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Pugliese NR, De Biase N, Del Punta L, Balletti A, Armenia S, Buralli S, Mengozzi A, Taddei S, Metra M, Pagnesi M, Borlaug BA, Williams B, Masi S. Deep phenotype characterization of hypertensive response to exercise: implications on functional capacity and prognosis across the heart failure spectrum. Eur J Heart Fail 2023; 25:497-509. [PMID: 36992634 DOI: 10.1002/ejhf.2827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/31/2023] Open
Abstract
AIMS Limited evidence is available regarding the role of hypertensive response to exercise (HRE) in heart failure (HF). We evaluated the systolic blood pressure (SBP) to workload slope during exercise across the HF spectrum, investigating haemodynamic and prognostic correlates of HRE. METHODS AND RESULTS We prospectively enrolled 369 patients with HF Stage C (143 had preserved [HFpEF], and 226 reduced [HFrEF] ejection fraction), 201 subjects at risk of developing HF (HF Stages A-B), and 58 healthy controls. We performed a combined cardiopulmonary exercise stress echocardiography testing. We defined HRE as the highest sex-specific SBP/workload slope tertile in each HF stage. Median SBP/workload slope was 0.53 mmHg/W (interquartile range 0.36-0.72); the slope was 39% steeper in women than men (p < 0.0001). After adjusting for age and sex, SBP/workload slope in HFrEF (0.47, 0.30-0.63) was similar to controls (0.43, 0.35-0.57) but significantly lower than Stages A-B (0.61, 0.47-0.75) and HFpEF (0.63, 0.42-0.86). Patients with HRE showed significantly lower peak oxygen consumption and peripheral oxygen extraction. After a median follow-up of 16 months, HRE was independently associated with adverse outcomes (all-cause mortality and hospitalization for cardiovascular reasons: hazard ratio 2.05, 95% confidence interval 1.81-5.18), while rest and peak SBP were not. Kaplan-Meier analysis confirmed a worse survival probability in Stages A-B (p = 0.005) and HFpEF (p < 0.001), but not HFrEF. CONCLUSION A steeper SBP/workload slope is associated with impaired functional capacity across the HF spectrum and could be a more sensitive predictor of adverse events than absolute SBP values, mainly in patients in Stages A-B and HFpEF.
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Affiliation(s)
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Buralli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, and National Institute for Health Research University College London Biomedical Research Centre, London, UK
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, and National Institute for Health Research University College London Biomedical Research Centre, London, UK
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Ahmad Ibrahim O, Ahmad AB, Nigm DA, Hussien AN, Mohammad Ibrahim WH. Subclinical atherosclerotic predictive value of inflammatory markers in thalassemia intermedia patients. Expert Rev Hematol 2021; 14:669-677. [PMID: 34296962 DOI: 10.1080/17474086.2021.1959316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A high incidence of thromboembolic events is observed in thalassemia patients. This study investigated the relationship between carotid intima-media thickness (CIMT) and lipid profile, iron metabolic indices (IMI), and inflammatory markers in β-thalassemia intermedia (β- TI) patients. PATIENTS AND METHODS Forty-five β-TI patients at Assiut University Hospital and 34 healthy individuals were enrolled in the study. We measured Lipid profile, IMI, high sensitive CRP (Hs-CRP), and interleukin-6 (IL-6) and compared the results between both groups. We used CIMT measurement as a marker for subclinical atherosclerosis. We used both univariate and multivariate analyses to test relations and independent predictors of CIMT. RESULTS β-TI patients had higher CIMT (P = 0.000). CIMT was positively correlated with absolute neutrophil count (ANC) (r = 0.320, p = 0.032), ferritin (r = 0.544, p = 0.000), Hs-CRP (r = 0.603, p = 0.000), and IL-6 (r = 0.520, p = 0.000). Hs-CRP was an independent predictor of CIMT (p = 0.000). Hs-CRP cut off value of 60.4 ug/dl has sensitivity of 63.3% and specificity of 93.3% in predicting premature atherosclerosis. CONCLUSION β-TI patients had higher CIMT despite the protective lipid profile. Hs-CRP was an independent predictor of CIMT.
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Affiliation(s)
- Osama Ahmad Ibrahim
- Department of Internal Medicine, Hematology Unit, Assiut University Hospital, Assiut, Egypt
| | - Ahmad B Ahmad
- Department of Internal Medicine, Cardiology and Critical Care Unit, Assiut University Hospital, Assiut, Egypt
| | - Dalia Ahmad Nigm
- Department of Clinical Pathology, Assiut University Hospital, Assiut, Egypt
| | - Asmaa Nady Hussien
- Department of Internal Medicine, Hematology Unit, Assiut University Hospital, Assiut, Egypt
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Mozos I, Jianu D, Gug C, Stoian D. Links between High-Sensitivity C-Reactive Protein and Pulse Wave Analysis in Middle-Aged Patients with Hypertension and High Normal Blood Pressure. DISEASE MARKERS 2019; 2019:2568069. [PMID: 31396293 PMCID: PMC6664701 DOI: 10.1155/2019/2568069] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023]
Abstract
Arterial stiffness and arterial age provide valuable prognostic cardiovascular information. The present study aimed at assessing the levels of vitamin D, high-sensitivity C-reactive protein (hsCRP), low-density lipoprotein cholesterol (LDL), and oxidized LDL (oxLDL) in a group of middle-aged hypertensive patients and their relationship with pulse wave velocity (PWV), central blood pressure, and early arterial aging (EAA), respectively. A total of 56 patients, aged 48 ± 6 years, 57% males, with hypertension and high normal blood pressure (HNBP), were investigated using a Mobile-O-Graph, to assess central and peripheral blood pressure, PWV, and arterial age. Additionally, hsCRP, LDL, oxLDL, and 25-hydroxy vitamin D3 were assessed. PWV, 25-hydroxy vitamin D3, hsCRP, oxLDL, and LDL levels were 7.26 ± 0.69 m/s, 25.99 ± 11.17 microg/l, 0.48 ± 0.44 mg/dl, 261.37 ± 421 ng/ml, and 145.73 ± 39.53 mg/dl, respectively. Significant correlations were obtained between oxLDL and pulse pressure amplification (rS = -0.347, p = 0.028) and between hsCRP and LDL levels with PWV and EAA, respectively. ROC curve analysis revealed that hsCRP is a sensitive and specific predictor of EAA and increased PWV values. Concluding, vitamin D deficiency and increased hsCRP and LDL values are very common, and high oxidized LDL is related to pulse pressure amplification in patients with elevated blood pressure. Vitamin D level and high-sensitivity C-reactive protein and LDL provide valuable information in middle-aged hypertensive and HNBP patients related to arterial stiffness and early arterial aging, but only hsCRP is a sensitive predictor of EAA and PWV.
