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Ankle-brachial index measured by oscillometry is predictive for cardiovascular disease and premature death in the Japanese population: An individual participant data meta-analysis. Atherosclerosis 2018; 275:141-148. [DOI: 10.1016/j.atherosclerosis.2018.05.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 01/13/2023]
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Nagayama D, Watanabe Y, Saiki A, Shirai K, Tatsuno I. Lipid Parameters are Independently Associated with Cardio-Ankle Vascular Index (CAVI) in Healthy Japanese Subjects. J Atheroscler Thromb 2018; 25:621-633. [PMID: 29332863 PMCID: PMC6055041 DOI: 10.5551/jat.42291] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022] Open
Abstract
AIM To investigate the associations of conventional lipid parameters with arterial stiffness assessed by cardio-ankle vascular index (CAVI). METHODS A retrospective cross-sectional study was conducted in 23,257 healthy Japanese subjects (12,729 men and 10,528 women, aged 47.1±12.5 years, body mass index (BMI) 22.9±3.4 kg/m2) who underwent health screening between 2004 and 2006 in Japan. RESULTS Male subjects had significantly higher BMI, CAVI and triglycerides (TG), and lower high-density lipoprotein cholesterol (HDL-C) compared to female subjects. After adjusting for confounders, including gender, age, systolic blood pressure and BMI identified by multiple regression analysis, adjusted CAVI was lower in normolipidemic than in dyslipidemic subjects. Among dyslipidemic subjects, those with hypertriglyceridemia had higher adjusted CAVI. A trend test detected linear relations between adjusted CAVI and all the conventional lipid parameters throughout the entire range of serum levels. After adjusting for confounders, logistic regression models showed that all lipid parameters contributed independently to high CAVI (≥90th percentile). Receiver-operating-characteristic analysis determined reliable cut-off values of 93 mg/dl for TG (area under the curve, AUC= 0.735), 114 mg/dl for low-density lipoprotein cholesterol (AUC=0.614) and 63 mg/dl for HDL-C (AUC=0.728) in predicting high CAVI. These cut-off values were confirmed to independently predict high CAVI in a bivariate logistic regression model. CONCLUSION The present study demonstrated independent contribution of conventional lipid parameters to CAVI, indicating a possible association of lipid parameters with early vascular damage.
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Affiliation(s)
- Daiji Nagayama
- Center of Diabetes and Metabolism, Shin-Oyama City Hospital, Tochigi, Japan
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, Chiba, Japan
| | - Yasuhiro Watanabe
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, Chiba, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, Chiba, Japan
| | - Kohji Shirai
- Department of Internal Medicine, Mihama Hospital, Chiba, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrinology and Metabolism, Toho University, Sakura Medical Center, Chiba, Japan
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Tomiyama H, Ohkuma T, Ninomiya T, Mastumoto C, Kario K, Hoshide S, Kita Y, Inoguchi T, Maeda Y, Kohara K, Tabara Y, Nakamura M, Ohkubo T, Watada H, Munakata M, Ohishi M, Ito N, Nakamura M, Shoji T, Vlachopoulos C, Yamashina A. Simultaneously Measured Interarm Blood Pressure Difference and Stroke. Hypertension 2018; 71:1030-1038. [DOI: 10.1161/hypertensionaha.118.10923] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/12/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Hirofumi Tomiyama
- From the Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T., C.M., A.Y.)
- Department of Medicine and Clinical Science (T.O.)
| | - Toshiaki Ohkuma
- From the Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T., C.M., A.Y.)
| | | | - Chisa Mastumoto
- From the Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T., C.M., A.Y.)
| | | | | | - Yoshikuni Kita
- Faculty of Nursing Science, Tsuruga Nursing University, Fukui, Japan (Y.K.)
| | | | - Yasutaka Maeda
- and Department of Medicine and Bioregulatory Science (Y.M.)
| | - Katsuhiko Kohara
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (K. Kario, S.H.)
- Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Matsuyama, Japan (K. Kohara)
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.)
| | - Motoyuki Nakamura
- Department of Internal Medicine, Iwate Medical University, Morioka, Japan (M.N.)
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Itabashi, Tokyo, Japan (T.O.)
| | - Hirotaka Watada
- Departments of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University, Bunkyo, Tokyo, Japan (H.W.)
| | - Masanori Munakata
- Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.)
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.)
| | - Norihisa Ito
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Japan (N.I.)
| | | | - Tetsuo Shoji
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (K. Kario, S.H.)
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.)
| | - Charalambos Vlachopoulos
- and Hypertension and Cardiometabolic Unit, (1 st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Akira Yamashina
- From the Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T., C.M., A.Y.)
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Obstructive sleep apnoea is associated with progression of arterial stiffness independent of obesity in participants without hypertension: A KoGES Prospective Cohort Study. Sci Rep 2018; 8:8152. [PMID: 29802398 PMCID: PMC5970272 DOI: 10.1038/s41598-018-26587-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/11/2018] [Indexed: 11/21/2022] Open
Abstract
Accumulating evidence shows that obstructive sleep apnoea (OSA) is associated with an increased risk of cardiovascular disease. However, there are no published prospective studies on the relationship between OSA and the progression of arterial stiffness. We hypothesised that OSA would increase the risk of arterial stiffness progression, independent of obesity. In the present large cohort study, 1921 participants were randomly selected and underwent polysomnography. The brachial ankle pulse wave velocity (baPWV) was measured at baseline and during the follow-period using a standard protocol. Elevated baPWV was defined as a value greater than the cut-off of highest tertile level in the complete study cohort. The percentage of elevated baPWV and the ΔbaPWV significantly increased with OSA severity. After adjusting for potential confounding factors, participants with moderate-to-severe OSA without hypertension had a significantly higher risk of elevated ΔbaPWV than those without OSA. More importantly, using multivariate mixed-effect models, we found that the ΔbaPWV over 6 years significantly differed according to OSA severity. Therefore, moderate-to-severe OSA in participants without hypertension was a predictor of future burden of arterial stiffness progression, independent of obesity, suggesting that it may contribute to the increased risk of cardiovascular disease.
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Brachial-Ankle Pulse Wave Velocity is Associated with the Risk of New Carotid Plaque Formation: Data from a Chinese Community-based Cohort. Sci Rep 2018; 8:7037. [PMID: 29728607 PMCID: PMC5935681 DOI: 10.1038/s41598-018-25579-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/24/2018] [Indexed: 01/15/2023] Open
Abstract
Artery stiffness is an independent marker for atherosclerotic cardiovascular diseases. However, whether the brachial-ankle pulse wave velocity (ba-PWV) is related to new carotid plaque formation is unresolved. This study aimed to investigate the association between baseline ba-PWV and new carotid plaque formation in a Chinese community-based population without carotid plaques at baseline. This study population consisted of a total of 738 participants from an atherosclerosis cohort in Beijing, China. After a mean 2.3-year follow-up, the incidence of carotid plaques were 21.2% and 36.5% in the groups with ba-PWV < 1,400 cm/s and ≥1,400 cm/s, respectively. Compared with baseline ba-PWV < 1,400 cm/s group, ba-PWV ≥ 1,400 cm/s group was significantly associated with the incidence of new carotid plaque formation (odds ratio [OR] = 2.14, 95% CI: 1.50–3.03, P < 0.01), even after adjusting for common risk factors (OR = 1.52, 95% CI: 1.02–2.25, P = 0.04). Furthermore, there was a strong relationship between baseline ba-PWV and carotid plaque formation in subjects with ba-PWV < 1,400 cm/s, but no such relationship was found in subjects with baseline ba-PWV ≥ 1,400 cm/s. In conclusion, this study suggests that baseline ba-PWV is independently associated with the risk of carotid plaque formation in a Chinese community-based population.
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Lee CC, Tsai MC, Liu SC, Pan CF. Relationships between chronic comorbidities and the atherosclerosis indicators ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes mellitus. J Investig Med 2018; 66:966-972. [DOI: 10.1136/jim-2017-000638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/04/2022]
Abstract
This study aimed to determine associations between ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) with different comorbidities in patients with type 2 diabetes mellitus (DM). Records of patients with type 2 DM who received an ABI and baPWV examination between August 2013 and February 2015 were retrospectively reviewed. Associations of ABI and baPWV with chronic kidney disease (CKD), chronic liver disease (CLD), coronary artery disease (CAD) and diabetic nephropathy (DN) were examined by regression analysis. A total of 1232 patients (average age, 65.1±10.0 years) were included in the analysis. CKD and DN were associated with low ABI and increased baPWV (all, P<0.001). No associations were found between CAD and CLD and ABI or baPWV. Thus, regression analysis was performed for CKD and DN. Low ABI was associated with risk of CKD in the crude model (OR 0.724, 95% CI 0.648 to 0.808, P<0.001) and adjusted model (OR 0.872, 95% CI 0.762 to 0.999, P=0.048), whereas baPWV was only significant in the crude model (OR 1.199, 95% CI 1.112 to 1.294, P<0.001). Low ABI was associated with risk of DN in the crude model (OR 0.873, 95% CI 0.780 to 0.977, P=0.018) and adjusted model (OR 0.884, 95% CI 0.782 to 0.999, P=0.048). No association was found for baPWV. In conclusion, low ABI was associated with risk of CKD and DN in patients with type 2 diabetes.
