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Traylor MK, Batman GB, Sears KN, Ransom KV, Hammer SM, Keller JL. Sex-specific microvascular and hemodynamic responses to passive limb heating in young adults. Microcirculation 2024; 31:e12848. [PMID: 38281244 DOI: 10.1111/micc.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE We examined sex-specific microvascular reactivity and hemodynamic responses under conditions of augmented resting blood flow induced by passive heating compared to normal blood flow. METHODS Thirty-eight adults (19 females) completed a vascular occlusion test (VOT) on two occasions preceded by rest with or without passive heating in a randomized, counterbalanced order. Skeletal muscle tissue oxygenation (StO2, %) was assessed with near-infrared spectroscopy (NIRS), and the rate of desaturation and resaturation as well as maximal StO2 (StO2max) and prolonged hypersaturation (area under the curve, StO2AUC) were quantified. Before the VOT, brachial artery blood flow (BABF), vascular conductance, and relative BABF (BABF normalized to forearm lean mass) were determined. Sex × condition ANOVAs were used. A p-value ≤.05 was considered statistically significant. RESULTS Twenty minutes of heating increased BABF compared to the control (102.9 ± 28.3 vs. 36.0 ± 20.9 mL min-1; p < .01). Males demonstrated greater BABF than females (91.9 ± 34.0 vs. 47.0 ± 19.1 mL min-1; p < .01). There was no sex difference in normalized BABF. There were no significant interactions for NIRS-VOT outcomes, but heat did increase the rate of desaturation (-0.140 ± 0.02 vs. -0.119 ± 0.03% s-1; p < .01), whereas regardless of condition, males exhibited greater rates of resaturation and StO2max than females. CONCLUSIONS These results suggest that blood flow is not the primary factor causing sex differences in NIRS-VOT outcomes.
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Affiliation(s)
- Miranda K Traylor
- Integrative Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, USA
| | - Genevieve B Batman
- Integrative Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, USA
| | - Kylie N Sears
- School of Kinesiology, Applied Health and Recreation, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Kyndall V Ransom
- Integrative Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, USA
- Chemistry Department, College of Arts and Science, University of South Alabama, Mobile, Alabama, USA
| | - Shane M Hammer
- School of Kinesiology, Applied Health and Recreation, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Joshua L Keller
- Integrative Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, USA
- Department of Physiology & Cell Biology, College of Medicine, University of South Alabama, Mobile, Alabama, USA
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Ferreira-Santos L, Martinez-Lemus LA, Padilla J. Sitting leg vasculopathy: potential adaptations beyond the endothelium. Am J Physiol Heart Circ Physiol 2024; 326:H760-H771. [PMID: 38241008 PMCID: PMC11221807 DOI: 10.1152/ajpheart.00489.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 02/29/2024]
Abstract
Increased sitting time, the most common form of sedentary behavior, is an independent risk factor for all-cause and cardiovascular disease mortality; however, the mechanisms linking sitting to cardiovascular risk remain largely elusive. Studies over the last decade have led to the concept that excessive time spent in the sitting position and the ensuing reduction in leg blood flow-induced shear stress cause endothelial dysfunction. This conclusion has been mainly supported by studies using flow-mediated dilation in the lower extremities as the measured outcome. In this review, we summarize evidence from classic studies and more recent ones that collectively support the notion that prolonged sitting-induced leg vascular dysfunction is likely also attributable to changes occurring in vascular smooth muscle cells (VSMCs). Indeed, we provide evidence that prolonged constriction of resistance arteries can lead to modifications in the structural characteristics of the vascular wall, including polymerization of actin filaments in VSMCs and inward remodeling, and that these changes manifest in a time frame that is consistent with the vascular changes observed with prolonged sitting. We expect this review will stimulate future studies with a focus on VSMC cytoskeletal remodeling as a potential target to prevent the detrimental vascular ramifications of too much sitting.
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Affiliation(s)
| | - Luis A Martinez-Lemus
- NextGen Precision Health, University of Missouri, Columbia, Missouri, United States
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri, United States
- Center for Precision Medicine, Department of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Jaume Padilla
- NextGen Precision Health, University of Missouri, Columbia, Missouri, United States
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, United States
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Arabi SM, Bahari H, Chambari M, Bahrami LS, Mohaildeen Gubari MI, Watts GF, Sahebkar A. Omega-3 fatty acids and endothelial function: A GRADE-assessed systematic review and meta-analysis. Eur J Clin Invest 2024; 54:e14109. [PMID: 37859571 DOI: 10.1111/eci.14109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION N-3 polyunsaturated fatty acids (PUFAs) supplementation has been reported to have an impact on flow-mediated dilatation (FMD), a conventionally used clinical technique for estimating endothelial dysfunction. However, its proven effects on endothelial function are unclear. This systematic review and meta-analysis were conducted to evaluate the effects of n-3 PUFAs supplementation on FMD of the brachial artery. METHOD This study was performed following the PRISMA guidelines. To identify eligible RCTs, a systematic search was completed in PubMed/Medline, Scopus and Web of Science using relevant keywords. A fixed- or random-effects model was utilized to estimate the weighted mean difference (WMD) and 95% confidence interval (95% CI). RESULTS Thirty-two studies (with 35 arms) were included in this meta-analysis, involving 2385 subjects with intervention duration ranging from 4 to 48 weeks. The pooled meta-analysis demonstrated a significant effect of omega-3 on FMD (WMD = 0.8%, 95% CI = 0.3-1.3, p = .001) and heterogeneity was significant (I2 = 82.5%, p < .001). CONCLUSION We found that n-3 PUFA supplementation improves endothelial function as estimated by flow-mediated dilatation of the brachial artery.
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Affiliation(s)
- Seyyed Mostafa Arabi
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hossein Bahari
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Chambari
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Leila Sadat Bahrami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Gerald F Watts
- Cardiometabolic Service, Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Western Australia, Perth, Australia
- School of Medicine, University of Western Australia, Western Australia, Perth, Australia
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Chatlaong MA, Stanford DM, Miller WM, Davidson CJ, Jessee MB. Post-occlusive reactive hyperemia in habituated caffeine users: Effects of abstaining versus consuming typical doses. Clin Hemorheol Microcirc 2024; 87:101-113. [PMID: 38250766 DOI: 10.3233/ch-232036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Post-occlusive reactive hyperemia (PORH) typically requires caffeine abstinence. For habitual users, it is unknown if abstinence affects PORH. OBJECTIVE Compare PORH after habitual users consume or abstain from caffeine. METHODS On separate visits (within-subject), PORH was measured in 30 participants without abstinence from typical caffeine doses (CAFF) and with abstinence (ABS). Measurements included baseline and peak hyperemic velocity, tissue saturation index slopes during ischemia (Slope 1) and following cuff deflation (Slope 2), resting arterial occlusion pressure (AOP), heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure. All variables were compared using Bayesian paired t-tests. BF10 = likelihood of alternative vs null. Results are mean±SD. RESULTS Comparing baseline velocity (cm/s) between CAFF (9.3±4.8) and ABS (7.5±4.9) yielded anecdotal evidence (BF10 = 1.0). Peak hyperemic velocity (cm/s) was similar (CAFF = 77.3±16.7; ABS = 77.6±19.0, BF10 = 0.20). For slopes (TSI% /s), CAFF Slope 1 = -0.11±0.04 and Slope 2 = 1.9±0.46 were similar (both BF10≤0.20) to ABS Slope 1 = -0.12±0.03 and Slope 2 = 1.8±0.42. SBP and DBP (mmHg) were both similar (CAFF SBP = 116.0±9.8, DBP = 69.6±5.8; ABS SBP = 115.5±10.7, DBP = 69.5±5.4; both BF10≤0.22). Comparing AOP (mmHg) (CAFF = 146.6±15.0; ABS = 143.0±16.4) yielded anecdotal evidence (BF10 = 0.46). HR (bpm) was similar (CAFF = 66.5±12.3; ABS = 66.9±13.0; BF10 = 0.20). CONCLUSIONS In habitual users, consuming or abstaining from typical caffeine doses does not appear to affect post-occlusive reactive hyperemia.
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Affiliation(s)
- Matthew A Chatlaong
- Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, University of Mississippi, Oxford, MS, USA
| | - Daphney M Stanford
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, USA
| | - William M Miller
- University of Evansville, School of Health Sciences, Evansville, IN, USA
| | - Chance J Davidson
- Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, University of Mississippi, Oxford, MS, USA
| | - Matthew B Jessee
- Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, University of Mississippi, Oxford, MS, USA
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Valensi P, Barber-Chamoux N, Rezki A, Lambert C, Pereira B, Dualé C, Delmas D, Duclos M. Effects of single and multiple sessions of lower body diastole-synchronized compressions using a pulsating pneumatic suit on endothelium function and metabolic parameters in patients with type 2 diabetes: two controlled cross-over studies. Cardiovasc Diabetol 2022; 21:286. [PMID: 36550568 PMCID: PMC9784294 DOI: 10.1186/s12933-022-01710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endothelium function is often impaired in patients with type 2 diabetes. We hypothesized that by improving endothelial function using diastole-synchronized compressions/decompressions (DSCD) to the lower body may improve the metabolic profile. The objective of this research was to evaluate the effects of single and multiple DSCD sessions on microcirculation, endothelium function and metabolic parameters of patients with type 2 diabetes. METHODS Two monocentric, controlled, randomized cross-over studies (Study 1 and Study 2) were performed. In Study 1, 16 patients received one 20 min DSCD and one simulated (control) session at 2 week intervals; continuous glucose monitoring and cutaneous blood flow were recorded continuously before, during and after DSCD or Control session; other vascular assessments were performed before and after DSCD and control sessions. In Study 2, 38 patients received 60 min DSCD sessions three times/week for three months followed by a 4-6 week washout and 3 month control period (without simulated sessions); vascular, metabolic, body composition, physical activity and quality of life assessments were performed before and after 3 months. RESULTS Both studies showed significant, multiplex effects of DSCD sessions. In Study 1, cutaneous blood flow and endothelium function increased, and plasma and interstitial glucose levels after a standard breakfast decreased after DSCD sessions. In Study 2, cutaneous endothelium function improved, LDL-cholesterol and non-HDL cholesterol decreased, extra-cell water decreased and SF-36 Vitality score increased after 3 months of DSCD sessions. CONCLUSIONS Our findings support the beneficial effect of DSCD on the endothelium and show concomitant beneficial metabolic and vitality effects. Future clinical trials need to test whether DSCD use translates into a preventive measure against microvascular diabetic complications and its progression. Trial registration ClinicalTrials.gov identifiers: NCT02293135 and NCT02359461.