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Affiliation(s)
- Ioana Mozos
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300173 Timisoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Daniela Jianu
- 1st Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Military Hospital, 300041 Timisoara, Romania
| | - Cristina Gug
- Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dana Stoian
- 2nd Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300723 Timisoara, Romania
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Differential effects of arterial stiffness and fluid overload on blood pressure according to renal function in patients at risk for cardiovascular disease. Hypertens Res 2018; 42:341-353. [DOI: 10.1038/s41440-018-0151-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 12/30/2022]
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Molani Gol R, Rafraf M, Asghari Jafarabadi M. Evaluation of cardiovascular risk factors in women referring to health centers in Tabriz, Iran, 2017. Health Promot Perspect 2018; 8:315-322. [PMID: 30479987 PMCID: PMC6249489 DOI: 10.15171/hpp.2018.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/11/2018] [Indexed: 01/25/2023] Open
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality among men and women around the world. The aim of this study was to investigate major cardiovascular risk factors in women living in the Tabriz petrochemical region, Iran during spring 2017. Methods: In this cross-sectional study, a sample of 152 women aged 30-55 years was selected from who attended health center in Tabriz, Iran. Anthropometric measurements, blood pressure,daily dietary intakes and fasting serum lipid profile, oxidized LDL (ox-LDL) and high sensitivity C-reactive protein (hs-CRP) were evaluated. Results: The prevalence of overweight, general and abdominal obesity (based on Body mass index [BMI] and waist circumference [WC]) was 34.2%, 52.6%, and 73.7%, respectively. Eleven point two percent and 4.6% of women had pre-hypertension based on systolic blood pressure (SBP)and diastolic blood pressure (DBP). High serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C)were determined in 32.5%, 25.7%, 17.8% and 56.6% of subjects, respectively. The median of serum ox-LDL concentration was 3181.5 ng/L. Sixty-five point eight percent of participants hadhigh hs-CRP levels. In the multiple-adjusted quintile regression analysis, significant relationships were found between serum ox-LDL and age (B = 96.7, P = 0.003) and between serum hs-CRP with diastolic blood pressure (B = 0.1, P = 0.083) and TG (B = 0.01, P = 0.088). Conclusion: The high prevalence of cardiovascular risk factors in the studied women warrants more public health attention. The results also suggest that aging was associated with high serumox-LDL and increased serum hs-CRP levels, which may reflect enhanced DBP and serum TG.
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Affiliation(s)
- Roghayeh Molani Gol
- Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rafraf
- Nutrition Research Center, Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
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Teymoori F, Asghari G, Mirmiran P, Azizi F. High dietary intake of aromatic amino acids increases risk of hypertension. ACTA ACUST UNITED AC 2017; 12:25-33. [PMID: 29208471 DOI: 10.1016/j.jash.2017.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/20/2017] [Accepted: 11/10/2017] [Indexed: 01/14/2023]
Abstract
Recent studies investigated the relation between amino acids and blood pressure. Our aim was to examine the association between intake of aromatic amino acids (AAAs) and risk of hypertension. A total of 4288 individuals, aged 20-70 years, participants of the Tehran Lipid and Glucose Study, who were free of hypertension at baseline (2008-2011), were followed for 3 years (2011-2014). Average intakes of AAAs including phenylalanine, tyrosine, and tryptophan were collected using a valid and reliable food frequency questionnaire at baseline. Adjusted logistic regression models were used to report odds ratio (OR) of hypertension across quartiles of AAAs. At the end of follow-up, 429 (10%) hypertension cases were ascertained. The adjusted OR of hypertension for percentage of AAAs from total protein intakes was 1.63 (95% confidence interval, 1.06-2.50; P for trend: .03) when comparing the highest quartile to the lowest. Furthermore, in the adjusted analyses, a statistically significant positive relationship was observed between the highest versus the lowest quartile intake of phenylalanine (OR = 1.66; 95% confidence interval, 1.14-2.47; P for trend: .03). However, there was no significant association of tyrosine and tryptophan intakes with hypertension risk. Our data suggest that AAAs may increase the risk of incident hypertension.
