Arterial stiffness and cardiovascular risk factors in a population-based study Jacques Amar a , Jean Bernard Ruidavets b , Bernard Chamontin a , Ludovic Drouet c and Jean Ferrie Á res b Objective To determine the relationships between pulse wave velocity (PWV), an estimate of arterial distensibility and cardiovascular risk factors. Design This cross-sectional population-based study was carried out from 1995 to 1997 to investigate these relationships. Population and methods Some 993 subjects, aged 35± 64 years (52.7% men), living in the south-west of France, were randomly selected from electoral rolls and participated in a cross-sectional study. Medical examinations were performed by specially trained medical staff. Carotid-femoral PWV was measured using a semi- automatic device (Complior, Garges les Gonesse, France). The relationships between PWV and risk factors were assessed, ®rst in subjects not treated with hypolipidaemic, antidiabetic and antihypertensive drugs and then in treated subjects. In subjects not treated for cardiovascular risk factors, age, gender, systolic blood pressure (SBP) and heart rate ( P < 0.001) were the variables signi®cantly associated with PWV. In treated patients, age ( P < 0.01), SBP ( P < 0.001), heart rate ( P < 0.001), apolipoprotein B ( P < 0.05) and the number of treated cardiovascular risk factors ( P < 0.05) were positively correlated with PWV. Conclusion This study shows that, in a sample of subjects at high risk, the cumulative in¯uence of risk factors, even treated, is an independent determinant of arterial stiffness. These results suggest that PWV may be used as a relevant tool to assess the in¯uence of cardiovascular risk factors on aortic stiffness in high-risk patients. J Hypertens 19:381±387 & 2001 Lippincott Williams & Wilkins. Journal of Hypertension 2001, 19:381±387 Keywords: pulse wave velocity, population-based study, arterial stiffness, atherosclerosis, arteriosclerosis a Service de Me  decine Interne et d'Hypertension Arte  rielle, CHU Purpan Toulouse, 31059, b INSERM 518, Department of Epidemiology, 37 Alle  es Jules Guesde, 31073 Toulouse and c Laboratoire d'He  matologie, Hopital Lariboisie Á re Paris, France. Correspondence and requests for reprints to Jacques Amar, Service de Medecine Interne et d'Hypertension Arte  rielle, CHU Purpan Toulouse, France. 31059 Tel: 33 05 61 77 21 17; fax: 33 05 61 77 74 10; email: amar.j@chu-toulouse.fr Received 14 January 2000 Revised 25 October 2000 Accepted 8 November 2000 Introduction Arterial compliance plays an important role in cardio- vascular diseases and an increasing interest is focused on non-invasive measurement of arterial distensibility. Arterial stiffness was positively correlated with age and blood pressure. Conduit vessel stiffening resulted in increased impedance of the aorta, thus leading to an increase in left ventricular mass [1,2] and an increase in pulse pressure [3]. An association between increased pulse pressure and adverse cardiovascular events has been demonstrated in hypertensive patients and in the general population [4±6]. Also, an association between increased pulse pressure and stroke has been observed in elderly patients with isolated systolic hypertension, independently of the effects of mean blood pressure [7]. However, few data [8] demonstrate that arterial distensibility is actually independently predictive of cardiovascular diseases. Case±control studies have shown an increase in aortic stiffness after adjustment for age and blood pressure in speci®c populations: subjects with diabetes, hypercho- lesterolaemia, or end-stage renal disease or in patients with symptomatic cardiovascular disease, stroke or ischaemic heart disease [9±16]. Recently, Lehmann et al. [17] have found in diabetics and/or in patients with vascular disease, a positive relationship between pre- sumed atherosclerotic load (as assessed by the number of cardiovascular risk factors and events) and non- invasively determined aortic stiffening, based on aortic pulse wave velocity measurements. Even if a great number of studies have focused on the fact that arterial stiffness was involved in various cardiovascular diseases, the interest of aortic stiffness measurement, as a non-invasive marker integrating the vascular damages caused by the most common cardiovascular risk factors in the general population, has not yet been assessed. A population-based study was carried out to discuss this question and to determine the relation- ships between aortic pulse wave velocity, a classical evaluation of arterial distensibility, and cardiovascular risk factors. Original article 381 0263-6352 & 2001 Lippincott Williams & Wilkins