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Affiliation(s)
- Paul Valensi
- grid.414153.60000 0000 8897 490XPresent Address: Endocrinology, Diabetology and Nutrition Unit, AP-HP, Jean Verdier Hospital, Sorbonne Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - Nicolas Barber-Chamoux
- grid.411163.00000 0004 0639 4151Department of Cardiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Amel Rezki
- grid.414153.60000 0000 8897 490XPresent Address: Endocrinology, Diabetology and Nutrition Unit, AP-HP, Jean Verdier Hospital, Sorbonne Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - Céline Lambert
- grid.411163.00000 0004 0639 4151Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- grid.411163.00000 0004 0639 4151Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Christian Dualé
- grid.411163.00000 0004 0639 4151Clinical Investigation Center (INSERM CIC1405), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Martine Duclos
- grid.494717.80000000115480420Department of Sports Medicine and Functional Explorations, CHU Clermont-Ferrand, INRAE, UNH, CRNH Auvergne, Clermont Auvergne University, Clermont-Ferrand, France
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Thakkar AB, Ma Y, Dela Cruz M, Wu Y, Arechiga V, Swaminathan S, Ganz P, Wu AHB, Scherzer R, Deeks S, Hsue PY. Effect of HIV-1 Infection on Angiopoietin 1 and 2 Levels and Measures of Microvascular and Macrovascular Endothelial Dysfunction. J Am Heart Assoc 2021; 10:e021397. [PMID: 34726064 PMCID: PMC8751943 DOI: 10.1161/jaha.121.021397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Individuals infected with HIV have an increased risk of developing cardiovascular disease; yet, the underlying mechanisms remain unknown. Recent evidence has implicated the Tie-2 tyrosine kinase receptor system and its associated ligands ANG1 (angiopoietin 1) and ANG2 (angiopoietin 2) in maintaining vascular homeostasis. In the general population, lower ANG1 levels and higher ANG2 levels are strongly correlated with the development of cardiovascular disease. In this study, we aim to investigate the associations of HIV infection with angiopoietin levels and endothelial dysfunction. Methods and Results In this cross-sectional study, we compared measures of ANG1, ANG2, and endothelial dysfunction using flow-mediated vasodilation of the brachial artery in 39 untreated subjects infected with HIV, 47 treated subjects infected with HIV, and 46 uninfected subjects from the SCOPE (Observational Study of the Consequences of the Protease Inhibitor Era) cohort. Compared with uninfected controls, treated individuals infected with HIV had 53.1% lower mean ANG1 levels (P<0.01) and similar ANG2 levels. On the other hand, untreated individuals infected with HIV had similar ANG1 levels, and 29.2% had higher ANG2 levels (P<0.01) compared with uninfected controls. When compared with individuals with untreated HIV infection, those with treated HIV infection had 56% lower ANG1 levels (P<0.01) and 22% lower ANG2 levels (P<0.01).Both treated and untreated HIV infection were associated with significant impairment in hyperemic velocity, a key measure of microvascular dysfunction (median 61 versus 72 cm/s, P<0.01), compared with uninfected controls (median 73 cm/s). This difference persisted after adjustment for ANG1 and ANG2 levels. Interestingly, when compared with untreated individuals infected with HIV, treated individuals infected with HIV had worse hyperemic velocity (-12.35 cm/s, P=0.05). In contrast, HIV status, ANG1 levels, and ANG2 levels were not associated with macrovascular dysfunction as measured by flow-mediated dilatation and brachial artery diameter, 2 other measures of vascular homeostasis. Conclusions HIV infection affects the balance between levels of ANG1 and ANG2 and may disturb endothelial homeostasis through disruption of vascular homeostasis. Individuals with treated HIV had decreased ANG1 levels and similar ANG2 levels, whereas individuals with untreated HIV had similar ANG1 levels and increased ANG2 levels, suggesting that treatment status may alter the balance between ANG1 and ANG2. HIV also promotes endothelial dysfunction via impairment of microvascular dysfunction, independent of the Tie-2 receptor system; the finding of worse microvascular dysfunction in the setting of treated HIV infection may reflect the impact of viral persistence on the microvasculature or toxicities of specific antiretroviral regimens. Further research to clarify the mechanism of HIV-mediated endothelial dysfunction is necessary to advance treatment of cardiovascular complications of HIV infection.
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Affiliation(s)
- Anjali B Thakkar
- Division of Cardiology Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
| | - Yifei Ma
- Division of Cardiology Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
| | - Mark Dela Cruz
- Section of Cardiology Department of Medicine University of Chicago Medical Center Chicago IL
| | - Yuaner Wu
- Division of Cardiology Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
| | - Victor Arechiga
- Division of Cardiology Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
| | - Shreya Swaminathan
- Division of Cardiology Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
| | - Peter Ganz
- Division of Cardiology Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
| | - Alan H B Wu
- Division of Clinical Chemistry Department of Laboratory Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
| | - Rebecca Scherzer
- San Francisco Veteran's Affairs Medical Center San Francisco CA.,Department of Medicine University of California San Francisco CA
| | - Steven Deeks
- Positive Health Program Zuckerberg San Francisco General HospitalUniversity of California San Francisco CA
| | - Priscilla Y Hsue
- Division of Cardiology Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco San Francisco CA
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D'Agata MN, Hoopes EK, Berube FR, Hirt AE, Witman MA. Young black women demonstrate impaired microvascular but preserved macrovascular function compared to white women. Exp Physiol 2021; 106:2031-2037. [PMID: 34184350 DOI: 10.1113/ep089702] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/23/2021] [Indexed: 01/01/2023]
Abstract
NEW FINDINGS What is the central question of this study? Is there a racial disparity in macrovascular and/or microvascular function between young black and white women? What is the main finding and its importance? Black women (BLW) demonstrated impaired microvascular function but similar macrovascular function compared to white women (WHW). These findings suggest an identifiable racial disparity in microvascular function between BLW and WHW as early as young adulthood. Microvascular dysfunction is predictive of future cardiovascular disease (CVD) and generally precedes the development of macrovascular dysfunction. Therefore, these findings also suggest that evaluating microvascular function and CVD risk in young, otherwise healthy BLW are important, as there are known racial disparities in CVD morbidity and mortality in black adults. ABSTRACT Black women (BLW) have a higher incidence of cardiovascular disease (CVD) morbidity and mortality compared to white women (WHW). Vascular dysfunction is a non-traditional risk factor for CVD and BLW demonstrate impaired vascular function when compared to WHW throughout the lifespan. Several previous studies assessed macrovascular and microvascular function in young BLW compared to WHW, but there has been no recent work exploring this disparity in young women using current, up-to-date methodologies. Therefore, the purpose of this study was to evaluate both macrovascular and microvascular function as assessed by haemodynamic responses to flow-mediated dilatation (FMD), following current FMD guidelines, in young adult BLW and WHW. We hypothesized that BLW would demonstrate attenuated macrovascular and microvascular responses to FMD compared to WHW. Macrovascular function was assessed as the percentage dilatation of the brachial artery following FMD occlusion-cuff release (FMD%). Microvascular function was assessed by total reactive hyperaemia area under the curve (RH-AUC), calculated as the cumulative increase in brachial artery blood flow above baseline following FMD occlusion-cuff release. Participants were tested in the morning hours during the early follicular phase of their menstrual cycle. Twenty-eight young, apparently healthy women completed the study: 17 WHW (23 ± 4 years) and 11 BLW (24 ± 5 years). FMD% was lower in BLW (WHW: 8.0 ± 1.6, BLW: 6.2 ± 2.4%; P = 0.02), but significance was abolished when FMD% was normalized for shear (WHW: 0.1230 ± 0.0388, BLW: 0.1132 ± 0.0405; P = 0.53). RH-AUC was lower in BLW (WHW: 438 ± 133, BLW: 268 ± 66 ml/min; P < 0.001). Young, otherwise healthy BLW demonstrated impaired microvascular function compared to WHW.
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Hoopes EK, Berube FR, D'Agata MN, Patterson F, Farquhar WB, Edwards DG, Witman MAH. Sleep duration regularity, but not sleep duration, is associated with microvascular function in college students. Sleep 2021; 44:5903410. [PMID: 32905591 DOI: 10.1093/sleep/zsaa175] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
STUDY OBJECTIVES Vascular dysfunction is a hypothesized mechanism linking poor sleep habits to an increased incidence of cardiovascular diseases (CVDs). However, the vascular profile associated with free-living sleep duration and sleep regularity has not been well elucidated, particularly in young adults. Thus, this study aimed to evaluate the associations between mean sleep duration, regularity in sleep duration, and peripheral vascular function in young adult college students. METHODS Fifty-one healthy undergraduate students (20 ± 1 years) completed 14 days of 24-hour wrist actigraphy and subsequent vascular assessments. Macrovascular function was measured using brachial artery flow-mediated dilation (FMD) while microvascular function was measured via passive leg movement (PLM). RESULTS Mean sleep duration was unrelated to FMD and PLM. Conversely, more irregular sleep duration (14-day sleep duration standard deviation [SD]) was unfavorably associated with all three measures of PLM-induced hyperemia (peak leg blood flow [LBF], p = 0.01; change in LBF from baseline to peak, p < 0.01; LBF area under the curve, p < 0.01), and remained significant in regression models which adjusted for sex, body mass index, blood pressure, physical activity, alcohol and caffeine consumption, and sleep duration (all p < 0.05). When using a median split to dichotomize "low" and "high" sleep duration SD groups, those demonstrating high variability in sleep duration exhibited ~45% lower PLM responses compared with those demonstrating low variability. CONCLUSIONS Irregular sleep duration is associated with poorer microvascular function as early as young adulthood. These findings support the growing body of evidence that irregular sleep patterns may be an independent and modifiable risk factor for CVD.
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Affiliation(s)
- Elissa K Hoopes
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE
| | - Felicia R Berube
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE
| | - Michele N D'Agata
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE
| | - Freda Patterson
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE
| | - Melissa A H Witman
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE
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9
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Kish B, Herr S, Yang HCS, Sun S, Shi R, Tong Y. Whole body measurements using near-infrared spectroscopy in a rat spinal cord contusion injury model. J Spinal Cord Med 2021; 46:508-520. [PMID: 33890843 PMCID: PMC10116927 DOI: 10.1080/10790268.2021.1911504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Spinal cord injuries cause great damage to the central nervous system as well as the peripheral vasculature. While treatments for spinal cord injury typically focus on the spine itself, improvements in the function of the peripheral vasculature after spinal cord injury have shown to improve overall neurological recovery. OBJECTIVE This study focused on the use of near-infrared spectroscopy (NIRS) as a mode to monitor cerebral and peripheral vascular condition non-invasively during the recovery process. DESIGN Animal research study. METHODS Rats underwent spinal contusion or sham injury and relative concentrations of de-/oxyhemoglobin (Δ[HbO]/Δ[Hb]) over time were measured over the cerebral, spinal, and pedal regions via NIRS. Correlational relationships across the body were determined. Rats received 1 NIRS measurement before injury and 3 after injury: 4, 7, and 14 days post. RESULTS Correlational relationships between signals across the body, between animals with and without spinal cord injury, indicate that NIRS was able to detect patterns of vascular change in the spine and the periphery occurring secondary to spinal cord injury and evolving during subsequent recovery. Additionally, NIRS determined an overall correlational decrease within the central nervous system, between spinal and cerebral measurements. CONCLUSION NIRS was able to closely reflect physiologic changes in the rat during recovery, demonstrating a promising method to monitor whole body hemodynamics after spinal cord injury.
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Affiliation(s)
- Brianna Kish
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Seth Herr
- Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Ho-Ching Shawn Yang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Siyuan Sun
- Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA.,Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Yunjie Tong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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Sposito AC, Breder I, Soares AAS, Kimura-Medorima ST, Munhoz DB, Cintra RMR, Bonilha I, Oliveira DC, Breder JC, Cavalcante P, Moreira C, Moura FA, de Lima-Junior JC, do Carmo HRP, Barreto J, Nadruz W, Carvalho LSF, Quinaglia T. Dapagliflozin effect on endothelial dysfunction in diabetic patients with atherosclerotic disease: a randomized active-controlled trial. Cardiovasc Diabetol 2021; 20:74. [PMID: 33771149 PMCID: PMC8004411 DOI: 10.1186/s12933-021-01264-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022] Open
Abstract
Background The glucose-lowering independent effect of sodium glucose cotransporter-2 inhibitors (SGLT2i) on arterial wall function has not yet been clarified. This study aims to assess whether SGLT2i treatment can attenuate endothelial dysfunction related to type 2 diabetes mellitus (T2D) compared with glucose-lowering equivalent therapy. Methods In a prospective, open-label, single-center, randomized clinical trial, 98 patients with T2DM and carotid intima-media thickness above the 75th percentile were randomized 1:1 to 12 weeks of therapy with dapagliflozin or glibenclamide in addition to metformin in glucose-lowering equivalent regimens. The coprimary endpoints were 1-min flow-mediated dilation (FMD) at rest and 1-min FMD after 15 min of ischemia followed by 15 min of reperfusion time (I/R). Results Ninety-seven patients (61% males, 57 ± 7 years) completed the study. The median HbA1c decreased by − 0.8 (0.7)% and -0.7 (0.95)% following dapagliflozin and glibenclamide, respectively. The first coprimary endpoint, i.e., rest FMD changed by + 3.3(8.2)% and − 1.2(7.5)% for the dapagliflozin and glibenclamide arms, respectively (p = 0.0001). Differences between study arms in the second coprimary endpoint were not significant. Plasma nitrite 1 min after rest FMD was higher for dapagliflozin [308(220) nmol/L] than for glibenclamide (258[110] nmol/L; p = 0.028). The resistive indices at 1 min [0.90 (0.11) vs. 0.93 (0.07); p = 0.03] and 5 min [0.93 (0.07) vs. 0.95 (0.05); p = 0.02] were higher for the glibenclamide group than for the dapagliflozin group. Plasma biomarkers for inflammation and oxidative stress did not differ between the treatments. Conclusions Dapagliflozin improved micro- and macrovascular endothelial function compared to glibenclamide, regardless of glycemic control in patients with T2DM and subclinical carotid atherosclerotic disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01264-z.