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Affiliation(s)
- Farshad Teymoori
- Students Research Committee, Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kaur R, Kaur M, Kapoor R, Singh J. Assessment of Metabolic Syndrome and Clinical Significance of Brachial-Ankle Pulse Wave Velocity in Type 2 Diabetes Mellitus Patients. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2017. [DOI: 10.1515/rjdnmd-2017-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims: Metabolic syndrome (MS) is a constellation of various CVD risk factors comprised of abdominal obesity, glucose intolerance, hyperinsulinemia, hypertension and dyslipidemia. The present study was aimed to assess the prevalence of MS in type 2 diabetes mellitus (T2DM) patients, and to evaluate the clinical significance of brachial-ankle pulse wave velocity in these patients.
Methods: The sample comprised of 251 T2DM patients. MS was evaluated in all the studied subjects according to NCEP-ATP III, IDF and JIS criteria. The subjects were screened for demographic as well as clinical characteristics.
Results: Prevalence of MS was estimated to be 65%, 69% and 75% according NCEP-ATP-III, IDF and JIS criteria respectively. JIS criteria was only preceded for further analysis as it explained the highest prevalence and also showed the better level of agreement (0.862) with IDF criteria. Abdominal obesity was the most frequent component of MS in the studied subjects. Moreover, 20.21% of MS subjects were found to have very high risk of cardiovascular disease (CVD) / future mortality according to different combinations of brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI).
Conclusions: The study revealed an increased prevalence of MS in the studied subjects. Risk of CVD may be better explained when these subjects were segregated according to different combinations of baPWV and ABI.
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Affiliation(s)
- Raminderjit Kaur
- Department of Molecular Biology & Biochemistry , Guru Nanak Dev University , Amritsar , Punjab, India
| | - Manpreet Kaur
- Department of Human Genetics , Guru Nanak Dev University , Amritsar , Punjab, India
| | - Rohit Kapoor
- Carewell Heart & Superspeciality Hospital , Amritsar , Punjab, India
| | - Jatinder Singh
- Department of Molecular Biology & Biochemistry , Guru Nanak Dev University , Amritsar , Punjab, India
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Rogowicz-Frontczak A, Pilacinski S, Araszkiewicz A, Zozulinska-Ziolkiewicz D, Wykretowicz A, Wierusz-Wysocka B. C-Reactive protein and soluble intracellular adhesion molecule-1 are related to pulse wave reflection in type 1 diabetes 1C-1. J Diabetes 2014; 6:577-85. [PMID: 24456036 DOI: 10.1111/1753-0407.12129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/10/2013] [Accepted: 01/16/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The association of inflammation with cardiovascular (CV) complications in diabetes remains a matter of considerable debate. Arterial stiffness and enhanced wave reflection play an important role in CV complications. Therefore, in the present study we investigated whether markers of inflammation are correlated with parameters of wave reflection in type 1 diabetes (T1D). METHODS In all, 145 T1D patients were included in the study (median age 32 years, disease duration 10 years, HbA1c 8.2%). Serum concentrations of high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase (MMP)-9, soluble intracellular adhesion molecule-1 (sICAM-1), and myeloperoxidase (MPO) were estimated as markers of inflammation. Parameters of pulse wave reflection (central augmentation index [cAIx] and peripheral augmentation index [pAIx]) were assessed using pulse wave analysis. RESULTS Multivariate linear regression analysis revealed that, after adjustment for age, mean blood pressure, HbA1c, low-density lipoprotein-cholesterol, and the presence of at least one microangiopathic complication of diabetes, cAIx and pAIx were associated with serum concentration of hs-CRP (β = 1.838, 95% confidence interval [CI] 0.336-3.339 [P = 0.017]; and β = 2.041, 95% CI 0.683-3.400 [P = 0.004], respectively) and sICAM-1 (β = 0.073, 95% CI 0.015-0.131 [P = 0.014]; and β = 0.066, 95% CI 0.013-0.119 [P = 0.016], respectively) in the study group. CONCLUSIONS In T1D parameters of wave reflection are related to markers of inflammation.
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Affiliation(s)
- Anita Rogowicz-Frontczak
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
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Salles Rosa Neto N, Levy-Neto M, Tolezani EC, Bonfá E, Bortolotto LA, Pereira RMR. Determinants of Arterial Stiffness in Female Patients with Takayasu Arteritis. J Rheumatol 2014; 41:1374-8. [DOI: 10.3899/jrheum.131110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.The assessment of pulse wave velocity (PWV) in Takayasu arteritis (TA) is complex because of many confounding factors. We evaluated PWV in female patients with TA and controls with comparable anthropometric and clinical variables and assessed a possible association of TA with disease variables.Methods.We evaluated 27 patients with TA consecutively. Exclusion criteria were menopause, smoking, diabetes, renal insufficiency, poorly controlled hypertension, cardiac arrhythmias, obesity, inflammatory comorbidities, pregnancy, and surgical procedures involving the aorta. Disease activity was determined by clinical and laboratory variables. As healthy controls, 27 subjects with comparable age, blood pressure, height, and weight were selected. Carotid-femoral PWV measurements were obtained using the Complior system.Results.The mean PWV in patients with TA was higher than in healthy controls (9.77 ± 3.49 vs 7.83 ± 1.06 m/s; p = 0.009). Despite our strict selection criteria, patients with TA had an average systolic blood pressure (SBP) 8 mmHg higher than controls (p = NS), and significantly higher pulse pressure values. The multivariate linear regression model shows that 93.8% of the PWV variability is explained by the variables age, mean BP, and the disease itself (adjusted R2= 0.938). Stepwise logistic analysis using the PWV cutoff value established by the receiver-operator characteristic curve (> 8.34 m/s) as dependent variable, and measures with significance in univariate analysis as independent variables revealed that TA (OR 4.69; 95% CI 1.31–16.72; p = 0.017) and mean BP (OR 1.06; 95% CI 1.00–1.12; p = 0.048) were independently associated with higher PWV. Further analysis of disease variables revealed that PWV values were not correlated with erythrocyte sedimentation rate, C-reactive protein, cumulative dose of glucocorticoid, or ejection fraction (p > 0.05).Conclusion.In our cohort of female patients with TA, the disease itself and mean BP were the strongest determinants associated with arterial stiffness.