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Carter JC, Auckley D. Watch What You're Doing! J Clin Sleep Med 2018; 14:301-302. [PMID: 29458708 DOI: 10.5664/jcsm.6962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 11/13/2022]
Affiliation(s)
- John C Carter
- Department of Pediatrics and Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Kinoshita T, Yahaba M, Terada J, Matsumura T, Sakurai Y, Nagashima K, Sakao S, Tatsumi K. Impact of Arterial Stiffness on WatchPAT Variables in Patients With Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:319-325. [PMID: 29458701 DOI: 10.5664/jcsm.6970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/01/2017] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES The WatchPAT is a wrist-worn portable device that creates integration data regarding peripheral arterial tone (PAT), oxyhemoglobin saturation, heart rate, and actigraphy to diagnose or screen for obstructive sleep apnea (OSA). Previous studies have demonstrated the efficacy and validity of respiratory variables measured by the WatchPAT compared to those using polysomnography (PSG). However, the effects of arterial stiffness or atherosclerosis on WatchPAT parameters remain to be elucidated. METHODS Sixty-one consecutive patients with suspected OSA who underwent home-based testing with the WatchPAT 200, standard in-laboratory overnight polysomnography (PSG), and pulse wave velocity (PWV) as an index of arterial stiffness were studied. All PSG recordings were scored manually using the American Academy of Sleep Medicine criteria, whereas WatchPAT data were analyzed by an automatic algorithm. We evaluated how arterial stiffness affected respiratory event index data in WatchPAT (WP-AHI), because WP-AHI could be partly influenced by PAT, comparing WP-AHI and the apneahypopnea index measured by PSG (PSG-AHI) in consideration of PWV result. RESULTS Overall, WP-AHI was moderately correlated to PSG-AHI, but WP-AHI was significantly lower than PSG-AHI (28.4 ± 19.2 versus 53.6 ± 30.2 events/h, P < .0001). For the lower PWV group, there was a significant correlation and good agreement between the WP-AHI and PSG-AHI, but as the PWV increased, there was low correlation between the WP-AHI and PSG-AHI. CONCLUSIONS Arterial stiffness may affect the respiratory variables measured by WatchPAT in patients with OSA. COMMENTARY A commentary on this article appears in this issue on page 301.
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Affiliation(s)
- Taku Kinoshita
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Misuzu Yahaba
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jiro Terada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuma Matsumura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoriko Sakurai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kengo Nagashima
- Department of Global Clinical Research, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Elias MF, Crichton GE, Dearborn PJ, Robbins MA, Abhayaratna WP. Associations between Type 2 Diabetes Mellitus and Arterial Stiffness: A Prospective Analysis Based on the Maine-Syracuse Study. Pulse (Basel) 2018; 5:88-98. [PMID: 29761082 PMCID: PMC5939695 DOI: 10.1159/000479560] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/15/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate prospective associations between type 2 diabetes mellitus status and the gold standard non-invasive method for ascertaining arterial stiffness, carotid femoral pulse wave velocity. METHODS The prospective analysis employed 508 community-dwelling participants (mean age 61 years, 60% women) from the Maine-Syracuse Longitudinal Study. Pulse wave velocity at wave 7 (2006-2010) was compared between those with type 2 diabetes mellitus at wave 6 (2001-2006) (n = 52) and non-diabetics at wave 6 (n = 456), with adjustment for demographic factors, cardiovascular risk factors and lifestyle- and pulse wave velocity-related factors. RESULTS Type 2 diabetes mellitus status was associated with a significantly higher pulse wave velocity (12.5 ± 0.36 vs. 10.4 ± 0.12 m/s). Multivariate adjustment for other cardiovascular risk factors and lifestyle- and pulse wave velocity-related variables did not attenuate the findings. The risk of an elevated pulse wave velocity (≥12 m/s) was over 9 times higher for those with uncontrolled type 2 diabetes mellitus than for those without diabetes (OR 9.14, 95% CI 3.23-25.9, p < 0.001). CONCLUSIONS Type 2 diabetes mellitus, particularly if uncontrolled, is significantly associated with risk of arterial stiffness later in life. Effective management of diabetes mellitus is an important element of protection from arterial stiffness.
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Affiliation(s)
- Merrill F. Elias
- Department of Psychology, University of Maine, Orono, ME, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
| | - Georgina E. Crichton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | | | - Michael A. Robbins
- Department of Psychology, University of Maine, Orono, ME, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
| | - Walter P. Abhayaratna
- College of Medicine, Biology, and Environment, Australian National University, Canberra, ACT, Australia
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Riandini T, Wee HL, Khoo EYH, Tai BC, Wang W, Koh GCH, Tai ES, Tavintharan S, Chandran K, Hwang SW, Venkataraman K. Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes. Acta Diabetol 2018; 55:155-164. [PMID: 29185052 PMCID: PMC5816102 DOI: 10.1007/s00592-017-1077-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
AIMS To examine differences in health-related quality of life (HRQoL) between patients with and without diabetic peripheral neuropathy (DPN), and whether these differences can be explained by functional deficits. METHODS This was a cross-sectional study of 160 patients with type 2 diabetes mellitus, 80 with DPN and 80 without. Assessments included HRQoL (health utility score derived from EQ-5D-5L), functional status measurements [muscle strength, timed up and go (TUG), five times sit-to-stand (FTSTS), functional reach, body sway velocity] and self-reported balance confidence [Activities-specific Balance Confidence (ABC) scale]. RESULTS Mean utility scores were 0.67 ± 0.14 and 0.77 ± 0.16 in patients with and without DPN, respectively (p < 0.001). Patients with DPN had lower great toe extensor strength (6.4 ± 1.8 vs 7.6 ± 2.8 lbs, p = 0.001), greater body sway velocity (2.40 ± 1.31 vs 1.90 ± 0.52 mm/s, p = 0.002), slower TUG (12.1 ± 4.6 vs 10.1 ± 2.3 s, p < 0.001) and FTSTS (15.8 ± 5.8 vs 13.9 ± 5.4 s, p = 0.03) scores, and lower ABC score (73.4 ± 21.3 vs 82.6 ± 16.9, p = 0.003), compared to those without DPN. On stepwise multiple regression, DPN status, FTSTS, body sway velocity, BMI, diabetes duration, pain, and gender explained 38% of HRQoL variance. Addition of ABC score into the model explained 45% of variance. Results from structural equation modelling showed that DPN had direct effects on HRQoL and indirect effects through FTSTS, body sway velocity, and ABC score, with χ 2 = 8.075 (p = 0.044), root mean square error of approximation = 0.103 (lower bound 0.015, upper bound 0.191), Comparative Fit Index = 0.966, Tucker-Lewis Index = 0.887, and Standardized Root Mean Square Residual = 0.053. CONCLUSIONS Patients with DPN have worse HRQoL compared to patients without DPN, partly mediated by functional status parameters. Effective interventions targeting functional status may be beneficial in improving HRQoL in these patients.
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Affiliation(s)
- Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549 Singapore
| | - Hwee Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117559 Singapore
| | - Eric Y. H. Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228 Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549 Singapore
| | - Wilson Wang
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, and University Orthopaedics Hand & Reconstructive Microsurgery Cluster, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119288 Singapore
| | - Gerald C. H. Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549 Singapore
| | - E. Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228 Singapore
| | | | - Kurumbian Chandran
- Department of Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Siew Wai Hwang
- SingHealth Polyclinics - Bukit Merah, 163 Bukit Merah Central, Singapore, 150163 Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549 Singapore
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Lu CW, Lee CJ, Hou JS, Wu DA, Hsu BG. Positive correlation of serum leptin levels and peripheral arterial stiffness in patients with type 2 diabetes. Tzu Chi Med J 2018; 30:10-14. [PMID: 29643710 PMCID: PMC5883830 DOI: 10.4103/tcmj.tcmj_183_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: Leptin plays a pathophysiologic role in the pathogenesis of aortic dysfunction and peripheral arterial stiffness (PAS). Our aim was to evaluate the risk factors for developing PAS and the association of leptin and PAS in patients with type 2 diabetes mellitus (DM). Materials and Methods: Fasting blood samples were obtained for biochemical data and leptin determinations from 105 patients with type 2 DM. In this study, we applied an automatic pulse wave analyzer (VaSera VS-1000) to measure the brachial-ankle pulse wave velocity (baPWV); a baPWV value >14.0 m/s on either side was considered high PAS. Results: Seventy-five patients (71.4%) had high PAS and they included a higher percentage of patients with hypertension (P < 0.001), older age (P < 0.001), and a higher body fat mass (P = 0.043), systolic blood pressure (P < 0.001), diastolic blood pressure (P = 0.016), serum blood urea nitrogen (P = 0.003), and leptin level (P < 0.001), and lower height (P = 0.027) and glomerular filtration rate (P < 0.001) compared with type 2 DM patients with low PAS. After adjusting for factors significantly associated with PAS in these patients by multivariate logistic regression analysis, age (β = 0.470, adjusted R2 change = 0.279; P < 0.001), logarithmically transformed leptin (log-leptin, β = 0.259, adjusted R2 change = 0.085; P = 0.001), and hypertension (β = 0.197, adjusted R2 change = 0.031; P = 0.011) were significant independent predictors of PAS in type 2 DM patients. Conclusion: The serum leptin level could be a predictor of PAS in type 2 DM patients.
