Kabutoya T. Arterial stiffness and endothelial dysfunction in diabetes mellitus. World J Transl Med 2026; 12(3): 123615 [DOI: 10.5528/wjtm.123615]
Corresponding Author of This Article
Tomoyuki Kabutoya, Associate Professor, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 3290498, Tochigi, Japan. kabu@jichi.ac.jp
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Tomoyuki Kabutoya, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke 3290498, Tochigi, Japan
Author contributions: Kabutoya T conceived the idea for the review, conducted the literature search, analyzed the relevant publications, wrote the manuscript, and reviewed and approved the final version of the manuscript.
AI contribution statement: AI tools (ChatGPT) were used solely to assist in the initial conceptual development and organization of the framework presented in Figure 1. No AI tool was used for study design, literature selection, interpretation of evidence, formulation of conclusions, or reference preparation. The final figure was independently created, edited, and validated by the authors using Microsoft PowerPoint. During the preparation of the revised manuscript and the response to reviewers, ChatGPT (Copilot) was used solely to assist with improving language, readability, and grammar.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Tomoyuki Kabutoya, Associate Professor, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 3290498, Tochigi, Japan. kabu@jichi.ac.jp
Received: May 26, 2026 Revised: July 18, 2026 Accepted: July 28, 2026 Published online: September 28, 2026 Processing time: 102 Days and 20.5 Hours
Abstract
In diabetes mellitus, arterial stiffness and endothelial dysfunction develop from an early stage, and their combined progression increases the risk of cardiovascular disease. In recent years, noninvasive measures of vascular function - such as pulse wave velocity, the cardio-ankle vascular index, flow-mediated dilation (FMD), and reactive hyperemia-peripheral arterial tonometry (RH-PAT) - have attracted attention as tools for assessing subclinical vascular damage in diabetes. Pulse wave velocity is regarded as the gold standard for evaluating arterial stiffness and is supported by extensive evidence, while cardio-ankle vascular index, which is less dependent on blood pressure, has demonstrated predictive value for cardiovascular events, mainly in prospective studies. In contrast, FMD and RH-PAT primarily reflect endothelial function: FMD assesses nitric oxide-dependent endothelial function in large conduit arteries, whereas RH-PAT evaluates endothelial reactivity at the level of the microvasculature, thereby capturing different aspects of vascular physiology. These indices are not interchangeable; rather, they complement one another by reflecting distinct facets of vascular pathology in diabetes. An integrated assessment of both arterial stiffness and endothelial function may therefore enable cardiovascular risk stratification beyond traditional risk factors.
Core Tip: Diabetes mellitus accelerates vascular aging through the concurrent progression of arterial stiffness and endothelial dysfunction, both of which independently contribute to cardiovascular risk. Noninvasive vascular indices - including pulse wave velocity, the cardio-ankle vascular index, flow-mediated dilation, and reactive hyperemia-peripheral arterial tonometry - capture distinct but complementary aspects of diabetic vascular pathology. These measures are not interchangeable; rather, their integrated assessment may enhance early detection of subclinical vascular damage and improve cardiovascular risk stratification beyond traditional risk factors in patients with diabetes.