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Kawamoto R, Tabara Y, Kusunoki T, Abe M, Kohara K, Miki T. A slightly high-normal glucose level is associated with increased arterial stiffness in Japanese community-dwelling persons with pre-diabetes. Vasc Med 2013; 18:251-6. [DOI: 10.1177/1358863x13503192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impaired fasting glucose (IFG) in diabetes is a risk factor for arterial stiffness and cardiovascular disease (CVD), but the impact of a slightly high-normal glucose level remains controversial. We investigated whether slightly high-normal fasting plasma glucose (FPG) was independently associated with arterial stiffness in non-diabetic community-dwelling persons. We recruited 114 men aged 69 ± 9 years (range 40–89) and 208 women aged 68 ± 7 years (range 36–84) during their annual health examination in a single community. Arterial stiffness was evaluated by the mean of the right and left brachial–ankle pulse wave velocity (ba-PWV). Age-adjusted ba-PWV increased significantly from the lowest to the highest FPG group ( p < 0.001). Multiple linear regression analyses for ba-PWV revealed that FPG levels (β=0.154, p < 0.001) were independently and significantly associated with ba-PWV. The multivariate-adjusted ba-PWV value of the high-normal glucose group (Group 3: 95–100 mg/dL) was significantly higher than that of the lowest normal glucose group (Group 1: 52–89 mg/dL) ( p=0.021), and the ba-PWV value in the IFG group (Group 4: 101–125 mg/dL) was significantly higher than those of the normal glucose groups (Group 1: <90 mg/dL; Group 2: 90–94 mg/dL) ( p<0.001 and p=0.009, respectively). Slightly high-normal glucose levels were associated with arterial stiffness in Japanese community-dwelling persons.
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Affiliation(s)
- Ryuichi Kawamoto
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomo Kusunoki
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masanori Abe
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Katsuhiko Kohara
- Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tetsuro Miki
- Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
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Adiponectin and progression of arterial stiffness in hypertensive patients. Int J Cardiol 2013; 163:316-319. [DOI: 10.1016/j.ijcard.2011.06.061] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 05/18/2011] [Accepted: 06/09/2011] [Indexed: 01/19/2023]
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Ortiz RM, Mamalis A, Navar LG. Aldosterone Receptor Antagonism Reduces Urinary C-Reactive Protein Excretion in Angiotensin II-Infused, Hypertensive Rats. ACTA ACUST UNITED AC 2012; 3:184-91. [PMID: 20161115 DOI: 10.1016/j.jash.2009.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Elevated C-reactive protein (CRP) may contribute to elevated arterial pressure in Ang II-dependent hypertension. However, the in vivo effects of Ang II and of mineralocorticoid receptor (MR) antagonism on CRP during Ang II-dependent hypertension have not been examined. In addition, urinary CRP excretion as a method to monitor the progression of Ang II-induced inflammation has not been evaluated. METHODS Urine samples were collected from three groups (n = 10/group) of rats: 1) normotensive control, 2) angiotensin II infused (Ang II; 60 ng/min), and 3) Ang II + eplerenone (epl; 25 mg/d). A diet containing epl (0.1 %) was provided after 1 week of Ang II infusion. RESULTS After 28 d, Ang II increased SBP from 136 +/- 5 to 207 +/- 8 mmHg; this response in SBP was not altered following MR antagonism (215 +/- 6 mmHg). Ang II-infusion increased plasma CRP from 14 +/- 2 to 26 +/- 3 mug/mL and increased urinary CRP excretion nearly 8-fold (143 +/- 26 vs 1102 +/- 115 ng/d). Treatment with eplerenone reduced plasma CRP by 25 % and urinary immunoreactive CRP (irCRP) by 34 % in Ang II-infused rats suggesting that aldosterone contributes to the CRP-associated inflammatory response in Ang II-dependent hypertension. CONCLUSIONS The increase in SBP preceded the increase in irCRP excretion by at least 4 days suggesting that CRP does not significantly contribute to increased arterial blood pressure in Ang II-dependent hypertension. The blockade of MR reduced plasma CRP and urinary irCRP excretion demonstrating the contribution of aldosterone to the Ang II-induced generation of CRP. Furthermore, urinary CRP may serve as a non-invasive index for monitoring cardiovascular inflammation during hypertension.