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Affiliation(s)
- Chia-Wen Lu
- Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Jia-Sian Hou
- Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Du-An Wu
- Department of Metabolism and Endocrinology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Bang-Gee Hsu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Hwang IC, Jin KN, Kim HL, Kim YN, Im MS, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Additional prognostic value of brachial-ankle pulse wave velocity to coronary computed tomography angiography in patients with suspected coronary artery disease. Atherosclerosis 2018; 268:127-137. [DOI: 10.1016/j.atherosclerosis.2017.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
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Wu Y, Yu J, Jin C, Li Y, Su J, Wei G, Zheng X, Gao J, Gao W, Wu S. Longitudinal fasting blood glucose patterns and arterial stiffness risk in a population without diabetes. PLoS One 2017; 12:e0188423. [PMID: 29155890 PMCID: PMC5695806 DOI: 10.1371/journal.pone.0188423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/07/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To identify long-term fasting blood glucose trajectories and to assess the association between the trajectories and the risk of arterial stiffness in individuals without diabetes. METHODS We enrolled 16,454 non-diabetic participants from Kailuan cohort. Fasting blood glucose concentrations were measured in 2006, 2008, and 2010 survey. Brachial-ankle pulse wave velocities were measured during 2011 to 2016. Multivariate regression model was used to estimate the difference of brachial-ankle pulse wave velocity levels and logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs) of arterial stiffness risk, according to the fasting blood glucose trajectories. RESULTS We identified five distinct fasting blood glucose trajectories and each of the trajectories was labeled according to its range and change over 2006-2010 survey: elevated-stable pattern (5.0% of participants), elevated-decreasing pattern (6.6%), moderate-increasing pattern (10.9%), moderate-stable pattern (59.3%), and low-stable pattern (18.2%). After adjustment for potential confounders, individuals with elevated-stable pattern had a 42.6 cm/s (95%CI: 24.7 to 60.6 cm/s) higher brachial-ankle pulse wave velocity level and a 37% (OR 1.37, 95%CI: 1.14 to 1.66) higher arterial stiffness risk, and individuals with moderate-increasing pattern had a 19.6 cm/s (95%CI: 6.9 to 32.3 cm/s) higher brachial-ankle pulse wave velocity level and a 17% (OR 1.17, 95%CI: 1.03 to 1.33) higher arterial stiffness risk, related to individuals with moderate-stable pattern. We did not find significant associations of the elevated-decreasing or low-stable patterns with arterial stiffness. Consistently, the cumulative average, variability, and increased rate of fasting blood glucose during 2006-2010 survey were significantly associated with the arterial stiffness risk. CONCLUSION Discrete fasting blood glucose trajectories were associated with the arterial stiffness risk in non-diabetic individuals.
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Affiliation(s)
- Yuntao Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Junxing Yu
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Cheng Jin
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Yun Li
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Jinmei Su
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Guoqing Wei
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Xiaoming Zheng
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Jingsheng Gao
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Wenyuan Gao
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
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Gomez-Sanchez L, Garcia-Ortiz L, Patino-Alonso MC, Recio-Rodriguez JI, Rigo F, Martí R, Agudo-Conde C, Rodriguez-Sanchez E, Maderuelo-Fernandez JA, Ramos R, Gomez-Marcos MA. Adiposity measures and arterial stiffness in primary care: the MARK prospective observational study. BMJ Open 2017; 7:e016422. [PMID: 28963288 PMCID: PMC5623460 DOI: 10.1136/bmjopen-2017-016422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The cardiovascular risk of obesity is potentially increased by arterial stiffness. OBJECTIVE To assess the relationship of adiposity measures with arterial stiffness in Caucasian adults with intermediate cardiovascular risk. SETTING Six Spanish health centres. PARTICIPANTS We enrolled 2354 adults (age range, 35-74 years; mean age, 61.4±7.7 years, 61.9% male). METHODS This is a cross-sectional study that analyses data from the baseline visit of the improving interMediAte RisK management (MARK) study. The main outcome variables were body mass index (BMI), waist-to-height ratio (WHtR), Clínica Universidad de Navarra-body adiposity estimation (CUN-BAE) body fat percentage and body roundness index (BRI). Vascular function was assessed by the cardio-ankle vascular index (CAVI) with the VaSera device; brachial-ankle pulse wave velocity (baPWV) was determined using a validated equation. RESULTS The mean adiposity measures were a BMI of 29.2±4.4, WHtR of 0.61±0.07, CUN-BAE of 35.7±1.7 and BRI of 5.8±1.7. The mean stiffness measures were a CAVI of 8.8±1.2 and baPWV of 14.9±2.5. In multiple linear regression analyses, all adiposity measures were negatively associated with CAVI and baPWV (p<0.01 for all) after adjustment for possible factors of confusion. The proportion of CAVI variability via the adiposity measures were 5.5% for BMI, 5.8% for CUN-BAE, 3.8% for WHtR and 3.7% for BRI. These were higher among diabetic, obese, younger (≤62 years) and non-hypertensive subjects who had similar activity and sedentary profiles. CONCLUSIONS Adiposity measures are negatively associated with arterial stiffness measures. The percentage of variation in CAVI explained by its relation to the different measures of adiposity ranges from 5.8% (CUN-BAE) to 3.7% (BRI). In the case of baPWV, it oscillates between 0.7% (CUN-BAE and BMI) and 0.1% (WHtR). TRIAL REGISTRATION NUMBER NCT01428934.
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Affiliation(s)
- Leticia Gomez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Luis Garcia-Ortiz
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Maria C Patino-Alonso
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
- Department of Statistics, University of Salamanca, Salamanca, Spain
| | - Jose I Recio-Rodriguez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Fernando Rigo
- San Agustín Health Center, Illes Balears Health Service (IBSALUT), Palma of Mallorca, Spain
| | - Ruth Martí
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- Institut d'Investigació Biomèdica of Girona Dr. Josep Trueta (IDBGI), Girona, Spain
| | - Cristina Agudo-Conde
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Jose A Maderuelo-Fernandez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- Institut d'Investigació Biomèdica of Girona Dr. Josep Trueta (IDBGI), Girona, Spain
- Departament of Ciències Mèdiques, Universitat de Girona, Girona, Spain
| | - Manuel A Gomez-Marcos
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
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65
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Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, Inoguchi T, Maeda Y, Kohara K, Tabara Y, Nakamura M, Ohkubo T, Watada H, Munakata M, Ohishi M, Ito N, Nakamura M, Shoji T, Vlachopoulos C, Yamashina A. Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease: An Individual Participant Data Meta-Analysis. Hypertension 2017; 69:1045-1052. [PMID: 28438905 DOI: 10.1161/hypertensionaha.117.09097] [Citation(s) in RCA: 347] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/03/2017] [Accepted: 03/24/2017] [Indexed: 12/22/2022]
Abstract
An individual participant data meta-analysis was conducted in the data of 14 673 Japanese participants without a history of cardiovascular disease (CVD) to examine the association of the brachial-ankle pulse wave velocity (baPWV) with the risk of development of CVD. During the average 6.4-year follow-up period, 687 participants died and 735 developed cardiovascular events. A higher baPWV was significantly associated with a higher risk of CVD, even after adjustments for conventional risk factors (P for trend <0.001). When the baPWV values were classified into quintiles, the multivariable-adjusted hazard ratio for CVD increased significantly as the baPWV quintile increased. The hazard ratio in the subjects with baPWV values in quintile 5 versus that in those with the values in quintile 1 was 3.50 (2.14-5.74; P<0.001). Every 1 SD increase of the baPWV was associated with a 1.19-fold (1.10-1.29; P<0.001) increase in the risk of CVD. Moreover, addition of baPWV to a model incorporating the Framingham risk score significantly increased the C statistics from 0.8026 to 0.8131 (P<0.001) and also improved the category-free net reclassification (0.247; P<0.001). The present meta-analysis clearly established baPWV as an independent predictor of the risk of development of CVD in Japanese subjects without preexisting CVD. Thus, measurement of the baPWV could enhance the efficacy of prediction of the risk of development of CVD over that of the Framingham risk score, which is based on the traditional cardiovascular risk factors.