Citation: Kabutoya T. Arterial stiffness and endothelial dysfunction in diabetes mellitus. World J Transl Med 2026; 12(3): 123615
Diabetes mellitus is a major risk factor for cardiovascular disease, largely because atherosclerotic changes can progress from an early stage of disease[1,2]. In recent years, various noninvasive indices that reflect arterial stiffness and endothelial function have attracted increasing attention as tools for evaluating subclinical vascular damage before the onset of overt cardiovascular events[3-5]. Although pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), flow-mediated dilation (FMD), and reactive hyperemia-peripheral arterial tonometry (RH-PAT) are widely used to assess vascular function, they reflect different aspects and stages of vascular injury. Diabetic vascular disease progresses from early endothelial dysfunction to increased arterial stiffness and eventually to structural vascular remodeling. Therefore, integrated interpretation of these complementary indices may improve both pathophysiological understanding and clinical utility. However, few reviews have examined the characteristics and clinical significance of these modalities from such a perspective. This mini-review aims to summarize the characteristics, strengths, and limitations of PWV, CAVI, FMD, and RH-PAT and to propose an integrated framework for interpreting these vascular assessments across the stages of diabetic vascular damage. By clarifying the complementary roles of these modalities, we examine their potential utility for the early detection of subclinical vascular dysfunction and improved cardiovascular risk stratification in patients with diabetes. As this article was prepared as a mini-review rather than a systematic review and was intended to provide a concise overview of recent advances in the field, no comprehensive literature search based on a predefined search strategy or formal article-selection criteria was performed. The literature discussed in this mini-review was identified primarily through PubMed and Google Scholar searches, and representative or influential studies were selected based on the authors’ expert judgment.
PROGRESSIVE PATTERNS OF DIABETIC VASCULAR COMPLICATIONS ACCORDING TO DISEASE STAGE
In diabetes mellitus, chronic hyperglycemia leads to the accumulation of advanced glycation end products (AGEs), increased oxidative stress, and activation of inflammatory pathways, resulting in both structural and functional impairment of the vascular wall[6,7]. These pathological changes manifest at the macrovascular level as reduced arterial elasticity (i.e., increased arterial stiffness) and at the microvascular level as endothelial dysfunction, primarily characterized by reduced nitric oxide (NO) bioavailability. These processes progress in parallel and interact with each other over time[7-9].
Although diabetic vascular damage affects both large and small vessels from the early disease stages, the dominant pathological features vary according to disease stage. In prediabetes and early-stage diabetes, endothelial dysfunction - primarily driven by reduced NO bioavailability - tends to precede other changes, while as the disease progresses, structural alterations of the arterial wall and irreversible increases in arterial stiffness become more apparent[10,11]. Considering this temporal heterogeneity, vascular function indices should be selected and interpreted with careful attention to the stage of diabetes. The progression of atherosclerosis in patients with diabetes mellitus and the corresponding assessments of vascular endothelial function and arterial stiffness are shown in Figure 1.
Figure 1 The progression of atherosclerosis in patients with diabetes mellitus and the evaluation of vascular endothelial function and arterial stiffness.
CV: Cardiovascular; FMD: Flow-mediated dilation; RH-PAT: Reactive hyperemia-peripheral arterial tonometry; PWV: Pulse wave velocity; CAVI: Cardio-ankle vascular index; CT: Computed tomography; MRI: Magnetic resonance imaging. The conceptual framework of this figure was initially developed with the assistance of ChatGPT. The final figure was independently created, edited, and validated by the authors using Microsoft PowerPoint.
Prediabetes stage
In the prediabetic stage, including impaired fasting glucose and impaired glucose tolerance, structural changes in the arterial wall, such as fibrosis and calcification, are generally minimal. However, functional endothelial dysfunction is already evident due to increased oxidative stress associated with postprandial hyperglycemia and insulin resistance. Large-scale cross-sectional studies, as well as the Japan-based FMD Japan study, have demonstrated that reduced FMD is observed even in individuals with high-normal fasting glucose levels or impaired fasting glucose[12]. In addition, because RH-PAT reflects microvascular reactivity, it has been reported to be useful for detecting early vascular functional abnormalities during the prediabetic stage[13]. In contrast, many individuals at this stage still show PWV and CAVI values within the normal range, indicating that arterial stiffness indices alone have limited sensitivity for detecting vascular abnormalities in the prediabetic stage.