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Affiliation(s)
- Andrei C Sposito
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil.
| | - Ikaro Breder
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Alexandre A S Soares
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Sheila T Kimura-Medorima
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Daniel B Munhoz
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Riobaldo M R Cintra
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Isabella Bonilha
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Daniela C Oliveira
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Jessica Cunha Breder
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Pamela Cavalcante
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Camila Moreira
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Filipe A Moura
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Jose Carlos de Lima-Junior
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Helison R P do Carmo
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Joaquim Barreto
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Wilson Nadruz
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Luiz Sergio F Carvalho
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
| | - Thiago Quinaglia
- Aterosclerose and Vascular Biology Laboratory (Aterolab), Cardiology Division, State University of Campinas Medical School, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria Zeferino Vaz, Campinas, SP, 13084-971, Brazil
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11
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Stein JH, Kime N, Korcarz CE, Ribaudo H, Currier JS, Delaney JC. Effects of HIV Infection on Arterial Endothelial Function: Results From a Large Pooled Cohort Analysis. Arterioscler Thromb Vasc Biol 2021; 41:512-522. [PMID: 33327750 PMCID: PMC7770018 DOI: 10.1161/atvbaha.120.315435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the effects of HIV serostatus and disease severity on endothelial function in a large pooled cohort study of people living with HIV infection and HIV- controls. Approach and Results: We used participant-level data from 9 studies: 7 included people living with HIV (2 treatment-naïve) and 4 had HIV- controls. Brachial artery flow-mediated dilation (FMD) was measured using a standardized ultrasound imaging protocol with central reading. After data harmonization, multiple linear regression was used to examine the effects of HIV- serostatus, HIV disease severity measures, and cardiovascular disease risk factors on FMD. Of 2533 participants, 986 were people living with HIV (mean 44.4 [SD 11.8] years old) and 1547 were HIV- controls (42.9 [12.2] years old). The strongest and most consistent associates of FMD were brachial artery diameter, age, sex, and body mass index. The effect of HIV+ serostatus on FMD was strongly influenced by kidney function. In the highest tertile of creatinine (1.0 mg/dL), the effect of HIV+ serostatus was strong (β=-1.59% [95% CI, -2.58% to -0.60%], P=0.002), even after covariate adjustment (β=-1.36% [95% CI, -2.46% to -0.47%], P=0.003). In the lowest tertile (0.8 mg/dL), the effect of HIV+ serostatus was strong (β=-1.90% [95% CI, -2.58% to -1.21%], P<0.001), but disappeared after covariate adjustment. HIV RNA viremia, CD4+ T-cell count, and use of antiretroviral therapy were not meaningfully associated with FMD. CONCLUSIONS The significant effect of HIV+ serostatus on FMD suggests that people living with HIV are at increased cardiovascular disease risk, especially if they have kidney disease.
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Affiliation(s)
- James H. Stein
- University of Wisconsin School of Medicine and Public Health; Madison, WI
| | - Noah Kime
- University of Washington Collaborative Health Studies Coordinating Center, Seattle, WA
| | - Claudia E. Korcarz
- University of Wisconsin School of Medicine and Public Health; Madison, WI
| | | | - Judith S. Currier
- David Geffen School of Medicine at University of California -Los Angeles; Los Angeles, CA
| | - Joseph C. Delaney
- University of Washington Collaborative Health Studies Coordinating Center, Seattle, WA
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, MB
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12
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Alexander Y, Osto E, Schmidt-Trucksäss A, Shechter M, Trifunovic D, Duncker DJ, Aboyans V, Bäck M, Badimon L, Cosentino F, De Carlo M, Dorobantu M, Harrison DG, Guzik TJ, Hoefer I, Morris PD, Norata GD, Suades R, Taddei S, Vilahur G, Waltenberger J, Weber C, Wilkinson F, Bochaton-Piallat ML, Evans PC. Endothelial function in cardiovascular medicine: a consensus paper of the European Society of Cardiology Working Groups on Atherosclerosis and Vascular Biology, Aorta and Peripheral Vascular Diseases, Coronary Pathophysiology and Microcirculation, and Thrombosis. Cardiovasc Res 2021; 117:29-42. [PMID: 32282914 PMCID: PMC7797212 DOI: 10.1093/cvr/cvaa085] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/08/2020] [Accepted: 04/07/2020] [Indexed: 12/14/2022] Open
Abstract
Endothelial cells (ECs) are sentinels of cardiovascular health. Their function is reduced by the presence of cardiovascular risk factors, and is regained once pathological stimuli are removed. In this European Society for Cardiology Position Paper, we describe endothelial dysfunction as a spectrum of phenotypic states and advocate further studies to determine the role of EC subtypes in cardiovascular disease. We conclude that there is no single ideal method for measurement of endothelial function. Techniques to measure coronary epicardial and micro-vascular function are well established but they are invasive, time-consuming, and expensive. Flow-mediated dilatation (FMD) of the brachial arteries provides a non-invasive alternative but is technically challenging and requires extensive training and standardization. We, therefore, propose that a consensus methodology for FMD is universally adopted to minimize technical variation between studies, and that reference FMD values are established for different populations of healthy individuals and patient groups. Newer techniques to measure endothelial function that are relatively easy to perform, such as finger plethysmography and the retinal flicker test, have the potential for increased clinical use provided a consensus is achieved on the measurement protocol used. We recommend further clinical studies to establish reference values for these techniques and to assess their ability to improve cardiovascular risk stratification. We advocate future studies to determine whether integration of endothelial function measurements with patient-specific epigenetic data and other biomarkers can enhance the stratification of patients for differential diagnosis, disease progression, and responses to therapy.
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Affiliation(s)
- Yvonne Alexander
- Centre for Bioscience, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK
| | - Elena Osto
- Institute of Clinical Chemistry, University and University Hospital Zurich, University Heart Center, Zurich, Switzerland
- Laboratory of Translational Nutrition Biology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Michael Shechter
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danijela Trifunovic
- Cardiology Department, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Inserm U-1094, Limoges University, Limoges, France
| | - Magnus Bäck
- Department of Cardiology, Center for Molecular Medicine, Karolinska University Hospital, Solna, Stockholm, Sweden
- INSERM U1116, Université de Lorraine, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - Lina Badimon
- Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, CiberCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesco Cosentino
- Unit of Cardiology, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Marco De Carlo
- Catheterization Laboratory, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Maria Dorobantu
- ‘CarolDavila’ University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Medicine, Jagiellonian University Collegium Medicum, Cracow, Poland
| | - Imo Hoefer
- Laboratory of Clinical Chemistry and Hematology, University Medical Centre Utrecht, The Netherlands
| | - Paul D Morris
- Department of Infection, Immunity and Cardiovascular Disease, Bateson Centre & INSIGNEO Institute, University of Sheffield, Sheffield S10 2RX, UK
- Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - Giuseppe D Norata
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Rosa Suades
- Unit of Cardiology, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gemma Vilahur
- Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, CiberCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, Medical Faculty, University of Münster, Münster, Germany
- SRH Central Hospital Suhl, Suhl, Germany
| | - Christian Weber
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximillian-Universität (LMU) München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Fiona Wilkinson
- Centre for Bioscience, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK
| | | | - Paul C Evans
- Department of Infection, Immunity and Cardiovascular Disease, Bateson Centre & INSIGNEO Institute, University of Sheffield, Sheffield S10 2RX, UK
- Insigneo Institute for In Silico Medicine, Sheffield, UK
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13
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Grunewald ZI, Ramirez-Perez FI, Woodford ML, Morales-Quinones M, Mejia S, Manrique-Acevedo C, Siebenlist U, Martinez-Lemus LA, Chandrasekar B, Padilla J. TRAF3IP2 (TRAF3 Interacting Protein 2) Mediates Obesity-Associated Vascular Insulin Resistance and Dysfunction in Male Mice. Hypertension 2020; 76:1319-1329. [PMID: 32829657 DOI: 10.1161/hypertensionaha.120.15262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Insulin resistance in the vasculature is a characteristic feature of obesity and contributes to the pathogenesis of vascular dysfunction and disease. However, the molecular mechanisms underlying obesity-associated vascular insulin resistance and dysfunction remain poorly understood. We hypothesized that TRAF3IP2 (TRAF3 interacting protein 2), a proinflammatory adaptor molecule known to activate pathological stress pathways and implicated in cardiovascular diseases, plays a causal role in obesity-associated vascular insulin resistance and dysfunction. We tested this hypothesis by employing genetic-manipulation in endothelial cells in vitro, in isolated arteries ex vivo, and diet-induced obesity in a mouse model of TRAF3IP2 ablation in vivo. We show that ectopic expression of TRAF3IP2 blunts insulin signaling in endothelial cells and diminishes endothelium-dependent vasorelaxation in isolated aortic rings. Further, 16 weeks of high fat/high sucrose feeding impaired glucose tolerance, aortic insulin-induced vasorelaxation, and hindlimb postocclusive reactive hyperemia, while increasing blood pressure and arterial stiffness in wild-type male mice. Notably, TRAF3IP2 ablation protected mice from such high fat/high sucrose feeding-induced metabolic and vascular defects. Interestingly, wild-type female mice expressed markedly reduced levels of TRAF3IP2 mRNA independent of diet and were protected against high fat/high sucrose diet-induced vascular dysfunction. These data indicate that TRAF3IP2 plays a causal role in vascular insulin resistance and dysfunction. Specifically, the present findings highlight a sexual dimorphic role of TRAF3IP2 in vascular control and identify it as a promising therapeutic target in vasculometabolic derangements associated with obesity, particularly in males.
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Affiliation(s)
- Zachary I Grunewald
- From the Department of Nutrition and Exercise Physiology (Z.I.G., M.L.W., J.P.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia
| | - Francisco I Ramirez-Perez
- Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia.,Department of Biological Engineering (F.I.R.-P., L.A.M.-L.), University of Missouri, Columbia
| | - Makenzie L Woodford
- From the Department of Nutrition and Exercise Physiology (Z.I.G., M.L.W., J.P.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia
| | - Mariana Morales-Quinones
- Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia
| | - Salvador Mejia
- Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia
| | - Camila Manrique-Acevedo
- Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia.,Division of Endocrinology and Metabolism, Department of Medicine (C.M.-A.), University of Missouri, Columbia.,Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (C.M.-A., B.C.)
| | | | - Luis A Martinez-Lemus
- Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia.,Department of Biological Engineering (F.I.R.-P., L.A.M.-L.), University of Missouri, Columbia.,Department of Medical Pharmacology and Physiology (L.A.M.-L., B.C.), University of Missouri, Columbia
| | - Bysani Chandrasekar
- Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia.,Division of Cardiovascular Medicine, Department of Medicine (B.C.), University of Missouri, Columbia.,Department of Medical Pharmacology and Physiology (L.A.M.-L., B.C.), University of Missouri, Columbia.,Harry S. Truman Memorial Veterans' Hospital, Columbia, MO (C.M.-A., B.C.)
| | - Jaume Padilla
- From the Department of Nutrition and Exercise Physiology (Z.I.G., M.L.W., J.P.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (Z.I.G., F.I.R.-P., M.L.W., M.M.-Q., S.M., C.M.-A., L.A.M.-L., B.C., J.P.), University of Missouri, Columbia
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14
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Haptonstall KP, Choroomi Y, Moheimani R, Nguyen K, Tran E, Lakhani K, Ruedisueli I, Gornbein J, Middlekauff HR. Differential effects of tobacco cigarettes and electronic cigarettes on endothelial function in healthy young people. Am J Physiol Heart Circ Physiol 2020; 319:H547-H556. [PMID: 32734819 DOI: 10.1152/ajpheart.00307.2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tobacco cigarette (TC) smoking has never been lower in the United States, but electronic cigarette (EC) vaping has reached epidemic proportions among our youth. Endothelial dysfunction, as measured by flow-mediated vasodilation (FMD) is a predictor of future atherosclerosis and adverse cardiovascular events and is impaired in young TC smokers, but whether FMD is also reduced in young EC vapers is uncertain. The aim of this study in otherwise healthy young people was to compare the effects of acute and chronic tobacco cigarette (TC) smoking and electronic cigarette (EC) vaping on FMD. FMD was compared in 47 nonsmokers (NS), 49 chronic EC vapers, and 40 chronic TC smokers at baseline and then after EC vapers (n = 31) and nonsmokers (n = 47) acutely used an EC with nicotine (ECN), EC without nicotine (EC0), and nicotine inhaler (NI) at ~4-wk intervals and after TC smokers (n = 33) acutely smoked a TC, compared with sham control. Mean age (NS, 26.3 ± 5.2 vs. EC, 27.4 ± 5.45 vs. TC, 27.1 ± 5.51 yr, P = 0.53) was similar among the groups, but there were more female nonsmokers. Baseline FMD was not different among the groups (NS, 7.7 ± 4.5 vs. EC:6.6 ± 3.6 vs. TC, 7.9 ± 3.7%∆, P = 0.35), even when compared by group and sex. Acute TC smoking versus control impaired FMD (FMD pre-/postsmoking, -2.52 ± 0.92 vs. 0.65 ± 0.93%∆, P = 0.02). Although the increase in plasma nicotine was similar after EC vapers used the ECN versus TC smokers smoked the TC (5.75 ± 0.74 vs. 5.88 ± 0.69 ng/mL, P = 0.47), acute EC vaping did not impair FMD. In otherwise healthy young people who regularly smoke TCs or ECs, impaired FMD compared with that in nonsmokers was not present at baseline. However, FMD was significantly impaired after smoking one TC, but not after vaping an equivalent "dose" (estimated by change in plasma nicotine) of an EC, consistent with the notion that non-nicotine constituents in TC smoke mediate the impairment. Although it is reassuring that acute EC vaping did not acutely impair FMD, it would be dangerous and premature to conclude that ECs do not lead to atherosclerosis.NEW & NOTEWORTHY In our study of otherwise healthy young people, baseline flow-mediated dilation (FMD), a predictor of atherosclerosis and increased cardiovascular risk, was not different among tobacco cigarette (TC) smokers or electronic cigarette (EC) vapers who had refrained from smoking, compared with nonsmokers. However, acutely smoking one TC impaired FMD in smokers, whereas vaping a similar EC "dose" (as estimated by change in plasma nicotine levels) did not. Finally, although it is reassuring that acute EC vaping did not acutely impair FMD, it would be premature and dangerous to conclude that ECs do not lead to atherosclerosis or increase cardiovascular risk.
