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Anness AR, Nath M, Osman MW, Webb D, Robinson T, Khalil A, Mousa HA. Does treatment modality affect measures of arterial stiffness in women with gestational diabetes? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:422-429. [PMID: 37099764 DOI: 10.1002/uog.26234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/10/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To investigate whether arterial stiffness (AS) differs between healthy women and women with gestational diabetes mellitus (GDM) managed by different treatment modalities. METHODS This was a prospective longitudinal cohort study comparing AS in pregnancies complicated by GDM and low-risk controls. AS was assessed by recording aortic pulse-wave velocity (AoPWV), brachial augmentation index (BrAIx) and aortic augmentation index (AoAIx) using the Arteriograph® at four gestational-age windows: 24 + 0 to 27 + 6 weeks (W1); 28 + 0 to 31 + 6 weeks (W2); 32 + 0 to 35 + 6 weeks (W3) and ≥ 36 + 0 weeks (W4). Women with GDM were considered both as a single group and as subgroups stratified by treatment modality. Data were analyzed using a linear mixed model on each AS variable (log-transformed) with group, gestational-age window, maternal age, ethnicity, parity, body mass index, mean arterial pressure and heart rate as fixed effects and individual as a random effect. We compared the group means including relevant contrasts and adjusted the P-values using Bonferroni correction. RESULTS The study population comprised 155 low-risk controls and 127 women with GDM, of whom 59 were treated with dietary intervention, 47 were treated with metformin only and 21 were treated with metformin + insulin. The two-way interaction term of study group and gestational age was significant for BrAIx and AoAIx (P < 0.001), but there was no evidence that mean AoPWV was different between the study groups (P = 0.729). Women in the control group demonstrated significantly lower BrAIx and AoAIx compared with the combined GDM group at W1-W3, but not at W4. The mean difference in log-transformed BrAIx was -0.37 (95% CI, -0.52 to -0.22), -0.23 (95% CI, -0.35 to -0.12) and -0.29 (95% CI, -0.40 to -0.18) at W1, W2 and W3, respectively. The mean difference in log-transformed AoAIx was -0.49 (95% CI, -0.69 to -0.30), -0.32 (95% CI, -0.47 to -0.18) and -0.38 (95% CI -0.52 to -0.24) at W1, W2 and W3, respectively. Similarly, women in the control group also demonstrated significantly lower BrAIx and AoAIx compared with each of the GDM treatment subgroups (diet, metformin only and metformin + insulin) at W1-W3. The increase in mean BrAIx and AoAIx seen between W2 and W3 in women with GDM treated with dietary management was attenuated in the metformin-only and metformin + insulin groups. However, the mean differences in BrAIx and AoAIx between these treatment groups were not statistically significant at any gestational-age window. CONCLUSIONS Pregnancies complicated by GDM demonstrate significantly higher AS compared with low-risk pregnancies regardless of treatment modality. Our data provide the basis for further investigation into the association of metformin therapy with changes in AS and risk of placenta-mediated diseases. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A R Anness
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- University of Leicester, Leicester, UK
| | - M Nath
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M W Osman
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D Webb
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - T Robinson
- College of Life Sciences, University of Leicester, Leicester, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - H A Mousa
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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Schott A, Kluttig A, Mikolajczyk R, Greiser KH, Werdan K, Sedding D, Nuding S. Association of arterial stiffness and heart failure with preserved ejection fraction in the elderly population - results from the CARLA study. J Hum Hypertens 2022:10.1038/s41371-022-00703-y. [PMID: 35581324 DOI: 10.1038/s41371-022-00703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022]
Abstract
Arterial stiffness has been suspected as a cause of left ventricular diastolic dysfunction and may thereby contribute to the development of heart failure with preserved ejection fraction (HFpEF). However, this association is derived from a small number of studies and application of outdated criteria to diagnose HFpEF. This study aimed to investigate the association of arterial stiffness measured by the augmentation index (AIx) and criteria for diagnosing HFpEF according to the recommended HFA-PEFF score. Our analysis based on data from the first follow-up of the CARdiovascular Disease, Living and Ageing in Halle study. The current analysis included participants with available information about comorbidities and risk factors for HFpEF, parameters for calculation of the HFA-PEFF and noninvasive AIx estimated by applanation tonometry. The association of AIx and HFA-PEFF was investigated through descriptive and inductive statistics. A total of 767 participants were included in the analysis. AIx was associated with E/e', left ventricular wall thickness (LVWT), relative wall thickness, left ventricular mass index (LVMI) and NT-proBNP but not with e' or left atrial volume index. However, after adjustment for confounders, only LVMI and LVWT remained associated with AIx. Males with a high AIx had a 3.2-fold higher likelihood of HFpEF than those with a low AIx. In contrast, that association was not present in females. In summary, AIx is associated with the morphological domain of the HFA-PEFF score represented by LVMI and LVWT. Higher values of AIx are associated with a higher likelihood for HFpEF in elderly males but not in females.