Early diabetes (within a few years after diagnosis)
The early stage following diabetes diagnosis represents a transitional phase in which chronic hyperglycemia-driven endothelial dysfunction progresses, while increased arterial stiffness also begins to emerge. RH-PAT reflects peripheral endothelial dysfunction in patients with diabetes and has been reported to have predictive value for future cardiovascular events[14]. PWV and CAVI can capture early structural changes in the arterial wall[15,16], and increases in PWV reflect the duration of diabetes[16]. In contrast, CAVI is relatively less dependent on blood pressure and may therefore be more suitable for evaluating the “pure” progression of arteriosclerosis in the early stages of diabetes, relatively independent of blood pressure levels.
Mid-stage diabetes (stage of complication manifestation)
The accumulation of AGEs and progressive remodeling of the vascular wall become more pronounced, marking a transition to a stage in which arterial stiffness becomes a major determinant of cardiovascular risk with longer disease duration. PWV has been shown to be an independent predictor of cardiovascular events and mortality in patients with diabetes in meta-analyses[17,18]. Prospective cohort studies in Japan have found that CAVI has predictive value for cardiovascular events and is therefore positioned as a complementary marker to PWV[19,20]. In contrast, when endothelial dysfunction has already reached an advanced stage, FMD and RH-PAT are more susceptible to floor effects and are mainly used as adjunctive tools to assess the effects of therapeutic interventions rather than for risk stratification.
Long-standing diabetes
In patients with long-standing diabetes, prolonged exposure to hyperglycemia leads to the accumulation of AGEs, chronic inflammation, and increased oxidative stress, resulting in progressive remodeling of the arterial wall and the manifestation of irreversible atherosclerotic changes accompanied by vascular calcification and medial sclerosis. At this stage, impaired endotheliumdependent vasodilation is accompanied by a predominant reduction in intrinsic vascular wall elasticity, and vascular dysfunction becomes largely structural and less reversible.
Indices of arterial stiffness assume the greatest prognostic importance at this stage, with PWV and CAVI playing central roles in cardiovascular risk stratification[21,22]. When disease duration is prolonged and structural arteriosclerosis becomes established, endothelial reversibility diminishes, and FMD and RH-PAT values tend to plateau at low levels. Consequently, in advanced diabetes, their ability to predict cardiovascular events is considered relatively limited compared with that of PWV and CAVI. Established structural vascular lesions should also be evaluated using imaging modalities such as computed tomography, magnetic resonance imaging, and ultrasound, with treatment selected according to lesion type and severity.
ARTERIAL STIFFNESS INDICES IN PATIENTS WITH DIABETES MELLITUS
PWV
PWV is an index that quantitatively evaluates arterial stiffness by measuring the speed of arterial pulse-wave propagation between two arterial sites, thereby reflecting reduced arterial wall elasticity. In particular, carotid-femoral PWV (cfPWV) directly reflects central elastic artery stiffness and has been firmly established as a predictor of cardiovascular events through numerous epidemiological and prospective studies. Accordingly, cfPWV is currently regarded as the gold standard for assessing arterial stiffness[23,24].
Unlike cfPWV, brachial-ankle PWV (baPWV) can be simply measured using blood pressure cuffs placed on the extremities and does not require groin exposure or specialized technical expertise. Therefore, baPWV has been widely adopted in health screening and outpatient settings, especially in Japan and other Asian countries. baPWV shows a good correlation with aortic PWV and demonstrates high reproducibility[25,26]. Moreover, prospective studies and meta-analyses have shown that baPWV predicts cardiovascular events and mortality, supporting its utility for cardiovascular risk stratification[27].
In patients with diabetes mellitus, PWV is consistently reported to be significantly higher than in individuals without diabetes. This increase in PWV is thought to reflect structural remodeling of the arterial wall induced by chronic hyperglycemia, including collagen cross-linking due to AGE accumulation, fragmentation of elastic fibers, and phenotypic transformation and proliferation of vascular smooth muscle cells[28]. Disease duration has been shown to be associated with PWV, suggesting that PWV may serve as an integrated marker of cumulative exposure to dysglycemia and long-term vascular damage[16].