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Affiliation(s)
- Kacey P Haptonstall
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Yasmine Choroomi
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Roya Moheimani
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kevin Nguyen
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Elizabeth Tran
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Karishma Lakhani
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Isabella Ruedisueli
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Jeffrey Gornbein
- Departments of Medicine and Computational Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Holly R Middlekauff
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
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15
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Rosenberry R, Nelson MD. Reactive hyperemia: a review of methods, mechanisms, and considerations. Am J Physiol Regul Integr Comp Physiol 2020; 318:R605-R618. [PMID: 32022580 DOI: 10.1152/ajpregu.00339.2019] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Reactive hyperemia is a well-established technique for noninvasive assessment of peripheral microvascular function and a predictor of all-cause and cardiovascular morbidity and mortality. In its simplest form, reactive hyperemia represents the magnitude of limb reperfusion following a brief period of ischemia induced by arterial occlusion. Over the past two decades, investigators have employed a variety of methods, including brachial artery velocity by Doppler ultrasound, tissue reperfusion by near-infrared spectroscopy, limb distension by venous occlusion plethysmography, and peripheral artery tonometry, to measure reactive hyperemia. Regardless of the technique used to measure reactive hyperemia, blunted reactive hyperemia is believed to reflect impaired microvascular function. With the advent of several technological advancements, together with an increased interest in the microcirculation, reactive hyperemia is becoming more common as a research tool and is widely used across multiple disciplines. With this in mind, we sought to review the various methodologies commonly used to assess reactive hyperemia and current mechanistic pathways believed to contribute to reactive hyperemia and reflect on several methodological considerations.
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Affiliation(s)
- Ryan Rosenberry
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas.,Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
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Limberg JK, Casey DP, Trinity JD, Nicholson WT, Wray DW, Tschakovsky ME, Green DJ, Hellsten Y, Fadel PJ, Joyner MJ, Padilla J. Assessment of resistance vessel function in human skeletal muscle: guidelines for experimental design, Doppler ultrasound, and pharmacology. Am J Physiol Heart Circ Physiol 2019; 318:H301-H325. [PMID: 31886718 DOI: 10.1152/ajpheart.00649.2019] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The introduction of duplex Doppler ultrasound almost half a century ago signified a revolutionary advance in the ability to assess limb blood flow in humans. It is now widely used to assess blood flow under a variety of experimental conditions to study skeletal muscle resistance vessel function. Despite its pervasive adoption, there is substantial variability between studies in relation to experimental protocols, procedures for data analysis, and interpretation of findings. This guideline results from a collegial discussion among physiologists and pharmacologists, with the goal of providing general as well as specific recommendations regarding the conduct of human studies involving Doppler ultrasound-based measures of resistance vessel function in skeletal muscle. Indeed, the focus is on methods used to assess resistance vessel function and not upstream conduit artery function (i.e., macrovasculature), which has been expertly reviewed elsewhere. In particular, we address topics related to experimental design, data collection, and signal processing as well as review common procedures used to assess resistance vessel function, including postocclusive reactive hyperemia, passive limb movement, acute single limb exercise, and pharmacological interventions.
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Affiliation(s)
- Jacqueline K Limberg
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa.,François M. Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa.,Fraternal Order of Eagles Diabetes Research, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | | | - D Walter Wray
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Michael E Tschakovsky
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | | | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
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17
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Thijssen DHJ, Bruno RM, van Mil ACCM, Holder SM, Faita F, Greyling A, Zock PL, Taddei S, Deanfield JE, Luscher T, Green DJ, Ghiadoni L. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J 2019; 40:2534-2547. [DOI: 10.1093/eurheartj/ehz350] [Citation(s) in RCA: 338] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/13/2018] [Accepted: 05/24/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
Endothelial dysfunction is involved in the development of atherosclerosis, which precedes asymptomatic structural vascular alterations as well as clinical manifestations of cardiovascular disease (CVD). Endothelial function can be assessed non-invasively using the flow-mediated dilation (FMD) technique. Flow-mediated dilation represents an endothelium-dependent, largely nitric oxide (NO)-mediated dilatation of conduit arteries in response to an imposed increase in blood flow and shear stress. Flow-mediated dilation is affected by cardiovascular (CV) risk factors, relates to coronary artery endothelial function, and independently predicts CVD outcome. Accordingly, FMD is a tool for examining the pathophysiology of CVD and possibly identifying subjects at increased risk for future CV events. Moreover, it has merit in examining the acute and long-term impact of physiological and pharmacological interventions in humans. Despite concerns about its reproducibility, the available evidence shows that highly reliable FMD measurements can be achieved when specialized laboratories follow standardized protocols. For this purpose, updated expert consensus guidelines for the performance of FMD are presented, which are based on critical appraisal of novel technical approaches, development of analysis software, and studies exploring the physiological principles underlying the technique. Uniformity in FMD performance will (i) improve comparability between studies, (ii) contribute to construction of reference values, and (iii) offer an easy accessible and early marker of atherosclerosis that could complement clinical symptoms of structural arterial disease and facilitate early diagnosis and prediction of CVD outcomes.
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Affiliation(s)
- Dick H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy
| | - Anke C C M van Mil
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sophie M Holder
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy
| | - Arno Greyling
- Department Nutrition & Health, Unilever Vlaardingen, Vlaardingen, The Netherlands
| | - Peter L Zock
- Department Nutrition & Health, Unilever Vlaardingen, Vlaardingen, The Netherlands
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - John E Deanfield
- Institute of Cardiovascular Sciences, University College of London, 1 St Martin le Grand, London, UK
| | - Thomas Luscher
- Royal Brompton and Harefield Hospitals, London University Heart Center, Sydney Street, London, UK
| | - Daniel J Green
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, Perth, Australia
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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18
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Ayer A, Mills C, Donovan C, Christenson RH, Ganz P, Dubin RF. Associations of microvascular dysfunction with cardiovascular outcomes: The cardiac, endothelial function and arterial stiffness in ESRD (CERES) cohort. Hemodial Int 2019; 23:58-68. [DOI: 10.1111/hdi.12675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/08/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Amrita Ayer
- Division of Nephrology, San Francisco VA Medical CenterUniversity of California San Francisco California USA
| | - Claire Mills
- Division of Cardiology, Center for Vascular Excellence, Zuckerberg San Francisco General HospitalUniversity of California San Francisco California USA
| | - Catherine Donovan
- Division of Cardiology, Center for Vascular Excellence, Zuckerberg San Francisco General HospitalUniversity of California San Francisco California USA
| | - Robert H. Christenson
- Department of PathologyUniversity of Maryland School of Medicine Baltimore Maryland USA
| | - Peter Ganz
- Division of Cardiology, Center for Vascular Excellence, Zuckerberg San Francisco General HospitalUniversity of California San Francisco California USA
| | - Ruth F. Dubin
- Division of Nephrology, San Francisco VA Medical CenterUniversity of California San Francisco California USA
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19
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Vranish JR, Young BE, Stephens BY, Kaur J, Padilla J, Fadel PJ. Brief periods of inactivity reduce leg microvascular, but not macrovascular, function in healthy young men. Exp Physiol 2018; 103:1425-1434. [PMID: 30110509 DOI: 10.1113/ep086918] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
NEW FINDINGS What is the central question of this study? We aimed to examine leg vascular responses to brief periods of inactivity. What is the main finding and its importance? We demonstrate that a mere 10 min of sitting is sufficient to impair leg microvascular function (reactive hyperaemia). However, conduit artery vasodilatation (flow-mediated dilatation) was unaffected, indicating maintained macrovascular function. Interestingly, immobile supine rest also resulted in a reduction in microvascular function alone that was prevented when calf muscle contractions were performed. Collectively, these data highlight the susceptibility of the microcirculation to short periods of inactivity and the beneficial role of skeletal muscle contraction for vascular health. ABSTRACT Prolonged sitting for 1-6 h has been shown to impair leg macrovascular [i.e. reduced flow-mediated dilatation (FMD)] and microvascular (i.e. reduced reactive hyperaemia) function. These impairments appear to be mediated through reductions in shear stress. Interestingly, a reduction in shear rate has been observed as early as 10 min into sitting. However, it is unknown whether this acute reduction in shear stress is sufficient to affect vascular function. Accordingly, we studied 18 young men and assessed popliteal artery FMD and reactive hyperaemia before (Baseline) and after (PostSit) a 10 min sitting period. Popliteal artery shear rate was significantly reduced during sitting (Baseline, 62 ± 35 s-1 ; 10 min sitting, 27 ± 13 s-1 ; P < 0.001). Macrovascular function was unaffected by 10 min of sitting (Baseline, 4.4 ± 2.1%; PostSit, 4.3 ± 2.3%; P = 0.97), but microvascular function was reduced (Baseline, 4852 ± 2261 a.u.; PostSit, 3522 ± 1872 a.u.; P = 0.02). In a subset of individuals, we extended the recovery period after sitting and demonstrated that resting shear rate and reactive hyperaemia responses remained low up to 1 h post-sitting (P < 0.001), whereas FMD was unchanged throughout (P = 0.99). Additionally, time control experiments were performed with participants in an immobile supine position, which demonstrated no change in macrovascular function (P = 0.94) but, unexpectedly, a reduction in microvascular function (P = 0.008). Importantly, when calf muscle contractions were performed during supine rest, reactive hyperaemia responses were maintained (P = 0.76), along with FMD (P = 0.88). These findings suggest that the leg microcirculation might be more vulnerable to short periods of inactivity, whereas conduit artery vasodilatation appears well maintained. Moreover, intermittent skeletal muscle contractions are beneficial for microvascular function.
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Affiliation(s)
- Jennifer R Vranish
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Benjamin E Young
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Brandi Y Stephens
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Jasdeep Kaur
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA.,Department of Child Health, University of Missouri, Columbia, MO, USA
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
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20
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Maruhashi T, Iwamoto Y, Kajikawa M, Oda N, Kishimoto S, Matsui S, Hashimoto H, Aibara Y, Yusoff FM, Hidaka T, Kihara Y, Chayama K, Noma K, Nakashima A, Goto C, Hida E, Higashi Y. Interrelationships Among Flow-Mediated Vasodilation, Nitroglycerine-Induced Vasodilation, Baseline Brachial Artery Diameter, Hyperemic Shear Stress, and Cardiovascular Risk Factors. J Am Heart Assoc 2017; 7:e006797. [PMID: 29288158 PMCID: PMC5778958 DOI: 10.1161/jaha.117.006797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Flow-mediated vasodilation (FMD) of the brachial artery has been used for the assessment of endothelial function. Considering the mechanism underlying the vasodilatory response of the brachial artery to reactive hyperemia, hyperemic shear stress (HSS), a stimulus for FMD; nitroglycerine-induced vasodilation (NID), an index of endothelium-independent vasodilation; and baseline brachial artery diameter (BAD) are also involved in vasodilatory response. The purpose of this study was to investigate the interrelationships among FMD, HSS, NID, baseline BAD, and cardiovascular risk factors. METHODS AND RESULTS We measured FMD, HSS, NID, and baseline BAD simultaneously in 1033 participants (633 men and 400 women; mean age: 58.6±17.0 years). Framingham risk score was negatively correlated with FMD, HSS, and NID and was positively correlated with baseline BAD. HSS and NID were positively correlated with FMD, and baseline BAD was negatively correlated with FMD. In participants with normal NID, FMD was correlated with HSS, NID, and baseline BAD, all of which were independent variables of FMD in multivariate analysis. In participants with impaired NID, FMD was correlated with NID and baseline BAD, both of which were independent variables of FMD in multivariate analysis, but there was no association between FMD and HSS. CONCLUSIONS NID and baseline BAD were independent variables of FMD regardless of the status of endothelium-independent vasodilation, whereas there was a significant association between FMD and HSS in participants with normal NID but not in those with impaired NID. The influence of HSS on FMD seems to be dependent on the status of endothelium-independent vasodilation.