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Affiliation(s)
- Artjom Schott
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany.
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Karl Werdan
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Sebastian Nuding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
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George C, Matsha TE, Davidson FE, Goedecke JH, Erasmus RT, Kengne AP. Chronic Kidney Disease Modifies The Relationship Between Body Fat Distribution and Blood Pressure: A Cross-Sectional Analysis. Int J Nephrol Renovasc Dis 2020; 13:107-118. [PMID: 32494185 PMCID: PMC7231753 DOI: 10.2147/ijnrd.s247907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Measures of adiposity are related to cardiovascular disease risk, but this relationship is inconsistent in disease states, such as chronic kidney disease (CKD). This study investigated the relationship between adiposity and blood pressure (BP) by CKD status. Materials and Methods South Africans of mixed-ancestry (n=1,621) were included. Estimated glomerular filtration rate (eGFR) was based on the modification of diet in renal disease (MDRD) equation, and CKD defined as eGFR <60mL/min/1.73m2. Body fat distribution was assessed using anthropometry [body mass index (BMI) and waist circumference (WC)] and dual-energy x-ray absorptiometry (DXA) (n=152). Pulse pressure (PP) and mean arterial pressure (MAP) were calculated from systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results In participants without CKD, anthropometric and DXA-derived measures positively correlated with SBP, DBP, MAP and PP (p<0.02 for all), except for leg fat mass (LFM), which was not associated with BP indices (p>0.100 for all). Contrary, in prevalent CKD (6%, n=96), only BMI was inversely associated with PP (p=0.0349). In multivariable analysis, only BMI and WC remained independently associated with SBP, DBP and MAP in the overall sample. Notably, the association between BMI, WC and LFM with SBP and PP, differed by CKD status (interaction: p<0.100 for all), such that only BMI and WC were associated with SBP in those without CKD and inversely associated with PP in those with CKD. LFM was inversely associated with SBP and PP in those with CKD. Conclusion In people without CKD, BP generally increases with increasing measures of adiposity. However, excess body fat has a seemingly protective or neutral effect on BP in people with CKD.
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Affiliation(s)
- Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tandi E Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Florence E Davidson
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa.,Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Julia H Goedecke
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Badhwar S, Chandran DS, Jaryal AK, Narang R, Deepak KK. Regional arterial stiffness in central and peripheral arteries is differentially related to endothelial dysfunction assessed by brachial flow-mediated dilation in metabolic syndrome. Diab Vasc Dis Res 2018; 15:106-113. [PMID: 29283006 DOI: 10.1177/1479164117748840] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The interrelationship between endothelial function and arterial stiffness may be different for central and peripheral arteries due to their structural and functional differences. The study aims to assess the interrelationship between central and peripheral vascular function and haemodynamics in metabolic syndrome. Thirty-seven patients [63.0 (57.5-66.0) years, 68.4% males] of metabolic syndrome (National Cholesterol Education Program - Adult Treatment Panel-III criteria) were studied. Carotid-femoral, carotid-radial pulse wave velocity and augmentation index (AIx@75) were assessed using applanation tonometry. Endothelial function was evaluated by brachial flow-mediated dilation using B-mode ultrasonography. Central and peripheral pressures were measured by radial tonometry and sphygmomanometer, respectively. Carotid-radial pulse wave velocity correlated significantly with peripheral diastolic blood pressure ( r = 0.33, p = 0.04) and inversely with flow-mediated dilation ( r = -0.61, p = 0.0001). AIx@75 correlated significantly with carotid-femoral pulse wave velocity ( r = 0.35, p = 0.03) and with aortic pulse pressure ( r = 0.43, p = 0.01). In principal component analysis, an inverse relationship was observed between flow-mediated dilation and carotid-radial pulse wave velocity but not with carotid-femoral pulse wave velocity. Regional arterial stiffness assessed by pulse wave velocity in central-elastic and peripheral-muscular arteries differentially relates to endothelial dysfunction. The central arteries might be predominantly influenced by endothelial dysfunction-induced structural changes, while the peripheral arteries are majorly affected by functional alterations.
