Benetos Athanase, Waeber Bernard, Izzo Joseph, Mitchell Gary, Resnick Lawrence, Asmar Roland, Safar Michel
IPC Center, Paris, France.
Am J Hypertens. 2002 Dec;15(12):1101-8. doi: 10.1016/s0895-7061(02)03029-7.
Age is the main clinical determinant of large artery stiffness. Central arteries stiffen progressively with age, whereas peripheral muscular arteries change little with age. A number of clinical studies have analyzed the effects of age on aortic stiffness. Increase of central artery stiffness with age is responsible for earlier wave reflections and changes in pressure wave contours. The stiffening of aorta and other central arteries is a potential risk factor for increased cardiovascular morbidity and mortality. Arterial stiffening with aging is accompanied by an elevation in systolic blood pressure (BP) and pulse pressure (PP). Although arterial stiffening with age is a common situation, it has now been confirmed that older subjects with increased arterial stiffness and elevated PP have higher cardiovascular morbidity and mortality. Increase in aortic stiffness with age occurs gradually and continuously, similarly for men and women. Cross-sectional studies have shown that aortic and carotid stiffness (evaluated by the pulse wave velocity) increase with age by approximately 10% to 15% during a period of 10 years. Women always have 5% to 10% lower stiffness than men of the same age. Although large artery stiffness increases with age independently of the presence of cardiovascular risk factors or other associated conditions, the extent of this increase may depend on several environmental or genetic factors. Hypertension may increase arterial stiffness, especially in older subjects. Among other cardiovascular risk factors, diabetes type 1 and 2 accelerates arterial stiffness, whereas the role of dyslipidemia and tobacco smoking is unclear. Arterial stiffness is also present in several cardiovascular and renal diseases. Patients with heart failure, end stage renal disease, and those with atherosclerotic lesions often develop central artery stiffness. Decreased carotid distensibility, increased arterial thickness, and presence of calcifications and plaques often coexist in the same subject. However, relationships between these three alterations of the arterial wall remain to be explored.
年龄是大动脉僵硬度的主要临床决定因素。随着年龄增长，中心动脉会逐渐变硬，而外周肌性动脉随年龄变化较小。多项临床研究分析了年龄对主动脉僵硬度的影响。随着年龄增长，中心动脉僵硬度增加会导致更早的波反射和压力波轮廓的改变。主动脉和其他中心动脉的硬化是心血管发病率和死亡率增加的潜在危险因素。随着年龄增长，动脉僵硬会伴随着收缩压（BP）和脉压（PP）升高。虽然随着年龄增长动脉僵硬是常见现象，但现已证实，动脉僵硬度增加且脉压升高的老年受试者心血管发病率和死亡率更高。主动脉僵硬度随年龄增长逐渐且持续增加，男性和女性情况相似。横断面研究表明，在10年期间，主动脉和颈动脉僵硬度（通过脉搏波速度评估）随年龄增长约增加10%至15%。同龄女性的僵硬度总是比男性低5%至10%。虽然大动脉僵硬度随年龄增长而增加，与心血管危险因素或其他相关疾病的存在无关，但这种增加的程度可能取决于多种环境或遗传因素。高血压可能会增加动脉僵硬度，尤其是在老年受试者中。在其他心血管危险因素中，1型和2型糖尿病会加速动脉僵硬度，而血脂异常和吸烟的作用尚不清楚。动脉僵硬度也存在于多种心血管和肾脏疾病中。心力衰竭、终末期肾病患者以及患有动脉粥样硬化病变的患者常出现中心动脉僵硬度增加。颈动脉扩张性降低、动脉厚度增加以及钙化和斑块的存在常共存于同一受试者中。然而，动脉壁这三种改变之间的关系仍有待探索。
