Cardiff Metropolitan University
Stone 2023. baPWV call_to_action v.2023.07.06_Keeron Stone.pdf (853.39 kB)

Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet

Download (853.39 kB)
journal contribution
posted on 2023-08-15, 13:43 authored by Keeron Stone, Dave Veerasingam, Michelle L. Meyer, Kevin S. Heffernan, Simon Higgins, Rosa-Maria Bruno, Celia Alvarez-Bueno, Marcus Döerr, Arno Schmidt-Trucksäss, Dimitrios Terentes-Printzios, Julija Voicehovska, Rachel E. Climie, Chloe Park, Giacomo Pucci, Martin Bahls, Lee Stoner, Network for Research in Vascular Ageing (VascAgeNet)

This review critiques the literature supporting clinical assessment and management of cardiovascular disease and cardiovascular disease risk stratification with brachial-ankle pulse wave velocity (baPWV). First, we outline what baPWV actually measures—arterial stiffness of both large central elastic arteries and medium-sized muscular peripheral arteries of the lower limb. Second, we argue that baPWV is not a surrogate for carotid-femoral pulse wave velocity. While both measures are dependent on the properties of the aorta, baPWV is also strongly dependent on the muscular arteries of the lower extremities. Increased lower-extremity arterial stiffness amplifies and hastens wave reflections at the level of the aorta, widens pulse pressure, increases afterload, and reduces coronary perfusion. Third, we used an established evaluation framework to identify the value of baPWV as an independent vascular biomarker. There is sufficient evidence to support (1) proof of concept; (2) prospective validation; (3) incremental value; and (4) clinical utility. However, there is limited or no evidence to support (5) clinical outcomes; (6) cost-effectiveness; (7) methodological consensus; or (8) reference values. Fourth, we address future research requirements. The majority of the evaluation criteria ([1] proof of concept, [2] prospective validation, [3] incremental value, [4] clinical utility, and [9] reference values) can be supported using existing cohort datasets, whereas the (5) clinical outcomes and (6) cost-effectiveness criteria require prospective investigation. The (8) methodological consensus criteria will require an expert consensus statement. Finally, we finish this review by providing an example of a future clinical practice model.



American Heart Association


  • AM (Accepted Manuscript)


Stone, K., Veerasingam, D., Meyer, M.L., Heffernan, K.S., Higgins, S., Maria Bruno, R., Bueno, C.A., Döerr, M., Schmidt-Trucksäss, A., Terentes-Printzios, D., Voicehovska, J. et al. (2023) 'Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet', Hypertension. doi: 10.1161/HYPERTENSIONAHA.123.21314

Print ISSN


Electronic ISSN


Cardiff Met Affiliation

  • Cardiff School of Sport and Health Sciences

Cardiff Met Authors

Keeron Stone

Cardiff Met Research Centre/Group

  • Cardiovascular Physiology

Copyright Holder

  • © The Publisher


  • en

Usage metrics

    Cardiovascular Health & Ageing - Journal Articles


    Ref. manager