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Affiliation(s)
- Toshiaki Ohkuma
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Toshiharu Ninomiya
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Hirofumi Tomiyama
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.).
| | - Kazuomi Kario
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Satoshi Hoshide
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Yoshikuni Kita
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Toyoshi Inoguchi
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Yasutaka Maeda
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Katsuhiko Kohara
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Yasuharu Tabara
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Motoyuki Nakamura
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Takayoshi Ohkubo
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Hirotaka Watada
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Masanori Munakata
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Mitsuru Ohishi
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Norihisa Ito
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Michinari Nakamura
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Tetsuo Shoji
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Charalambos Vlachopoulos
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Akira Yamashina
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
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Mohammedi K, Compaoré A, Potier L, Belhatem N, Feron M, Matallah N, Travert F, Hansel B, Velho G, Roussel R, Hallab M, Marre M. Outpatient measurement of arterial stiffness in patients with type 2 diabetes and obesity. J Diabetes 2017; 9:237-242. [PMID: 27059393 DOI: 10.1111/1753-0407.12405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 02/17/2016] [Accepted: 03/07/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pulse wave velocity (PWV) is a marker of arterial stiffness. The aim of the present study was to compare PWV in patients with type 2 diabetes mellitus (T2DM) or obesity and healthy subjects in an outpatient setting. METHODS A cross-sectional study was conducted in patients with obesity without T2DM (n = 37), T2DM without obesity (n = 40), T2DM plus obesity (n = 43), and healthy controls (n = 114). Outpatient measurements of the finger-toe PWV (ftPWV) were made. RESULTS Mean (± SD) ftPWV was higher in men than in women (10.57 ± 5.02 vs 9.14 ± 3.68 m/s, respectively P = 0.006) and was positively correlated with age (r2 = 0.31, P < 0.0001), body mass index (r2 = 0.03, P = 0.01), systolic blood pressure (SBP; r2 = 0.06, P < 0.0001), and right (r2 = 0.03, P = 0.01) and left (r2 = 0.03, P = 0.01) ankle-brachial index (ABI). Age, SBP and ABI remained significantly correlated with ftPWV in the stepwise regression analysis. Mean ftPWV in controls and in patients with obesity, T2DM, and T2DM plus obesity was 8.32 ± 2.68, 9.50 ± 3.38, 11.29 ± 4.34, and 12.36 ± 6.67 m/s, respectively (P < 0.0001). These differences remained significant after adjustments for sex, age, SBP, and ABI (P = 0.008). Although ftPWV was higher in patients with than without macrovascular complications (13.11 ± 6.25 vs 10.40 ± 4.54 m/s, respectively; P = 0.006) in univariate analysis, this was not so in the multivariate-adjusted model. CONCLUSIONS Outpatient-measured ftPWV was correlated with age, SBP, and ABI. It was higher in patients with T2DM and obesity compared with healthy controls. The highest ftPWV was observed in patients with both T2DM and obesity.
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Affiliation(s)
- Kamel Mohammedi
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Aminata Compaoré
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Louis Potier
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Narimène Belhatem
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Marilyne Feron
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Nadia Matallah
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Florence Travert
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Boris Hansel
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Ronan Roussel
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Magid Hallab
- Department of Gerontology, University Hospital of Nantes, Nantes, France
| | - Michel Marre
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
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Hamamura M, Mita T, Osonoi Y, Osonoi T, Saito M, Tamasawa A, Nakayama S, Someya Y, Ishida H, Gosho M, Kanazawa A, Watada H. Relationships Among Conventional Cardiovascular Risk Factors and Lifestyle Habits With Arterial Stiffness in Type 2 Diabetic Patients. J Clin Med Res 2017; 9:297-302. [PMID: 28270889 PMCID: PMC5330772 DOI: 10.14740/jocmr2870w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/21/2022] Open
Abstract
Background While conventional cardiovascular risk factors and certain lifestyle habits are associated with arterial stiffness in patients with type 2 diabetes mellitus (T2DM), it is still unknown whether they are actually associated with arterial stiffness even after adjustment for conventional cardiovascular risk factors and lifestyle habits. The aim of this study was to identify variables that are associated with brachial-ankle pulse wave velocity (baPWV). Methods The study participants comprised 724 Japanese T2DM outpatients free of history of cardiovascular diseases. Lifestyle habits were analyzed using self-reported questionnaires. The associations among conventional cardiovascular risk factors and lifestyle habits with baPWV were investigated by multivariable linear regression analysis. Results The mean age of the study subjects was 57.8 ± 8.6 years, and 62.8% of those were males. The mean HbA1c was 7.0±1.0%, and the estimated duration of T2DM was 9.9 ± 7.2 years. Multiple linear regression analysis that included age and gender demonstrated that age and male sex were positively associated with baPWV. In a model adjusted for numerous conventional cardiovascular risk factors and lifestyle habits, age, duration of T2DM, systolic blood pressure, serum uric acid, urinary albumin excretion and poor sleep quality were positively associated with baPWV, while body mass index was negatively associated with baPWV. Conclusions In Japanese T2DM, in addition to several conventional cardiovascular risk factors, poor sleep quality was associated with baPWV even after adjustment for numerous conventional cardiovascular risk factors and lifestyle habits.
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Affiliation(s)
- Misako Hamamura
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Yusuke Osonoi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Takeshi Osonoi
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, Ibaraki 311-0113, Japan
| | - Miyoko Saito
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, Ibaraki 311-0113, Japan
| | - Atsuko Tamasawa
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, Ibaraki 311-0113, Japan
| | - Shiho Nakayama
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Yuki Someya
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Hidenori Ishida
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, Ibaraki 311-0113, Japan
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Akio Kanazawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
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Hua S, Loehr LR, Tanaka H, Heiss G, Coresh J, Selvin E, Matsushita K. Ankle-brachial index and incident diabetes mellitus: the atherosclerosis risk in communities (ARIC) study. Cardiovasc Diabetol 2016; 15:163. [PMID: 27923363 PMCID: PMC5142100 DOI: 10.1186/s12933-016-0476-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Individuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus. Although diabetes is a risk factor for PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied. Methods We examined the association of ABI with incident diabetes using Cox proportional hazards models in the ARIC Study. ABI was measured in 12,247 black and white participants without prevalent diabetes at baseline (1987–1989). Incident diabetes cases were identified by blood glucose levels at three subsequent visits (1990–92, 1993–95, and 1996–98) or self-reported physician diagnosis or medication use at those visits or during annual phone interview afterward through 2011. Results A total of 3305 participants developed diabetes during a median of 21 years of follow-up. Participants with low (≤0.90) and borderline low (0.91–1.00) ABI had 30–40% higher risk of future diabetes as compared to those with ABI of 1.10–1.20 in the demographically adjusted model. The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.91–1.00 (HR = 1.17, 95% CI 1.04–1.31) and marginally significant for ABI ≤ 0.90 (HR = 1.19, 0.99–1.43). Although the association was largely consistent across subgroups, a stronger association was seen in participants without hypertension, those with normal fasting glucose, and those with a history of stroke compared to their counterparts. Conclusions Low ABI was modestly but independently associated with increased risk of incident diabetes in the general population. Clinical attention should be paid to the glucose trajectory among people with low ABI but without diabetes. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0476-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simin Hua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA
| | - Laura R Loehr
- Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, 137 East Franklin Street, Suite 306, Chapel Hill, NC, 27514, USA
| | - Hirofumi Tanaka
- Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, Austin, TX, 78712-1415, USA
| | - Gerardo Heiss
- Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, 137 East Franklin Street, Suite 306, Chapel Hill, NC, 27514, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street Suite 2-600, Baltimore, MD, 21287, USA.