From a clinical perspective, elevated aortic PWV, typically represented by cfPWV, has been demonstrated to be an independent predictor of future myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality in diabetic populations[29-31]. In addition, increased PWV assessed by cardiac magnetic resonance imaging has been shown to predict major adverse cardiovascular events in diabetic patients with suspected myocardial ischemia[32]. In Asian populations, several studies have shown that baPWV is associated with prognosis in patients with diabetes[33-36]. Although evidence linking PWV and prognosis in diabetes is primarily in high-risk populations (Table 1), PWV is considered one of the core assessment tools for cardiovascular risk stratification in patients with diabetes, particularly in the mid to advanced stages of the disease.
Table 1 Association between pulse wave velocity and prognosis in populations with a high prevalence of diabetes.
Major adverse cardiovascular events and all-cause mortality
5.75 years (median)
PWV was a predictor of total cardiovascular events, with a 13% excess risk per 1 m/second increase in a PWV (32% excess risk for a 1-SD increment) and a nearly twofold higher risk among patients with aortic stiffness ≥ 10 m/second)
CAVI is an arterial stiffness parameter derived from pulse wave propagation from the heart to the ankle and incorporates the stiffness parameter β to theoretically correct for the influence of blood pressure at the time of measurement. Due to this characteristic, CAVI is considered to more purely reflect intrinsic arterial wall stiffness. Clinical application and validation of CAVI have been extensively pursued, particularly in Japan[5,37].
CAVI values are consistently higher in patients with diabetes mellitus than in those without diabetes[38-40]. In addition, CAVI has been shown to be associated with higher glycated hemoglobin levels, reduced estimated glomerular filtration rate, microalbuminuria, and peripheral neuropathy in individuals with diabetes or dysglycemia[41-44]. These findings suggest that CAVI may serve as a marker of cumulative exposure to disordered glucose metabolism. Importantly, CAVI has been reported to improve in response to diabetes treatment[45], indicating that it is not a completely irreversible structural marker. This reversibility represents a potential advantage in diabetes management, particularly for evaluating vascular responses to therapeutic interventions.
In recent years, studies from Japan have highlighted the significance of using CAVI to assess ventricular-arterial coupling[40,46]. These investigations have demonstrated that CAVI is associated not only with peripheral arterial stiffness but also with left ventricular systolic and diastolic function, as well as the integrated hemodynamic load on the cardiovascular system. Collectively, these findings suggest that increased arterial stiffness is closely linked to cardiac function and may constitute a substrate for cardiovascular events in patients with diabetes and hypertension[20]. From this perspective, CAVI may be reconceptualized as a phenotypic marker of the overall cardiovascular system rather than merely an index of vascular stiffness.
Results from prospective cohort studies of CAVI including large numbers of patients with diabetes have become increasingly available in recent years (Table 2). The TRIPLE-A-Stiffness study, the CAVI-J study, and the Cardiovascular Prognostic Coupling Study demonstrated that elevated CAVI was independently associated with cardiovascular events and cardiovascular mortality[19,20,22]. In contrast, Suwannasom et al[47] reported that a CAVI value > 9 was associated with a 1.31-fold increased risk (95% confidence interval: 0.89-1.92) in patients with diabetes, although this association did not reach statistical significance, suggesting limited prognostic utility. However, it should be noted that participants in this study were relatively younger (40-69 years) compared with those in other cohorts.
Table 2 Association between cardio-ankle vascular index and prognosis in populations with a high prevalence of diabetes.
