Relations of cardiovascular risk factors to aortic pulse wave velocity in asymptomatic middle-aged women

Central and Peripheral Hemodynamics in Young Adults Who Use Water Pipes and the Acute Effects of Water-Pipe Use

BACKGROUND

Tobacco use via water pipe (commonly referred to as water-pipe smoking [WPS]) is popular among young adults globally and exposes those who smoke to toxicants.

RESEARCH QUESTION

Is WPS associated with impaired measures of arterial function and does WPS acutely impair these measures in young adults?

STUDY DESIGN AND METHODS

We assessed heart rate (HR), brachial and aortic BP, HR-adjusted augmentation index (AI), and carotid-femoral pulse wave velocity (CFPWV) in 62 individuals who use water pipes and 34 individuals who have never used a water pipe recruited from the community (mean age, 22.5 ± 3.0 years; 48% female). Measurements were obtained before and after an outdoor session of WPS among participants who use water pipes and among the control group of participants who have never used a water pipe. Measurements were compared after vs before exposure and between those who use and those who do not use water pipes, adjusting for possible confounders using linear regression.

RESULTS

Participants who use water pipes and control participants had similar demographic characteristics. BP and HR increased acutely after WPS (brachial systolic BP by 4.13 mm Hg [95% CI, 1.91-6.36 mm Hg]; aortic systolic BP by 2.31 mm Hg [95% CI, 0.28-4.33 mm Hg]; brachial diastolic BP by 3.69 mm Hg [95% CI, 1.62-5.77 mm Hg]; aortic diastolic BP by 3.03 mm Hg [95% CI, 0.74-5.33 mm Hg]; and HR by 7.75 beats/min [95% CI, 5.46-10.04 beats/min]), but not in the control group. AI was significantly higher in participants who use water pipes compared with those who do not (9.02% vs 3.06%; P = .03), including after adjusting for BMI and family history of cardiovascular disease (β = 6.12; 95% CI, 0.55-11.69; P = .03) and when assessing habitual tobacco use via water-pipe extent (water pipes used/day × water-pipe use duration) in water-pipe-years (β = 2.51/water-pipe-year; 95% CI, 0.10-4.92/water-pipe-year; P = .04). However, CFPWV was similar in those who use water pipes and those who do not, and AI and CFPWV did not change acutely after WPS.

INTERPRETATION

In apparently healthy young individuals from the community, habitual WPS was associated with increased AI, a predictor of cardiovascular risk, and one WPS session acutely increased HR and brachial and aortic BP.

Involvement of lysyl oxidase in the pathogenesis of arterial stiffness in chronic kidney disease

Patients with chronic kidney disease (CKD) are at increased risk for adverse cardiovascular events. CKD is associated with increases in arterial stiffness, whereas improvements in arterial stiffness correlate with better survival. However, arterial stiffness is increased early in CKD, suggesting that there might be additional factors, unique to kidney disease, that increase arterial stiffness. Lysyl oxidase (LOX) is a key mediator of collagen cross linking and matrix remodeling. LOX is predominantly expressed in the cardiovascular system, and its upregulation has been associated with increased tissue stiffening and extracellular matrix remodeling. Thus, this study was designed to evaluate the role of increased LOX activity in inducing aortic stiffness in CKD and whether β-aminopropionitrile (BAPN), a LOX inhibitor, could prevent aortic stiffness by reducing collagen cross linking. Eight-week-old male C57BL/6 mice were subjected to 5/6 nephrectomy (Nx) or sham surgery. Two weeks after surgery, mice were randomized to BAPN (300 mg/kg/day in water) or vehicle treatment for 4 wk. Aortic stiffness was assessed by pulse wave velocity (PWV) using Doppler ultrasound. Aortic levels of LOX were assessed by ELISA, and cross-linked total collagen levels were analyzed by mass spectrometry and Sircol assay. Nx mice showed increased PWV and aortic wall remodeling compared with control mice. Collagen cross linking was increased in parallel with the increases in total collagen in the aorta of Nx mice. In contrast, Nx mice that received BAPN treatment showed decreased cross-linked collagens and PWV compared with that received vehicle treatment. Our results indicated that LOX might be an early and key mediator of aortic stiffness in CKD.NEW & NOTEWORTHY Arterial stiffness in CKD is associated with adverse cardiovascular outcomes. However, the mechanisms underlying increased aortic stiffness in CKD are unclear. Herein, we demonstrated that 1) increased aortic stiffness in CKD is independent of hypertension and calcification and 2) LOX-mediated changes in extracellular matrix are at least in part responsible for increased aortic stiffness in CKD. Prevention of excess LOX may have therapeutic potential in alleviating increased aortic stiffness and improving cardiovascular disease in CKD.

Association of arterial stiffness with a prothrombotic state in uncomplicated nondiabetic hypertensive patients

Background and aims

Past studies reported a significant contribution of a prothrombotic state to the development and progression of target organ damage in hypertensive patients. Stiffening of arterial vessels is associated with aging and hypertension, and additional factors could contribute to this process. This study was designed to examine the relationships between arterial stiffening and the hemostatic and fibrinolytic system.

Methods

In 128 middle-aged, nondiabetic, essential hypertensive patients without major cardiovascular and renal complications, we measured coagulation markers that express the spontaneous activation of the hemostatic and fibrinolytic system and assessed stiffness of the arterial tree by measurement of the carotid/femoral pulse wave velocity (cfPWV) and pulse wave analysis with calculation of the brachial augmentation index (AIx).

Results

Levels of fibrinogen (FBG), D-dimer (D-d), and plasminogen activator-inhibitor 1 (PAI-1) were significantly higher in patients with PWV and AIx above the median of the distribution. FBG, D-d, and PAI-1 were significantly and directly related with both cfPWV and AIx, and multivariate regression analysis indicated that the relationships of D-d and PAI-1 with both cfPWV and AIx and of FBG with AIx, were independent of age, body mass index, severity and duration of hypertension, use of antihypertensive drugs, blood glucose, and plasma lipids.

Conclusion

In middle-aged, uncomplicated, nondiabetic patients with essential hypertension, spontaneous activation of plasma hemostatic cascade and impaired fibrinolysis is significantly and independently associated with stiffening of the arterial tree.

Comparison of carotid-femoral and brachial-ankle pulse wave velocity in association with carotid plaque in a Chinese community-based population

Pulse wave velocity (PWV) is the most widely used measurement of arterial stiffness in clinical practice. This study aimed to evaluate and compare the relationships between carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle PWV (baPWV) and the presence of carotid plaque. This study was designed cross-sectionally and included 6027 participants from a community-based cohort in Beijing. Logistic regression analyses were performed to evaluate and compare the associations of cfPWV and baPWV with the presence of carotid plaque. The mean (SD) cfPWV and baPWV were 8.55 ± 1.83 and 16.79 ± 3.36, respectively. The prevalence of carotid plaque was 45.26% (n = 2728). Both cfPWV (per 1 m/s increase: OR = 1.11, 95% CI: 1.07-1.16) and baPWV (OR = 1.04, 95% CI: 1.02-1.06) were independently associated with carotid plaque after adjusting for various confounders. Compared with bottom quartile (cfPWV ≤7.31 m/s and baPWV ≤14.44 m/s), the top quartile of cfPWV and baPWV had a significantly higher prevalence of carotid plaque (for cfPWV: OR = 1.59, 95% CI: 1.32-1.92; for baPWV: OR = 1.53, 95% CI: 1.26-1.86). However, the relationship of baPWV and carotid plaque was nonlinear, with a positive trend only when baPWV < 16.85 m/s. When comparing relationships between PWV indices and carotid plaque in one model, both cfPWV and baPWV were significantly associated with carotid plaque in participants with baPWV < 16.85 m/s; however, only cfPWV was independently associated with carotid plaque in participants with baPWV ≥16.85 m/s. Both cfPWV and baPWV were significantly associated with carotid plaque in the Chinese community-based population. Furthermore, cfPWV was more strongly correlated with carotid plaque than baPWV in participants with baseline baPWV ≥16.85 m/s.

Association between remnant cholesterol and arterial stiffness in a Chinese community-based population: A cross-sectional study

Objectives

As a surrogate of arterial stiffness, the brachial-ankle pulse wave velocity (baPWV) is a good predictor of incident cardiovascular disease. Remnant cholesterol (RC) is a proven independent risk factor for cardiovascular disease. However, the relationship between RC and baPWV is unknown. The present study was performed to explore this relationship.