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Affiliation(s)
- Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yumiko Iwamoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masato Kajikawa
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nozomu Oda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kishimoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Matsui
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Haruki Hashimoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiki Aibara
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Farina Mohamad Yusoff
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kensuke Noma
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
- Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Ayumu Nakashima
- Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Chikara Goto
- Hirohsima International University, Hiroshima, Japan
| | - Eisuke Hida
- Department of Biostatistics and Data Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
- Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan
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21
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van der Heijden DJ, van Leeuwen MAH, Janssens GN, Lenzen MJ, van de Ven PM, Eringa EC, van Royen N. Body Mass Index Is Associated With Microvascular Endothelial Dysfunction in Patients With Treated Metabolic Risk Factors and Suspected Coronary Artery Disease. J Am Heart Assoc 2017; 6:e006082. [PMID: 28912211 PMCID: PMC5634274 DOI: 10.1161/jaha.117.006082] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity is key feature of the metabolic syndrome and is associated with high cardiovascular morbidity and mortality. Obesity is associated with macrovascular endothelial dysfunction, a determinant of outcome in patients with coronary artery disease. Here, we compared the influence of obesity on microvascular endothelial function to that of established cardiovascular risk factors such as diabetes mellitus, hypertension, hypercholesterolemia, and smoking in patients with suspected coronary artery disease. METHODS AND RESULTS Endothelial function was assessed during postocclusive reactive hyperemia of the brachial artery and downstream microvascular beds in 108 patients who were scheduled for coronary angiography. In all patients, microvascular vasodilation was assessed using peripheral arterial tonometry; laser Doppler flowmetry and digital thermal monitoring were performed. Body mass index was significantly associated with decreased endothelium-dependent vasodilatation measured with peripheral arterial tonometry (r=0.23, P=0.02), laser Doppler flowmetry (r=0.30, P<0.01), and digital thermal monitoring (r=0.30, P<0.01). In contrast, hypertension, hypercholesterolemia, and smoking had no influence on microvascular vasodilatation. Especially in diabetic patients, endothelial function was not significantly reduced (control versus diabetes mellitus, mean±SEM or median [interquartile range], peripheral arterial tonometry: 1.90±0.20 versus 1.67±0.20, P=0.19, laser Doppler flowmetry: 728% [interquartile range, 427-1110] versus 589% [interquartile range, 320-1067] P=0.28, and digital thermal monitoring: 6.6±1.0% versus 2.5±1.7%, P=0.08). In multivariate linear regression analysis, body mass index was the only risk factor that significantly attenuated endothelium-dependent vasodilatation using all 3 microvascular function tests. CONCLUSIONS Higher body mass index is associated with reduced endothelial function in patients with suspected coronary artery disease, even after adjustment for treated diabetes mellitus, hypertension, hypercholesterolemia, and smoking.
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Affiliation(s)
| | | | - Gladys N Janssens
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Etto C Eringa
- Department of Physiology, VU University Medical Center and Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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22
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Dysangco A, Liu Z, Stein JH, Dubé MP, Gupta SK. HIV infection, antiretroviral therapy, and measures of endothelial function, inflammation, metabolism, and oxidative stress. PLoS One 2017; 12:e0183511. [PMID: 28817706 PMCID: PMC5560712 DOI: 10.1371/journal.pone.0183511] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/05/2017] [Indexed: 11/19/2022] Open
Abstract
Background HIV-infected patients have an increased risk of cardiovascular disease (CVD). Impaired endothelial function is an early risk factor for CVD in the general population. It is presumed that HIV infection is associated with impaired endothelial function, but results have been inconsistent. Objectives Our objectives were to determine the relationships between HIV infection, virologic suppression with antiretroviral therapy (ART), in vivo measures of conduit artery and microvascular endothelial function, and circulating biomarkers of pathways associated with CVD. Methods We performed a cross-sectional analysis of three prospectively enrolled groups from a single center: 28 were HIV-infected and virologically-suppressed on a regimen of FTC/TDF/EFV (HIV+ART+), 44 were HIV-infected but not on ART (HIV+ART-), and 39 were HIV-uninfected healthy volunteers (HIV-) matched to the HIV+ART- group for age, sex, smoking status, and height. None had diabetes, uncontrolled hypertension, known CVD, or other pro-inflammatory condition. Flow mediated dilation (FMD), nitroglycerin-mediated dilation (NTGMD), reactive hyperemia velocity time integral (RHVTI), and FMD/RHVTI of the brachial artery were measured, as well as circulating biomarkers of systemic inflammation, metabolism, oxidative stress, and endothelial activation. Results No significant differences were found amongst the three groups in FMD (P = 0.46), NTGMD (P = 0.42), RHVTI (P = 0.17), and FMD/RHVTI (P = 0.22) in unadjusted comparisons. Adjusted ANOVA models which included brachial artery diameter, demographics, and conventional CVD risk factors did not appreciably change these findings. In pairwise comparisons, the HIV+ART- group had significantly higher soluble tumor necrosis factor receptor II, soluble CD163, β-2 microglobulin, interferon-γ- induced protein-10, tissue inhibitor of metalloproteinase-1, and vascular cell adhesion molecule-1 compared to the other two groups (all p<0.05). Correlates of endothelial function differed between study groups. Conclusion Although untreated HIV infection was associated with elevated levels of several biomarkers of inflammation and endothelial activation, we were unable to demonstrate differences in measures of conduit artery and microvascular endothelial function in this study population.
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Affiliation(s)
- Andrew Dysangco
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Ziyue Liu
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, Indiana, United States of America
| | - James H. Stein
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Michael P. Dubé
- Division of Infectious Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Samir K. Gupta
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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23
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Sun H, Yang M, Fung M, Chan S, Jawi M, Anderson T, Poon MC, Jackson S. Adult males with haemophilia have a different macrovascular and microvascular endothelial function profile compared with healthy controls. Haemophilia 2017. [DOI: 10.1111/hae.13278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. Sun
- Division of Hematology; Department of Medicine; University of British Columbia; Vancouver Canada
- British Columbia Provincial Bleeding Disorders Program-Adult Division; Vancouver Canada
| | - M. Yang
- British Columbia Provincial Bleeding Disorders Program-Adult Division; Vancouver Canada
| | - M. Fung
- Department of Medicine; University of Calgary; Calgary Canada
| | - S. Chan
- Division of Cardiology; Department of Medicine; University of British Columbia; Vancouver Canada
| | - M. Jawi
- Healthy Heart Program; St. Paul's Hospital; University of British Columbia; Vancouver Canada
| | - T. Anderson
- Department of Cardiac Sciences and the Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Canada
| | - M.-C. Poon
- Division of Hematology; Department of Medicine; University of Calgary; Calgary Canada
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary Foothills Hospital; Calgary Canada
| | - S. Jackson
- Division of Hematology; Department of Medicine; University of British Columbia; Vancouver Canada
- British Columbia Provincial Bleeding Disorders Program-Adult Division; Vancouver Canada
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Rossman MJ, Groot HJ, Garten RS, Witman MAH, Richardson RS. Vascular function assessed by passive leg movement and flow-mediated dilation: initial evidence of construct validity. Am J Physiol Heart Circ Physiol 2016; 311:H1277-H1286. [PMID: 27638879 DOI: 10.1152/ajpheart.00421.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/08/2016] [Indexed: 12/11/2022]
Abstract
The vasodilatory response to passive leg movement (PLM) appears to provide a novel, noninvasive assessment of vascular function. However, PLM has yet to be compared with the established noninvasive assessment of vascular health, flow-mediated dilation (FMD). Therefore, as an initial evaluation of the construct validity of PLM and upright seated and supine PLM as well as brachial (BA) and superficial femoral (SFA) artery FMDs were performed in 10 young (22 ± 1) and 30 old (73 ± 2) subjects. During upright seated PLM, the peak change in leg blood flow (ΔLBF) and leg vascular conductance (ΔLVC) was significantly correlated with BA (r = 0.57 and r = 0.66) and SFA (r = 0.44 and r = 0.41, ΔLBF and ΔLVC, respectively) FMD. Furthermore, although the relationships were not as strong, the supine PLM response was also significantly correlated with BA (r = 0.38 and r = 0.35) and SFA (r = 0.39 and r = 0.35, ΔLBF and ΔLVC, respectively) FMD. Examination of the young and old separately, however, revealed that significant relationships persisted in both groups only for the upright seated PLM response and BA FMD (young: r = 0.73 and r = 0.77; old: r = 0.35 and r = 0.45, ΔLBF and ΔLVC, respectively). Normalizing FMD for shear rate during PLM abrogated all significant relationships between the PLM and FMD response, suggesting a role for nitric oxide (NO) in these associations. Collectively, these data indicate that PLM, particularly upright seated PLM, likely provides an index of vascular health analogous to the traditional FMD test. Given the relative ease of PLM implementation, these data have important positive implications for PLM as a clinical vascular health assessment.
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Affiliation(s)
- Matthew J Rossman
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - H Jonathan Groot
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Ryan S Garten
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Melissa A H Witman
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah; .,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah; and.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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25
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Paine NJ, Hinderliter AL, Blumenthal JA, Adams KF, Sueta CA, Chang PP, O’Connor CM, Sherwood A. Reactive hyperemia is associated with adverse clinical outcomes in heart failure. Am Heart J 2016; 178:108-14. [PMID: 27502858 DOI: 10.1016/j.ahj.2016.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/16/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Impaired endothelial function, as assessed by brachial artery flow-mediated dilation (FMD), is an established risk factor for cardiovascular events. FMD is impaired in heart failure (HF) patients, but less is known about hyperemic brachial artery flow. We investigated the relationship between FMD and hyperemic flow with adverse clinical outcomes in HF patients. METHODS Brachial artery FMD and hyperemic flow were assessed in 156 patients (70.5 % Male; 45.5% Caucasian; mean age (± SD) = 56.2 (±12.4) years) with HF and reduced left ventricular ejection fraction (LVEF). Cox proportional hazard models were used to assess the potential explanatory association of FMD and hyperemic flow with the composite outcome of death or cardiovascular hospitalization over a median 5-year follow-up period. RESULTS Both FMD and hyperemic flow were negatively correlated with age, but unrelated to sex, race, body mass index, LVEF or N-terminal pro-B-Type natriuretic peptide (NT-ProBNP). Reduced hyperemic flow, but not FMD, was associated with an increased risk of death or cardiac hospitalization after controlling for traditional risk factors. CONCLUSION The association of reduced hyperemic flow with increased risk of adverse clinical outcomes suggests that micro-vascular function may be an important prognostic marker in patients with HF.
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26
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Lam CSP, Lund LH. Microvascular endothelial dysfunction in heart failure with preserved ejection fraction. Heart 2016; 102:257-9. [DOI: 10.1136/heartjnl-2015-308852] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Carallo C, Franceschi MSD, Tripolino C, Iovane C, Catalano S, Giudice A, Crispino A, Figliuzzi M, Irace C, Fortunato L, Gnasso A. Periodontal Treatment Elevates Carotid Wall Shear Stress in the Medium Term. Medicine (Baltimore) 2015; 94:e1724. [PMID: 26496285 PMCID: PMC4620837 DOI: 10.1097/md.0000000000001724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n = 20) or SRP + LLLT (n = 20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P = 0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.