Outpatient clinics for prevention, check-up, and/or monitoring of CV risk factors
23%-24% DM
CV morbidity and mortality
3.82 years (median)
The optimal CAVI thresholds for predicting outcomes differed among age groups, with thresholds of 9.25 for CV morbidity and mortality and 9.95 for all-cause mortality in subjects aged ≥ 60 years
A CAVI > 9.5 was significantly associated with higher risks of cardiovascular death and nonfatal stroke (crude HR = 3.83, 95%CI: 1.28-11.40; crude HR = 2.07, 95%CI: 1.07-3.91)
While PWV is more susceptible to the influence of blood pressure at the time of measurement, CAVI allows relatively stable assessment, even in patients with diabetes in whom blood pressure control is often unstable. Consequently, CAVI is gaining importance as an arterial stiffness index well suited for clinical risk stratification and evaluation of therapeutic effects in real-world practice. Together, these results show that CAVI plays an important role in assessing the progression of arteriosclerosis and cardiovascular risk in patients with diabetes. By complementing the established evidence for PWV and offering an integrated perspective through ventricular-arterial coupling, CAVI represents a clinically valuable arterial stiffness index developed in Japan.
DIABETES MELLITUS AND INDICATORS OF ENDOTHELIAL FUNCTION
FMD
FMD is an ultrasound-based method that assesses reactive dilation of the brachial artery and reflects NO-dependent endothelial function in arteries[48]. In patients with diabetes mellitus, endothelial dysfunction develops from an early stage, and FMD is used as a noninvasive marker of this impairment. FMD has been shown to be significantly reduced both in patients with type 1 diabetes and those with type 2 diabetes compared with healthy individuals[49,50]. Furthermore, decreased FMD has been observed in individuals with impaired glucose tolerance and prediabetes[12,51].
Prospective studies specifically examining the relationship between FMD and prognosis in patients with diabetes are limited. However, in cohorts that include diabetic patients as a high-risk group, reduced FMD has consistently been shown to independently predict the occurrence of cardiovascular events. Gokce et al[52] reported that decreased FMD predicted cardiovascular events in patients with peripheral arterial disease, approximately half of whom had diabetes. In addition, Yeboah et al[53] demonstrated in a general population cohort (the Multi-Ethnic Study of Atherosclerosis) that although the addition of FMD to the Framingham risk score did not improve discrimination for cardiovascular disease events, combining FMD with the Framingham risk score improved risk classification into low-, intermediate-, and high-risk categories compared with Framingham risk score alone. However, this study included relatively few patients with diabetes.
FMD is considered a surrogate marker reflecting a high-risk state rather than a direct prognostic indicator. Although an association between reduced FMD and future cardiovascular events has been reported, evidence specifically in diabetic patients remains limited. Additionally, the technical expertise required for FMD measurement and issues related to standardization remain important limitations, and its use is currently largely limited to research settings or specialized centers.
RH-PAT
RH-PAT is an index that evaluates changes in peripheral arterial tone at the fingertip and predominantly reflects endothelial responsiveness at the microvascular level[54]. RH-PAT demonstrates good reproducibility and minimal operator dependence, and its application in clinical research and screening is therefore expected to expand.
In diabetes mellitus, microvascular dysfunction is known to progress from an early stage, and RH-PAT may therefore be useful for detecting early endothelial dysfunction[55,56]. In the Framingham Heart Study, Hamburg et al[57] demonstrated that RH-PAT was inversely associated with diabetes. In a cohort of symptomatic patients, Rubinshtein et al[58] showed that in approximately 12% of the patients with diabetes, that a low RH-PAT index was an independent predictor of cardiovascular events. In addition, although their study was based on a small sample size, Koo et al[14] reported an association between low RH-PAT values and cardiovascular events in asymptomatic diabetic patients with albuminuria.
At present, large-scale prospective prognostic studies focusing exclusively on diabetic patients are limited; nevertheless, RH-PAT is considered a useful indicator of endothelial function that may contribute to cardiovascular risk stratification in patients with diabetes mellitus.
INTEGRATED INTERPRETATION OF VASCULAR FUNCTION INDICES IN DIABETES MELLITUS AND FUTURE PERSPECTIVES
PWV and CAVI primarily reflect arterial stiffness, which is largely driven by structural changes in the vascular wall. In contrast, FMD and RH-PAT assess functional endothelial reactivity, mainly based on NO-mediated vasodilatory responses. Because these indices reflect fundamentally different aspects of vascular pathology, they are not interchangeable and are best used in a complementary manner.