Design

Cross-sectional study.

Setting and participants

This study involved 8,028 participants of a community-based atherosclerosis cohort from China. Community residents aged ≥40 years were enrolled by responding to detailed research recruitment posters or by phone invitation. The participants comprised 2,938 (36.60%) men, and their mean age was 56.57 ± 9.04 years.

Methods and results

The baPWV was measured with a standard protocol using the Omron Colin BP-203RPE III device (Omron Healthcare, Kyoto, Japan). RC was calculated as follows: RC = TC – LDL-C – HDL-C. The mean baPWV was 1,646.85 ± 374.11 cm/s. The median RC concentration was 0.56 (0.41–0.74) mmol/L. In the multivariate logistic regression analyses, the concentrations of RC, triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) were all positively and independently associated with baPWV. The baPWV was higher in the fourth than first lipid profile quartile. The HDL-C concentration was inversely associated with baPWV. When RC was forced into the model with other lipid profile indices simultaneously, only the RC and TG concentrations remained significantly associated with baPWV.

Conclusion

Lipids are independently associated with baPWV. The RC and TG concentrations have stronger associations with arterial stiffness than other lipid indices in the Chinese community-based population.

The association of waterpipe smoking with arterial stiffness and wave reflection in a community-based sample

PURPOSE

The evidence linking waterpipe smoking to cardiovascular disease is limited. We evaluated the association of waterpipe smoking (WPS) with arterial stiffness and wave reflection measured by augmentation pressure (AP), augmentation index (AIx), and carotid-femoral pulse wave velocity (CFPWV), which are validated predictors of cardiovascular disease.

MATERIALS AND METHODS

Community-based, cross-sectional study including 205 exclusive waterpipe smokers and 199 matched never-smokers aged 35 years or older (mean age 51.7 ± 8.9 years, 36% females). Smoking and its extent were assessed using a validated questionnaire and urine cotinine levels. CFPWV, AP, AIx (AP/aortic pulse pressure) and heart rate adjusted AIx (AIx@75) were determined using tonometry and compared between smokers and non-smokers, and the association of WPS with tonometry measures was assessed using linear regression adjusting for possible confounders.

RESULTS

Waterpipe smokers and non-smokers had similar mean age and sex distribution. Compared to non-smokers, waterpipe smokers had significantly higher adjusted AP (10.5 ± 3.9 vs. 9.4 ± 3.9 mmHg respectively; p = 0.01), AIx (28.1 ± 8.4 vs. 25.7 ± 8.5% respectively; p = 0.01) and AIx@75 (24.2 ± 8.7 vs. 21.8 ± 8.9% respectively; p = 0.01). AIx was significantly associated with WPS extent, measured by a number of waterpipe smoked/day (β = 1.04/waterpipe, 95%CI:[0.50-1.58]), duration of waterpipe smoking (β = 0.77/10-years, 95%CI:[0.16-1.38]), their products in waterpipe-years (β = 0.30/10-waterpipe-year, 95%CI:[0.12-0.47]) and plasma cotinine (β = 0.56/100 ng/ml, 95%CI:[0.14-0.98]), adjusting for possible confounders, and so were AP and AIx@75. CFPWV however, was not associated with waterpipe smoking.

CONCLUSION

In a community-based sample, exclusive WPS and its extent were associated with a dose-dependent increase in AIx and AP, accounting for other risk factors, suggesting that waterpipe smokers are at increased risk of cardiovascular disease.

Arterial Stiffness Accelerates Within 1 Year of the Final Menstrual Period: The SWAN Heart Study

OBJECTIVE

Menopause may augment age-dependent increases in arterial stiffness, with black women having greater progression in midlife compared with white women. We sought to determine whether and when women experience changes in arterial stiffness relative to the final menstrual period (FMP) and whether these changes differ between black and white midlife women. Approach and Results: We evaluated 339 participants from the SWAN (Study of Women's Health Across the Nation) Heart Ancillary study (Study of Women's Health Across the Nation). Women had ≤2 carotid-femoral pulse-wave velocity (cfPWV) exams over a mean±SD of 2.3±0.5 years of follow-up. Annual percentage changes in cfPWV were estimated in 3 time segments relative to FMP and compared using piecewise linear mixed-effects models. At baseline, women were 51.1±2.8 years of age and 36% black. Annual percentage change (95% CI) in cfPWV varied by time segments: 0.9% (-0.6% to 2.3%) for >1 year before FMP, 7.5% (4.1% to 11.1%) within 1 year of FMP, and -1.0% (-2.8% to 0.8%) for >1 year after FMP. Annual percentage change in cfPWV within 1 year of FMP was significantly greater than the other 2 time segments; P<0.05 for both comparisons. Adjusting for concurrent cardiovascular disease risk factors explained part of the change estimates but did not eliminate the difference. Black women had greater increase in cfPWV compared with white women in the first segment; P for interaction, 0.04.

CONCLUSIONS

The interval within 1 year of FMP is a critical period for women when vascular functional alterations occur. These findings underscore the importance of more intensive lifestyle modifications in women transitioning through menopause.

Inflammatory, Serological and Vascular Determinants of Cardiovascular Disease in Systemic Lupus Erythematosus Patients

Background and aim: Systemic lupus erythematosus (SLE) is associated with increased risk of cardiovascular disease (CVD). Among many mechanisms, accelerated atherosclerosis, endothelial dysfunction, and hypercoagulability play a main role. Here, we investigate whether inflammatory, serological and clinical markers of SLE determine and correlate with arterial stiffness in SLE patients. Materials and methods: Routine blood samples, inflammatory mediators, specific antibodies, and 24 h proteinuria were measured in 43 SLE patients and 43 age and sex-matched controls using routine laboratory assays. We also assessed arterial stiffness by measuring radial artery applanation tonometry-derived augmentation index (AI), normalized AI (AIx@75), aortic pulse pressure, central systolic, diastolic and peripheral blood pressure. Results: SLE patients showed a significantly greater arterial stiffness vs. controls, as demonstrated by the significantly higher AIx@75 and aortic pulse pressure. Interestingly, regression analysis showed that age, systolic pulse pressure, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), daily dose of glucocorticoids, and cumulative organ damage positively correlated with arterial stiffness. Conclusions: SLE patients show increased arterial stiffness which correlates with markers of inflammation, that is involved in early alterations in arterial walls. Applanation tonometry can be used to screen SLE patients for subclinical vascular damage to implement prevention strategies for CVD.

Betel nut chewing associated with increased risk of arterial stiffness

BACKGROUND

Betel nut chewing is associated with certain cardiovascular outcomes. Subclinical atherosclerosis may be one link between betel nut chewing and cardiovascular risk. Few studies have examined the association between chewing betel nut and arterial stiffness. The aim of this study was thus to determine the relationship between betel nut chewing and arterial stiffness in a Taiwanese population.

METHODS

We enrolled 7540 eligible subjects in National Cheng Kung University Hospital from October 2006 to August 2009. The exclusion criteria included history of cerebrovascular events, coronary artery disease, and taking lipid-lowering drugs, antihypertensives, and hypoglycemic agents. Increased arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1400cm/s. According to their habit of betel nut use, the subjects were categorized into non-, ex-, and current chewers.

RESULTS

The prevalence of increased arterial stiffness was 32.7, 43.3, and 43.2% in non-, ex- and current chewers, respectively (p=0.011). Multiple logistic regression analysis revealed that ex-chewers (odds ratio [OR] 1.69, 95% confidence interval (CI)=1.08-2.65) and current chewers (OR 2.29, 95% CI=1.05-4.99) had elevated risks of increased arterial stiffness after adjustment for co-variables.

CONCLUSIONS

Both ex- and current betel nut chewing were associated with a higher risk of increased arterial stiffness. Stopping betel nut chewing may thus potentially be beneficial to reduce cardiovascular risk, based on the principals of preventive medicine.