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Affiliation(s)
- Claudio Carallo
- From the Department of Chemical Engineering, Imperial College London, London, United Kingdom (CC, SC); Department of Clinical and Experimental Medicine, Institute of Dentistry, "Magna Graecia" University (MSDF, CI, AG, AC, MF, LF); and Department of Clinical and Experimental Medicine, Metabolic Disease Unit, "Magna Graecia" University, Catanzaro, Italy (CC, MSDF, CT, CI, AG)
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Vetter MW, Martin BJ, Fung M, Pajevic M, Anderson TJ, Raedler TJ. Microvascular dysfunction in schizophrenia: a case-control study. NPJ SCHIZOPHRENIA 2015; 1:15023. [PMID: 27336034 PMCID: PMC4849449 DOI: 10.1038/npjschz.2015.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/05/2015] [Accepted: 05/13/2015] [Indexed: 12/11/2022]
Abstract
Background: Schizophrenia is a mental illness associated with cardiovascular disease at a younger age than in the general population. Endothelial dysfunction has predictive value for future cardiovascular events; however, the impact of a diagnosis of schizophrenia on this marker is unknown. Aims: We tested the hypothesis that subjects with schizophrenia have impaired endothelial function. Methods: A total of 102 subjects (34.5±7.5 years) participated in this study. This sample consisted of 51 subjects with a diagnosis of schizophrenia and 51 healthy subjects, who were matched for age (P=0.442), sex (P>0.999), and smoking status (P=0.842). Peripheral artery microvascular and conduit vessel endothelial function was measured using hyperemic velocity time integral (VTI), pulse arterial tonometry (PAT), and flow-mediated dilation (FMD). Results: Significantly lower values of VTI were noted in subjects with schizophrenia (104.9±33.0 vs. 129.1±33.8 cm, P<0.001), whereas FMD (P=0.933) and PAT (P=0.862) did not differ between the two groups. A multivariable-linear-regression analysis, built on data from univariate and partial correlations, showed that only schizophrenia, sex, lipid-lowering medications, antihypertensive medications, and low-density lipoprotein (LDL)-cholesterol were predictive of attenuated VTI, whereas age, ethnicity, family history of cardiovascular disease, smoking status, systolic blood pressure, waist circumference, HDL-cholesterol, triglycerides, C-reactive protein, and homeostatic model assessment-insulin resistance (HOMA-IR), antidiabetic medications, antidepressant medications, mood stabilizers, benzodiazepines, and anticholinergic medications did not predict VTI in this model (adjusted R2=0.248). Conclusions: Our findings suggest that a diagnosis of schizophrenia is associated with impaired microvascular function as indicated by lower values of VTI, irrespective of many other clinical characteristics. It might be an early indicator of cardiovascular risk in schizophrenia, and might help to identify high-risk individuals.
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Affiliation(s)
- Martin W Vetter
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgery, AB, Canada; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Billie-Jean Martin
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary , Calgery, AB, Canada
| | - Marinda Fung
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary , Calgery, AB, Canada
| | - Milada Pajevic
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary , Calgery, AB, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary , Calgery, AB, Canada
| | - Thomas J Raedler
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgery, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgery, AB, Canada
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Matsuzawa Y, Li J, Aoki T, Guddeti RR, Kwon TG, Cilluffo R, Widmer RJ, Gulati R, Lennon RJ, Lerman LO, Lerman A. Predictive value of endothelial function by noninvasive peripheral arterial tonometry for coronary artery disease. Coron Artery Dis 2015; 26:231-8. [PMID: 25503420 PMCID: PMC4385480 DOI: 10.1097/mca.0000000000000208] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Endothelial dysfunction is a key step in the initiation and progression of atherosclerosis and subsequent cardiovascular complications. We examined whether peripheral endothelial function, as assessed by fingertip reactive hyperemia-peripheral arterial tonometry (RH-PAT), can provide additional clinical value to traditional risk factors for cardiovascular diseases in predicting coronary artery disease (CAD). METHODS We included 118 stable patients who were referred for coronary angiography for chest pain evaluation or due to abnormal stress test results. A natural logarithmic value of the RH-PAT index (Ln_RHI) was obtained before cardiac catheterization by an independent operator. Significant CAD was defined as luminal stenosis of at least 70% (≥50% at left main) and/or fractional flow reserve of up to 0.80 in one or more major coronary arteries or their major branches. RESULTS Levels of Ln_RHI were significantly lower in patients with CAD (n=60) compared with patients without CAD (n=58; 0.69±0.29 vs. 0.88±0.27, P<0.001). Ln_RHI was significantly associated with CAD independent from traditional risk factors (odds ratio for a 0.1 decrease in Ln_RHI=1.25, 95% confidence interval: 1.04-1.52, P=0.01). The net reclassification index was improved when Ln_RHI was added to traditional risk factors (0.62, 95% confidence interval: 0.27-0.97, P=0.001). CONCLUSION Peripheral endothelial function, as assessed by RH-PAT, improved risk stratification when added to traditional risk factors. RH-PAT is potentially useful for identifying patients at high risk for CAD.
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Affiliation(s)
- Yasushi Matsuzawa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jing Li
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Tatsuo Aoki
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Taek-Geun Kwon
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Rebecca Cilluffo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - R. Jay. Widmer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ryan J. Lennon
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Moore LE, Bhutani M, Petersen SR, McMurtry MS, Byers BW, Tedjasaputra V, Stickland MK. Physical activity, fitness, and vascular health in patients with asthma. J Allergy Clin Immunol 2015; 136:809-811.e3. [PMID: 25913103 DOI: 10.1016/j.jaci.2015.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Linn E Moore
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Stewart R Petersen
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - M Sean McMurtry
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bradley W Byers
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent Tedjasaputra
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; G. F. MacDonald Centre for Lung Health (Covenant Health), Edmonton, Alberta, Canada.
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Endothelial function, arterial stiffness and adherence to the 2010 Dietary Guidelines for Americans: a cross-sectional analysis. Br J Nutr 2015; 113:1773-81. [PMID: 25885520 DOI: 10.1017/s0007114515000859] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Endothelial dysfunction and arterial stiffness are early predictors of CVD. Intervention studies have suggested that diet is related to vascular health, but most prior studies have tested individual foods or nutrients and relied on small samples of younger adults. The purpose of the present study was to examine the relationships between adherence to the 2010 Dietary Guidelines for Americans and vascular health in a large cross-sectional analysis. In 5887 adults in the Framingham Heart Study Offspring and Third Generation cohorts, diet quality was quantified with the 2010 Dietary Guidelines Adherence Index (DGAI-2010). Endothelial function was assessed via brachial artery ultrasound and arterial stiffness via arterial tonometry. In age-, sex- and cohort-adjusted analyses, a higher DGAI-2010 score (greater adherence) was modestly associated with a lower resting flow velocity, hyperaemic response, mean arterial pressure, carotid-femoral pulse wave velocity (PWV), and augmentation index, but not associated with resting arterial diameter or flow-mediated dilation (FMD). In multivariable models adjusting for cardiovascular risk factors, only the association of a higher DGAI-2010 score with a lower baseline flow velocity and augmentation index persisted (β = - 0·002, P= 0·003 and β = - 0·05 ± 0·02, P< 0·001, respectively). Age-stratified multivariate-adjusted analyses suggested that the relationship of higher DGAI-2010 scores with lower mean arterial pressure, PWV and augmentation index was more pronounced among adults younger than 50 years. Better adherence to the 2010 Dietary Guidelines for Americans, particularly in younger adults, is associated with a lower peripheral blood flow velocity and arterial wave reflection, but not FMD. The present results suggest a link between adherence to the Dietary Guidelines and favourable vascular health.
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Matsuzawa Y, Guddeti RR, Kwon TG, Lerman LO, Lerman A. Secondary prevention strategy of cardiovascular disease using endothelial function testing. Circ J 2015; 79:685-94. [PMID: 25740088 DOI: 10.1253/circj.cj-15-0068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past decades, secondary prevention of cardiovascular (CV) disease has improved and considerably reduced mortality rates. However, there remains a high-rate of new or recurrent CV events in those with established atherosclerotic vascular diseases. Although most of the prevailing therapies target the conventional risk factors, there is notable interindividual heterogeneity in adaptation to risk factors and response to therapies, which affects efficacy. It is desirable to have a methodology for directly assessing the functional significance of atherogenesis, and for managing individual patients based on their comprehensive vascular health. Endothelial function plays a pivotal role in all stages of atherosclerosis, from initiation to atherothrombotic complication. Endothelial function reflects the integrated effect of all the atherogenic and atheroprotective factors present in an individual, and is therefore regarded as an index of active disease process and a significant risk factor for future CV events. Moreover, improvement in endothelial function is associated with decreased risk of CV events, even in the secondary prevention setting. The introduction of endothelial function assessment into clinical practice may trigger the development of a more tailored and personalized medicine and improve patient outcomes. In this review, we summarize current knowledge on the contribution of endothelial dysfunction to atherosclerotic CV disease in the secondary prevention setting. Finally, we focus on the potential of an endothelial function-guided management strategy in secondary prevention.
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Yang PT, Yuan H, Wang YQ, Cao X, Wu LX, Chen ZH. Correlations between brachial endothelial function and cardiovascular risk factors: a survey of 2,511 Chinese subjects. J Thorac Dis 2014; 6:1441-51. [PMID: 25364521 DOI: 10.3978/j.issn.2072-1439.2014.08.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We examined the relationship of several cardiovascular risk factors (CVRF) to brachial artery flow-mediated dilatation (FMD) in Chinese subjects. METHODS This was a cross-sectional study. In 2,511 Chinese adults (age 46.86±9.52 years, 1,891 men and 620 women) recruited from people who underwent health screening at The Third Xiangya Hospital, patients' CVRF [age, body mass index (BMI), waist circumference (WC), blood pressure (BP), cholesterol parameters, creatinine (Cr), uric acid (UA), glucose level and smoking] and prevalence of present disease (hypertension, diabetes mellitus, coronary heart disease and hyperlipidemia) were investigated. RESULTS Multivariate analysis revealed that FMD negative correlated with age (β=-0.29, P<0.001), gender (β=-0.12, P<0.001), BMI (β=-0.12, P=0.001), WC (β=-0.10, P=0.011), systolic BP (SBP) (β=-0.12, P<0.001), fasting glucose (β=-0.04, P=0.009), total cholesterol (TC) (β=-0.04, P=0.014), smoking (β=-0.05, P=0.003), and baseline brachial artery diameter (β=-0.35, P<0.001). FMD decreased with increasing age in both genders. In women, FMD was higher than men and age-related decline in FMD was steepest after age 40; FMD was similar in men above 55 years old. CONCLUSIONS In Chinese subjects, FMD may be a usefully marker of CVRF. Age, gender, BMI, WC, SBP, fasting glucose, TC, smoking, and baseline brachial artery diameter were independent variables related to the impairment of FMD. The influence of CVRF on endothelial function is more in women than men.
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Affiliation(s)
- Ping-Ting Yang
- 1 Department of Healthy Management Center, 2 The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Hong Yuan
- 1 Department of Healthy Management Center, 2 The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ya-Qin Wang
- 1 Department of Healthy Management Center, 2 The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xia Cao
- 1 Department of Healthy Management Center, 2 The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Liu-Xin Wu
- 1 Department of Healthy Management Center, 2 The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Zhi-Heng Chen
- 1 Department of Healthy Management Center, 2 The Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
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Gerber RE, Vita JA, Ganz P, Wager CG, Araujo AB, Rosen RC, Kupelian V. Association of peripheral microvascular dysfunction and erectile dysfunction. J Urol 2014; 193:612-7. [PMID: 25196657 DOI: 10.1016/j.juro.2014.08.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Increasing evidence of a link between erectile dysfunction and cardiovascular disease suggests a shared vascular etiology with endothelial dysfunction as a plausible underlying biological mechanism. To our knowledge whether this association is different for large arterial endothelium compared to microvascular endothelium has not yet been established. We investigated the association of erectile dysfunction with macrovascular and microvascular endothelial function. MATERIALS AND METHODS A sample of 390 men with a mean age of 55.5 years was recruited from the BACH survey, a population based survey of urological symptoms. Erectile dysfunction was assessed using IIEF-5. The percent of brachial artery flow mediated dilatation, a measure of macrovascular function, and hyperemic flow velocity in cm per second, a measure of microvascular function, were assessed by ultrasound. Linear regression was used to assess the association of erectile dysfunction and endothelial function, and adjust for potential confounders. RESULTS Reactive hyperemia was lower in men with vs without erectile dysfunction (mean ± SE 97.1 ± 2.5 vs 106.0 ± 1.6 cm per second, p = 0.003). However, the difference in flow mediated dilatation between men with vs without erectile dysfunction was statistically nonsignificant (mean 6.6% ± 0.33% vs 7.2% ± 0.24%, p = 0.147). The association of erectile dysfunction with reactive hyperemia was attenuated but it remained statistically significant in men with moderate to severe erectile dysfunction (IIEF-5 less than 12) after adjusting for traditional cardiovascular risk factors (p = 0.038). CONCLUSIONS These results provide evidence of greater microvascular than macrovascular endothelial dysfunction as a potential contributor to erectile dysfunction and an underlying mechanism linking erectile dysfunction and cardiovascular disease.
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Affiliation(s)
| | - Joseph A Vita
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University, Boston, Massachusetts
| | - Peter Ganz
- Division of Cardiology, San Francisco General Hospital, University of California-San Francisco, San Francisco, California
| | - Carrie G Wager
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Andre B Araujo
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Raymond C Rosen
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Varant Kupelian
- New England Research Institutes, Inc., Watertown, Massachusetts.