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Affiliation(s)
- Rudy M Ortiz
- Division of Natural Sciences, University of California, Merced CA
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Associations of C-Reactive Protein to Indices of Vascular Health and the Influence of Serum 25(OH)D Status in Healthy Adults. J Nutr Metab 2012; 2012:475975. [PMID: 23029606 PMCID: PMC3457628 DOI: 10.1155/2012/475975] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/22/2012] [Indexed: 02/06/2023] Open
Abstract
Elevated serum high-sensitivity C-reactive protein (hs-CRP) and low serum 25-hydroxyvitamin D [25(OH)D] are associated with increased cardiovascular disease (CVD) risk. Ethnic differences in serum hs-CRP and 25(OH)D concentrations and CVD are known. Objectives: to investigate the ethnic differences in hs-CRP concentrations, to assess the influence of 25(OH)D on these ethnic differences and to examine the influence of 25(OH)D on association between hs-CRP and cardiovascular health indices. Subjects: 62 healthy adults [26 African Americans (AA), 26 European Americans (EA), and 10 Hispanic Americans (HA)], ages 18–55 years. Serum hs-CRP and 25(OH)D as well as pulse wave velocity (PWV), augmentation index (AIx), and flow-mediated dilatation (FMD) were measured. hs-CRP was inversely associated with 25(OH)D (r = −0.25, P = 0.049), and hs-CRP was positively associated with PWV (r = 0.29, P = 0.04). The association of hs-CRP with PWV attenuated after adjustment for 25(OH)D (P = 0.15). hs-CRP was higher in AA compared to EA (P = 0.05); this differences was reduced by 32% after adjusting for serum 25(OH)D. Conclusion: eventhough the inverse association between serum 25(OH)D and CRP does not infer causality, lower serum 25(OH)D may increase risk for inflammation and endothelial dysfunction. The lower 25(OH)D in AA may predispose to greater inflammation and associated vascular dysfunction.
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Kim WJ, Park CY, Park SE, Rhee EJ, Lee WY, Oh KW, Park SW, Kim SW, Song S. The association between regional arterial stiffness and diabetic retinopathy in type 2 diabetes. Atherosclerosis 2012; 225:237-41. [PMID: 23017354 DOI: 10.1016/j.atherosclerosis.2012.08.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 08/18/2012] [Accepted: 08/27/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Although several studies have reported that PWV is associated with diabetic retinopathy, it remains controversial as to which segment provides the PWV that might best reflect the presence of retinopathy. The aim of this study was to determine the pulse wave velocity (PWV) of arterial segments that is most closely associated with diabetic retinopathy in subjects without a history of macrovascular complications. METHODS After excluding subjects with a history of ischemic heart disease, peripheral artery disease, ischemic stroke, renal insufficiency, overt proteinuria, and other nondiabetic ophthalmic lesions or insufficient retinal examinations, a total of 494 subjects were analyzed by cross-sectional study. The central PWVs, including the heart-femoral (hf), heart-carotid (hc), heart-ankle (ha), and carotid-brachial (cb) segments, and the peripheral PWVs, including brachial-ankle (ba) and femoral-ankle (fa), were measured for each subject. RESULTS The group with diabetic retinopathy exhibited significantly higher hfPWV, hcPWV, haPWV and baPWV, but notcbPWV, faPWV or augmentation index (AI). Age, duration of diabetes, systolic and diastolic BP and pulse pressure were all positively associated with hfPWV, hcPWV, haPWV and baPWV. Quartiles of hfPWV were significantly associated with diabetic retinopathy after adjustment for covariates and known risk factors of diabetic retinopathy (P for trend = 0.023). Conversely, all quartiles of haPWV, hcPWV and baPWV lost significance after adjustment. CONCLUSIONS We found that diabetic retinopathy was most closely associated with hfPWV, suggesting the most reliable index of regional arterial stiffness index in retinopathy.
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Affiliation(s)
- Won Jun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
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15
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Youn JC, Kim JY, Park S, Kwon J, Lee HS, Shin DH, Lee SH, Kang SM, Hoon Son N, Jang Y. Comparison of arterial stiffness indices measured by the Colins and SphygmoCor systems. Hypertens Res 2012; 35:1180-4. [PMID: 22833159 DOI: 10.1038/hr.2012.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Arterial stiffness is a known independent predictor of cardiovascular mortality. The Colins system is an easy device and has gained widespread use, but the cutoff value for high-risk central arterial stiffness is not well established. We investigated the correlation between arterial stiffness measured by the Colins system with conventional measurements from the SphygmoCor system. Arterial pulse wave velocity (PWV) and augmentation indices (AIs) were measured on a single visit using two different devices in 948 patients with hypertension or coronary artery disease. Strong positive correlations were observed for PWV values measured by the SphygmoCor and Colins systems. The Colins system measurements accurately predicted high-risk central arterial stiffness, defined as carotid-femoral PWV≥12 m s(-1), with an area under the receiver-operating characteristic curve (AUC) of 0.884 (heart-femoral PWV, hfPWV) and 0.830 (brachial-ankle PWV, baPWV) in the training set (N=664). The cutoff values, 11.18 (hfPWV) and 16.17 m s(-1) (baPWV), showed good discrimination in the validation set (N=284), with sensitivity of 83.3 (hfPWV) and 76.0% (baPWV), and specificity of 74.9 (hfPWV) and 82.6% (baPWV). The SphygmoCor and Colins AI systems also showed moderate positive correlation. The Colins AI system better predicted high-risk central pulse pressure as defined by pulse pressure≥50 mm Hg (AUC: Colins, 0.765; SphygmoCor, 0.692; P=0.011). Arterial stiffness measured by the Colins system showed strong positive correlation and agreement with the SphygmoCor system measurement. Cutoff values for high-risk central arterial stiffness in the Colins system need further validation in a prospective study.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Blasco-Baque V, Kémoun P, Loubieres P, Roumieux M, Heymes C, Serino M, Sixou M, Burcelin R. [Impact of periodontal disease on arterial pressure in diabetic mice]. Ann Cardiol Angeiol (Paris) 2012; 61:173-177. [PMID: 22621847 DOI: 10.1016/j.ancard.2012.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 04/15/2012] [Indexed: 06/01/2023]
Abstract
Diabetes-driven cardiovascular diseases represent a high challenge for developed countries. Periodontal disease is strictly linked to the aforementioned diseases, due to its Gram negative-driven inflammation. Thus, we investigated the effects of periodontal disease on arterial pressure during the development of diabetes in mice. To this aim, C57BL/6 female mice were colonized with pathogens of periodontal tissue (Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum) for 1month, whereas another group of mice did not undergo the colonization. Subsequently, all mice were fed a high-fat carbohydrate-free diet for 3months. Then, arterial pressure was measured in vivo and a tomodensitometric analysis of mandibles was realized as well. Our results show increased mandibular bone-loss induced by colonization with periopathogens. In addition, periodontal infection augmented glucose-intolerance and systolic and diastolic arterial pressure, parameters already known to be affected by a fat-diet. In conclusion, we show here that periodontal disease amplifies metabolic troubles and deregulates arterial pressure, emerging as a new axis of metabolic investigation.
