Arterial stiffness and cardiovascular risk factors in a population-based study

Higher usual dietary intake of phytoestrogens is associated with lower aortic stiffness in postmenopausal women

OBJECTIVE

Phytoestrogens have been postulated to protect against cardiovascular diseases, but few studies have focused on the effect of Western dietary phytoestrogen intake.

METHODS AND RESULTS

Four hundred three women with natural menopause either between 1987 and 1989 or between 1969 and 1979 were selected from the baseline data of the PROSPECT study (n=17 395). Isoflavone and lignan intake was calculated from a food-frequency questionnaire. Aortic stiffness was noninvasively assessed by pulse-wave velocity measurement of the aorta. Linear regression analysis was used. After adjustment for age, body mass index, smoking, physical activity, mean arterial pressure, follow-up time, energy intake, dietary fiber intake, glucose, and high density lipoprotein cholesterol, increasing dietary isoflavone intake was associated with decreased aortic stiffness: -0.51 m/s (95% CI -1.00 to -0.03, fourth versus first quartile, P for trend=0.07). Increasing dietary intake of lignans was also associated with decreased aortic pulse-wave velocity: -0.42 m/s (95% CI -0.93 to 0.11, fourth versus first quartile, P for trend=0.06). Results were most pronounced in older women: for isoflavones, -0.94 m/s (95% CI -1.65 to -0.22, P for trend=0.02), and for lignans, -0.80 m/s (95% CI -1.85 to -0.05), fourth versus first quartile.

CONCLUSIONS

The results of our study support the view that phytoestrogens have a protective effect on the risk of atherosclerosis and arterial degeneration through an effect on arterial walls, especially among older women.

Serum hepatocyte growth factor concentration is correlated with the forearm vasodilator response in hypertensive patients

To evaluate the clinical importance of serum hepatocyte growth factor (HGF) concentration, we designed two clinical investigations. The first study analyzed the correlation between serum HGF concentration and clinical arterial stiffness or the vasodilator response to reactive hyperemia in hypertensive patients. The second study investigated the correlation between changes in serum HGF concentration and clinical arterial stiffness or reactive hyperemia during treatment with cilazapril or atenolol. A total of 210 hypertensive patients were analyzed in the first study, and 25 patients with essential hypertension were evaluated in the second study. Pulse wave velocity (PWV), strain gauge plethysmography, and serum HGF concentration were measured in the first study. We also evaluated these factors before and after treatment with either cilazapril (2.0 mg/day) or atenolol (25 mg/day) for 6 months in the second study. Serum HGF concentration was negatively correlated to reactive hyperemia in overall (r = 0.434, P < .0001) and nontreatment (r = 0.452, P < .0001) hypertensive patients. Arterial stiffness was weakly related to serum HGF concentration (P < .05) after adjusting for age and mean blood pressure (BP). By multiple regression analysis, only serum HGF concentration showed a strong independent correlation with reactive hyperemia, age and mean BP with PWV. Moreover, a relationship between endothelium-dependent vasodilation and serum HGF concentration was observed during treatment with cilazapril or atenolol (r = 0.406, P < .005). These results suggest that in evaluation of serum HGF concentration, the forearm vasodilator response to reactive hyperemia and PWV might be useful for managing hypertension in patients who are receiving antihypertensive therapy.

Hypertension in high-risk patients: beware of the underuse of effective combination therapy (results of the PRATIK study)

OBJECTIVE

To determine whether blood pressure control in a general practice setting is influenced by the presence of additional risk factors, and to analyse the role of antihypertensive therapy in this relationship.

DESIGN

A cross-sectional study was conducted with a sample of 3153 general practitioners.

SETTING

Primary care.

PARTICIPANTS

The first five hypertensive patients presenting at the practitioner's office were included.

MAIN OUTCOME MEASURES

Cardiovascular risk factors, antihypertensive drugs and cardiovascular history were reported. Blood pressure was measured. The analysis was conducted in treated patients who were divided in three groups: no other risk factors (group I); 1-2 risk factors (group II); 3 or more risk factors or target-organ damage or diabetes or associated cardiovascular disease (group III).

RESULTS

Data were available for all variables in the 14 066 treated hypertensive individuals who form the basis of this report. Blood pressure control had been achieved in a lower percentage of individuals in group III (27%) than in group I (42.9%). To control hypertension, combination therapies were more frequently required in group III (55.8%) than in group II (43.5%) or group I (34.2%). Among individuals with uncontrolled hypertension, about 39% of patients in group III were receiving monotherapy and the percentage receiving two-drug treatments identified as effective in the 1999 WHO guidelines was significantly lower in group III.

CONCLUSION

The study shows that, in general practice, control of blood pressure decreases as the number of risk factors present increases. An underuse of combination therapy, especially effective two-drug treatment in patients with several risk factors, may account for this finding.