Scragg, RobertSluyter, JohnBeros, Angela Lukrica2025-01-132025-01-132024https://hdl.handle.net/2292/71038Aim This thesis aimed to identify if arterial stiffness, predominantly assessed by pulse wave velocity (PWV), is a risk factor for diabetes and microvascular disease, and if so, whether aortic PWV estimated with a single cuff oscillometric device PWV (oPWV), which is easy-to-apply in clinical practice, can predict future disease incidence. Methods Four systematic reviews were conducted based on existing observational studies, incorporating where possible meta-analysis, to investigate the association of arterial stiffness with each of diabetes, chronic kidney disease (CKD), microvascular eye disease and neuropathy. These reviews also investigated the temporality of the associations. Three analyses were undertaken of the Vitamin D Assessment (ViDA) Study, a population-based cohort of 5108 people in Auckland, New Zealand, aged 50-84 years, to determine if arterial stiffness, estimated using oPWV, predicted incident diabetes/prediabetes, CKD and glaucoma. Findings The systematic reviews established that there appears to be a bi-directional association between increased arterial stiffness and diabetes and that increased arterial stiffness may predict incident CKD. Further, increased arterial stiffness appears to be associated with the development of age-related macular degeneration, glaucoma, retinal vein occlusion, and retinopathy. Though there is a lack of longitudinal evidence, increased arterial stiffness also appears to be associated with incident peripheral neuropathy and cardiac autonomic neuropathy. The ViDA Study confirmed that over a mean period of 10.5 years, arterial stiffness, estimated using oPWV, is associated with the development of diabetes/prediabetes, CKD and glaucoma. Conclusions Increased arterial stiffness could be an additional risk factor to be incorporated into clinical practice when determining a person’s future risk of diabetes and microvascular disease. Validated risk-prediction models incorporating increased arterial stiffness, however, must first show the utility of increased arterial stiffness as a risk factor, and investigation must be undertaken as to whether lifestyle and pharmacological interventions which lower arterial stiffness also translate into reduced incidence of these conditions.https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htmThesisCopyright: The authorAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/