Evidence from animal data and studies of diabetes and ESRD suggests that medial calcification directly increases arterial stiffness. Evidence linking intimal calcification with arterial stiffness is less definitive. The number of studies is small and studies of extracoronary calcification have generally not differentiated between intimal calcification (calcified plaques) versus medial calcification. Other measures of atheroma such as aortic and carotid plaque have also been shown to be associated with higher levels of arterial stiffening, but it is not entirely clear whether or not this is due to shared risk factors or to a causal relationship between arterial stiffness and atheroma development.
As technology allows, future studies should attempt to differentiate between medial, or non-atherosclerotic, calcification versus calcified plaques. Since both arterial stiffness and vascular calcification (both medial and inti-mal) have been shown to predict cardiovascular risk, further evaluation of the relationship between arterial stiffness and vascular calcification is needed, including investigation into potential differences by race/ethnicity. Also, because atherosclerosis-associated calcification (intimal calcification) is a separate process from arterial stiffening, future studies should also evaluate potential additive effects of arterial stiffness and vascular calcification in predicting CVD risk among various populations, which has already been demonstrated among ESRD patients .
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