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Takase B, Hattori H, Tanaka Y, Uehata A, Nagata M, Ishihara M, Fujita M. Acute Effect of Whole-Body Periodic Acceleration on Brachial Flow-Mediated Vasodilatation Assessed by a Novel Semi-Automatic Vessel Chasing UNEXEF18G System. J Cardiovasc Ultrasound 2013; 21:130-6. [PMID: 24198919 PMCID: PMC3816163 DOI: 10.4250/jcu.2013.21.3.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/31/2013] [Accepted: 08/12/2013] [Indexed: 11/30/2022] Open
Abstract
Background Repeated application of whole-body periodic acceleration (WBPA) upregulates endothelial nitric oxide synthase and improves brachial artery endothelial function (BAEF) as assessed by measurement of flow-mediated vasodilatation (FMD). However, the acute effect of a single application of WBPA on BAEF has not been fully characterized. In addition, although a novel semi-automatic vessel chasing system (UNEXEF18G) has now been developed in Japan, the direct comparison of UNEXEF18G with a conventional method for FMD measures has not been conducted even if UNEXEF18G has already been utilized in a relatively large scale study. Methods We have developed a novel semi-automatic vessel chasing system (UNEXEF18G) that can measure FMD on-line, identify time to peak vasodilatation (TPV), and determine the area under the vasodilatation curve (AUC). Thus, 45 min of WBPA was applied in 20 healthy volunteers (age, 34 ± 13 years), and BAEF was measured by UNEXEF18G before and after WBPA. Also, UNEXEF18G measured FMD was compared with those of a conventional FMD measurement method at rest in order to validate a novel UNEXEF18G measured FMD. Results Single WBPA resulted in a significant increase in FMD (from 6.4 ± 3.4 to 10.7 ± 4.3%, p < 0.01), a significant decrease in TPV and a significant increase in AUC. In the validation study for UNEXEF18G, Bland and Altman analysis showed that UNEXEF18G measured FMD was almost identical to those of the conventional method at rest. Conclusion These data suggest the usefulness of a new UNEXEF18G and that single application of WBPA results in acute improvement in BAEF in humans.
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Affiliation(s)
- Bonpei Takase
- Department of Intensive Care Medicine, National Defense Medical College, National Defense Medical College Research Institute, Saitama, Japan
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Crecelius AR, Richards JC, Luckasen GJ, Larson DG, Dinenno FA. Reactive hyperemia occurs via activation of inwardly rectifying potassium channels and Na+/K+-ATPase in humans. Circ Res 2013; 113:1023-32. [PMID: 23940309 DOI: 10.1161/circresaha.113.301675] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Reactive hyperemia (RH) in the forearm circulation is an important marker of cardiovascular health, yet the underlying vasodilator signaling pathways are controversial and thus remain unclear. OBJECTIVE We hypothesized that RH occurs via activation of inwardly rectifying potassium (KIR) channels and Na(+)/K(+)-ATPase and is largely independent of the combined production of the endothelial autocoids nitric oxide (NO) and prostaglandins in young healthy humans. METHODS AND RESULTS In 24 (23±1 years) subjects, we performed RH trials by measuring forearm blood flow (FBF; venous occlusion plethysmography) after 5 minutes of arterial occlusion. In protocol 1, we studied 2 groups of 8 subjects and assessed RH in the following conditions. For group 1, we studied control (saline), KIR channel inhibition (BaCl2), combined inhibition of KIR channels and Na(+)/K(+)-ATPase (BaCl2 and ouabain, respectively), and combined inhibition of KIR channels, Na(+)/K(+)-ATPase, NO, and prostaglandins (BaCl2, ouabain, L-NMMA [N(G)-monomethyl-L-arginine] and ketorolac, respectively). Group 2 received ouabain rather than BaCl2 in the second trial. In protocol 2 (n=8), the following 3 RH trials were performed: control; L-NMMA plus ketorolac; and L-NMMA plus ketorolac plus BaCl2 plus ouabain. All infusions were intra-arterial (brachial). Compared with control, BaCl2 significantly reduced peak FBF (-50±6%; P<0.05), whereas ouabain and L-NMMA plus ketorolac did not. Total FBF (area under the curve) was attenuated by BaCl2 (-61±3%) and ouabain (-44±12%) alone, and this effect was enhanced when combined (-87±4%), nearly abolishing RH. L-NMMA plus ketorolac did not impact total RH FBF before or after administration of BaCl2 plus ouabain. CONCLUSIONS Activation of KIR channels is the primary determinant of peak RH, whereas activation of both KIR channels and Na(+)/K(+)-ATPase explains nearly all of the total (AUC) RH in humans.
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Affiliation(s)
- Anne R Crecelius
- From the Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, and Vascular Physiology Research Group, Department of Biomedical Sciences, Colorado State University, Fort Collins, CO; and Medical Center of the Rockies Foundation, University of Colorado Health, Loveland, CO
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Tarro Genta F, Eleuteri E, Temporelli PL, Comazzi F, Tidu M, Bouslenko Z, Bertolin F, Vigorito C, Giannuzzi P, Giallauria F. Flow-mediated dilation normalization predicts outcome in chronic heart failure patients. J Card Fail 2013; 19:260-7. [PMID: 23582092 DOI: 10.1016/j.cardfail.2013.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reduced flow-mediated dilation (FMD) is a known prognostic marker in heart failure (HF), but may be influenced by the brachial artery (BA) diameter. Aiming to adjust for this influence, we normalized FMD (nFMD) by the peak shear rate (PSR) and tested its prognostic power in HF patients. METHODS AND RESULTS BA diameter, FMD, difference in hyperemic versus rest brachial flow velocity (FVD), PSR (FVD/BA), and nFMD (FMD/PSR × 1000) were assessed in 71 HF patients. At follow-up (mean 512 days), 19 HF (27%) reached the combined endpoint (4 heart transplantations [HTs], 1 left ventricle assist device implantation [LVAD], and 14 cardiac deaths [CDs]). With multivariate Cox regression analysis, New York Heart Association functional class ≥III (hazard ratio [HR] 9.36, 95% confidence interval [CI] 2.11-41.4; P = .003), digoxin use (HR 6.36, 95% CI 2.18-18.6; P = .0010), FMD (HR 0.703, 95% CI 0.547-0.904; P = .006), PSR (HR 1.01, 95% CI 1.005-1.022; P = .001), FVD (HR 1.04, 95% CI 1.00-1.06; P = .02), and nFMD (HR 0.535, 95% CI 0.39-0.74; P = .0001) were predictors of unfavorable outcome. Receiver operating characteristic curve for nFMD showed that patients with nFMD >5 seconds had significantly better event-free survival than patients with nFMD ≤5 seconds (log-rank test: P < .0001). CONCLUSIONS nFMD is a strong independent predictor of CD, HT, and LVAD in HF with left ventricular ejection fraction <40%. Patients with nFMD >5 seconds have a better prognosis than those with lower values.
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Affiliation(s)
- Franco Tarro Genta
- Division of Cardiology, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Turin, Italy.
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Kiani S, Aasen JG, Holbrook M, Khemka A, Sharmeen F, LeLeiko RM, Tabit CE, Farber A, Eberhardt RT, Gokce N, Vita JA, Hamburg NM. Peripheral artery disease is associated with severe impairment of vascular function. Vasc Med 2013; 18:72-8. [PMID: 23509089 DOI: 10.1177/1358863x13480551] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with peripheral artery disease (PAD) have higher cardiovascular event rates than patients with established coronary artery disease (CAD) and abnormal endothelial function predicts cardiovascular risk in PAD and CAD. We investigated the hypothesis that PAD is associated with a greater degree of impairment in vascular function than CAD. We used several non-invasive tests to evaluate endothelial function in 1320 men and women with combined PAD and CAD (n = 198), PAD alone (n = 179), CAD alone (n = 466), or controls aged > 45 years without CAD or PAD (n = 477). Patients with PAD had lower brachial artery flow-mediated dilation (5.1 ± 3.9% PAD and CAD, 5.9 ± 4.4% PAD alone) compared to patients with CAD alone (7.0 ± 4.5%) and no PAD or CAD (8.1 ± 5.1%, p < 0.0001). In multivariable models adjusting for clinical covariates and the presence of CAD, PAD remained associated with lower flow-mediated dilation (p < 0.0001). PAD was associated also with lower nitroglycerin-mediated dilation and reactive hyperemia. Patients with both PAD and CAD had a lower digital pulse amplitude tonometry (PAT) ratio in unadjusted models but not in adjusted models. Flow-mediated dilation was modestly associated with PAT ratio in patients with atherosclerotic disease (r = 0.23, p < 0.0001) but not among control participants (r = 0.008, p = 0.93). Our findings indicate that patients with PAD have greater impairment of vasodilator function and are consistent with the possibility that endothelial dysfunction may contribute to adverse cardiovascular prognosis in PAD.
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Affiliation(s)
- Soroosh Kiani
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
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Martin BJ, Verma S, Charbonneau F, Title LM, Lonn EM, Anderson TJ. The relationship between anthropometric indexes of adiposity and vascular function in the FATE cohort. Obesity (Silver Spring) 2013; 21:266-73. [PMID: 23532989 DOI: 10.1002/oby.20266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 04/13/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Numerous indexes of adiposity have been proposed and are currently in use in clinical practice and research. However, the correlation of these indexes with measures of vascular health remain poorly defined. This study investigated which measure of adiposity is most strongly associated with endothelial function. DESIGN AND METHODS Data from the Firefighters And Their Endothelium (FATE) study was used. The relationships between three measures of vascular function: flow-mediated dilation (FMD), hyperemic velocity time integral (VTI), and hyperemic shear stress (HSS), and five measures of adiposity: BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body adiposity index (BAI) were tested. Univariate comparisons were made, and subsequently models adjusted for traditional risk factors were constructed. RESULTS A total of 1,462 male firefighters (mean age 49 ± 9) without cardiovascular disease comprised the study population. No measure of adiposity correlated with FMD; all five measures of adiposity were negatively correlated with VTI and HSS (P values <0.0001), with WHtR most strongly correlated with VTI, and WC most strongly correlated with HSS (both P < 0.05). In models including all five measures of obesity simultaneously, BMI, WC, and WHtR were all predictive of HSS (all P values <0.05), and BMI and WHR were both predictive of VTI (P values <0.05). CONCLUSIONS Anthropometric measures of adiposity may help refine estimations of atherosclerotic burden. BMI was most consistently associated with endothelial dysfunction, but measures of adiposity that reflect distribution of mass were additive.
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Affiliation(s)
- Billie-Jean Martin
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Martin BJ, Gurtu V, Chan S, Anderson TJ. The relationship between peripheral arterial tonometry and classic measures of endothelial function. Vasc Med 2012; 18:13-8. [PMID: 23263153 DOI: 10.1177/1358863x12468194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess the association between peripheral arterial tonometry (PAT) and two more traditional measures of endothelial function – flow-mediated dilation (FMD) and its hyperemic stimulus, hyperemic peak velocity time integral (VTI). We related three vascular function measures (natural log transformed PAT, FMD, and VTI) from 304 patients (mean age 48.9 ± 12.5 years), including 105 with coronary artery disease (CAD). Using linear regression, we studied the relationships between lnPAT, FMD, and VTI, and compared differences in these parameters in those with and without CAD. Although FMD and lnPAT both had a correlation with VTI (Pearson’s r = 0.119, p = 0.039 and r = 0.167, p = 0.004, respectively), lnPAT had no correlation with FMD ( r = −0.0471, p = 0.414). lnPAT was also lower in patients with CAD compared to controls (mean 0.51 ± 0.19 versus 0.65 ± 0.26, respectively, p < 0.0001). In multivariate analysis, VTI remained associated with lnPAT (standardized β = 0.1369, p = 0.04). Among this group of subjects with and without CAD, lnPAT was found to be unrelated to FMD but correlated with VTI. This would suggest that lnPAT is a measure of microvascular function. Although it is unrelated to FMD, lnPAT is decreased in patients with pre-existing cardiovascular disease. Further studies are required to determine if this can be used clinically as a tool for cardiac risk stratification and prediction of CAD.
