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AbstractCHAPTER 2. ARTERIAL STIFFNESS – A LITERATURE REVIEWThe aim of this chapter was to review existing literature, which has evaluatedthe mechanism of arterial stiffness and the methods of measuring arterialstiffness non-invasively. The association of arterial stiffness with coronary arterydisease and myocardial ischaemia is well established. Arterial stiffness is amarker of cardiovascular disease and mortality. Several cardiovascular riskssuch as hypertension, diabetes, obesity, dyslipidaemia are also associated withthe stiffness of arteries. A number of molecular, cellular and genetic causesunderlie the mechanism of arterial stiffness with an associated increase incollagen fibres, a decrease in elastin fibres and endothelial dysfunction.Systolic pulse wave is reflected backwards to the heart throughout the vascularsystem. In chronic vascular stiffening, there is an early or premature pulse wavereflection. Analysis of pulse wave has a long history. In the modern era, severalinvasive and non-invasive techniques have been developed. The non-invasivetechniques are simple, portable, less time consuming and cost-effective.Tonometric, piezo-electronic and oscillometric techniques are commonly usedand have established their clinical validity. Applanation tonometry is consideredas a gold standard method. Many of the arterial stiffness variables such aspulse pressure, augmentation pressure, augmentation index and pulse wavevelocity are established for individual predictive values for cardiovasculardisease and mortality. The variables are of more prognostic value thandiagnostic. More studies are needed to establish the clinical validity on variousethnic and clinical populations.14