Increased aortic stiffness: an unfavorable cardiorenal connection.

Despite the many potentially life-threatening complications that can accompany renal disease, cardiovascular disease (CVD) remains the leading cause of death in these patients. Patients with renal dysfunction have more cardiovascular events at an earlier age and they tolerate these events poorly.1,2 Established renal disease is associated with increased aortic stiffness and left ventricular (LV) hypertrophy, which are two important risk factors for CVD events. Conversely, aortic stiffness and LV mass have been related to each other and to early signs of renal damage, such as microalbuminuria.3,4 There are several potential explanations for this 3-way interrelationship between cardiac, aortic, and renal function. These organs share several increasingly prevalent risk factors, including advanced age, hypertension, and diabetes, which may contribute to a parallel deterioration in function. Alternatively, dysfunction in one organ may damage the others. Unfortunately, our understanding of these complex interrelationships is currently limited. The arterial and renal components of the cardio-aorto-renal ménage au trois are highlighted in a review by Safar et al in this issue of Hypertension.5 In work that has spanned nearly 3 decades, Professor Safar and colleagues have contributed immeasurably to our understanding of the role of abnormal arterial function in renal disease. As detailed in the review, they have shown that after accounting for common risk factors, increased arterial stiffness is present at various stages of renal dysfunction and represents a grave prognostic indicator. In an end-stage renal disease cohort, they demonstrated that arterial wall stiffness was an independent predictor of all-cause and cardiovascular mortality and that failure of arterial stiffness to improve after an intervention that lowered blood pressure was also associated with increased total mortality. Conversely, they found that serum creatinine on an index examination is associated with increased arterial stiffness in a cross-sectional analysis and is an independent predictor of further arterial stiffening when evaluated prospectively. However, as detailed in the review, many aspects of the relationship between arterial stiffness and renal dysfunction and the effects on the heart remain incompletely understood.