardiovascular risk prediction independent of standard risk factors, glycemic control, and ambulatory BPs and improves cardiovascular risk stratification in high-risk type 2 diabetes.In the past decade, knowledge of the importance of arterial stiffness in the pathogenesis of cardiovascular diseases grew (1,2). Arterial stiffness depends on the structural and geometric properties of the arterial wall and on the distending pressure, and aging and blood pressure (BP) are its main determinants (1,2). The measurement of carotid-femoral pulse wave velocity (PWV) is considered the gold standard evaluation of central aortic stiffness (1). Furthermore, aortic stiffness has been demonstrated to predict cardiovascular morbidity and mortality above and beyond other traditional cardiovascular risk factors in patients with end-stage renal disease (3) and hypertension (4), elderly individuals (5), and general population-based samples (6,7). This prognostic importance has also been recently confirmed in a meta-analysis (8).Type 2 diabetic patients have increased arterial stiffness (9–11) and are at particular risk for augmented cardiovascular morbidity and mortality. This high cardiovascular risk is not completely explained by clustering of traditional risk factors, and increased arterial stiffness may be one pathophysiological mechanism that links diabetes to increased cardiovascular morbidity and mortality (12). Nevertheless, only one previous study investigated the prognostic impact of increased aortic stiffness for cardiovascular outcomes in type 2 diabetes (13), but because of a smaller sample size (397 diabetic individuals), the study could not completely adjust for traditional cardiovascular risk factors, chronic diabetes complications, or metabolic control parameters. Therefore, we aimed to investigate in a prospective follow-up cohort of high-risk type 2 diabetic patients the prognostic impact of increased aortic stiffness for cardiovascular morbidity and mortality and for all-cause mortality. In particular, we evaluated whether aortic stiffness was able to add prognostic information beyond traditional cardiovascular risk markers and whether there were interactions between aortic stiffness and other important covariates, such as age, sex, presence of diabetes complications, and glycemic control.