Mitchell GF et al (Circulation. 2010; 121: 505-511) addressed a very hot issue regarding the association of a variety of measures of central hemodynamics, with various indices of regional pulsatile hemodynamics on cardiovascular (CV) events in participants of the Framingham Heart Study with a mean age of 63 years and a median of 7.8 years follow-up. In their study, they concluded that only higher aortic stiffness (aortic PWV), not muscular PWV, was associated with increase risk of a first CV events, the primary outcome. And also they added that the relation between aortic PWV and events is distinguishable from excessive central pressure pulsatility or abnormal wave reflection. Although debate remains on the distinction between arterial stiffness and wave reflections, there are many data supporting the strong association between central heomdynamics and CV events (Agabiti-Rosei E et al. Hypertension. 2007;50:154-160, the Strong Heart Study, Hypertension. 2007;50:197-203 and J Am Coll Cardiol. 2009;54:1730-1734, the ICARe Dicomano Study, J Am Coll Cardiol. 2008;51:2432-2439). Sex and aging may be key determinants of the correlation of aortic stiffness and augmentation index (AIx) with CV events; eg, AIx might be a more sensitive marker of arterial stiffening and risk in younger individuals but aortic PWV is likely to be a better measure in older individuals. By Park JB 2010 Jan.