Therefore, it is considered an exacerbating factor in heart failure.42, 43 The primary cause of arterial stiffness is a change in medial structural components.44 Matrix metalloproteinases promote overproduction of abnormal collagen and degradation of elastin in the extracellular matrix.45 Moreover, an accumulation of advanced glycation end products, calcium deposition, neurohormonal factors, and sympathetic nerve activation also play roles in development of arterial stiffness. This evidence concerns the gene ELN and heart failure.