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Affiliation(s)
- Smriti Badhwar
- 1 Autonomic and Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dinu S Chandran
- 1 Autonomic and Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- 1 Autonomic and Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Narang
- 2 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore Kumar Deepak
- 1 Autonomic and Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Fu YS, Wang JH, Lee CJ, Hsu BG. Positive correlation of the serum angiopoietin-like protein 3 levels with the aortic augmentation index in patients with coronary artery disease. Ther Clin Risk Manag 2018; 14:231-236. [PMID: 29440908 PMCID: PMC5804136 DOI: 10.2147/tcrm.s150476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Angiopoietin-like protein 3 (ANGPTL3) plays an important role in lipid metabolism and angiogenesis and is elevated in familial hypercholesterolemia, metabolic syndrome, and insulin resistance. This study aims to evaluate the relationship between the fasting serum ANGPTL3 levels and the aortic augmentation index (AIx) in patients with coronary artery disease (CAD). Materials and methods Fasting blood samples were obtained from 100 patients with CAD. The AIx was measured using a validated tonometry system (SphygmoCor). The serum ANGPTL3 levels were assessed using a commercial enzyme-linked immunosorbent assay kit. Results The aortic AIx values were higher in female patients with CAD (P=0.003) than those in male patients with CAD. The univariate linear analysis of the aortic AIx values reveals that the height (r=−0.363; P<0.001) and body weight (r=−0.350; P<0.001) were negatively correlated, whereas the age (r=0.202; P=0.044) and logarithmically transformed ANGPTL3 (log-ANGPTL3, r=0.357; P<0.001) were positively correlated with the aortic AIx values in patients with CAD. The multivariate forward stepwise linear regression analysis of the factors significantly associated with the aortic AIx revealed that the height (β=−0.269; adjusted R2 change=0.123; P=0.007) and serum log-ANGPTL3 level (β=0.259; adjusted R2 change=0.051; P=0.010) were independent predictors of the aortic AIx values in patients with CAD. Conclusion The fasting serum ANGPTL3 level positively correlated with the aortic AIx values among patients with CAD.
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Affiliation(s)
- Yu-Shan Fu
- School of Medicine, Tzu Chi University, Hualien
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien.,Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien.,Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Momin M, Li JP, Zhang Y, Fan FF, Xu XP, Xu X, Wang BY, Yang WB, Xie LL, Huo Y. Body mass index is inversely associated with arterial stiffness in Chinese adults with primary hypertension: results from the China Stroke Primary Prevention Trial (CSPPT). Clin Exp Hypertens 2017; 39:394-401. [PMID: 28534657 DOI: 10.1080/10641963.2016.1254226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study aimed to elucidate the relationship between body mass index (BMI) and the presence of arterial stiffness in rural-dwelling Chinese adults with primary hypertension. METHODS Primary hypertension patients (n = 19,375) receiving an average of 4.5 years of antihypertension therapy were selected from the Chinese Stroke Primary Prevention Trial (mean age: 64.7 ± 7.4 years, male: 37.8%). Anthropometric, demographic, hemodynamic, and biochemical data were obtained. Arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV). RESULTS BMI was inversely associated with baPWV after adjusting for gender, age, smoking, alcohol consumption, center, pulse, SBP, DBP, FBG, TC, TG, HDL-C, BUN, Scr, UA, HCY, antidiabetes treatment, lipid-lowing treatment, and antihypertensive treatment (β (SE): -10.72 (0.69), P < 0.0001). Quintile1 (Q1) was used as a reference; Q2, Q3, Q4, and Q5 groups were all inversely associated with baPWV. The β increased with increasing BMI, β (SE) was -20.29 (6.74), -30.66 (7.01), -51.82 (7.27), and -103.1 (7.62), respectively, for Q2 - Q5, P < 0.05. BMI remained inversely correlated with baPWV across differences in gender, center, blood pressure, lipid levels, and the presence or absence of diabetes subgroups. CONCLUSION Increased BMI is a positive factor against the development of arterial stiffness in Chinese rural-dwelling adults with primary hypertension undergoing antihypertension treatments, after adjusting for confounding factors.
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Affiliation(s)
- Mohetaboer Momin
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Jian-Ping Li
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Yan Zhang
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Fang-Fang Fan
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Xi-Ping Xu
- b National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Xin Xu
- b National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Bin-Yan Wang
- b National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Wen-Bin Yang
- c Institute for Biomedicine , Anhui Medical University , Hefei , China
| | - Li-Ling Xie
- c Institute for Biomedicine , Anhui Medical University , Hefei , China
| | - Yong Huo
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
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