Vascular Aging and Arterial Stiffness / Envelhecimento Vascular e Rigidez Arterial

Abstract Cardiovascular diseases (CVD) account annually for almost one third of all deaths worldwide. Among the CVD, systemic arterial hypertension (SAH) is related to more than half of those outcomes. Type 2 diabetes mellitus is an independent risk factor for SAH because it causes functional and structural damage to the arterial wall, leading to stiffness. Several studies have related oxidative stress, production of free radicals, and neuroendocrine and genetic changes to the physiopathogenesis of vascular aging. Indirect ways to analyze that aging process have been widely studied, pulse wave velocity (PWV) being considered gold standard to assess arterial stiffness, because there is large epidemiological evidence of its predictive value for cardiovascular events, and it requires little technical knowledge to be performed. A pulse wave is generated during each cardiac contraction and travels along the arterial bed until finding peripheral resistance or any bifurcation point, determining the appearance of a reflected wave. In young individuals, arteries tend to be more elastic, therefore, the reflected wave occurs later in the cardiac cycle, reaching the heart during diastole. In older individuals, however, the reflected wave occurs earlier, reaching the heart during systole. Because PWV is an important biomarker of vascular damage, highly valuable in determining the patient's global cardiovascular risk, we chose to review the articles on vascular aging in the context of cardiovascular risk factors and the tools available to the early identification of that damage.

Resumo As doenças cardiovasculares são anualmente responsáveis por quase um terço do total de mortes no mundo. Dentre elas, a hipertensão arterial sistêmica (HAS) está relacionada com mais da metade desses desfechos. O diabetes mellitus tipo 2 é visto com um fator de risco independente para HAS por causar lesões funcionais e estruturais na parede arterial, ocasionando-lhe enrijecimento. Diversos estudos relacionam o stress oxidativo, a produção de radicais livres, as alterações neuroendócrinas e genéticas com a fisiopatogenia do envelhecimento vascular. Formas indiretas para analisar esse processo de envelhecimento têm sido amplamente estudadas, dentre elas, a velocidade de onda de pulso (VOP) é vista como o padrão-ouro para avaliar a rigidez arterial por existir maior número de evidências epidemiológicas do seu valor preditivo para eventos cardiovasculares além de requerer pouco conhecimento técnico para sua realização. A onda de pulso é gerada durante cada contração cardíaca e percorre o leito arterial até encontrar resistência periférica ou algum ponto de bifurcação, ocasionando o surgimento de uma onda refletida. Em indivíduos jovens, as artérias tendem a ser mais elásticas, em consequência, a onda é refletida mais tardiamente no ciclo cardíaco e atinge o coração no momento da diástole, enquanto nos mais velhos, com reflexão mais precoce da onda, tende a acontecer na sístole. Por ser a VOP um importante biomarcador de dano vascular, de grande valia para a determinação do risco global cardiovascular do paciente, optamos por revisar os artigos referentes ao envelhecimento vascular no contexto dos fatores de risco cardiovasculares e as ferramentas disponíveis para a identificação precoce desse dano.

Vascular Aging and Arterial Stiffness.

Cardiovascular diseases (CVD) account annually for almost one third of all deaths worldwide. Among the CVD, systemic arterial hypertension (SAH) is related to more than half of those outcomes. Type 2 diabetes mellitus is an independent risk factor for SAH because it causes functional and structural damage to the arterial wall, leading to stiffness. Several studies have related oxidative stress, production of free radicals, and neuroendocrine and genetic changes to the physiopathogenesis of vascular aging. Indirect ways to analyze that aging process have been widely studied, pulse wave velocity (PWV) being considered gold standard to assess arterial stiffness, because there is large epidemiological evidence of its predictive value for cardiovascular events, and it requires little technical knowledge to be performed. A pulse wave is generated during each cardiac contraction and travels along the arterial bed until finding peripheral resistance or any bifurcation point, determining the appearance of a reflected wave. In young individuals, arteries tend to be more elastic, therefore, the reflected wave occurs later in the cardiac cycle, reaching the heart during diastole. In older individuals, however, the reflected wave occurs earlier, reaching the heart during systole. Because PWV is an important biomarker of vascular damage, highly valuable in determining the patient's global cardiovascular risk, we chose to review the articles on vascular aging in the context of cardiovascular risk factors and the tools available to the early identification of that damage.