Relation between Arterial Stiffness and Markers of Inflammation and Hemostasis - Data from the Population-based Gutenberg Health Study

The relation between inflammation, hemostasis and arterial stiffness is of pathophysiological relevance for the development of cardiovascular disease (CVD). Data investigating this interplay using stiffness index (SI) by digital photoplethysmography are not available yet. Therefore, sex-specific relation between SI and inflammatory and hemostatic biomarkers was investigated within 13,724 subjects from the population-based Gutenberg Health Study. C-reactive protein (CRP), white blood cell count (WBCC), neopterin, interleukin-18, interleukin-1 receptor antagonist (IL-1RA), fibrinogen and hematocrit were measured. Multivariable linear regression analysis with adjustment for cardiovascular risk factors, medication, and hormonal status (in females) revealed an independent association between SI and WBCC, IL-1RA and hematocrit in both sexes, and with fibrinogen in women. There was a joint effect of increasing tertiles of SI and biomarker concentrations for future CVD risk prediction. Subjects with both SI and biomarker concentration above the median had the worst overall survival and with both below the median the best survival during a follow-up period of 6.2 ± 1.7 years, except for hematocrit. The results support the relation between inflammation, hemostasis and arterial stiffness measured by digital photoplethysmography. Markers of inflammation and hemostasis modulate the ability of SI to identify subjects at risk for future CVD or higher mortality.

Carotid and Aortic Stiffness in Patients with Heterozygous Familial Hypercholesterolemia

Background

The role of plasma cholesterol in impairing arterial function and elasticity remains unclear. We evaluated arterial stiffness, measured locally in the common carotid artery by high-resolution echo-tracking, and aortic stiffness, using carotid-femoral pulse wave velocity (PWV) (the “gold-standard” measurement of arterial stiffness), in treatment-naive patients with heterozygous familial hypercholesterolemia (FH).

Methods

The study included 66 patients with FH (10–66 years old) and 57 first-degree relatives without FH (11–61 years old). Carotid-femoral PWV was determined by SphygmoCor (AtCor, Australia). The parameters of carotid stiffness β-index, Peterson elastic modulus and local PWV were assessed with regard to the common carotid artery at a distance of 1cm from the bifurcation (AlokaProsound Alpha7, Japan).

Results

FH patients showed significantly higher β-index (6.3(4.8–8.2) vs. 5.2(4.2–6.4), p = 0.005), Ep (78(53–111) kPa vs. 62(48–79) kPa, p = 0.006), local PWV (5.4(4.5–6.4) m/c vs. 4.7(4.2–5.4) m/c, p = 0.005), but comparable values of carotid-femoral PWV (6.76(7.0–7.92) m/c vs. 6.48(6.16–7.12) m/c, p = 0.138). Carotid arteries and the aorta stiffened with age in patients with FH, but after 30 years, carotid arteries stiffened more significantly than the aorta.

Conclusions

Our study demonstrated that treatment-naive patients with FH had stiffer carotid arteries than their relatives, but showed no difference in aortic stiffness. We also found out that the rate of reduction of elasticity of the aorta and carotid arteries in FH patients varies: it is observed earlier in carotid arteries than in the aorta.

Investigating a Liver Fat

Objective—

To investigate the relationship between hepatic fat content, circulating triglyceride levels and aortic stiffness in adult and childhood obesity.

Approach and Results—

Seventy-seven adults and 18 children across a wide range of body mass index (18.5–52.6 kg/m 2 ; percentile 8–100) with no identifiable cardiac risk factors underwent; 1H- magnetic resonance spectroscopy to quantify hepatic fat content and magnetic resonance imaging to assess aortic pulse wave velocity (PWV) and regional distensibility. In adults, multivariable regression showed age (β=0.09; P =0.02), liver fat (β=2.5; P =0.04), and serum triglyceride (β=0.47; P =0.01) to be independent predictors of PWV. Age and blood pressure–adjusted, moderated regression showed that 43% of the total negative effect of hepatic fat on PWV is attributable to indirect effects via increased triglyceride ( P =0.005). In addition, regional distensibility was positively correlated with hepatic fat (ascending; r =−0.35; descending, r =−0.23; abdominal, r =−0.41; all P <0.001). Similar to that seen in adults, PWV ( r =0.72; P <0.001) and abdominal regional distensibility ( r =−0.52; P <0.001) were correlated with liver fat in children.

Conclusions—

Increasing age, liver fat, and triglyceride are all related to increased aortic stiffness in adults. Even when controlling for the effects of age and blood pressure, hepatic fat has a negative effect on PWV, with substantial indirect effect occurring via increased circulating triglyceride level. This relationship between hepatic fat and aortic stiffness occurs early in the obesity process and is also seen in children. As such, hepatic fat content is a potential therapeutic target to treat the elevated vascular risk in obesity.

Family history of stroke is potentially associated with arterial stiffness in the Japanese population

BACKGROUND

Studies on the association between family history of cardiovascular disease and arterial stiffness are rare.

AIMS

This study evaluated the possible relationship between family history of cardiovascular disease and arterial stiffness in the Japanese population, by measuring brachial-ankle pulse wave velocity (ba-PWV).

METHODS

A total of 1004 eligible subjects (664 men and 340 women) aged 35-69 years, who were enrolled in the baseline survey of a cohort study in Tokushima Prefecture (Japan) and who underwent ba-PWV measurement, were analysed. Information about their lifestyle characteristics and first-degree family histories of ischaemic heart disease (i.e. myocardial infarction or angina pectoris), stroke or hypertension were obtained from a structural self-administered questionnaire.

RESULTS

Subjects of both sexes with a family history of stroke showed significantly higher multivariable-adjusted means of ba-PWV than those without that trait (P values were 0.001 in men and 0.002 in women), while those with a family history of ischaemic heart disease did not. Subjects of both sexes with a family history of hypertension showed significantly higher age-adjusted means of ba-PWV than those without that trait, although these differences disappeared after further adjusting for blood pressure or multivariable covariates. When family histories of these diseases were inserted simultaneously into the same model, these results did not alter substantially.

CONCLUSION

A family history of stroke might be associated with increased arterial stiffness, independent of other known atherosclerotic risk factors, including hypertensive elements, in both sexes in the Japanese population.

Arterial stiffness as a risk factor for coronary artery disease

Hypertension is a major modifiable risk factor, and clinical trials have demonstrated that successful reduction of elevated blood pressure to target levels translates into decreased risk for the development of coronary artery disease, stroke, heart failure, and renal failure. The arterial system had previously been regarded as a passive conduit for the transportation of arterial blood to peripheral tissues. The physiologic role the arterial system was greatly expanded by the recognition of the central role of the endothelial function in a variety of physiologic processes. The role of arterial function and structure in cardiovascular physiology was expanded with the development of a variety of parameters that evaluate arterial stiffness. Markers of arterial stiffness have been correlated with cardiovascular outcomes, and have been classified as an emerging risk factor that provides prognostic information beyond standard stratification strategies involving hypertension, diabetes, obesity, dyslipidemia and smoking. Multiple epidemiologic studies have correlated markers of arterial stiffness such as pulse-wave velocity, augmentation index and pulse pressure with risk for the development of fatal and nonfatal cardiovascular events. Additionally, measurements of arterial stiffness had clarified the results of clinical trials that demonstrated differing impacts on clinical outcomes, despite similar reductions in blood pressure, as measured by brachial and sphygmomanometry.

Exploring the associations between arterial stiffness and spinal cord impairment: A cross-sectional study

BACKGROUND/OBJECTIVE

Elevated aortic arterial stiffness (aortic pulse wave velocity: aPWV) is an independent coronary artery disease predictor among the general population. The purpose of this study was to: (1) report aPWV values in a representative cohort of patients with spinal cord injury (SCI); (2) to compare aPWV values in people with SCI based on neurological level of injury; and (3) to contrast the reported aPWV values with available normal values for the general population.

METHODS

Adults with chronic SCI (n = 87) were divided into two groups (TETRA group, n = 37 and PARA group, n = 50). aPWV and potential confounders of aPWV were assessed. Analysis of covariance was used for comparisons between groups and adjusted for the confounders. Subjects' aPWV values were contrasted with reference values for general population determined by "The Reference value for arterial stiffness' collaboration" and prevalence of abnormal aPWV defined as greater than or equal to the age-specific 90th percentile was reported.

RESULTS

Prevalence of abnormal aPWV in the cohort was 25.3%. After adjusting for covariates, the mean aPWV values were significantly different between two groups (TETRA: 8.0 (95% confidence interval (CI): 7.5-8.6) m/second, PARA: 9.0 (95% CI: 8.5-9.4) m/second, P = 0.010). The prevalence of abnormal aPWV was significantly higher in the PARA group (36%) compared to the TETRA group (11%) (P = 0.012).

CONCLUSIONS

One-quarter of the total cohort had an abnormal aPWV. Subjects with paraplegia had higher aPWV values and a higher frequency of abnormal aPWV than subjects with tetraplegia. Elevated aPWV in people with SCI, particularly those with paraplegia, may impart significant adverse cardiovascular consequences.

