***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Arterial distensibility measures , generally from pulse-wave velocity ( PWV ) , are widely used with little knowledge of relationships to patient outcome . We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance – tested ( GTT ) multiethnic population sample s. Methods and Results — Participants were r and omly sample d from ( 1 ) a type 2 diabetes outpatient clinic and ( 2 ) primary care population registers , from which nondiabetic control subjects were given a GTT .  Brachial blood pressures  and Doppler-derived aortic PWV  were measured . Mortality data over 10 years ’ follow-up were obtained . At any level of systolic blood pressure ( SBP ) , aortic PWV was greater in subjects with diabetes than in controls . Mortality risk doubled in subjects with diabetes ( hazard ratio 2.34 , 95 % CI 1.5 to 3.74 ) and in those with glucose intolerance ( 2.12 , 95 % CI 1.11 to 4.0 ) compared with controls . For all groups combined , age , sex , and SBP predicted mortality ; the addition of PWV independently predicted all-cause and cardiovascular mortality ( hazard ratio 1.08 , 95 % CI 1.03 to 1.14 for each 1 m/s increase ) but displaced SBP . Glucose tolerance status and smoking were other independent contributors , with African-Caribbeans experiencing reduced mortality risk ( hazard ratio 0.41 , 95 % CI 0.25 to 0.69 ) . Conclusions —Aortic PWV is a powerful independent predictor of mortality in both diabetes and GTT population sample s. In displacing SBP as a prognostic factor , aortic PWV is probably further along the causal pathway for arterial disease and may represent a useful integrated index of vascular status and hence cardiovascular risk Measurement of blood pressure together with applanation tonometry at the radial artery allows the reproducible assessment of various indexes of arterial stiffness , including the peripheral ( PPp ) and central pulse pressures ( PPc ) and the peripheral ( AIp ) and central augmentation indexes ( AIc ) . We defined preliminary diagnostic thresholds , using the distributional characteristics of these hemodynamic measurements in a reference population . We r and omly recruited 870 subjects from 3 European population s. PPp was the average difference between systolic and diastolic blood pressure measured five times at one home visit . For measurement of PPc , AIp and AIc , we used the SphygmoCor device .  We selected subjects without hypertension , diabetes , dyslipidemia in need of medical treatment or previous or concomitant cardiovascular disease . The study population included 228 men and 306 women ( mean age 34.9 years ) . All hemodynamic measurements were curvilinearly related to age , and AIp and AIc were lower in men than in women . In men at age 40 , the upper 95 % prediction b and s of the relations of the hemodynamic measurements with age approximated 60 mmHg for PPp , 40 mmHg for PPc , 90 % for AIp , and 30 % for AIc . For PPc , AIp and AIc , these thresholds must be adjusted for age , leading to lower and higher thresholds at younger and older age , respectively . In addition , in women of any age , the AIp and AIc thresholds must be increased by 10 % and 7 % , respectively . Pending validation in prospect i ve outcome studies , distributional characteristics of arterial stiffness indexes in a reference population can be used to generate operational thresholds for use in clinical practice Background —Aortic pulse wave velocity ( PWV ) is a predictor of mortality in patients with end-stage renal failure ( ESRF ) . The PWV is partly dependent on blood pressure ( BP ) , and a decrease in BP can attenuate the stiffness . Whether the changes in PWV in response to decreases in BP can predict mortality in ESRF patients has never been investigated . Methods and Results —One hundred fifty ESRF patients ( aged 52±16 years ) were monitored for 51±38 months . From entry until the end of follow-up , the changes of PWV in response to decreased BP were measured ultrasonographically . BP was controlled by adjustment of “ dry weight ” and , when necessary , with ACE inhibitors , calcium antagonists , and /or & bgr;-blockers , in combination if necessary . Fifty-nine deaths occurred , including 40 cardiovascular and 19 noncardiovascular events . Cox analyses demonstrated that independent of BP changes , the predictors of all-cause and cardiovascular mortality were as follows : absence of PWV decrease in response to BP decrease , increased left ventricular mass , age , and preexisting cardiovascular disease . Survival was positively associated with ACE inhibitor use . After adjustment for all confounding factors , the risk ratio for the absence of PWV decrease was 2.59 ( 95 % CI 1.51 to 4.43 ) for all-cause mortality and 2.35 ( 95 % CI 1.23 to 4.41 ) for cardiovascular mortality . The risk ratio for ACE inhibitor use was 0.19 ( 95 % CI 0.14 to 0.43 ) for all-cause mortality and 0.18 ( 95 % CI 0.06 to 0.55 ) for cardiovascular mortality . Conclusions —These results indicate that in ESRF patients , the insensitivity of PWV to decreased BP is an independent predictor of mortality and that use of ACE inhibitors has a favorable effect on survival that is independent of BP changes Aortic pulse wave velocity ( PWV ) is a significant and independent predictor of cardiovascular mortality in subjects with essential hypertension and in patients with end-stage renal disease . Its contribution to cardiovascular risk in subjects 70 to 100 years old has never been tested . A cohort of 141 subjects ( mean±SD age , 87.1±6.6 years ) was studied in 3 geriatrics departments in a Paris suburb . Together with sphygmomanometric blood pressure measurements , aortic PWV was measured with a vali date d automatic device . During the 30-month follow-up , 56 patients died ( 27 from cardiovascular events ) . Logistic regressions indicated that age ( P = 0.005 ) and a loss of autonomy ( P = 0.01 ) were the best predictors of overall