In diabetes mellitus, vascular injury involves both the microvasculature and large conduit arteries, but the predominant pathological features evolve over time and vary by vascular site according to disease duration and the progression of complications. In the relatively early stages, endothelial dysfunction and microvascular impairment are more prominent, whereas with advancing disease, structural arterial stiffening accompanied by vascular remodeling and calcification becomes increasingly evident. Accordingly, combining multiple vascular indices that assess different vessel sizes and disease stages may enable more comprehensive cardiovascular risk stratification and deeper pathophysiological insight than reliance on a single marker.
However, current evidence regarding long-term prognostic prediction in patients with diabetes is more robust for arterial stiffness indices, such as PWV and CAVI, than for endothelial function indices such as FMD and RH-PAT. In particular, prospective studies focusing exclusively on patients with diabetes and clearly defined cutoff values for prognostic risk stratification using endothelial function markers remain limited. These gaps represent important challenges for implementing vascular function assessment in routine clinical practice. Future efforts should therefore focus on the standardization of endothelial function measurements and the validation of their prognostic significance through large-scale longitudinal studies. Table 3 presents a comparative summary of PWV, CAVI, FMD, and RH-PAT, highlighting their complementary roles in the assessment of diabetic vascular dysfunction. The current evidence has several important limitations: Most studies are observational, study populations are heterogeneous, and measurement protocols vary. In addition, large-scale prospective studies in patients with diabetes remain relatively scarce. These limitations should be considered when interpreting the available evidence and highlight the need for further standardized prospective research. Moreover, much of the evidence on CAVI comes from studies conducted in Japan and other Asian populations. Consequently, caution is warranted when extrapolating these findings to non-Asian populations. Further studies in ethnically diverse cohorts are needed to establish the generalizability and clinical applicability of CAVI in non-Asian populations. Finally, although several studies have reported associations between impaired FMD or RH-PAT responses and cardiovascular outcomes, the available evidence remains less robust and less consistent than that for established arterial stiffness indices such as PWV and CAVI. Moreover, prospective studies specifically conducted in patients with diabetes are limited. Therefore, the prognostic significance of these endothelial function markers should be interpreted with caution, and further validation in large-scale prospective studies is warranted.
Table 3 Comparison of pulse wave velocity, cardio-ankle vascular index, flow-mediated dilation, and reactive hyperemia-peripheral arterial tonometry.
Physiological target
Vascular territory assessed
Most informative stage of diabetic vascular dysfunction
In diabetes mellitus, the focus of vascular function assessment shifts across disease stages, from early endothelial dysfunction in the prediabetic phase to arterial stiffness as a key determinant of prognosis in long-standing diabetes. PWV, CAVI, FMD, and RH-PAT reflect distinct aspects of vascular pathology. Stage-specific selection and integrated interpretation of these indices may improve cardiovascular risk stratification beyond traditional risk factors.
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H; European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications.Eur Heart J. 2006;27:2588-2605.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 4952][Cited by in RCA: 4417][Article Influence: 220.9][Reference Citation Analysis (0)]
Ikonomidis I, Pavlidis G, Tsoumani M, Kousathana F, Katogiannis K, Tsilivarakis D, Thymis J, Kountouri A, Korakas E, Pliouta L, Raptis A, Parissis J, Andreadou I, Lambadiari V. Endothelial Dysfunction Is Associated with Decreased Nitric Oxide Bioavailability in Dysglycaemic Subjects and First-Degree Relatives of Type 2 Diabetic Patients.J Clin Med. 2022;11:3299.
[RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)][Cited by in Crossref: 1][Cited by in RCA: 9][Article Influence: 2.3][Reference Citation Analysis (0)]
Miyoshi T, Ito H, Shirai K, Horinaka S, Higaki J, Yamamura S, Saiki A, Takahashi M, Masaki M, Okura T, Kotani K, Kubozono T, Yoshioka R, Kihara H, Hasegawa K, Satoh-Asahara N, Orimo H; CAVI‐J (Prospective Multicenter Study to Evaluate Usefulness of Cardio‐Ankle Vascular Index in Japan) investigators. Predictive Value of the Cardio-Ankle Vascular Index for Cardiovascular Events in Patients at Cardiovascular Risk.J Am Heart Assoc. 2021;10:e020103.
[RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)][Cited by in Crossref: 6][Cited by in RCA: 66][Article Influence: 13.2][Reference Citation Analysis (0)]
Kario K, Hoshide S, Kabutoya T, Nishizawa M, Yamagiwa K, Kawashima A, Fujiwara T, Nakazato J, Yoshida T, Negishi K, Matsui Y, Sekizuka H, Abe Y, Fujita Y, Hashizume T, Morimoto T, Nozue R, Kanegae H. Impact of vascular biomarkers and supine hypertension on cardiovascular outcomes in hypertensive patients: first results from the Cardiovascular Prognostic COUPLING Study in Japan.Hypertens Res. 2025;48:693-701.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 15][Cited by in RCA: 16][Article Influence: 16.0][Reference Citation Analysis (0)]
Bäck M, Topouchian J, Labat C, Gautier S, Blacher J, Cwynar M, de la Sierra A, Pall D, Duarte K, Fantin F, Farkas K, Garcia-Ortiz L, Hakobyan Z, Jankowski P, Jelakovic A, Kotsani M, Konradi A, Mikhailova O, Mintale I, Plunde O, Ramos R, Rogoza A, Sirenko Y, Tasic N, Rudyk I, Urazalina S, Wohlfahrt P, Zelveian P, Asmar R, Benetos A. Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study.EBioMedicine. 2024;103:105107.
[RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)][Cited by in RCA: 18][Reference Citation Analysis (0)]
Kabutoya T, Hoshide S, Fujiwara T, Negishi K, Nishizawa M, Yamamoto M, Yamagiwa K, Kawashima A, Yoshida T, Nakazato J, Matsui Y, Sekizuka H, Abe H, Abe Y, Fujita Y, Sato K, Narita K, Tsuchiya N, Kubota Y, Hashizume T, Kario K. Age-related difference of the association of cardiovascular risk factors with the cardio-ankle vascular index in the Cardiovascular Prognostic Coupling Study in Japan (the Coupling Registry).J Clin Hypertens (Greenwich). 2020;22:1208-1215.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 9][Cited by in RCA: 14][Article Influence: 2.3][Reference Citation Analysis (0)]
Kario K, Kabutoya T, Fujiwara T, Negishi K, Nishizawa M, Yamamoto M, Yamagiwa K, Kawashima A, Yoshida T, Nakazato J, Matsui Y, Sekizuka H, Abe H, Abe Y, Fujita Y, Sato K, Narita K, Tsuchiya N, Kubota Y, Hashizume T, Hoshide S. Rationale, design, and baseline characteristics of the Cardiovascular Prognostic COUPLING Study in Japan (the COUPLING Registry).J Clin Hypertens (Greenwich). 2020;22:465-474.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 10][Cited by in RCA: 17][Article Influence: 2.8][Reference Citation Analysis (0)]
Suwannasom P, Thonghong T, Leemasawat K, Nantsupawat T, Prasertwitayakij N, Pairoj C, Wongcharoen W, Phrommintikul A; CORE‐Thailand Investigators. Predictive value of Systematic Coronary Risk Evaluation 2-Diabetes risk model and arterial stiffness for cardiovascular events in the Asian population with type 2 diabetes mellitus.J Diabetes Investig. 2024;15:1266-1275.
[RCA] [PubMed] [DOI] [Full Text][Cited by in RCA: 2][Reference Citation Analysis (0)]
Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R; International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force.J Am Coll Cardiol. 2002;39:257-265.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 3677][Cited by in RCA: 3398][Article Influence: 141.6][Reference Citation Analysis (3)]