Smoking and arterial stiffness in youth with type 1 diabetes: the SEARCH Cardiovascular Disease Study

OBJECTIVE

To evaluate the effects of smoking on early markers of cardiovascular disease (arterial stiffness) in adolescents with and without type 1 diabetes (T1D) in the SEARCH Cardiovascular Disease Study.

STUDY DESIGN

Participants included 606 youth (18.9 ± 3.3 years, 83% non-Hispanic white; 50% male). Six groups were defined: (1) smokers with T1D (n = 80); (2) former smokers with T1D (n = 88); (3) nonsmokers with T1D (n = 232); (4) smokers without T1D (n = 40); (5) former smokers without T1D former (n = 51); and (6) nonsmokers without T1D (n = 115). Arterial stiffness measurements included pulse wave velocity (PWV), augmentation index, and brachial distensibility. Multivariate linear regression was used to assess the independent and joint effects of T1D and smoking on arterial stiffness.

RESULTS

Nearly 20% of both youth with and without T1D and T1D were smokers. In youth without T1D, smokers had higher trunk and arm PWV. After adjustment for potential confounders, T1D, but not smoking, was an independent predictor of PWV (P < .05). Moreover, smoking status did not modify the association between T1D and increased arterial stiffness.

CONCLUSIONS

We found a high prevalence of smoking among youth with and without T1D; however, smoking status was not independently associated with increased arterial stiffness in youth with T1D.

Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study

Cardiovascular disease (CVD) is a major cause of death in systemic lupus erythematosus (SLE) patients. Although the risk for cardiovascular events in patients with SLE is significant, the absolute number of events per year in any given cohort remains small. Thus, CVD risks stratification in patients with SLE focuses on surrogate markers for atherosclerosis at an early stage, such as reduced elasticity of arteries. Our study was designed to determine whether arterial stiffness is increased in SLE patients at low risk for CVD and analyze the role for traditional and non-traditional CVD risk factors on arterial stiffness in SLE. Carotid-femoral pulse wave velocity (PWV) was prospectively assessed as a measure of arterial stiffness in 41 SLE patients and 35 controls (CTL). Adjustment on age or Framingham score was performed using a logistic regression model. Factors associated with PWV were identified separately in SLE patients and in controls using Pearson's correlation coefficient for univariate analysis and multiple linear regression for multivariate analysis. SLE patients and controls displayed a low 10-year risk for CVD according to Framingham score (1.8±3.6% in SLE vs 1.6±2.8% in CTL, p = 0.46). Pulse wave velocity was, however, higher in SLE patients (7.1±1.6 m/s) as compared to controls (6.3±0.8 m/s; p = 0.01, after Framingham score adjustment) and correlated with internal carotid wall thickness (p = 0.0017). In multivariable analysis, only systolic blood pressure (p = 0.0005) and cumulative dose of glucocorticoids (p = 0.01) were associated with PWV in SLE patients. Interestingly, the link between systolic blood pressure (SBP) and arterial stiffness was also confirmed in SLE patients with normal systolic blood pressure. In conclusion, arterial stiffness is increased in SLE patients despite a low risk for CVD according to Framingham score and is associated with systolic blood pressure and glucocorticoid therapy.

Obesity and overweight associated with increased carotid diameter and decreased arterial function in young otherwise healthy men

BACKGROUND

Obesity is linked to cardiovascular disease, stroke, increased mortality and vascular remodeling. Although increased arterial diameter is associated with multiple cardiovascular risk factors and obesity, it is unknown whether lumen enlargement is accompanied by unfavorable vascular changes in young and otherwise healthy obese individuals. The purpose of this study was to compare carotid and brachial artery diameter, blood pressure, arterial stiffness, and endothelial function in young, apparently healthy, normal-weight, overweight, and obese male subjects.

METHODS

One hundred sixty-five male subjects (27.39±0.59 years) were divided into 3 groups (normal weight, overweight, and obese) according to body mass index. Subjects underwent cardiovascular measurements to determine arterial diameter, function, and stiffness.

RESULTS

After adjusting for age, the obese group had significantly greater brachial, carotid, and aortic pressures, brachial pulse wave velocity, carotid intima media thickness, and carotid arterial diameter compared with both the overweight and normal-weight groups.

CONCLUSIONS

Obesity is associated with a much worse arterial profile, as an increased carotid lumen size was accompanied by higher blood pressure, greater arterial stiffness, and greater carotid intima media thickness in obese compared with overweight or normal-weight individuals. These data suggest that although obesity may be a factor in arterial remodeling, such remodeling is also accompanied by other hemodynamic and arterial changes consistent with reduced arterial function and increased cardiovascular risk.

Adiponectin, systolic blood pressure, and alcohol consumption are associated with more aortic stiffness progression among apparently healthy men

OBJECTIVE

Limited data are available about risk factors for the progression of aortic stiffness in healthy population. We examined several risk factors as possible independent predictors of aortic stiffness progression among a population-based sample of US men.

METHODS

A total of 240 men (40-49 years) free of CVD at baseline from the Pittsburgh site of the ERA JUMP study were evaluated. Aortic stiffness was measured as carotid-femoral pulse wave velocity at baseline and after 4.6 ± 0.2 (mean ± SD) years of follow-up. Progression of aortic stiffness was evaluated as relative annual change in carotid-femoral pulse wave velocity (% change/year). Using linear regression, both baseline potential risk factors and their annual changes were evaluated as possible risk factors for aortic stiffness progression. Baseline age, follow-up time, race, heart rate, and medications use were forced in all models.

RESULTS

During follow-up, relative to baseline level, aortic stiffness increased 0.3% ± 5.3% per year. In final models, the independent predictors of degree of aortic stiffness progression were lower levels of adiponectin (P = 0.03), higher levels of systolic blood pressure (P = 0.03), greater annual change in systolic blood pressure (P = 0.04), and alcohol consumption ≥ 2 times/week (P = 0.02). Adiponectin levels within the third (9.8 μg/Ml ≤ adiponectin < 13.0 μg/mL) and the fourth (adiponectin ≥ 13.0 μg/mL) quartiles were associated with an improvement in relative annual aortic stiffness progression (P = 0.02, P = 0.01, respectively) compared to levels within the first quartile (adiponectin ≤ 7.0 μg/mL).

CONCLUSION

Among apparently healthy men, lower levels of baseline adiponectin could be a novel marker for greater risk of aortic stiffness progression. Longitudinal research is required to evaluate whether adiponectin change over time would have similar association with aortic stiffness progression.

Test-retest reliability of pulse wave velocity in individuals with chronic spinal cord injury

BACKGROUND

Pulse wave velocity (PWV), which reflects arterial stiffness, is an important predictor of future coronary artery disease. The test-retest reliability of PWV has not been investigated in people with spinal cord injury (SCI).

PURPOSE

To report the test-retest (day-to-day) reliability of PWV measurements among people with SCI, and to determine the smallest real difference (SRD) of PWV values.

PARTICIPANTS

Twenty men (n = 19) and a woman (n = 1) with SCI (C4-T10; AIS A-D; ≥ 1-year post-injury; 10 with paraplegia and 10 with tetraplegia; time post-injury: 11.8 ± 8.7 years; age: 43.0 ± 12.6 years).

METHODS

On two occasions within a 2-week period, aortic PWV (between the common carotid and femoral artery), arm PWV (between the brachial and radial artery), and leg PWV (between femoral and posterior tibial artery) were assessed at the same time of day using Doppler flowmeters.

RESULTS

No statistically significant differences were found between days 1 and 2 in aortic PWV (day 1: 941 ± 185 cm/seconds, day 2: 917 ± 160 cm/seconds, P = 0.257), leg PWV (day 1: 1088 ± 141 cm/seconds, day 2: 1122 ± 165 cm/seconds, P = 0.099) and arm PWV (day 1: 1283 ± 185 cm/seconds, day 2: 1358 ± 256 cm/seconds, P = 0.180). The aortic and leg PWVs had high test-retest reliability (intraclass correlation coefficient: ICC = 0.920 and 0.913, respectively; P < 0.001 for both) and arm PWV had moderate test-retest reliability (ICC = 0.598, P = 0.03). SRDs for each PWV were 104 cm/seconds (aortic PWV), 97 cm/seconds (leg PWV) and 143 cm/seconds (arm PWV).