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Affiliation(s)
- V Blasco-Baque
- Parodontites et maladies générales LU 51, faculté de chirurgie dentaire, 3, chemin des Maraîchers, 31062 Toulouse cedex, France.
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17
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Kocyigit I, Kaya MG, Orscelik O, Kaya C, Akpek M, Zengin H, Sipahioglu MH, Unal A, Yilmaz MI, Tokgoz B, Oymak O, Axelsson J. Early arterial stiffness and inflammatory bio-markers in normotensive polycystic kidney disease patients. Am J Nephrol 2012; 36:11-8. [PMID: 22699414 DOI: 10.1159/000339440] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/10/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS Cardiovascular disease is the main cause of morbidity and mortality in autosomal-dominant polycystic kidney disease (ADPKD) patients. To clarify temporal relationship between ADPKD, hypertension and the loss of renal function, we examined these factors in patients with early-stage ADPKD who did not yet have hypertension. METHODS Fifty patients with ADPKD (42% males, 36.6 ± 9.9 years, no blood pressure medication) and 50 healthy controls (44% males, 35.4 ± 6.4 years) were studied cross-sectionally. Pulse wave velocity (PWV), cardiac morphology and function, aortic elastic indexes, estimated glomerular filtration rate (eGFR), 24-hour ambulatory blood pressure, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and highly sensitive C-reactive protein (hs-CRP) were measured in all participants, using conventional methods. RESULTS Despite a normal blood pressure, aortic stiffness index and pulse wave velocity values were increased in patients compared to controls (6.8 ± 4.7 vs. 5.1 ± 3.3, p = 0.043 and 9.6 ± 1.3 vs. 5.8 ± 1.1 m/s, p < 0.001). In univariate analysis, IL-6, TNF-α, hs-CRP and eGFR were all significantly correlated with PWV. The independence of these correlations were analyzed in a regression model, and showed PWV to be significantly predicted by IL-6, TNF-α and hs-CRP. CONCLUSION Increased arterial stiffness and pulse wave velocity are early manifestations of ADPKD appearing before hypertension or reduced eGFR. However, these vascular abnormalities are related to signs of systemic low grade inflammation, suggesting a common pathophysiological mechanism apparently present also in other vascular diseases but yet to be elucidated.
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Affiliation(s)
- Ismail Kocyigit
- Department of Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey.
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18
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Lack of independent association between C-reactive protein and central aortic hemodynamics in black Africans with high risk of cardiovascular disease. Am J Hypertens 2011; 24:1094-101. [PMID: 21753803 DOI: 10.1038/ajh.2011.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND As the independent relationship between C-reactive protein (CRP) concentrations and central aortic blood pressures (BP) in populations with high CRP concentrations is uncertain, we aimed to evaluate this question in a community sample, 57% with CRP concentrations >3 mg/l (high cardiovascular risk). METHODS Central aortic hemodynamics (applanation tonometry, SphygmoCor software) and serum ultrasensitive-CRP concentrations were assessed in 836 randomly recruited participants from an urban developing community of African ancestry. RESULTS Log CRP was strongly correlated with age, steady-state pressures (indexed by mean arterial pressure (MAP)), indexes of adiposity, central systolic BP (SBPc), central pulse pressure (PPc), the augmented (reflected) (AP) and forward (P1) pressure wave components of PPc, aortic pulse wave velocity (PWV), and the effective reflecting distance (ERD) (P < 0.0001 for all). Moreover, before adjustments SBPc, PPc, AP, P1, PWV, and ERD increased incrementally across low, moderate and high risk categories of CRP (P < 0.0001). However, in multivariate models with adjustments for confounders, no independent association between CRP and SBPc, PPc, AP, P1, PWV, or ERD was noted (P > 0.10 for all) and multivariate adjusted central hemodynamic variables were similar in participants with low, moderate, or high risk CRP concentrations. The lack of independent relationship between CRP concentrations and central aortic hemodynamics was reproduced in normotensives, hypertensives, men, women, lean and overweight/obese participants, and in participants lesser or ≥ 60 years of age. CONCLUSION Even in communities with prevalent high CRP concentrations, low-grade inflammation as indexed by CRP, does not independently account for increases in aortic PP, the component waves, or the determinants of PPc.
