Can arteries reveal risk before it becomes visible?
Professor Rosa Maria Bruno on vascular ageing, prevention and identifying the people who need attention earlier
In cardiovascular prevention, age is one of the most influential factors in assessing risk. It is also one of the reasons why early changes can be difficult to recognise.
A younger person may have a low calculated short-term cardiovascular risk, while their arteries have already begun to show the cumulative effects of high blood pressure, metabolic factors, lifestyle or other exposures. At the same time, two people of the same age with similar routine measurements may not have the same vascular health.
This question matters across Europe. Cardiovascular diseases remain the leading cause of death and disability in the WHO European Region. In 2019, they caused an estimated 4.2 million deaths, representing 42.5% of all deaths in the Region.¹
Prevention is therefore not only about responding to established disease. It is also about identifying people whose risk requires attention before symptoms or acute events occur.
This was the focus of Professor Rosa Maria Bruno’s presentation at MESI Conference 2026. Professor Bruno is Professor at Université Paris Cité and Head of the Clinical Pharmacology Unit at Hôpital Européen Georges Pompidou in Paris. Her work focuses on vascular ageing and on how non-invasive assessment can help identify people whose risk may not be fully visible through conventional measures alone.
Conversation with Professor Rosa Maria Bruno, MD, PhD
Chronological age is not the whole story
Arteries do not age at the same pace in every person.
Hypertension, diabetes, chronic kidney disease, smoking and other long-term cardiovascular risk factors can accelerate changes in the arterial wall.² Yet the impact of these factors can differ considerably from one individual to another.
This is the principle behind vascular ageing. A person’s date of birth provides important context, but it does not show how their vascular system has responded to the risks they have carried over time.
Professor Bruno describes arterial stiffness assessment as one way to assess vascular ageing. It can provide insight into the mechanical condition of the arteries and may help reveal when vascular health appears older, or younger, than chronological age alone would suggest.
“We do not want to consider everyone unwell when they are young. We want to identify the people at risk.”
The aim is not broader testing for its own sake. It is to recognise the people whose risk may not be fully visible through conventional measures alone, so that prevention, follow-up or further assessment can be considered at the right time.
What measuring arterial stiffness can add
Arterial stiffness describes the mechanical properties of the arteries. Healthy arteries expand and recoil with each heartbeat, helping to cushion the pulsatile force generated by the heart. As arteries become stiffer, this cushioning function is reduced.
Pulse wave velocity, or PWV, is one of the most established non-invasive methods for measuring arterial stiffness. The principle is straightforward: the pulse wave travels faster through a stiff artery than through a more elastic one.
Carotid-femoral PWV, or cfPWV, is considered the reference standard for non-invasive assessment of aortic stiffness.³ Brachial-ankle PWV, or baPWV, is also recognised in the 2023 ESH Guidelines as a measure of arterial stiffness and a marker of hypertension-mediated organ damage.⁶
Measuring arterial stiffness does not replace conventional cardiovascular risk assessment. Blood pressure, cholesterol, diabetes status, smoking, family history and clinical judgement all remain essential. But it can add clinical context when these factors do not fully explain an individual’s risk.
What the evidence tells us
The clinical value of arterial stiffness assessment is supported by evidence from prospective studies.
Although aortic PWV can be measured invasively during cardiac catheterisation, this is not practical for routine preventive care. Evidence comparing invasive aortic PWV with non-invasive cfPWV has shown a close relationship between the two measures, supporting cfPWV as a clinically meaningful, non-invasive approach to assessing aortic stiffness.⁷
One of the largest analyses combined individual-level data from 17,635 participants. During follow-up, 1,785 participants experienced a cardiovascular event. Higher aortic PWV was associated with a higher risk of coronary heart disease, stroke and cardiovascular events overall.⁴
For every standard-deviation increase in log-transformed aortic PWV, the age- and sex-adjusted risk was 35% higher for coronary heart disease, 54% higher for stroke and 45% higher for cardiovascular events overall.⁴
The analysis also found that aortic PWV added prognostic information beyond conventional cardiovascular risk factors. Its value in improving risk classification was particularly relevant in some people at intermediate risk, while the relative association with cardiovascular events was stronger in younger individuals.⁴
These findings do not mean that PWV should be measured indiscriminately. They show why arterial health can offer a useful additional perspective when conventional information leaves an important clinical question unanswered.
Prevention is a multidimensional challenge
Cardiovascular risk is shaped by more than one factor. Blood pressure, cholesterol, blood glucose, lifestyle, family history, cardiac findings and vascular health can all provide relevant clinical information.
“Cardiovascular prevention is, by definition, a multidimensional problem.”
This is why prevention cannot rely on a single number or a single moment in time. The challenge for healthcare professionals is to interpret relevant information in context and understand what it means for the individual patient.
The 2024 European Society of Cardiology guidelines recognise PWV as a cardiovascular risk modifier that may be considered in selected people with elevated blood pressure when the decision about blood-pressure-lowering treatment remains uncertain after conventional risk assessment.⁵
The 2023 European Society of Hypertension guidelines identify cfPWV and baPWV as measures of large-artery stiffness that can support cardiovascular risk assessment. Both are included among measures of hypertension-mediated organ damage.⁶
Together, these recommendations support a targeted clinical role for measuring PWV: not as a universal screening measure, but as additional information when the result may influence risk classification, follow-up or management.
From individual measurements to a more connected view
As prevention becomes more proactive, diagnostics need to support more than the confirmation or exclusion of disease. They need to help healthcare professionals identify patterns, understand individual risk and determine the most appropriate next step.
This requires relevant diagnostic information to be available within a structured clinical workflow. Blood pressure, cardiovascular risk factors, medical history and arterial measurements can each contribute to a broader understanding of vascular health when considered together.
This is the principle behind Integrated Arterial Assessment: moving beyond isolated results towards a connected and clinically meaningful view of arterial health.
The purpose is not to replace clinical judgement or to make decisions through technology alone. It is to help healthcare professionals bring objective diagnostic information together, interpret it in context and determine the most appropriate next step for the patient.
About Professor Rosa Maria Bruno
Professor Rosa Maria Bruno is Professor at Université Paris Cité and Head of the Clinical Pharmacology Unit at Hôpital Européen Georges Pompidou in Paris. Her work focuses on hypertension, vascular ageing and the clinical application of non-invasive vascular assessment.
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