CONCLUSION

The test-retest reliability of PWV assessment is high among patients with chronic SCI. Changes in aortic PWV values above 104 cm/seconds with repeated testing like represent true changes in health status.

Associations among different functional and structural arterial wall properties and their relations to traditional cardiovascular risk factors in healthy subjects: a cross-sectional study

BACKGROUND

The arterial wall possesses several functional and structural properties that define arterial health. Once they become impaired, cardiovascular risk increases. We aimed to ascertain the pattern of correlations among different arterial wall properties and to explore their relations to traditional risk factors and cardiovascular risk stratification. To allow such an investigation a middle-aged healthy population was recruited.

METHODS

This cross-sectional study included 100 healthy males (aged 41.9 ± 6.4 years). Pulse wave velocity (PWV), β-stiffness and intima-media thickness (IMT) of the carotid artery, and brachial artery flow-mediated dilation (FMD) were measured by a standardized ultrasound approach.

RESULTS

No correlation between FMD and IMT was found; only relatively poor correlations between PWV (or β-stiffness) and FMD existed, as well as between PWV (or β-stiffness) and IMT. PWV and β-stiffness highly correlated. Unexpectedly, only weak associations between PWV, β-stiffness, FMD, IMT and traditional risk factors were revealed. Hence, traditional risk factors (mainly age) explained only 10-50% of variability for PWV, β-stiffness, FMD and IMT. Although the subjects had low cardiovascular risk according to their Framingham score, their arterial wall properties were already impaired, particularly FMD.

CONCLUSIONS

In healthy middle-age males we found: i) absent or poor correlations among arterial stiffness, IMT and endothelial function; ii) a low impact of traditional risk factors on the studied variables, and iii) the presence of impaired arterial wall properties despite low calculated cardiovascular risk. These results provide a deepened understanding of arterial wall properties and could help to improve cardiovascular risk stratification.

Gender differences in artery wall biomechanical properties throughout life

Elevated large artery stiffness and pulse pressure have emerged as important risk factors for cardiovascular disease. The genders differ in large artery biomechanical properties throughout the lifespan with females displaying higher stiffness than males during the prepubertal years and a dramatic increase after menopause. Males on the other hand experience an increase in arterial stiffness postpuberty and a linear increase thereafter, suggesting that females have intrinsically stiffer large arteries than males, but that such effects are mitigated by sex steroids during the reproductive years. This review discusses anthropometric and sex steroid influences on gender differences in large artery stiffness and pressure dynamics from childhood to senescence. In particular, the sex-specific effects of estrogen, progesterone and testosterone on vascular structure and function and how these influence arterial stiffness are explored. These factors may contribute in part to the observed gender differences in the pathophysiology and clinical manifestations of cardiovascular disease.

Association of serum lipids with arterial stiffness in a population-based study in Beijing

BACKGROUND

Some cardiovascular risk factors such as age, hypertension and diabetes have been confirmed to be positively correlated with arterial stiffness. However, the relationship between serum lipids and arterial stiffness is incompletely understood. Recent studies have been far from conclusive and consistent data were not obtained. We investigated the relationship between serum lipids and pulse wave velocity (PWV) in community-dwelling individuals in Beijing, China.

METHODS

This was a population-based, cross-sectional sample of adults (n = 2375; 48·1% men; age range, 40-96 years) from two communities in Beijing. A questionnaire was used for the risk factors of arterial stiffness. Anthropometry, blood pressure and heart rate were measured. Values of fasting plasma glucose (FPG), serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and uric acid were measured. Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were assessed non-invasively.

RESULTS

Carotid-femoral pulse wave velocity was significantly positively related to TC (r = 0·221; P < 0·0001), LDL-C (r = 0·193; P < 0·0001) and inversely related to HDL-C (r = -0·240; P < 0·0001), but not with TG (r = 0·073; P = 0·6721). crPWV was inversely related to HDL-C (r = -0·272; P < 0·0001), but not with TC (r = 0·007; P = 0·4781), LDL-C (r = 0·021; P = 0·6393) or TG (r = 0·008; P = 0·2498). The multiple regression analysis showed that LDL-C was independently associated with cfPWV and that HDL-C was inversely associated with cfPWV and crPWV. TC and TG were not independently related to cfPWV and crPWV.

CONCLUSIONS

These data show the correlation between some of the parameters of serum lipids and arterial stiffness. LDL-C was independently associated with aortic stiffness, and HDL-C was independently inversely associated with aortic stiffness and peripheral stiffness.

Establishing baseline criteria of cardio-ankle vascular index as a new indicator of arteriosclerosis: a cross-sectional study

BACKGROUND

A cardio-ankle vascular index (CAVI) has been developed to represent the extent of arteriosclerosis throughout the aorta, femoral artery and tibial artery independent of blood pressure. To practically use CAVI as a diagnostic tool for determining the extent of arteriosclerosis, our study objectives were (1) to establish the baseline CAVI scores by age and gender among cardiovascular disease (CVD) risk-free persons, (2) to compare CAVI scores between genders to test the hypothesis that the extent of arteriosclerosis in men is greater than in women, and (3) to compare CAVI scores between the CVD risk-free group and the CVD high-risk group in order to test the hypothesis that the extent of arteriosclerosis in the CVD high-risk group is greater than in the CVD risk-free group.

METHODS

Study subjects were 32,627 urban residents 20-74 years of age who participated in CVD screening in Japan during 2004-2006. A new device (model VaSera VS-1000) was used to measure CAVI scores. At the time of screening, CVD high-risk persons were defined as those having any clinical abnormalities of CVD, and CVD risk-free persons were defined as those without any clinical abnormalities of CVD. Age-specific average CAVI scores were compared between genders and between the CVD risk-free group and the CVD high-risk group. Student's t-test using two independent samples was applied to a comparison of means between two groups.

RESULTS

Average age-specific baseline scores of CAVI in the CVD risk-free group linearly increased in both genders as their age increased. Average age-specific baseline scores of CAVI in the CVD risk-free group were significantly greater among men than among women. Average age-specific baseline scores of CAVI in the CVD risk-free group were significantly smaller than those in the CVD high-risk group in both genders after 40 years of age.

CONCLUSIONS

The baseline CAVI scores from the CVD risk-free group are useful for future studies as control values. The CAVI method is a useful tool to screen persons with moderate to advanced levels of arteriosclerosis.

African-American ethnicity and cardiovascular risk factors are related to aortic pulse-wave velocity progression

BACKGROUND

Accelerated central arterial stiffening as represented by progression of aortic pulse-wave velocity (PWV) may be influenced by cardiovascular disease (CVD) risk factors. Little is known about the relationships between CVD risk factors and PWV progression among women transitioning through the menopause, or whether these relationships vary by ethnicity.

METHODS

We conducted a subgroup analysis of 303 African-American and Caucasian participants in the Study of Women's Health Across the Nation (SWAN) Heart Study which received PWV scans at baseline examination and at a follow-up examination at an average of 2.3 years later. CVD risk factors were also assessed at baseline.

RESULTS

Systolic blood pressure (SBP) and waist circumference were the strongest predictors of PWV progression, after adjustment for age, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, diastolic blood pressure (DBP), glucose, and triglyceride levels. The magnitude of the influence of SBP, DBP, LDL-C, and glucose on PWV progression varied by ethnicity (difference in slopes: P = 0.02 for SBP, P = 0.0009 for DBP, P = 0.005 for LDL-C, and P = 0.02 for glucose). The positive relationship between SBP and PWV progression was significant among women of both ethnicities. LDL-C, DBP, and, to a lesser extent, glucose levels were positively associated with PWV progression only among African Americans.

CONCLUSIONS

Blood pressure, LDL-C, glucose, and excess body size may be important targets for improving vascular health and preventing clinical outcomes related to arterial stiffening, particularly among African-American women.

Apolipoprotein B is related to arterial pulse wave velocity in young adults: the Cardiovascular Risk in Young Finns Study

OBJECTIVE

Limited data are available regarding the relationship of apolipoproteins B (ApoB) and A-1 (ApoA-1) with arterial stiffness. We conducted the present study to determine whether adulthood ApoB and ApoA-1 are related to arterial pulse wave velocity (PWV). Moreover, we examined whether ApoB and ApoA-1 measured in young adulthood are predictive of PWV assessed 6 years later.