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Gomez-Sanchez L, Garcia-Ortiz L, Patino-Alonso MC, Recio-Rodriguez JI, Fernando R, Marti R, Agudo-Conde C, Rodriguez-Sanchez E, Maderuelo-Fernandez JA, Ramos R, Gomez-Marcos MA. Association of metabolic syndrome and its components with arterial stiffness in Caucasian subjects of the MARK study: a cross-sectional trial. Cardiovasc Diabetol 2016; 15:148. [PMID: 27776526 PMCID: PMC5078926 DOI: 10.1186/s12933-016-0465-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/06/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV) can reflect both central and peripheral arterial stiffness. Metabolic syndrome (MetS) and its components may increase arterial stiffness and the risk of cardiovascular diseases. However, the correlation of MetS and its components with arterial stiffness is still not clear. The primary aim of this study is thus the relationship using baPWV and CAVI in Caucasian adults with intermediate cardiovascular risk. The secondary aim is to analyze sex differences. METHODS This study analyzed 2351 subjects aged 35-74 years (mean, 61.4 ± 7.7 years) comprising 61.7 % males and enrolled in the improving interMediAte Risk management (MARK) study. CAVI was measured using a VaSera VS-1500 ® device, and baPWV was calculated using a validated equation. MetS was defined based on the Joint Scientific Statement National Cholesterol Education Program III. Waist circumference, blood pressure, fasting plasma glucose, and lipid profile were measured. RESULTS MetS was found in 51.9 % of the subjects. All MetS components except reduced HDL-cholesterol (p = 0.578) were associated with CAVI. High density lipoprotein cholesterol (p = 0.075) and waist circumference (p = 0.315) were associated with baPWV. The different MetS components that assess dyslipidemia using the stiffness measures show different associations according to patient sex. The high blood pressure component had a greater odds ratio (OR) for both baPWV ≥ 17.5 m/sec (OR = 6.90, 95 % CI 3.52-13.519) and CAVI ≥ 9 (OR = 2.20, 95 % CI 1.63-1.90). CONCLUSIONS MetS and all its components (except HDL-cholesterol with baPWV and CAVI and WC with baPWV) were associated with baPWV and CAVI. However, there were sex differences in the association of MetS and its components with baPWV and CAVI. Data from this study suggest a greater association of CAVI and baPWV values with MetS components in males than in females and indicate greater arterial stiffness in the event of simultaneously elevated blood pressure, fasting plasma glucose, and waist circumference. Trial Registration Clinical Trials.gov Identifier: https://clinicaltrials.gov/ct2/show/ NCT01428934. Registered 2 September 2011. Last updated September 8, 2016.
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Affiliation(s)
| | - Luis Garcia-Ortiz
- Primary Care Research Unit, The Alamedilla Health Center, 37003, Salamanca, Spain.,Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.,Biomedical and Diagnostic Sciences Department, University of Salamanca, Salamanca, Spain
| | - M Carmen Patino-Alonso
- Primary Care Research Unit, The Alamedilla Health Center, 37003, Salamanca, Spain.,Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.,Statistics Department, University of Salamanca, Salamanca, Spain
| | - Jose I Recio-Rodriguez
- Primary Care Research Unit, The Alamedilla Health Center, 37003, Salamanca, Spain.,Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Rigo Fernando
- San Agustín Health Center, Illes Balears Health Service (IBSALUT), Palma of Mallorca, Spain
| | - Ruth Marti
- Unitat of Suport a the Recerca of Girona, Institut Universitari D'Investigació in Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain.,Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDBGI), Girona, Spain
| | - Cristina Agudo-Conde
- Primary Care Research Unit, The Alamedilla Health Center, 37003, Salamanca, Spain.,Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, 37003, Salamanca, Spain.,Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Jose A Maderuelo-Fernandez
- Primary Care Research Unit, The Alamedilla Health Center, 37003, Salamanca, Spain.,Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Rafel Ramos
- Unitat of Suport a the Recerca of Girona, Institut Universitari D'Investigació in Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain.,Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDBGI), Girona, Spain.,Departament of Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Girona, Spain
| | - Manuel A Gomez-Marcos
- Primary Care Research Unit, The Alamedilla Health Center, 37003, Salamanca, Spain.,Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
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Ikura K, Hanai K, Oka S, Watanabe M, Oda Y, Hamada M, Kato Y, Shinjyo T, Uchigata Y. Brachial-ankle pulse wave velocity, but not ankle-brachial index, predicts all-cause mortality in patients with diabetes after lower extremity amputation. J Diabetes Investig 2016; 8:250-253. [PMID: 27422213 PMCID: PMC5334322 DOI: 10.1111/jdi.12554] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/13/2016] [Accepted: 07/07/2016] [Indexed: 12/01/2022] Open
Abstract
We examined whether brachial‐ankle pulse wave velocity (baPWV) and ankle‐brachial pressure index (ABI) are predictors for mortality in diabetic patients after lower extremity amputation. This was an observational historical cohort study of 102 Japanese diabetic patients after first non‐traumatic lower extremity amputation, with a mean age of 63 years (standard deviation 12 years). The end‐point was all‐cause mortality. During the mean follow‐up period of 3.3 years, 44 patients reached the end‐point. In both univariate and multivariate analyses, baPWV (m/s) (hazard ratio [HR] 1.05 and 1.04, both P < 0.01, respectively), but not ABI (HR 0.38 and 0.89, P = 0.08 and 0.86, respectively), was a significant predictor for the end‐point. When baPWV (above or below the median [21.8 m/s]) and ABI (normal [0.9–1.4] or not) were analyzed as categorical variables, the results were similar. In conclusion, baPWV, but not ABI, might be a predictor for all‐cause mortality in diabetic patients after lower extremity amputation.
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Affiliation(s)
- Kazuki Ikura
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ko Hanai
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Seiji Oka
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Makiko Watanabe
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yuri Oda
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Mariko Hamada
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yuka Kato
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takamichi Shinjyo
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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71
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Kobayashi Y, Fujikawa T, Kobayashi H, Sumida K, Suzuki S, Kagimoto M, Okuyama Y, Ehara Y, Katsumata M, Fujita M, Fujiwara A, Saka S, Yatsu K, Hashimoto T, Kuji T, Hirawa N, Toya Y, Yasuda G, Umemura S. Relationship between Arterial Stiffness and Blood Pressure Drop During the Sit-to-stand Test in Patients with Diabetes Mellitus. J Atheroscler Thromb 2016; 24:147-156. [PMID: 27453255 PMCID: PMC5305675 DOI: 10.5551/jat.34645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim: Patients with orthostatic hypotension (OH) have high arterial stiffness. Patients with diabetes mellitus (DM) often have cardiac autonomic neuropathy that leads to OH; however, whether OH is an indicator of arterial stiffness progression is unclear. We aimed to investigate whether the cardioankle vascular index (CAVI) varies between DM patients with and without OH using the sit-to-stand test (STST). Methods: One hundred and fifty-nine patients with DM underwent CAVI assessment and blood pressure (BP) and heart rate change evaluation during the STST. OH was defined as a decline in systolic BP (SBP) and/or diastolic BP of at least 20 mmHg or 10 mmHg, respectively, in the initial and late upright positions compared with that in the sitting position. Results: OH was diagnosed in 42 patients (26.4%). DM patients with OH had significantly higher CAVI (9.36 ± 1.15 versus 8.89 ± 1.18, p = 0.026) than those without OH. CAVI was significantly inversely correlated with systolic and diastolic BP changes (R = −0.347, p <0.001 and R = −0.314, p <0.001, respectively) in the initial upright position. Multivariate regression analysis revealed that age, SBP changes, and low frequency component in the initial upright position were independent determinants of CAVI. Conclusion: Patients with DM having large BP drops occurring when moving from sitting to standing have high arterial stiffness. A significant BP drop during the STST necessitates careful evaluation of advanced arterial stiffness in patient with DM.
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72
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Hsu BG, Liou HH, Lee CJ, Chen YC, Ho GJ, Lee MC. Serum Sclerostin as an Independent Marker of Peripheral Arterial Stiffness in Renal Transplantation Recipients: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3300. [PMID: 27082570 PMCID: PMC4839814 DOI: 10.1097/md.0000000000003300] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Wnt/β-catenin signaling pathway is thought to be implicated in the development of arterial stiffness and vascular calcification. As a Wnt signaling pathway inhibitor, it is interesting to investigate whether sclerostin or dickkopf-1 (DKK1) level is correlated with arterial stiffness in renal transplant (RT) recipients. Fasting blood samples were obtained for biochemical data, sclerostin, DKK1, and osteoprotegerin (OPG) determinations. In this study, we applied automatic pulse wave analyzer (VaSera VS-1000) to measure brachial-ankle pulse wave velocity and either sides of brachial-ankle pulse wave velocity value, which greater than 14.0 m/s was determined as high arterial stiffness. Among 68 RT recipients, 30 patients (44.1%) were in the high arterial stiffness group. Compared with patients in the low arterial stiffness group, patients in the high arterial stiffness group had higher prevalence of hypertension (P = 0.002), diabetes (P < 0.001), metabolic syndrome (P = 0.025), longer posttransplant duration (P = 0.005), higher systolic blood pressure (P < 0.001) and diastolic blood pressure (P = 0.018), and higher fasting glucose (P = 0.004), total cholesterol (P = 0.042), blood urea nitrogen (P = 0.020), phosphorus (P = 0.042), and sclerostin levels (P = 0.001). According to our multivariable forward stepwise linear regression analysis, age (β = 0.272, P = 0.014), phosphorus (β = 0.308, P = 0.007), and logarithmically-transformed OPG (log-OPG; β = 0.222, P = 0.046) were positively associated with sclerostin levels, and multivariate logistic regression analysis, sclerostin (odds ratio 1.052, 95% confidence interval 1.007-1.099, P = 0.024), and posttransplant duration (odds ratio 1.024, 95% confidence interval 1.004-1.045, P = 0.019) were the independent predictors of peripheral arterial stiffness in RT recipients. In this study, serum sclerostin level, but not DKK1, was proved to be involved in the pathogenetic process of peripheral arterial stiffness in RT recipients.
