A blood vessel can become stiffer with age without that process being identical to the build-up of atherosclerotic plaque. It can also widen, thicken, calcify or change in several ways at once.
That distinction is more than vocabulary. Twin studies in women suggest these vascular traits have partly different relationships with genetics and with each other.
Quick answer
Is arterial stiffness another name for atherosclerosis?
No. Arterial stiffness describes how resistant an artery is to expansion with each pulse. Atherosclerosis describes plaque formation within the arterial wall. They can coexist and share risk factors, but twin studies show that stiffness relates more closely to calcification than to some noncalcified atherosclerosis measures.
Key takeaways
- Arterial stiffness, plaque, calcification and wall thickening are related but distinct vascular phenotypes.
- A TwinsUK study of 900 women estimated heritability at 38% for carotid-femoral pulse-wave velocity and 61% for calcified plaque.
- In that study, arterial stiffness correlated with calcified plaque but not independently with noncalcified plaque or carotid IMT.
- A longitudinal study of 762 female twins showed that stiffening, dilation and wall thickening did not progress as one identical process.
- “Vascular age” is therefore best understood as a collection of traits, not one hidden number.
What arterial stiffness actually measures
Healthy large arteries expand and recoil as blood is ejected from the heart. With ageing and disease, that elastic behaviour can change.
Carotid-femoral pulse-wave velocity, or cfPWV, estimates how quickly the pressure wave travels along the aorta and large arteries. Faster propagation generally reflects greater arterial stiffness. It is a functional vascular measure, not an image of plaque.
Nine hundred female twins: stiffness and calcification travelled together
A 2011 TwinsUK study examined 900 women and compared cfPWV with measures of plaque, calcification, carotid intima-media thickness and bone density.
After adjustment, stiffness was associated with calcified plaque but not with noncalcified plaque or carotid IMT. Adjusted heritability estimates were 0.38 for cfPWV and 0.61 for calcified plaque. Shared genetic factors explained much of the observed correlation between the two traits in the model.
Five years later: the arteries did not age in lockstep
A longitudinal TwinsUK study followed 762 female twins for an average of about five years, repeating measurements of cfPWV, arterial diameter, distensibility and carotid IMT.
The results supported a heritable component to arterial stiffening and showed that stiffening was related to arterial dilation rather than simply to wall thickening. This argues against treating every measurable sign of vascular ageing as one biological pathway.
Why the distinction matters
If stiffness, calcification and plaque composition are different phenotypes, they may also respond differently to age, blood pressure, metabolism, medication and inherited biology.
That does not make one measure more “real” than another. It means each answers a different question. Combining them carelessly can create false certainty about what a single scan or wearable-derived metric represents.
TwinPare perspective: precision beats a single “vascular age” score
Health technology increasingly compresses complex physiology into simple scores. Scores can be useful interfaces, but research must preserve what sits underneath them.
Twin evidence suggests that vascular ageing has multiple dimensions. A responsible digital-health product should therefore explain the signal, the uncertainty and the difference between measured data and inferred biological meaning.
Source notes
The sources have been verified and editorially reviewed for this article. The limitations below show which level of conclusion the sources support.
- [cecelja-2011] Arterial stiffening relates to arterial calcification but not to noncalcified atheroma in women. A twin study Marina Cecelja et al.. Journal of the American College of Cardiology, 2011. Evidence type: Cross-sectional TwinsUK study of 900 women Limitation: Adjusted heritability was estimated at 0.38 for carotid-femoral pulse-wave velocity and 0.61 for calcified plaque. Arterial stiffness correlated with calcification, not with noncalcified plaque or IMT after adjustment. PubMed PMC DOI
- [cecelja-2018] Arterial stiffening is a heritable trait associated with arterial dilation but not wall thickening: a longitudinal study in the twins UK cohort Marina Cecelja et al.. European Heart Journal, 2018. Evidence type: Longitudinal study of 762 female twins followed for about five years Limitation: The study showed that progression of arterial stiffness, dilation and wall thickening do not behave as one identical ageing process. Heritability estimates are population/model specific. PubMed DOI
Editorial source review
This section shows how the article's key factual claims are linked to the source.
Phrasings that require caution
- Do not equate pulse-wave velocity with atherosclerotic plaque burden.
- Do not use a heritability estimate as a personal vascular-age score.
- Do not imply a consumer device can diagnose arterial stiffness or atherosclerosis unless specifically clinically validated for that purpose.
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