METHODS

The study population consisted of 1618 apparently healthy Finnish young adults (aged 30-45 years, 44.9% males) whose apolipoproteins, other cardiovascular risk factors and PWV were measured in 2007. In a sub-sample population, apolipoproteins and other cardiovascular risk factors had also been measured in 2001 (n=1264). PWV measurements were performed using a whole-body impedance cardiography device.

RESULTS

ApoB (p<0.001) and the ApoB/ApoA-1 ratio (p<0.001) were directly associated with PWV. ApoB and the ApoB/ApoA-1 ratio measured in young adulthood were also predictive of PWV measured 6 later (p<0.001 for both). These relations remained significant (p<0.006) in models adjusted for non-lipid risk factors. The areas under the receiver-operating characteristic (ROC) curves (AUC) were similar for ApoB and non-HDL cholesterol (2001: p for AUC comparison=0.15; 2007: p for AUC comparison=0.07) in detecting subjects with increased PWV (PWV≥90th percentile).

CONCLUSION

The present study suggests that elevation of ApoB or non-HDL cholesterol is associated with increased arterial stiffness in young adults.

An analysis of prospective risk factors for aortic stiffness in men: 20-year follow-up from the Caerphilly prospective study

Arterial stiffness is an important determinant of cardiovascular risk. The precise risk factors for arterial stiffening remain unclear. We aimed to identify potential risk factors using prospective exposure data from the Caerphilly Prospective Study. Aortic pulse wave velocity and augmentation index were measured in 825 men and related to current (2004) and baseline (1979-1988) anthropometric, hemodynamic, and biochemical factors. The mean age of the men was 74 years, with an average follow-up of 20 years. The only independent baseline predictors of current velocity were pulse pressure (standardized beta-coefficient: 0.58), C-reactive protein (0.35), glucose (0.25), and waist circumference (0.23). The sole baseline predictor of current augmentation index was fibrinogen (0.78). After additional adjustment for the corresponding current risk factor, pulse wave velocity was best related to cumulative exposure to C-reactive protein, whereas augmentation index was most strongly related to current levels. Velocity was also more strongly correlated with baseline levels of triglycerides and smoking but with current waist circumference. The pulse pressure heart rate product assessed over the whole of 20 years was independently correlated with aortic pulse wave velocity but not augmentation index. Other than blood pressure, established cardiovascular risk factors have only a modest effect on aortic stiffness and wave reflection. Inflammation and the level of repetitive cyclic stress are important predictors of aortic stiffness, whereas wave reflection is predicted by acute inflammation only. Adequate control of pulse pressure and heart rate, as well as reducing inflammation, may, in the long-term, retard aortic stiffening, although this remains to be tested directly.

Relations of pulse wave velocity to waist circumference independent of hip circumference

OBJECTIVES

Little is known about the effect of waist circumference (WC) on brachial artery pulse wave velocity (baPWV) independent of hip circumference (HC). Therefore, this study aimed to dissociate specific effect of WC on baPWV independent of HC.

METHODS

Of 1,053 rural residents (2004-2005), 777 subjects with no known history of coronary artery diseases or diabetes mellitus over 40 yr were included. To reduce collinearity, we assessed the independent effect of WC with HC on PWV by residual method (WC [RM]).

RESULTS

In women, most correlation coefficients were significant between measures of abdominal obesity and baPWV, with the highest (0.32) in waist to hip ratio (WHR), whereas no significance was found in men. All mean values of baPWV among the abdominally obese were higher than those of normal group in women, which were in the order of WHR, WC (RM), and WC. Adjusted OR with 95% CI for baPWV was significantly elevated by increase of WC (RM) upto 4.8 (95% CI: 2.1-11.2), and as 4.3 by WHR (95% CI: 1.6-11.4).

CONCLUSION

Considering the difficulty in biologically interpreting WHR, WC (RM) may be a useful indicator of abdominal obesity among females in that it reflects the risk of pulse wave velocity.

The effect of smoking on arterial stiffness

A systematic literature review was conducted using PubMed, Embase and the Cochrane Library to determine the effect of acute, chronic and passive smoking on arterial stiffness and to determine whether these effects are reversible after smoking cessation. A total of 39 relevant studies were identified and included. Acute smoking was found to cause an acute increase in arterial stiffness. Similarly, passive smoking increased arterial stiffness acutely and chronically. The majority of studies identified chronic smoking as a risk factor for increasing arterial stiffness. However, some studies found no statistical difference in arterial stiffness between nonsmokers and long-term smokers, although chronic smoking seems to sensitize the arterial response to acute smoking. In addition, whether arterial stiffness is reversed after smoking cessation and the timeline in which this may occur could not be determined from the identified literature. The effect of smoking discontinuation on arterial stiffness remains to be established by prospective smoking cessation trials.

Delivery may affect arterial elasticity in women

BACKGROUND

Estrogen is considered to be cardioprotective, but estrogen replacement therapy for postmenopausal women has not shown results for either primary or secondary cardiovascular event prevention. During normal pregnancy, women have significantly higher levels of estrogen and it may be endogenous estrogen that helps prevent atherosclerosis.

METHODS AND RESULTS

The present cross-sectional study examined the association between pregnancy followed by delivery and clinical atherosclerosis using the brachial-ankle pulse wave velocity (PWV). A total of 2,560 women undergoing annual health screening at the Institute of Hyogo Prefecture Health Promotion Association in Japan were recruited. Pregnancy history (the age of menarche/menopause and the number of gravida/para), conventional coronary risk factors, and brachial-ankle PWV were recorded. Multivariate linear regression by stepwise selection analysis demonstrated that women who had 1 or more deliveries had a significantly lower PWV, independent of age and other conventional coronary risk factors.

CONCLUSIONS

Pregnancy followed by delivery may decrease arterial stiffness and prevent the progress of atherosclerosis in women. The contribution of such a pregnancy followed by delivery-related decrease in arterial stiffness to the reduction of cardiovascular disease in women should be further evaluated.

Pulse wave velocity for assessment of arterial stiffness among people with spinal cord injury: a pilot study

BACKGROUND/OBJECTIVE

The most significant complication and leading cause of death for people with spinal cord injury (SCI) is coronary artery disease (CAD). It has been confirmed that aortic pulse wave velocity (PWV) is an emerging CAD predictor among able-bodied individuals. No prior study has described PWV values among people with SCI. The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PWV, and leg (the femoral to posterior tibial artery) PWV in people with SCI (SCI group) to able-bodied controls (non-SCI group).

METHODS

Participants included 12 men with SCI and 9 non-SCI controls matched for age, sex, height, and weight. Participants with a history of CAD or current metabolic syndrome were excluded. Aortic, arm, and leg PWV was measured using the echo Doppler method.

RESULTS

Aortic PWV (mean +/- SD) in the SCI group (1,274 +/- 369 cm/s) was significantly higher (P < 0.05) than in the non-SCI group (948 +/- 110 cm/s). There were no significant between-group differences in mean arm PWV (SCI: 1,152 +/- 193 cm/s, non-SCI: 1,237 +/- 193 cm/s) or mean leg PWV (SCI: 1,096 +/- 173 cm/s, non-SCI: 994 +/- 178 cm/s) values.

CONCLUSIONS

Aortic PWV was higher among the SCI group compared with the non-SCI group. The higher mean aortic PWV values among the SCI group compared with the non-SCI group indicated a higher risk of CAD among people with SCI in the absence of metabolic syndrome.

Increased arterial stiffness in female-to-male transsexuals treated with androgen

AIM

Female-to-male (FTM) transsexuals are treated with long-term and high-dose androgen. Although androgen is known to affect the cardiovascular system, vascular function in FTM transsexuals has not been fully elucidated. The aim of this study was to evaluate the arterial stiffness in FTM transsexuals treated with androgen.

METHODS

We evaluated the arterial stiffness in 111 FTM transsexuals (63 untreated FTM transsexuals and 48 FTM transsexuals treated with androgen) using a volume-plethysmographic apparatus equipped with a multi-element applanation tonometry sensor.

RESULTS

There were no significant differences in age, body mass index and heart rate between the untreated FTM transsexuals and those treated with androgen. The systolic and diastolic blood pressures in FTM transsexuals treated with androgen were significantly higher than those in untreated FTM transsexuals. The level of brachial-ankle pulse wave velocity in FTM transsexuals treated with androgen (1202.8+/-138.2 cm/s) was significantly higher than that in untreated FTM transsexuals (1080.2+/-113.7 cm/s) while there was no significant difference in the carotid augmentation index between untreated FTM transsexuals and those treated with androgen.

