New Epoch for Arterial Stiffness Measurement in the Clinic.

Age changes the vascular structure and function in the normal population, but it has a different effect on wave reflection and pulse wave transmission [1, 2] . Many longitudinal studies have found that arterial stiffness measurement among hypertensive patients, diabetic patients, healthy elderly, and people with high cardiovascular (CV) risk will better evaluate arterial health and predict CV events. European guidance for arterial stiffness measurements described in the European consensus document (2006) [3] , the publication of the international reference standards (2010) [4] and the American Heart Association (AHA) scientific statement on arterial stiffness measurements in the USA (2015) have standardized arterial measurement [5] , and thus arterial stiffness measurements have been more widely used in clinical settings. The question now is which measurement of arterial stiffness is more accurate to precisely predict future CV events. Most of the guidelines designated aortic pulse wave velocity (PWV; carotid-femoral PWV) as the golden standard (especially in the Western society) [6] , but in Japan, where arterial stiffness is the most widely used and where they achieved a great amount of data on brachial-ankle PWV and cardio-ankle vascular index (CAVI) [7] , studies found a relationship between organ damage and future CV events. Townsend’s [8] brief review on recommendations and standardization of PWV measurements also justified its clinical and scholarly use. The articles from Korea [9] and Thailand [10] describe CV risk factors and outcomes using the CAVI. The modified RAMA-EGAT score from Thailand combined the conventional risk prevention model with arterial function. It would be helpful to have ageand genderstratified values of the CAVI in healthy Koreans and in high-risk patients of a metabolically risky condition. The study from Thailand developed its own risk prediction model called the RAMA-EGAT score, which proved to be accurate in the prediction of CV risk in patients with intermediate atherosclerotic risk factors in the Thai population [11] , and a further modification of the RAMA-EGAT score with the CAVI enhanced its accuracy. Now they are conducting a long-term prognosis study in patients with diverse risk conditions. The Framingham-CAVI Published online: December 23, 2016 www.karger.com/pls DOI: 10.1159/000448497