Arterial stiffness is not homogenous

Identification of three hemodynamic phenotypes using cluster analysis

Abstract

Introduction: arterial stiffness is an early and independent marker of vascular damage, associated with a higher risk of cardiovascular events. It is measured by aortic pulse wave velocity (PWV), with >10 m/s being the diagnostic threshold. However, this cut-off point does not reflect the clinical and hemodynamic heterogeneity found in patients, which suggests different pathophysiological pathways. Phenotype identification could improve risk stratification and treatment decisions.

Materials and method: this was a retrospective observational study of 336 adults evaluated with Arteriography® in Medellín, Colombia. Demographic, clinical, and hemodynamic variables were included, like blood pressure, central aortic pressure, pulse pressure (PP), aortic augmentation index (AIx), and PWV. Arterial stiffness was defined as a PWV >10 m/s. A k-means cluster analysis was applied to patients with stiffness, finding three optimal groups according to the silhouette score.

Results: of the 336 participants, 113 had arterial stiffness. Three phenotypes were found: Phenotype 0, consisting of younger, non-smoking patients with moderate pressures; Phenotype 1, characterized by severe central hypertension, elevated PP, and a greater adverse hemodynamic burden, with female predominance; and Phenotype 2, consisting of older adults with a history of smoking and a lower body mass index, compatible with vascular aging.

Conclusion: arterial stiffness is not a homogenous phenomenon but rather reflects different pathophysiological mechanisms. Phenotypic stratification helps identify higher-risk subgroups and differentiate patterns associated with aging and smoking, supporting a more personalized approach in clinical practice.