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Affiliation(s)
- Billie-Jean Martin
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Vikram Gurtu
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sammy Chan
- Department of Medicine and Division of Cardiology, St Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
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Wexler O, Morgan MAM, Gough MS, Steinmetz SD, Mack CM, Darling DC, Doolin KP, Apostolakos MJ, Graves BT, Frampton MW, Chen X, Pietropaoli AP. Brachial artery reactivity in patients with severe sepsis: an observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R38. [PMID: 22390813 PMCID: PMC3568781 DOI: 10.1186/cc11223] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/23/2012] [Accepted: 03/05/2012] [Indexed: 01/19/2023]
Abstract
Introduction Ultrasound measurements of brachial artery reactivity in response to stagnant ischemia provide estimates of microvascular function and conduit artery endothelial function. We hypothesized that brachial artery reactivity would independently predict severe sepsis and severe sepsis mortality. Methods This was a combined case-control and prospective cohort study. We measured brachial artery reactivity in 95 severe sepsis patients admitted to the medical and surgical intensive care units of an academic medical center and in 52 control subjects without acute illness. Measurements were compared in severe sepsis patients versus control subjects and in severe sepsis survivors versus nonsurvivors. Multivariable analyses were also conducted. Results Hyperemic velocity (centimeters per cardiac cycle) and flow-mediated dilation (percentage) were significantly lower in severe sepsis patients versus control subjects (hyperemic velocity: severe sepsis = 34 (25 to 48) versus controls = 63 (52 to 81), P < 0.001; flow-mediated dilation: severe sepsis = 2.65 (0.81 to 4.79) versus controls = 4.11 (3.06 to 6.78), P < 0.001; values expressed as median (interquartile range)). Hyperemic velocity, but not flow-mediated dilation, was significantly lower in hospital nonsurvivors versus survivors (hyperemic velocity: nonsurvivors = 25 (16 to 28) versus survivors = 39 (30 to 50), P < 0.001; flow-mediated dilation: nonsurvivors = 1.90 (0.68 to 3.41) versus survivors = 2.96 (0.91 to 4.86), P = 0.12). Lower hyperemic velocity was independently associated with hospital mortality in multivariable analysis (odds ratio = 1.11 (95% confidence interval = 1.04 to 1.19) per 1 cm/cardiac cycle decrease in hyperemic velocity; P = 0.003). Conclusions Brachial artery hyperemic blood velocity is a noninvasive index of microvascular function that independently predicts mortality in severe sepsis. In contrast, brachial artery flow-mediated dilation, reflecting conduit artery endothelial function, was not associated with mortality in our severe sepsis cohort. Brachial artery hyperemic velocity may be a useful measurement to identify patients who could benefit from novel therapies designed to reverse microvascular dysfunction in severe sepsis and to assess the physiologic efficacy of these treatments.
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Affiliation(s)
- Orren Wexler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
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West CR, AlYahya A, Laher I, Krassioukov A. Peripheral vascular function in spinal cord injury: a systematic review. Spinal Cord 2012. [DOI: 10.1038/sc.2012.136] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Philpott AC, Hubacek J, Sun YC, Hillard D, Anderson TJ. Niacin improves lipid profile but not endothelial function in patients with coronary artery disease on high dose statin therapy. Atherosclerosis 2012; 226:453-8. [PMID: 23174368 DOI: 10.1016/j.atherosclerosis.2012.10.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 10/05/2012] [Accepted: 10/25/2012] [Indexed: 01/01/2023]
Abstract
AIMS To determine the effect of extended release (ER) niacin on endothelial and vascular function assessed by brachial flow-mediated dilatation (FMD), peak hyperemic velocity (VTiRH) and pulse arterial tonometry (PAT) in patients with established coronary artery disease (CAD), already treated with high dose statins. Endothelial dysfunction is common in patients with established coronary artery disease (CAD) and has prognostic implications. Niacin has proven clinical benefit in patients with CAD, but its additive effect in patients on statin therapy is being evaluated. The effect of niacin on endothelial function, in the presence of optimal LDL cholesterol is unclear. METHODS AND RESULTS Sixty-six patients with CAD (mean age 57.9 ± 8.5 yrs) received ER niacin (1500 mg per day) and placebo in a randomized crossover fashion for 3 months of each therapy. All patients received atorvastatin 80 mg per day. FMD, VTiRH and PAT measurements were performed at baseline and after each treatment period. Treatment with niacin improved dyslipidemia parameters (LDL placebo 1.52 ± 0.51 vs. niacin 1.30 ± 0.43; p = 0.004; HDL placebo 0.95 ± 0.16 vs. niacin 1.11 ± 0.22; p < 0.001). However, there was no observed improvement in endothelial function as assessed by FMD (placebo 6.1 ± 4.9 vs. niacin 6.6 ± 4.8%; p = 0.48), VTiRH (placebo 75 ± 28 vs. niacin 78 ± 26 cm; p = 0.23) or PAT (placebo 1.8 ± 0.42 vs. niacin 1.79 ± 0.5; p = 0.43). CONCLUSION Niacin as add-on treatment to high dose statins in patients with established CAD significantly improves lipid profile. However, these changes were not associated with improved endothelial or microvascular function. Registered clinical trial with clinicaltrials.gov: NCT00150722.
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Affiliation(s)
- Andrew C Philpott
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Adelaide, South Australia 5000, Australia.
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Flammer AJ, Anderson T, Celermajer DS, Creager MA, Deanfield J, Ganz P, Hamburg NM, Lüscher TF, Shechter M, Taddei S, Vita JA, Lerman A. The assessment of endothelial function: from research into clinical practice. Circulation 2012; 126:753-67. [PMID: 22869857 DOI: 10.1161/circulationaha.112.093245] [Citation(s) in RCA: 827] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andreas J Flammer
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Lee V, Martin BJ, Fung M, Anderson TJ. The optimal measure of microvascular function with velocity time integral for cardiovascular risk prediction. Vasc Med 2012; 17:287-93. [DOI: 10.1177/1358863x12451337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent evidence suggests that microvascular function may be important in cardiovascular risk prediction. One measure of microvascular function is hyperaemic velocity time integral (VTI). We assessed whether the VTI of more than one beat of reactive hyperaemia would provide a stronger correlate to traditional cardiovascular risk factors using a subset of subjects from the Firefighters and Their Endothelium (FATE) study. Vascular function was assessed by measurement of hyperaemic blood velocity with high-resolution ultrasound of the brachial artery. We evaluated three measures in the current analysis: the VTI of the first beat, average VTI of 10 beats, and maximum VTI of 10 beats post-cuff release. A total of 399 male subjects (45.5 ± 10 years) were included in this analysis. Univariate correlations between the three end points and cardiovascular risk factors were calculated, and multivariable regression models constructed. Intra-observer variability was approximately equal for all VTI end points (coefficient of variation: first = 1.6%, average = 1.4%, maximum = 1.4%). Univariate correlations between VTI and cardiovascular risk factors were similar across all three end points. In multivariable analyses, there were no differences in the relationships between cardiovascular risk factors and the various VTI end points ( R2 from 0.090 to 0.102). Age, systolic blood pressure, and BMI were predictors of the three VTI end points ( p < 0.05). In conclusion, the first beat of reactive hyperaemia remains the suitable measure of microvascular function.
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Affiliation(s)
- Vincent Lee
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Billie-Jea Martin
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Marinda Fung
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Cunningham S, Rush J, Freeman L. Systemic Inflammation and Endothelial Dysfunction in Dogs with Congestive Heart Failure. J Vet Intern Med 2012; 26:547-57. [DOI: 10.1111/j.1939-1676.2012.00923.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 01/31/2012] [Accepted: 03/01/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- S.M. Cunningham
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton; MA
| | - J.E. Rush
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton; MA
| | - L.M. Freeman
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton; MA
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Green DJ, Jones H, Thijssen D, Cable NT, Atkinson G. Flow-mediated dilation and cardiovascular event prediction: does nitric oxide matter? Hypertension 2011; 57:363-9. [PMID: 21263128 DOI: 10.1161/hypertensionaha.110.167015] [Citation(s) in RCA: 359] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endothelial dysfunction is an early atherosclerotic event that precedes clinical symptoms and may also render established plaque vulnerable to rupture. Noninvasive assessment of endothelial function is commonly undertaken using the flow-mediated dilation (FMD) technique. Some studies indicate that FMD possesses independent prognostic value to predict future cardiovascular events that may exceed that associated with traditional risk factor assessment. It has been assumed that this association is related to the proposal that FMD provides an index of endothelium-derived nitric oxide (NO) function. Interestingly, placement of the occlusion cuff during the FMD procedure alters the shear stress stimulus and NO dependency of the resulting dilation: cuff placement distal to the imaged artery leads to a largely NO-mediated response, whereas proximal cuff placement leads to dilation which is less NO dependent. We used this physiological observation and the knowledge that prognostic studies have used both approaches to examine whether the prognostic capacity of FMD is related to its role as a putative index of NO function. In a meta-analysis of 14 studies (>8300 subjects), we found that FMD derived using a proximal cuff was at least as predictive as that derived using distal cuff placement, despite the latter being more NO dependent. This suggests that, whilst FMD is strongly predictive of future cardiovascular events, this may not solely be related to its assumed NO dependency. Although this finding should be confirmed with more and larger studies, we suggest that any direct measure of vascular (endothelial) function may provide independent prognostic information in humans.
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Affiliation(s)
- Daniel J Green
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, UK.
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Anderson TJ, Charbonneau F, Title LM, Buithieu J, Rose MS, Conradson H, Hildebrand K, Fung M, Verma S, Lonn EM. Microvascular function predicts cardiovascular events in primary prevention: long-term results from the Firefighters and Their Endothelium (FATE) study. Circulation 2011; 123:163-9. [PMID: 21200002 DOI: 10.1161/circulationaha.110.953653] [Citation(s) in RCA: 295] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Biomarkers of atherosclerosis may refine clinical decision making in individuals at risk of cardiovascular disease. The purpose of the study was to determine the prognostic significance of endothelial function and other vascular markers in apparently healthy men. METHODS AND RESULTS The cohort consisted of 1574 men (age, 49.4 years) free of vascular disease. Measurements included flow-mediated dilation and its microvascular stimulus, hyperemic velocity, carotid intima-media thickness, and C-reactive protein. Cox proportional hazard models evaluated the relationship between vascular markers, Framingham risk score, and time to a first composite cardiovascular end point of vascular death, revascularization, myocardial infarction, angina, and stroke. Subjects had low median Framingham risk score (7.9%). Cardiovascular events occurred in 71 subjects (111 events) over a mean follow-up of 7.2±1.7 years. Flow-mediated dilation was not associated with subsequent cardiovascular events (hazard ratio, 0.92; P=0.54). Both hyperemic velocity (hazard ratio, 0.70; 95% confidence interval, 0.54 to 0.90; P=0.006) and carotid intima-media thickness (hazard ratio, 1.45; confidence interval, 1.15 to 1.83; P=0.002) but not C-reactive protein (P=0.35) were related to events in a multivariable analysis that included Framingham risk score (per unit SD). Furthermore, the addition of hyperemic velocity to Framingham risk score resulted in a net clinical reclassification improvement of 28.7% (P<0.001) after 5 years of follow-up in the intermediate-risk group. Overall net reclassification improvement for hyperemic velocity was 6.9% (P=0.24). CONCLUSIONS In men, hyperemic velocity, the stimulus for flow-mediated dilation, but not flow-mediated dilation itself was a significant risk marker for adverse cardiovascular outcomes. The prognostic value was additive to traditional risk factors and carotid intima-media thickness. Hyperemic velocity, a newly described marker of microvascular function, is a novel tool that may improve risk stratification of lower-risk healthy men.
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Affiliation(s)
- Todd J Anderson
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, 1403-29th St. NW, Calgary, AB, Canada.
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Thijssen DHJ, Maiorana AJ, O’Driscoll G, Cable NT, Hopman MTE, Green DJ. Impact of inactivity and exercise on the vasculature in humans. Eur J Appl Physiol 2010; 108:845-75. [PMID: 19943061 PMCID: PMC2829129 DOI: 10.1007/s00421-009-1260-x] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2009] [Indexed: 12/12/2022]
Abstract
The effects of inactivity and exercise training on established and novel cardiovascular risk factors are relatively modest and do not account for the impact of inactivity and exercise on vascular risk. We examine evidence that inactivity and exercise have direct effects on both vasculature function and structure in humans. Physical deconditioning is associated with enhanced vasoconstrictor tone and has profound and rapid effects on arterial remodelling in both large and smaller arteries. Evidence for an effect of deconditioning on vasodilator function is less consistent. Studies of the impact of exercise training suggest that both functional and structural remodelling adaptations occur and that the magnitude and time-course of these changes depends upon training duration and intensity and the vessel beds involved. Inactivity and exercise have direct "vascular deconditioning and conditioning" effects which likely modify cardiovascular risk.
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Affiliation(s)
- Dick H. J. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Andrew J. Maiorana
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, Australia
- School of Physiotherapy, Curtin University of Technology, Perth, Australia
| | - Gerry O’Driscoll
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Nigel T. Cable
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
| | - Maria T. E. Hopman
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Daniel J. Green
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Australia
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