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Lower-Limb Arterial Stiffness: Assessment, Novel Physiological Insight and Clinical Potential

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Stone, Keeron J. ORCID: 0000-0001-6572-7874 (2021) Lower-Limb Arterial Stiffness: Assessment, Novel Physiological Insight and Clinical Potential. PhD thesis, University of Gloucestershire. doi:10.46289/GW12HS44

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11421 Stone, Keeron J (2021) Lower-limb arterial stiffness PhD Thesis.pdf - Accepted Version
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Official URL: https://eprints.glos.ac.uk/id/eprint/11421

Abstract

There is an urgent need to identify novel cardiovascular biomarkers which can improve cardiovascular disease (CVD) risk prediction and permit timely-efficacious treatment; necessary to combat the unabated rise in global CVD. Arterial stiffness, representing the ability of an artery to accommodate changes in blood pressure by corresponding changes in dimension, has emerged as an important biomarker of CVD risk. Central (aortic) arterial stiffness, assessed using carotid-femoral pulse wave velocity (cfPWV), is the reference standard, improving the prediction of cardiovascular events beyond conventional risk factors. Whilst cfPWV is a powerful discriminator of CVD risk, its dependence on blood pressure limits its clinical utility. In contrast to cfPWV, the clinical value of lower-limb arterial stiffness has received little attention and its role in CVD risk is not well understood; its measurement may well improve CVD risk prediction by providing unique CVD risk information. The purpose of this thesis is to identify the clinical utility of lower-limb arterial stiffness, assessed using femoral-ankle PWV (faPWV). Using experimental and epidemiological research approaches, this thesis demonstrated that faPWV can be assessed simply with accuracy and precision and provides additional CVD risk information beyond conventional risk factors and existing lower-limb arterial health measures. The assessment of faPWV also permits determination of the aortic-femoral arterial stiffness gradient (af-SG), a novel biomarker of promising clinical utility. This thesis demonstrated that the af-SG has stronger associations with CVD than cfPWV alone, can be determined with acceptable precision, and is blood pressure independent. These findings indicate that the assessment of lower-limb arterial stiffness could be of clinical utility and may permit better identification of CVD risk.

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Thesis (PhD)

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