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Affiliation(s)
- Bang-Gee Hsu
- From the Division of Nephrology (B-GH); Department of Surgery (Y-CC, G-JH, M-CL), Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine (B- GH, Y-CC, G-JH, M-CL), Tzu Chi University, Hualien, Taiwan; Division of Nephrology (H-HL), Department of Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan; and Department of Nursing (C-JL), Tzu Chi University of Science and Technology, Hualien, Taiwan
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73
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Li YH, Lin SY, Sheu WHH, Lee IT. Relationship between percentage of mean arterial pressure at the ankle and mortality in participants with normal ankle-brachial index: an observational study. BMJ Open 2016; 6:e010540. [PMID: 27016246 PMCID: PMC4809088 DOI: 10.1136/bmjopen-2015-010540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Peripheral arterial disease (PAD) is associated with all-cause mortality. Ankle-brachial index (ABI) is the most widely used tool for detecting PAD, but can yield false-negative results in patients with non-compressible vessels. Pulse volume recording may be an alternative tool for assessing PAD in such patients. However, the association between pulse volume recording and all-cause mortality has seldom been reported. We hypothesised that the percentage of mean arterial pressure (%MAP) and upstroke time (UT), which are indexes of the arterial wave obtained on pulse volume recording, can predict mortality. DESIGN We conducted this as a retrospective cohort study. SETTING Data were collected from the Taichung Veterans General Hospital. PARTICIPANTS We included 314 participants with complete data on ABI and pulse volume recording performed between June 2007 and November 2011. PRIMARY OUTCOME MEASURE Mortality data served as the follow-up outcome. Mortality data were obtained from the Collaboration Center of Health Information Application, Ministry of Health and Welfare, Executive Yuan, Taiwan. RESULTS Participants with ABI ≤ 0.9 showed a highest mortality rate (p<0.001 in the log-rank test), but the mortality rate was not significantly different between participants with 0.9<ABI≤1.1 and those with 1.1<ABI≤1.3 (p=0.553). Among the participants with 0.9<ABI≤1.3, the high %MAP (>45%) group showed a higher risk of all-cause mortality than the low %MAP (≤ 45%) group (HR=5.389, p=0.004) after adjustment for ABI, pulse wave velocity, UT, age, sex, blood pressure, serum cholesterol, and history of cardiovascular disease and diabetes. CONCLUSIONS We thus demonstrated that a high %MAP based on pulse volume recording in participants with 0.9<ABI≤1.3 could predict all-cause mortality during 20.3 months of follow-up.
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Affiliation(s)
- Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Shih-Yi Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
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74
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Cheng YB, Li Y, Sheng CS, Huang QF, Wang JG. Quantification of the Interrelationship between Brachial-Ankle and Carotid-Femoral Pulse Wave Velocity in a Workplace Population. Pulse (Basel) 2016; 3:253-62. [PMID: 27195246 DOI: 10.1159/000444645] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Brachial-ankle pulse wave velocity (PWV) is increasingly used for the measurement of arterial stiffness. In the present study, we quantified the interrelationship between brachial-ankle and carotid-femoral PWV in a workplace population, and investigated the associations with cardiovascular risk factors and carotid intima-media thickness (IMT). METHODS Brachial-ankle and carotid-femoral PWV were measured using the Omron-Colin VP1000 and SphygmoCor devices, respectively. We investigated the interrelationship by the Pearson's correlation analysis and Bland-Altman plot, and performed sensitivity and specificity analyses. RESULTS The 954 participants (mean ± standard deviation age 42.6 ± 14.2 years) included 630 (66.0%) men and 203 (21.3%) hypertensive patients. Brachial-ankle (13.4 ± 2.7 m/s) and carotid-femoral PWV (7.3 ± 1.6 m/s) were significantly correlated in all subjects (r = 0.75) as well as in men (r = 0.72) and women (r = 0.80) separately. For arterial stiffness defined as a carotid-femoral PWV of 10 m/s or higher, the sensitivity and specificity of brachial-ankle PWV of 16.7 m/s or higher were 72 and 94%, respectively. The area under the receiver operating characteristic curve was 0.953. In multiple stepwise regression, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with age (partial r = 0.33 and 0.34, respectively) and systolic blood pressure (partial r = 0.71 and 0.66, respectively). In addition, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with carotid IMT (r = 0.57 and 0.55, respectively) in unadjusted analysis, but not in analysis adjusted for cardiovascular risk factors (p ≥ 0.08). CONCLUSIONS Brachial-ankle and carotid-femoral PWV were closely correlated, and had similar determinants. Brachial-ankle PWV can behave as an ease-of-use alternative measure of arterial stiffness for assessing cardiovascular risk.
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Affiliation(s)
- Yi-Bang Cheng
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Munakata M. Brachial-Ankle Pulse Wave Velocity: Background, Method, and Clinical Evidence. Pulse (Basel) 2016; 3:195-204. [PMID: 27195241 DOI: 10.1159/000443740] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The populations of many developed countries are becoming progressively older. In aged societies, assessment of total vascular risk is critically important, because old age is usually associated with multiple risks. In this regard, pulse wave velocity (PWV) could be a global cardiovascular marker, since it increases with advancing age, high blood pressure, hyperglycaemia, and other traditional risks, summating cardiovascular risks. Carotid-femoral PWV has been widely applied in Western countries and has been used as a gold-standard PWV measure. However, this measure has never been implemented by general practitioners in Japan, possibly because of methodological difficulties. The life expectancy of Japanese people is now the highest in the world, and the establishment of an adequate total vascular risk measure is an urgent need. Against this background, brachial-ankle PWV was developed at the beginning of this century. SUMMARY Measurement of this parameter is easy, and its reproducibility is good. Moreover, the generality of the methodology is guaranteed. Brachial-ankle PWV has been reported to consistently increase with most traditional cardiovascular risk factors except dyslipidaemia. A meta-analysis of cohort studies including various levels of risk has shown that a 1 m/s increase in brachial-ankle PWV is associated with a 12% increase in the risk of cardiovascular events. Moreover, simultaneous evaluation of the ankle-brachial index could allow further risk stratification of high-risk individuals, who are common in aged societies. This unique feature is indispensable for the management of aged populations, who usually are exposed to multiple risks and have polyvascular diseases. This evidence, however, is chiefly derived from East Asian countries. The collection of data from Caucasian populations, therefore, remains a task for the future. KEY MESSAGE Brachial-ankle PWV has the potential to become a measure of arterial stiffness worldwide.
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Affiliation(s)
- Masanori Munakata
- Research Center for Lifestyle-Related Disease and Division of Hypertension, Japan Health, Labor, and Welfare Organization, Tohoku Rosai Hospital, Sendai, Japan
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76
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Measurement of Arterial Stiffness: A Novel Tool of Risk Stratification in Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:475-488. [PMID: 27722956 DOI: 10.1007/5584_2016_78] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiovascular diseases are the leading causes of morbidity and mortality in industrialized countries worldwide, despite highly effective preventive treatments available. As a difference continues to exist between the estimated and true number of events, further improvement of risk stratification is an essential part of cardiovascular research.Among hypertensive patients measurement of arterial stiffness parameters, like carotid-femoral pulse wave velocity (cfPWV) or brachial-ankle pulse wave velocity (baPWV) can contribute to the identification of high-risk subpopulation of patients. This is a hot topic of vascular research including the possibility of the non-invasive measurement of central hemodynamics, wave reflections and recently, 24-h arterial stiffness monitoring as well. This chapter discusses the past and the present of this area including the scientific achievements with cfPWV, baPWV and other measures, provides a short overview of methodologies and the representation of arterial stiffness parameters in guidelines.