mortality . For cardiovascular mortality , aortic PWV was the major risk predictor ( P = 0.016 ) . The odds ratio was 1.19 ( 95 % confidence interval , 1.03 to 1.37 ) . Antihypertensive drug treatment and blood pressure , including systolic and pulse pressure , had no additive role . In subjects 70 to 100 years old , aortic PWV is a strong , independent predictor of cardiovascular death , whereas systolic or pulse pressure was not . This prospect i ve result will need to be confirmed in an intervention trial Background — Few population studies addressed the prognostic significance of aortic pulse wave velocity ( APWV ) above and beyond other cardiovascular risk factors . Methods and Results — We studied a sex- and age-stratified r and om sample of 1678 Danes aged 40 to 70 years . We used Cox regression to investigate the prognostic value of  APWV , office pulse pressure ( PP ) , and 24-hour ambulatory PP  while adjusting for mean arterial pressure ( MAP ) and other covariates . Over a median follow-up of 9.4 years , the incidence of fatal and nonfatal cardiovascular end points , cardiovascular mortality , and fatal and nonfatal coronary heart disease amounted to 154 , 62 , and 101 cases , respectively . We adjusted for sex , age , body mass index , MAP measured in the office ( conventional PP and APWV ) or by ambulatory monitoring ( 24-hour PP ) , smoking , and alcohol intake . With these adjustments , APWV maintained its prognostic significance in relation to each end point ( P<0.05 ) , whereas office and 24-hour PP lost their predictive value ( P>0.19 ) , except for office PP in relation to coronary heart disease ( P=0.02 ) . For each 1-SD increment in  APWV  ( 3.4 m/s ) , the risk of an event increased by 16 % to 20 % . In sensitivity analyses , APWV still predicted all cardiovascular events after st and ardization to a heart rate of 60 beats per minute , after adjustment for 24-hour MAP instead of office MAP , and /or after additional adjustment for the ratio of total to HDL serum cholesterol and diabetes mellitus at baseline . Conclusions — In a general Danish population , APWV predicted a composite of cardiovascular outcomes above and beyond traditional cardiovascular risk factors , including 24-hour MAP Aortic stiffness predicts  cardiovascular mortality  and may be influenced by dietary fat composition . The hypothesis that plasma fat composition influences arterial stiffness and subsequent mortality was tested here in a prospect i ve study . A total of 174 r and omly sample d nondiabetic participants aged 45 to 74 years were recruited from local population s , stratified by ethnicity and gender , and followed up for mortality . Aortic pulse wave velocity ( PWV ) , blood pressure , and fatty acid composition of plasma lipids were measured at baseline . PWV was associated with increased cardiovascular mortality and inversely related to the proportions of docosahexaenoic ( & rgr;=−0.22 ; P=0.02 ) and arachidonic acids ( & rgr;=−0.25 ; P<0.001 ) in plasma lipids . Principal component analyses identified a cluster characterized by higher proportions of palmitate , palmitoleic and oleic acid and lower proportions of linoleic , dihomo-γ linolenic , and arachidonic acids . This cluster was positively associated with PWV , central adiposity , smoking , and increased mortality ( hazard ratio : 1.13 ; 95 % CI : 1.01 to 1.27 ) . A second cluster , with higher proportions of arachidonic , eicosapentaenoic , and docosahexaenoic and lower proportions of oleic , palmitic , and linoleic acid levels , was associated with lower PWV and systolic blood pressure but also decreased risk of mortality ( hazard ratio : 0.57 ; 95 % CI : 0.39 to 0.82 ) , independent of PWV and blood pressure . These data suggest that plasma fatty acid profiles characterized by a higher proportion of long-chain polyunsaturated fatty acids are associated with decreased cardiovascular mortality , independent of the impact of aortic PWV . The results are consistent with an effect of dietary sources of n-3 long-chain polyunsaturates influencing arterial stiffness and mortality BACKGROUND Indices of arterial structure and stiffness are proposed as surrogate markers of cardiovascular disease in patients with chronic kidney disease ( CKD ) , but no study examined multiple markers in the same population . STUDY DESIGN Prospect i ve observational study . SETTING & PARTICIPANTS 315 subjects with stages 4 to 5 CKD , aged 24 to 79 years ( mean age , 56.6 + /- 13.6 [ SD ] years ) , enrolled in the Atherosclerosis and Folic Acid Supplementation Trial . PREDICTORS Carotid arterial intima-medial thickness ( IMT ; n = 315 ) and indices of arterial stiffness ( n = 207 ) , including  aortofemoral pulse wave velocity ( PWV[a-f ] ) ,  systemic arterial compliance ( SAC ) , and carotid-derived augmentation index . OUTCOMES The primary outcome was a composite of all fatal and nonfatal cardiovascular events . RESULTS During follow-up ( median , 3.6 years ) , 95 cardiovascular events occurred . On Cox proportional-hazard modeling , mean maximum IMT , PWV(a-f ) , and SAC were predictive of the composite clinical end point of all cardiovascular events , but carotid-derived augmentation index was not ( hazard ratio [ HR ] for every 0.01-mm increase in IMT , 1.09 ; P = 0.001 ; 95 % confidence interval [ CI ] , 1.03 to 1.14 ; HR for every 1-m/s increase in PWV(a-f ) , 1.18 ; P < 0.001 ; 95 % CI , 1.12 to 1.25 ; HR for every 0.01-U/mm Hg decrease in SAC , 0.98 ; P = 0.01 ; 95 % CI , 0.97 to 0.99 ) . After adjustment for age , sex , blood pressure , diabetes , past cardiovascular disease , cholesterol level , and smoking , PWV(a-f ) remained a significant independent predictor of cardiovascular events ( adjusted HR , 1.12 ; P = 0.00 
    Output:
    
Aortic stiffness expressed as aortic PWV is a strong predictor of future CV events and all-cause mortality .
The predictive ability of arterial stiffness is higher in subjects with a higher baseline CV risk