CONCLUSIONS

Long-term and high-dose administration of androgen is likely to cause increased arterial stiffness in FTM transsexuals. To prevent atherosclerosis and cardiovascular events, a periodic checkup and pharmacological therapies for hypertension should be tailored on an individual basis.

Multimarker approach to evaluate correlates of vascular stiffness: the Framingham Heart Study

BACKGROUND

Arterial stiffness increases with age and contributes to the pathogenesis of systolic hypertension and cardiovascular disease in the elderly. Knowledge about the pathophysiological processes that determine arterial stiffness may help guide therapeutic approaches.

METHODS AND RESULTS

We related 7 circulating biomarkers representing distinct biological pathways (C-reactive protein, aldosterone-to-renin ratio, N-terminal proatrial natriuretic peptide and B-type natriuretic peptide, plasminogen activator inhibitor-1, fibrinogen, and homocysteine) to 5 vascular function measures (central pulse pressure, carotid-femoral pulse-wave velocity, mean arterial pressure, forward pressure wave amplitude [all measures of conduit artery stiffness], and augmented pressure, an indicator of wave reflection) in 2000 Framingham Offspring Study participants (mean age, 61 years; 55% women). Tonometry measures were obtained on average 3 years after the biomarkers were measured. In multivariable linear regression models adjusting for covariates, the biomarker panel was significantly associated with all 5 vascular measures (P<0.003 for all). On backward elimination, the aldosterone-to-renin ratio was positively associated with each stiffness measure (P< or =0.002 for all). In addition, C-reactive protein was positively related to augmented pressure (P=0.0003), whereas plasminogen activator inhibitor-1 was positively associated with mean arterial pressure (P=0.003), central pulse pressure (P=0.001), and forward pressure wave (P=0.01).

CONCLUSIONS

Our cross-sectional data on a community-based sample suggest a distinctive pattern of positive associations of biomarkers of renin-angiotensin-aldosterone system activation with pan-arterial vascular stiffness, plasminogen activator inhibitor-1 with central vascular stiffness indices, and C-reactive protein with wave reflection. These observations support the notion of differential influences of biological pathways on vascular stiffness measures.

Impact of age on the independent association of adiposity with pulse-wave velocity in a population sample of African ancestry

BACKGROUND

We aimed to clarify whether age influences the independent relationship between adiposity and pulse-wave velocity (PWV).

METHODS

We explored the effect of age on the independent relationships between indexes of central adiposity (waist circumference (WC) and waist-to-hip ratio (WHR)) and carotid-femoral PWV, central augmentation index (AIc), or pressure wave amplification assessed from applanation tonometry measurements obtained at the radial, carotid, and femoral arteries in 508 randomly selected subjects >16 years of age in a population sample of African ancestry with a high prevalence of excess adiposity ( approximately 63% overweight or obese).

RESULTS

In women a strong interaction between age and either WC or WHR was associated with logPWV independent of confounders and the individual terms (r = 0.68, P < 0.0001). This translated into a markedly greater increase in logPWV with increases in either WC or WHR in women older than the median age as compared to women younger (slopes of WC-logPWV relationships = 0.0031 +/- 0.0009 vs. -0.0007 +/- 0.0007, P < 0.002). In women older than the median age for the group, a one s.d. increase in WC (12.8 cm) translated into a 0.70 m/s increase in PWV as compared to a 0.14 m/s decrease in PWV for each one s.d. increase in WC (13.0 cm) in women younger than the median age (P < 0.001). No index of adiposity was independently associated with the log of AIc or aortic-brachial wave amplification.

CONCLUSION

In women of African ancestry, a greater independent effect of adiposity on PWV is noted in older as compared to younger women.

Age-related differences in arterial compliance are independent of body mass index

The aim of this study is to examine the effect of age on large and small arterial compliance in apparently healthy adults, and to determine whether this effect is independent of body mass index. The subjects consisted of 126 men and women, aged 45 years and above. The subjects rested supine while pulse contour analysis was measured from the radial artery to evaluate large and small arterial compliance. Large (12.0 +/- 4.2 mL/mm Hg x 10, mean +/- standard deviation) and small (3.3 +/- 1.9 mL/mm Hg x 100) arterial compliance were lower in the oldest group (P = .007, P = .002, respectively) compared with the youngest group (15.2 +/- 4.6 mL/mm Hg x 10 and 5.0 +/- 2.5 mL/mm Hg x 100, respectively). After adjusting for body mass index, large and small arterial compliance remained lower in the oldest group. Large and small arterial compliance are decreased with advancing age, independent of body mass index.

Metabolic syndrome and its components in relation to brachial-ankle pulse wave velocity in middle-aged Taiwanese males

To evaluate the association of The study is to evaluate the association of metabolic syndrome (MS) and its components on brachial-ankle pulse wave velocity (baPWV), an indirect marker of subclinical atherosclerosis, in middle-aged Taiwanese males. A total of 442 men aged 40 to 65 years were included in this cross-sectional survey. Arterial stiffness was measured using a non-invasive method by baPWV. MS is defined by the presence of ≥ 3 components using the modified National Cholesterol Education Program criteria. The mean baPWV was 1478.6 and 1520.3 cm/sec in normal-weight and overweight adults, respectively. Age, systolic blood pressure (BP), diastolic BP, and fasting blood glucose (FBG) correlated with baPWV levels in normal-weight and overweight males. In multiple logistic regression analysis, after adjusting for potential confounders, MS and its components (such as high BP and high FBG) were significantly associated with abnormal baPWV (≥1400 cm/sec) (p < 0.001). MS and its components are significantly associated with abnormal baPWV in Taiwanese middle-aged males and in addition, high BP was the component of MS most significantly associated with abnormal baPWV.

Effect of weight loss and nutritional intervention on arterial stiffness in type 2 diabetes

OBJECTIVE

There is increased stiffness of the large central arteries in type 2 diabetic patients, and obesity is a risk factor. However, the effect of intentional weight loss on arterial stiffness is uncertain, and the purpose of the current study was to assess this effect.

RESEARCH DESIGN AND METHODS

Arterial stiffness was assessed by measuring aortic pulse wave velocity (aPWV) at baseline and at completion of a 1-year weight loss intervention. Metabolic control of type 2 diabetes was also appraised.

RESULTS

Mean weight loss at 1 year in 38 volunteers with type 2 diabetes was 7.8%. There were improvements in HbA1c, LDL cholesterol, homeostasis model assessment of insulin resistance, and inflammatory markers (plasminogen activator inhibitor-1, tumor necrosis factor-alpha, interleukin-6, and C-reactive protein). There was also a significant improvement in aPWV at completion of weight loss intervention, from 740 to 690 cm/s (P < 0.05).

CONCLUSIONS

Moderate weight loss improves arterial stiffness in type 2 diabetes.

Utility of second derivative of the finger photoplethysmogram for the estimation of the risk of coronary heart disease in the general population

BACKGROUND

Increased arterial stiffness has been shown to be associated with coronary heart disease (CHD). However, it remains unclear as to whether the second derivative of the finger photoplethysmogram (SDPTG), a non-invasive method for the assessment of arterial stiffness, is useful for the estimation of risk of CHD in the general population.

METHODS AND RESULTS

The SDPTG in 211 subjects (age: 63+/-15 years, range: 21-91 years, 93 males) was recorded without apparent atherosclerotic disorders from a community. The relationship between the SDPTG indices (b/a and d/a) and coronary risk factors (n=211) or the Framingham risk score (n=158, age: 60+/-12 years, range: 30-74 years, 63 males) were analyzed. The SDPTG indices significantly correlated with the Framingham risk score in both genders (b/a; r(male) =0.43, r(female) =0.54 and d/a; r(male) =-0.38, r(female) =-0.58), as well as several coronary risk factors. In the receiver operating characteristics curve analyses, the b/a discriminated high-risk subjects for CHD, who were in the highest quintile of the Framingham risk score in each gender, with a sensitivity and specificity of 0.85 and 0.58 in males and 0.83 and 0.72 in females, respectively.

CONCLUSIONS

These results suggest that the SDPTG is useful for the estimation of risk of CHD in the general population.