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77
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Gando Y, Murakami H, Kawakami R, Yamamoto K, Kawano H, Tanaka N, Sawada SS, Miyatake N, Miyachi M. Cardiorespiratory Fitness Suppresses Age-Related Arterial Stiffening in Healthy Adults: A 2-Year Longitudinal Observational Study. J Clin Hypertens (Greenwich) 2015; 18:292-8. [DOI: 10.1111/jch.12753] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Yuko Gando
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
| | - Haruka Murakami
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
| | - Ryoko Kawakami
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
- Faculty of Sport Sciences; Waseda University; Saitama Japan
| | - Kenta Yamamoto
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
- Faculty of Pharmaceutical Sciences; Teikyo Heisei University; Tokyo Japan
| | - Hiroshi Kawano
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
- Faculty of Letters; Kokushikan University; Tokyo Japan
| | - Noriko Tanaka
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
- Research Center of Health, Physical Fitness and Sports; Nagoya University; Nagoya Japan
| | - Susumu S. Sawada
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
| | - Nobuyuki Miyatake
- Department of Hygiene; Faculty of Medicine; Kagawa University; Miki Kagawa Japan
| | - Motohiko Miyachi
- Department of Health Promotion and Exercise; National Institutes of Biomedical Innovation, Health and Nutrition; Tokyo Japan
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Liao CC, Shih CC, Yeh CC, Chang YC, Hu CJ, Lin JG, Chen TL. Impact of Diabetes on Stroke Risk and Outcomes: Two Nationwide Retrospective Cohort Studies. Medicine (Baltimore) 2015; 94:e2282. [PMID: 26717365 PMCID: PMC5291606 DOI: 10.1097/md.0000000000002282] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Several limitations existed in previous studies which suggested that diabetic patients have increased risk of stroke. We conducted this study to better understand the stroke risk and poststroke outcomes in patients with diabetes.From the claims data of Taiwan's National Health Insurance, we identified 24,027 adults with new-diagnosed diabetes and 96,108 adults without diabetes between 2000 and 2003 in a retrospective cohort study. Stroke events (included hemorrhage, ischemia, and other type of stroke) during the follow-up period of 2000 to 2008 were ascertained and adjusted risk of stroke associated with diabetes was calculated. A nested cohort study of 221,254 hospitalized stroke patients (included hemorrhage, ischemia, and other type of stroke) between 2000 and 2009 was conducted. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for adverse events after stroke hospitalization in patients with and without diabetes.The incidences of stroke in cohorts with and without diabetes were 10.1 and 4.5 per 1000 person-years, respectively. During the follow-up period, diabetic patients had an increased risk of stroke (adjusted hazard ratio: 1.75; 95% CI: 1.64-1.86) than those without diabetes. Associations between diabetes and stroke risk were significant in both sexes and all age groups. Previous diabetes was associated with poststroke mortality (OR: 1.33; 95% CI: 1.19-1.49), pneumonia (OR: 1.30; 95% CI: 1.20-1.42), and urinary tract infection (OR: 1.66; 95% CI: 1.55-1.77). The impact of diabetes on adverse events after stroke was investigated particularly in those with diabetes-related complications.Diabetes was associated with stroke risk, and diabetic patients had more adverse events and subsequent mortality after stroke.
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Affiliation(s)
- Chien-Chang Liao
- From the Department of Anesthesiology, Taipei Medical University Hospital (CCL, TLC); School of Medicine, Taipei Medical University (CCL, CJH, TLC); Health Policy Research Center, Taipei Medical University Hospital, Taipei (CCL, TLC); School of Chinese Medicine, China Medical University, Taichung (CCL, JGL); School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung (CCS); Department of Surgery, China Medical University Hospital, Taichung, Taiwan (CCY); Department of Surgery, University of Illinois, Chicago, IL (CCY); Department of Internal Medicine, National Taiwan University Hospital (YCC); and Department of Neurology, Shuan Ho Hospital, Taipei Medical University, Taipei, Taiwan (CJH)
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Palombo C, Kozakova M. Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications. Vascul Pharmacol 2015; 77:1-7. [PMID: 26643779 DOI: 10.1016/j.vph.2015.11.083] [Citation(s) in RCA: 285] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/25/2015] [Accepted: 11/26/2015] [Indexed: 12/14/2022]
Abstract
Arterial stiffness results from a degenerative process affecting mainly the extracellular matrix of elastic arteries under the effect of aging and risk factors. Changes in extracellular matrix proteins and in the mechanical properties of the vessel wall related to arterial stiffening may activate number of mechanisms involved also in the process of atherosclerosis. Several noninvasive methods are now available to estimate large artery stiffness in the clinical setting, including carotid-femoral pulse wave velocity, the reference for aortic stiffness estimate, and local distensibility measures of superficial arteries, namely carotid and femoral. An independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been established. Thus, arterial stiffness is emerging as an interesting tissue biomarker for cardiovascular risk stratification and estimation of the individual "biological age". This paper overviews the mechanisms accounting for development and progression of arterial stiffness and for associations between arterial stiffness, atherosclerotic burden and incident cardiovascular events, summarizes the evidence and caveat for clinical use of stiffness as surrogate marker of cardiovascular risk, and briefly outlines some emerging methods for large artery stiffness characterization.
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Affiliation(s)
- Carlo Palombo
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Italy.
| | - Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Gómez-Marcos MÁ, Recio-Rodríguez JI, Gómez-Sánchez L, Agudo-Conde C, Rodríguez-Sanchez E, Maderuelo-Fernandez J, Gomez-Sanchez M, García-Ortiz L. Gender differences in the progression of target organ damage in patients with increased insulin resistance: the LOD-DIABETES study. Cardiovasc Diabetol 2015; 14:132. [PMID: 26427534 PMCID: PMC4591592 DOI: 10.1186/s12933-015-0293-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the evolution of vascular, cardiac and renal target organ damage (TOD) in patients with increased insulin resistance over a 3.5 year follow-up and to investigate gender difference and factors that influence its progression. METHODS We performed a prospective observational study involving 112 patients (71 men, 41 women) who were followed for 3.5 years. Measurements included blood pressure, blood glucose, lipids, smoking, body mass index (BMI) and HOMA-Ir Vascular TOD included carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI). Cardiac TOD included Cornell voltage-duration product and Sokolow. Renal TOD included creatinine, glomerular filtration and albumin/creatinine ratio. RESULTS The IMT increased in both genders. Each year, the IMT increased 0.005 mm in men and 0.011 in women and the PWV 0.024 and 0.020 m/sec, respectively. The highest increase was in women with type 2 diabetes mellitus, who had an increase in TOD carotid (40%), PWV (24%) and renal TOD (20 %). Multiple regression analysis, after adjusting for age and gender, showed a negative association between duration since diabetes diagnosis and ABI (β = -0.006; p = 0.017) and between BMI and glomerular filtration (β = -0.813; p = 0.014). HbA1c was positively associated with PWV (β = 0.501; p = 0.014). CONCLUSIONS This study showed that the progression of vascular and renal TOD differs by gender. The increase in vascular and renal TOD was higher in women, especially in diabetic women. The PWV increase showed a positive association with mean HbA1c levels during the follow-up. Glomerular filtration was associated with BMI and the ABI was associated with duration since type 2 diabetes mellitus diagnosis. TRIAL REGISTRATION Clinical Trials.gov Identifier NCT01065155.
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Affiliation(s)
- Manuel Ángel Gómez-Marcos
- Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. .,Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. .,Medicine Department, University of Salamanca, Salamanca, Spain.
| | | | - Leticia Gómez-Sánchez
- Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain.
| | - Cristina Agudo-Conde
- Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. .,Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain.
| | - Emiliano Rodríguez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. .,Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. .,Medicine Department, University of Salamanca, Salamanca, Spain.
| | - JoseAngel Maderuelo-Fernandez
- Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. .,Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain.
| | - Marta Gomez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain.
| | - Luís García-Ortiz
- Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. .,Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. .,Medicine Department, University of Salamanca, Salamanca, Spain.
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Tsai SS, Lin YS, Lin CP, Hwang JS, Wu LS, Chu PH. Metabolic Syndrome-Associated Risk Factors and High-Sensitivity C-Reactive Protein Independently Predict Arterial stiffness in 9903 Subjects With and Without Chronic Kidney Disease. Medicine (Baltimore) 2015; 94:e1419. [PMID: 26356694 PMCID: PMC4616642 DOI: 10.1097/md.0000000000001419] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Metabolic syndrome (MS), high-sensitivity C-reactive protein (hs-CRP), and chronic kidney disease (CKD) are related to cardiovascular diseases. Although MS is common in CKD subjects, the contribution of MS-associated risk factors and hs-CRP to arterial stiffness in CKD has not been well studied.In this cross-sectional cohort study, we enrolled 9903 subjects who underwent brachial-ankle pulse wave velocity (baPWV) measurements from our database of Health Care Center. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m. Comparing those grouped with and without CKD, multivariate linear regression analyses were used.Overall, baPWV was found to have an inverse relationship with eGFR (P for trend <0.001), which increased progressively with the presence of CKD, increasing number of MS-associated risk factors and hs-CRP (P for trend <0.001). In the non-CKD group, age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, triglyceride, high-density lipoprotein cholesterol, and hs-CRP independently predicted baPWV, whereas in CKD, eGFR, age, gender, body mass index, SBP, DBP, and fasting glucose remained predictors.The number of MS-associated risk factors and hs-CRP remains a determinant of arterial stiffness in both CKD and non-CKD groups. The decline of renal function contributes to arterial stiffness only in CKD but not in non-CKD. Our findings suggest that for CKD subjects, renal function, BP, and glycemic control are potential targets for further interventional studies of arterial stiffness.