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Blood pressure in relation to neurogenic, inflammatory and endothelial dysfunction biomarkers in patients with treated essential arterial hypertension. Adv Med Sci 2011; 56:80-7. [PMID: 21515487 DOI: 10.2478/v10039-011-0016-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Clinical relevance of relations among blood pressure (BP), inflammation, endothelial dysfunction and sympathetic activation is unknown. Study aimed, whether in patients with diagnosed and treated essential arterial hypertension (HTN) biomarkers of inflammation (hs-C-reactive protein, hs-CRP), endothelial dysfunction (endothelin-1, ET-1), and sympathetic nervous system modulation (epinephrine, E and norepinephrine, NE) could be related to BP values. MATERIAL AND METHODS In 62 patients with diagnosed and treated HTN (mean time of disease 5±3.2 years), serum hs-CRP and ET-1 as well as plasma E and NE concentrations were measured. 24-hour ambulatory blood pressure measurement device (ABPM) was used to estimate efficacy of treatment. RESULTS A positive correlation between epinephrine and norepinephrine concentrations was found (r=0.246, p=0.05), however such a statistically significant correlation neither to hs-CRP, nor ET-1 were found. Patients with the highest hs-CRP and NE concentrations had the highest systolic (SBP) and diastolic (DBP) blood pressure values. Similar relation was found in subgroup of patients with suboptimal blood pressure values (SPB ł 130mmHg, DBP ł 80mmHg). In a group of optimal treated patients, elevated levels of ET-1 and NE related to increased blood pressure values. ROC analysis identified ET-1 as statistically significant to diagnose elevated blood pressure: 0.665 (95% Confidence interval 0.512 to 0.796). CONCLUSIONS In patients with diagnosed and treated arterial hypertension, there are relations among measurements of hs-CRP, ET-1, NE and blood pressure values in spite of treatment, which may improve understanding of mechanisms involving inflammation, endothelial dysfunction and sympathetic nerve activation and may identify patients with refractory hypertension.
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Glasser SP, Dudenbostel T. The Global Burden of Cardiovascular Disease: The Role of Endothelial Function and Arterial Elasticity in Cardiovascular Disease as Novel and Emerging Biomarkers. CURRENT CARDIOVASCULAR RISK REPORTS 2011; 5:187-195. [PMID: 24000308 PMCID: PMC3758762 DOI: 10.1007/s12170-010-0151-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Some consider the measurements of arterial elasticity and flow-mediated dilation to be an indirect "biomarker" of endothelial dysfunction. As such, we describe the various uses of these techniques in the evaluation of the natural history of vascular disease. These measures are potential markers of disease, as abnormalities reflect changes in the integrity of vascular structure but occur prior to the manifestation of symptomatic cardiovascular events. In this review, the natural history of arterial elasticity is discussed, and the effects of aging and inflammation are reviewed. The role that arterial elasticity and flow-mediated dilation have in predicting future cardiovascular disease, and the effects of pharmacologic agents on these measures, is also reviewed.
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Affiliation(s)
- Stephen P. Glasser
- Division of Preventive Medicine and Department of Epidemiology, University of Alabama at Birmingham, 1717 11th Avenue South MT638, Birmingham, AL 35205, USA
| | - Tanja Dudenbostel
- Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 933 19th Street South CH19-115, Birmingham, AL 35205, USA
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Jung JY, Hwang YH, Lee SW, Lee H, Kim DK, Kim S, Oh YG, Yang J, Joo KW, Ahn C, Oh KH. Factors associated with aortic stiffness and its change over time in peritoneal dialysis patients. Nephrol Dial Transplant 2010; 25:4041-8. [PMID: 20501463 DOI: 10.1093/ndt/gfq293] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND An increase in aortic stiffness, as reflected by an increase in pulse wave velocity (PWV), is an important predictor of cardiovascular mortality in dialysis patients. Decreased serum concentration of calcification inhibitor, such as fetuin-A, is inversely related to mortality in haemodialysis patients. Our aim is to investigate the factors associated with aortic stiffness and its change over time in peritoneal dialysis (PD) patients. METHODS As a prospective observational study, we analysed 67 PD patients, aged 50 ± 14 years (mean ± SD) and with dialysis duration of 26 (5-58) months (median, interquartile range). At baseline, age, mean arterial pressure (MAP), left ventricular mass (LVM) index, diabetes, serum albumin, calcium (Ca), phosphorus (P) and intact parathyroid hormone (iPTH), uric acid, total bilirubin, high-sensitivity C-reactive protein (hsCRP), fetuin-A, and residual renal function were included in association analysis with aortic stiffness represented by heart-to-femoral PWV (hfPWV). We also evaluated simple vascular calcification score (SVCS) with plain radiograph of the pelvis and both hands. PWV was measured both at baseline and at 1 year. Change of aortic stiffness was determined by △PWV (difference between 1-year PWV and baseline PWV). Time-averaged concentrations were used to evaluate the relation between biologic markers and changes of aortic stiffness. RESULTS hfPWV was 1022 ± 276 cm/s at baseline, and hfPWV determined at 1 year was 1069 ± 317 cm/s. Mean serum fetuin-A concentration was 0.34 ± 0.08 g/L. At baseline, aortic PWV positively correlated with age, smoking status, diabetes, MAP, total cholesterol and LDL cholesterol. On the other hand, aortic PWV inversely correlated with fetuin-A, log PTH, haemoglobin and albumin. In a multiple regression model, association of serum fetuin-A (β = -0.329, P = 0.003) with aortic PWV remained significant, along with age (β = 0.512, P < 0.001), MAP (β = 0.215, P = 0.047) and log PTH (β = -0.269, P = 0.025). At follow-up, △MAP (β = 0.500, P < 0.001) and time-averaged TG (aTG) (β = 0.259 P = 0.019) were determinants of △PWV. CONCLUSIONS For our PD patients, serum fetuin-A was an independent determinant of aortic stiffness, as well as age, MAP and log PTH. Although 1 year is not sufficient to observe the change of aortic stiffness, some patients exhibited >15% increase of PWV during this period. △MAP and aTG were factors affecting the change of PWV. Follow-up over a longer period is necessary to elucidate factors that determine changes of aortic stiffness over time from PD patients.