Relationship Between Markers of Inflammation and Brachial-Ankle Pulse Wave Velocity in Japanese Men

The objective of the present study was to examine the relationship between markers of inflammation, such as high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR), and brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, in Japanese men. We studied 269 male subjects (mean age, 53 years) who entered our health check-up program. Subjects who were receiving any medication were excluded from the study. baPWV was measured using a volume-plethysmographic apparatus (Form /ABI; Colin, Co. Ltd., Komaki, Aichi, Japan). In addition to routine laboratory tests including ESR, serum levels of hsCRP were determined by a highly sensitive ELISA technique. baPWV was significantly correlated with age (r = 0.41, P < 0.0001), height (r = - 0.21, P = 0.0006), body weight (r = - 0.17, P = 0.007), mean blood pressure (r = 0.66, P < 0.0001), pulse pressure (r = 0.56, P < 0.0001), heart rate (r = 0.25, P < 0.0001), ln (ESR) (r = 0.20, P = 0.001), fasting blood glucose (r = 0.23, P = 0.0001), and ln (serum hsCRP) (r = 0.23, P = 0.0002). baPWV in the highest tertile of ESR was significantly higher than that in the lowest tertile of ESR (P = 0.005). baPWV in the highest tertile of serum hsCRP was significantly higher than those in the lowest tertile (P = 0.002) and the middle tertile of serum hsCRP (P = 0.02). In multiple regression analysis, baPWV significantly correlated with ln (serum hsCRP) independently of other clinical variables that showed a significant correlation with baPWV. baPWV is significantly associated with serum levels of hsCRP in Japanese men, suggesting that inflammation is involved in arterial stiffening.

Alcohol intake and aortic stiffness in young men and women

BACKGROUND

Moderate alcohol consumption has been shown to protect against cardiovascular disease. Aortic stiffness can be regarded as a marker of cardiovascular disease risk. Previously we have shown an inverse to J-shaped association between alcohol intake and aortic stiffness in middle-aged and elderly men and postmenopausal women.

OBJECTIVE

In the present study we examined whether a relation between alcohol intake and aortic stiffness is already present at a younger age.

DESIGN

Cross-sectional data of a cohort study in men and women aged 28 years were analysed stratified by gender (240 men and 283 women).

MEASUREMENTS

Alcohol intake was derived from a questionnaire and aortic stiffness was assessed by pulse-wave velocity measurement.

RESULTS

In women an alcoholic beverage intake of >/=1 glass/day is associated with a 0.36 m/s (95% confidence interval, -0.58 to -0.14) lower pulse-wave velocity compared with non-drinkers. In men alcohol intake is also inversely related to pulse-wave velocity, but this was not significant. These findings were independent of age, blood pressure and heart rate.

CONCLUSIONS

These findings suggest that moderate intake of alcohol may affect vascular stiffness at an early age, notably in women. These findings may be viewed as compatible with a vascular protective effect of alcohol that expresses well before the occurrence of symptomatic cardiovascular disease.

The association between abdominal visceral fat and carotid stiffness is mediated by circulating inflammatory markers in uncomplicated type 2 diabetes

Central obesity, insulin resistance, inflammation, as well as vascular changes are common in patients with type 2 diabetes. In this study we assessed the relationship among stiffness of the carotid artery, visceral fat, and circulating inflammatory markers in type 2 diabetic subjects. Carotid stiffness, quantified as the distensibility coefficient (DC), was measured by ultrasound in asymptomatic, normotensive patients with uncomplicated, well-controlled type 2 diabetes and in controls. Body fat distribution was quantified by magnetic resonance imaging. In patients, the carotid DC was inversely associated with visceral fat area (r = -0.660; P = 0.005) and plasma levels of C-reactive protein (CRP; r = -0.687; P = 0.002), but most strongly with plasma IL-6 (r = -0.766; P < 0.001). In multivariate analysis, the association between DC and visceral fat disappeared after adjustment for CRP and IL-6. Correction for age, body mass index, blood pressure, glycosylated hemoglobin, or fasting plasma glucose did not affect the association between carotid DC and inflammatory markers. Thus, carotid stiffness is associated with visceral obesity in patients with uncomplicated type 2 diabetes, but this association seems to be mediated by circulating IL-6 and CRP, of which IL-6, at least in part, originates from adipose tissue and stimulates hepatic CRP production.

Combined use of brachial-ankle pulse wave velocity and ankle-brachial index for fast assessment of arteriosclerosis and atherosclerosis in a community

BACKGROUND

Pulse volume recordings and blood pressures at arms and ankles can be obtained automatically and simultaneously to allow fast measurements of the brachial-ankle pulse wave velocity and the ankle-brachial index. We applied this novel technique to assess the extent of arteriosclerosis and atherosclerosis in a community.

METHODS

A total of 1329 residents in Kinmen completed a health survey including interview, physical examination, blood test, and the measurements of brachial-ankle pulse wave velocity and ankle-brachial index in 10 working days.

RESULTS

Brachial-ankle pulse wave velocity was significantly related to age, systolic blood pressure, body mass index, waist circumference, ankle-brachial index, and fasting blood levels of glucose, triglyceride, high-density lipoprotein cholesterol, uric acid, and creatinine, and was significantly related to the 10-year risk of developing coronary heart disease estimated from the Framingham risk function. The prevalence of arteriosclerosis as defined by brachial-ankle pulse wave velocity values higher than the age and sex stratified references from the low risk subjects was 27.1% for men and 25.4% for women. The prevalence of atherosclerosis defined by ankle-brachial index <0.9 was 2.8% in men and 1.7% in women. In men but not in women, subjects with low ankle-brachial index had significantly greater risk for developing coronary artery disease than those with normal values.

CONCLUSIONS

Brachial-ankle pulse wave velocity and ankle-brachial index can be obtained simultaneously and quickly for the assessment of arteriosclerosis and atherosclerosis in a community.

Brachial-Ankle Pulse Wave Velocity and Metabolic Syndrome in a Japanese Population: The Minoh Study

To investigate the association between brachial-ankle pulse wave velocity (baPWV) and metabolic syndrome (MS), we examined 374 men and 622 women aged 40 to 69 years who did not have a past history of either coronary heart disease or stroke. We used a modified National Cholesterol Education Program definition of MS that utilizes body mass index instead of waist circumference. Age-adjusted mean values of baPWV were greater when obesity, high systolic and diastolic blood pressures, high triglyceride level, low high-density lipoprotein cholesterol, high fasting glucose level or MS itself were present. baPWV was also associated with fasting insulin levels and homeostasis model assessment of insulin resistance (HOMA-IR) values. Mean values of baPWV (adjusted for age, smoking status, and drinking status) in men with 0, 1, 2, and > or =3 features of MS were 1,409, 1,517, 1,640, and 1,665 cm/s, respectively (p for trend <0.001). The respective adjusted mean baPWV values for women were 1,368, 1,531, 1,547, and 1,661 cm/s (p for trend <0.001). As for insulin resistance, the adjusted mean baPWV values across quartiles of HOMA-IR (lowest to highest) were 1,488, 1,514, 1,566, and 1,624 cm/s (p for trend <0.001) for men. The respective adjusted mean baPWV values for women were 1,395, 1,441, 1,464, and 1,539 cm/s (p for trend <0.001). Our findings indicate that clustered features of MS and insulin resistance are strongly associated with the risk for increased baPWV in Japanese men and women.

Total homocysteine is not a determinant of arterial pulse wave velocity in young healthy adults

AIMS

Hyperhomocysteinaemia has been associated with reduced pulse wave velocity (PWV) in patients with end-stage renal disease and in those with hypertension. The aim of this study was to examine the association between total homocysteine (tHcy) concentrations, the biochemical and genetic determinants of tHcy and PWV in healthy young adults.

METHODS AND RESULTS

A total of 489 subjects aged 20-25 years participated. A fasting blood sample was taken and PWV measured using a non-invasive optical method. tHcy did not correlate with PWV, whether assessed at the aorto-iliac segment (P = 0.18), the aorto-radial segment (P = 0.39) or the aorto-dorsalis-pedis segment (P = 0.22). When tHcy was classified into normal (<15) and high (> or =15micromol/l), PWV did not differ between the two groups at any segment. PWV did not differ by MTHFR C677T or NOS3 G894T genotype, even when smoking and folate sub-groups were considered. Considering aortic PWV as a dependent variable, stepwise regression analysis showed that the only parameter entering the model for all segments was systolic blood pressure (aorto-iliac, P < 0.001; aorto-radial, P = 0.01; aorto-dorsalis-pedis, P = 0.001). Age, sex, COL1A1 genotype and triglycerides entered the model significantly for two of three segments.

CONCLUSION

This study shows that arterial PWV is not associated with tHcy in a healthy young population.