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Affiliation(s)
- Sung-Sheng Tsai
- From the Division of Endocrinology and Metabolism (S-ST, J-SH), Department of Cardiology (Y-SL, C-PL, L-SW, P-HC), Healthcare Center (Y-SL, J-SH, P-HC), and Heart Failure Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan (P-HC)
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82
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Noh J, Kim E, Seo H, Kim SG. Independent association between glycated hemoglobin and arterial stiffness in healthy men. J Diabetes Investig 2015; 7:241-6. [PMID: 27042277 PMCID: PMC4773663 DOI: 10.1111/jdi.12389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/23/2015] [Accepted: 06/21/2015] [Indexed: 11/01/2022] Open
Abstract
Aims/Introduction Materials and Methods Results Conclusions
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Affiliation(s)
- Jin‐Won Noh
- Department of Healthcare Management and Institute of Global Healthcare Research Eulji University Seongnam Korea
| | - Eun‐Jung Kim
- Department of Economics Korea University Seoul Korea
| | - Hyun‐Ju Seo
- Department of Nursing College of Medicine Chosun University Gwangju Korea
| | - Soo Geun Kim
- Department of Occupational Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Korea
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83
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Osonoi Y, Mita T, Osonoi T, Saito M, Tamasawa A, Nakayama S, Someya Y, Ishida H, Kanazawa A, Gosho M, Fujitani Y, Watada H. Poor sleep quality is associated with increased arterial stiffness in Japanese patients with type 2 diabetes mellitus. BMC Endocr Disord 2015; 15:29. [PMID: 26084960 PMCID: PMC4472398 DOI: 10.1186/s12902-015-0026-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While poor sleep quality can worsen cardiovascular risk factors such as glucose and lipid profiles in patients with type 2 diabetes mellitus (T2DM), the relationship between sleep quality and atherosclerosis remains largely unknown. The aim of this study was to examine this relationship. METHODS The study participants comprised 724 Japanese T2DM outpatients free of history of cardiovascular diseases. The relationships between sleep quality (assessed by the Pittsburgh Sleep Quality Index (PSQI)) and various clinical and laboratory parameters were investigated. RESULTS The mean PSQI was 5.1 ± 3.0 (±SD). Patients were divided into three groups based on the total PSQI score; subjects with good sleep quality (n = 462), average sleep quality (n = 185), and poor sleep quality (n = 77). In the age/gender-adjusted model, patients with poor sleep quality tended to be obese, evening type and depressed. However, other lifestyles showed no significant trends. Alanine aminotransferase, fasting blood glucose, HbA1c, systolic blood pressure, urinary albumin excretion, and brachial-ankle pulse wave velocity (baPWV) tended to be higher in patients with poor sleep quality. High baPWV was the only parameter that correlated with poor sleep in a model adjusted for several other lifestyle factors. CONCLUSIONS Our study indicates that poor sleep quality in T2DM patients correlates with increased arterial wall stiffness, a marker of atherosclerosis and a risk factor for cardiovascular diseases.
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Affiliation(s)
- Yusuke Osonoi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Takeshi Osonoi
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Miyoko Saito
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Atsuko Tamasawa
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Shiho Nakayama
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Yuki Someya
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Hidenori Ishida
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Akio Kanazawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575, Ibaraki, Japan.
| | - Yoshio Fujitani
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
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Abstract
Cardiovascular disease (CVD) is an important cause of morbidity and mortality in dialysis patients. Brachial-ankle pulse wave velocity (baPWV) is more efficient to handily assess arteriosclerosis than aortic PWV. The cardio-ankle vascular index (CAVI) is also a novel blood pressure-independent arterial stiffness parameter. In dialysis patients, both baPWV and CAVI are increased compared to general subjects. Several studies have demonstrated that increased baPWV is associated with carotid atherosclerosis and diastolic left ventricular dysfunction in hemodialysis (HD) patients. In addition, higher baPWV is related to all-cause and cardiovascular (CV) mortality. CAVI is similarly associated with CVD. However, baPWV is superior to CAVI as a predictor of CV outcomes in HD patients. Besides these outcomes, a close relationship exists between sarcopenia, abdominal visceral obesity and arterial stiffening. Reduction of thigh muscle mass is inversely correlated with baPWV and CAVI in males. Abdominal fatness is also associated with increased arterial stiffness in females. These observations provide further evidence of higher risk of CV events in HD patients with sarcopenic obesity. In addition, arterial stiffness is associated with cerebral small vessel disease and decreased cognitive function in the elderly. However, it is unknown whether arterial stiffness may be useful as an early indicator of cognitive decline in dialysis patients. Because dialysis patients are at risk of developing dementia, more studies are needed to elucidate the causal link between arterial stiffness and cognitive impairment.
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Affiliation(s)
- Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan
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Gómez-Marcos MÁ, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Gómez-Sánchez L, Gomez-Sanchez M, Rodríguez-Sanchez E, Maderuelo-Fernandez JA, García-Ortiz L. Cardio-ankle vascular index is associated with cardiovascular target organ damage and vascular structure and function in patients with diabetes or metabolic syndrome, LOD-DIABETES study: a case series report. Cardiovasc Diabetol 2015; 14:7. [PMID: 25853841 PMCID: PMC4299688 DOI: 10.1186/s12933-014-0167-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 12/28/2014] [Indexed: 12/21/2022] Open
Abstract
Background The cardio ankle vascular index (CAVI) is a new index of the overall stiffness of the artery from the origin of the aorta to the ankle. This index can estimate the risk of atherosclerosis. We aimed to find the relationship between CAVI and target organ damage (TOD), vascular structure and function, and cardiovascular risk factors in Caucasian patients with type 2 diabetes mellitus or metabolic syndrome. Methods We included 110 subjects from the LOD-Diabetes study, whose mean age was 61 ± 11 years, and 37.3% were women. Measurements of CAVI, brachial ankle pulse wave velocity (ba-PWV), and ankle brachial index (ABI) were taken using the VaSera device. Cardiovascular risk factors, renal function by creatinine, glomerular filtration rate, and albumin creatinine index were also obtained, as well as cardiac TOD with ECG and vascular TOD and carotid intima media thickness (IMT), carotid femoral PWV (cf-PWV), and the central and peripheral augmentation index (CAIx and PAIx). The Framingham-D’Agostino scale was used to measure cardiovascular risk. Results Mean CAVI was 8.7 ± 1.3. More than half (54%) of the participants showed one or more TOD (10% cardiac, 13% renal; 48% vascular), and 13% had ba-PWV ≥ 17.5 m/s. Patients with any TOD had the highest CAVI values: 1.15 (CI 95% 0.70 to 1.61, p < 0.001) and 1.14 (CI 95% 0.68 to 1.60, p < 0.001) when vascular TOD was presented, and 1.30 (CI 95% 0.51 to 2.10, p = 0.002) for the cardiac TOD. The CAVI values had a positive correlation with HbA1c and systolic and diastolic blood pressure, and a negative correlation with waist circumference and body mass index. The positive correlations of CAVI with IMT (β = 0.29; p < 0.01), cf-PWV (β = 0.83; p < 0.01), ba-PWV (β = 2.12; p < 0.01), CAIx (β = 3.42; p < 0.01), and PAIx (β = 5.05; p = 0.04) remained after adjustment for cardiovascular risk, body mass index, and antihypertensive, lipid-lowering, and antidiabetic drugs. Conclusions The results of this study suggest that the CAVI is positively associated with IMT, cf-PWV, ba-PWV, CAIx, and PAIx, regardless of cardiovascular risk and the drug treatment used. Patients with cardiovascular TOD have higher values of CAVI. Trial registration Clinical Trials.gov Identifier: NCT01065155
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Morales MS, Cuffaro PE, Barochiner J, Rada MA, Alfie J, Aparicio L, Marin M, Galarza CR, Waisman GD. Validation of a new piezo-electronic device for non-invasive measurement of arterial pulse wave velocity according to the artery society guidelines. Artery Res 2015. [DOI: 10.1016/j.artres.2015.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Osonoi Y, Mita T, Osonoi T, Saito M, Tamasawa A, Nakayama S, Someya Y, Ishida H, Kanazawa A, Gosho M, Fujitani Y, Watada H. Morningness–eveningness questionnaire score and metabolic parameters in patients with type 2 diabetes mellitus. Chronobiol Int 2014; 31:1017-23. [DOI: 10.3109/07420528.2014.943843] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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