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Preventing cardiovascular risk thanks to a tool for measuring arterial stiffness

17 Apr 2024 | By Inserm (Newsroom) | Circulation, metabolism, nutrition

CAVI© Adobe stock

Cardiovascular diseases represent the leading cause of death worldwide[1]. Preventing cardiovascular risk by identifying the people most susceptible to these diseases is a major public health challenge. In a new study in this field, researchers from Inserm, Université de Lorraine and Nancy Regional University Hospital opted to focus on arterial stiffness and how it changes with age, given that ageing is associated with a loss of arterial flexibility. Thanks to health data collected from over 1,250 Europeans, their research confirms that the stiffer the arteries, the greater the cardiovascular risk. The scientists suggest measuring arterial stiffness as a way to predict a patient’s cardiovascular risk, and emphasise the utility of a specific clinical tool called the Cardio-Ankle Vascular Index (CAVI). These findings have been published in eBioMedicine.

Cardiovascular risk is the probability of developing a cardiovascular disease or accident (problems affecting the heart and arteries). Finding a measurement that can predict this risk through the early detection of the factors that can influence it is a major challenge for research. The risk factors that are already well-known are high blood pressure, smoking, diabetes, high cholesterol, excess weight and sedentary lifestyle.

Previous studies have shown that ageing affects the flexibility of our arteries in that they become increasingly rigid over time. What is more, the scientific literature indicates that this phenomenon may be accelerated by other factors during ageing, such as hypertension or diabetes, and is associated with an increased cardiovascular risk. On the basis of these factors, it had been suggested that looking at arterial stiffness could be useful in preventing cardiovascular risk. However, testing for arterial stiffness is not on the list of recommended clinical practices.

In a new study, researchers from Inserm, Université de Lorraine and Nancy Regional University Hospital looked at a tool for measuring arterial stiffness called the Cardio-Ankle Vascular Index (CAVI), hypothesising that its use in clinical practice could predict patient cardiovascular risk.

The scientists were specifically interested in CAVI because of its accuracy, non-invasiveness and the fact that it is not influenced by blood pressure but reflects the structure of the artery itself. CAVI is measured using four cuffs – one around each arm and one around each ankle – assessing stiffness from the femoral artery to the tibial artery. A microphone is also placed on the heart. The tool measures the speed of blood flow and calculates an index: the higher the number, the stiffer the arteries[2].

During their research, the scientists followed 1,250 people from 18 European countries, all over the age of 40[3]. They provided their medical history and underwent a physical examination, including an assessment of their arterial stiffness using CAVI. They were then invited for a follow-up examination 2 years after the first measurement, and for some, up to 5 years after the first measurement. The aim of the follow-up was to assess the progression of the arterial stiffness and correlate this with the participants’ general state of health.

Thanks to their measurements, the researchers were able to observe that each one-point increase in CAVI, which corresponds to an approximate 10% increase in arterial stiffness, was associated with a 25% increased risk of a cardiovascular event in the years following the measurement.

The researchers also looked at what might influence arterial stiffness. They saw that age affected not just the CAVI value but also its progression, in that it increases more rapidly with age. They also observed the impact of blood pressure: the higher the blood pressure, the higher the CAVI.

The scientists then tried to determine a threshold for arterial stiffness that would be associated with an increased cardiovascular risk and could be commonly recognised and adopted by clinicians, in order to implement more intensive patient monitoring. They found that a CAVI of over 9.25 was associated with a high cardiovascular risk from the age of 60.

Finally, they observed that treatment for cholesterol or diabetes affected the rate of progression of arterial stiffness. Although these observations are still being studied, they do suggest that certain treatments could help slow the progression of arterial stiffness.

‘Our findings suggest that CAVI could be a quick, easy and non-invasive tool for predicting cardiovascular risk. In the future, it could be included on the list of tests recommended in clinics to predict a person’s cardiovascular risk and provide preventive monitoring,’ explains Magnus Bäck, first author of the study.

‘As well as being easy to deploy, we could use CAVI to determine the actual age of the cardiovascular system,’ explains Athanase Benetos, the study’s final author.


[1] WHO data:

[2] An index of 10 is already a sign of great rigidity.

[3] TRIPLE-A-Stiffness is an international longitudinal cohort study having recruited more than 2,000 participants over 40 years of age from 18 European countries. Of these, 1,250 subjects (55% of whom women) were followed for a median duration of 3.82 (2.81 – 4.69) years.

Researcher Contact

Magnus Bäck

Unit 1116 Inserm/Université de Lorraine

Acute and chronic cardiovascular deficiency



Athanase Benetos

Unit 1116 Inserm/Université de Lorraine

Acute and chronic cardiovascular deficiency


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Cardio-Ankle Vascular Index for predicting cardiovascular morbimortality and determinants for its progression in the prospective Advanced Approach to Arterial Stiffness (TRIPLE-A-Stiffness) study

eBioMedicine, 16 April 2024


Magnus BÄCK1,2,3 , Jirar TOPOUCHIAN4, Carlos LABAT2, Sylvie GAUTIER3, Jacques BLACHER4, Marcin CWYNAR5, Alejandro de la SIERRA6, Denes PALL7, Kevin DUARTE3, Francesco FANTIN8, Katalin FARKAS9, Luis GARCIA-ORTIZ10, Zoya HAKOBYAN11, Piotr JANKOWSKI12, Ana JELAKOVIC13, Marina KOTSANI3, Alexandra KONRADI14, Oksana MIKHAILOVA15, Iveta MINTALE16, Oscar PLUNDE1, Rafael RAMOS17, Anatoly ROGOZA15, Yuriy SIRENKO18, Nebojsa TASIC19, Iurii RUDYK20, Saule URAZALINA21, Peter WOHLFAHRT22, Parounak ZELVEIAN11, Roland ASMAR23, Athanase BENETOS2,3

1 Department of Medicine Solna, Karolinska Institutet and Department of Cardiology Karolinska University Hospital, Stockholm, Sweden

2 Inserm U1116, Nancy, France

3 CHRU Nancy, University Hospital of Nancy, France

4 Paris-Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel Dieu, Paris, France

5 Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland

6 Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain

7 Department of Medical Clinical Pharmacology, University of Debrecen, Hungary

8 Department of Medicine, Section of Geriatric Medicine, University of Verona, Italy

9 Cardiometabolic Centre, Dept. of Angiology, Szent Imre University Teaching Hospital, Budapest Hungary

10 Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca (IBSAL). Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain

11 Institute of Cardiology, Centre of Preventive Cardiology, Yerevan, Armenia

12 Department of Internal Medicine and Geriatric Cardiology, , Centre of Postgraduate Medical Education, Warsaw, Poland

13 Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre, Zagreb, Croatia

14 Almazov Federal Medical Research Centre, St-Petersburg, Russia

15 FSBI “Chazov National Medical Research Centre of Cardiology” of the Ministery of Health of the Russian Federation, Moscow, Russia

16 P. Stradins University Hospital, Cardiology Centre, Riga, Latvia

17 Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Department of Medical Sciences, University of Girona, Primary Care Services, Biomedical Research Institute, Institut Català de la Salut, Girona, Spain

18 Institute of Cardiology, Kiev, Ukraine

19 Cardiovascular Institute, Dedinje, Belgrade, Serbia

20 Government Institution, L.T. Malaya Therapy Institute of the National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine

21 Scientific and Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan

22 Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

23 Foundation-Medical Research Institutes. Paris, France