Arterial stiffness and coronary ischemic disease.

Large artery stiffening may be both a cause and a consequence of atherosclerosis and is independently related to coronary outcome. This relationship is likely to be causal given the unfavourable effect of large artery stiffening on coronary hemodynamics. There is clear experimental and clinical evidence that large artery stiffening promotes myocardial ischemia secondary to central pulse pressure elevation. Many agents commonly used to treat ischemic heart disease symptoms also reduce large artery stiffness, through both functional and structural mechanisms. Such effects likely contribute to the anti-ischemic actions of these drugs. However, it remains to be elucidated whether agents specifically targeted to reduce large artery stiffness provide ischemic protection in the setting of coronary disease.