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Affiliation(s)
- Ji Yong Jung
- Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea
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22
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Intensive cholesterol-lowering therapy improves large artery elasticity in acute myocardial infarction patients. Heart Vessels 2009; 24:340-6. [DOI: 10.1007/s00380-008-1132-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 11/25/2008] [Indexed: 10/20/2022]
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Vidal F, Figueredo CMS, Cordovil I, Fischer RG. Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension. J Periodontol 2009; 80:786-91. [PMID: 19405832 DOI: 10.1902/jop.2009.080471] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent epidemiologic studies suggest that inflammation is the link between periodontal diseases and cardiovascular complications. This study aimed to evaluate the effects of non-surgical periodontal treatment on plasma levels of inflammatory markers (interleukin [IL]-6, C-reactive protein [CRP], and fibrinogen) in patients with severe periodontitis and refractory arterial hypertension. METHODS Twenty-two patients were examined and randomly divided into two groups. The test group was composed of 11 patients (mean age, 48.9 +/- 3.9 years) who received periodontal treatment, whereas the control group had 11 patients (mean age, 49.7 +/- 6.0 years) whose treatment was delayed for 3 months. Demographic and clinical periodontal data were collected, and blood tests were performed to measure the levels of IL-6, CRP, and fibrinogen at baseline and 3 months later. RESULTS The clinical results showed that the mean percentages of sites with bleeding on probing, probing depth (PD) 4 to 5 mm, PD > or =6 mm, clinical attachment loss (CAL) 4 to 5 mm, and CAL > or =6 mm were significantly reduced in the test group 3 months after periodontal treatment. There were no significant differences between the data at baseline and 3 months in the control group. Periodontal treatment significantly reduced the blood levels of fibrinogen, CRP, and IL-6 in the test group. CONCLUSION Non-surgical periodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis.
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Affiliation(s)
- Fábio Vidal
- Department of Periodontology, Faculty of Odontology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
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24
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Huang G, Luo C, Gu X, Wu Z, Wang Z, Du Z, Hu C, Tang L. Mechanical Strain Induces Expression of C-Reactive Protein in Human Blood Vessels. J Pharmacol Exp Ther 2009; 330:206-11. [DOI: 10.1124/jpet.109.150961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Meguro T, Nagatomo Y, Nagae A, Seki C, Kondou N, Shibata M, Oda Y. Elevated arterial stiffness evaluated by brachial-ankle pulse wave velocity is deleterious for the prognosis of patients with heart failure. Circ J 2009; 73:673-80. [PMID: 19246812 DOI: 10.1253/circj.cj-08-0350] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Arterial stiffness is used as an index of arteriosclerosis. The goal of this study was to clarify whether increased arterial stiffness, evaluated by measuring the brachial-ankle pulse wave velocity (baPWV), is a risk factor for the prognosis of heart failure (HF) patients. METHODS AND RESULTS After examination of the baPWV, as well as the levels of neurohumoral factors, the 72 enrolled HF patients were followed up for a survival study, which had a primary endpoint of re-admission because of HF. The secondary endpoint was cardiac death. Results of Cox proportional hazards modeling revealed that baPWV, systolic blood pressure (BP) and brain natriuretic peptide level were factors that affected survival (P<0.05). The patients were divided into 2 groups according to the cutoff baPWV value (1,750 cm/s). Although hemodynamic factors were similar between the groups, the high-baPWV group had a lower event-free survival rate for the primary and secondary endpoints than the low-baPWV group (P<0.05). BP at re-admission was higher in the high-baPWV group (174+/-30 mmHg) than in the low-baPWV group (121+/-33 mmHg, P<0.01). CONCLUSIONS Elevated arterial stiffness is a risk factor for re-admission or cardiac death of HF patients.
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Affiliation(s)
- Tomomi Meguro
- Department of Medicine, Tokyo Electric Power Company Hospital, Tokyo, Japan.
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Shroff GR, Cen YY, Duprez DA, Bart BA. Relationship between carotid artery stiffness index, BNP and high-sensitivity CRP. J Hum Hypertens 2009; 23:783-7. [PMID: 19262579 DOI: 10.1038/jhh.2009.17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Arterial stiffness is an independent predictor of cardiovascular morbidity and mortality. Brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) are considered as novel biomarkers that are useful in the prediction of early cardiovascular risk. We studied the relationship between carotid artery stiffness index beta and the cardiovascular biomarkers BNP and hs-CRP in 55 consecutive subjects. Carotid artery stiffness was assessed using the stiffness index beta derived from brachial artery blood pressure measurement and carotid ultrasonography. Venous blood samples were obtained for BNP and hs-CRP. Pearson's correlation coefficient suggested a strong bivariate relationship between carotid stiffness index beta and age (r=0.56, P<0.0001), BNP (r=0.45, P<0.004) and hs-CRP (r=0.26, P=0.06), respectively. On multiple regression analysis, significant correlations were found between carotid stiffness index beta and age (P=0.004), BNP (P=0.027) and hs-CRP (P=0.029). These findings suggest that there is a relationship between intra-cardiac pressures (measured by BNP), vascular inflammation (measured by hs-CRP) and vascular stiffness. Cardiovascular biomarkers are thus associated with functional parameters of the vascular tree.
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Affiliation(s)
- G R Shroff
- Cardiovascular Division, Medical School, University of Minnesota, Minneapolis, MN 55455, USA.
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Carotid artery stiffness, high-density lipoprotein cholesterol and inflammation in men with pre-hypertension. J Hum Hypertens 2009; 23:590-6. [PMID: 19225528 DOI: 10.1038/jhh.2009.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Low circulating levels of high-density lipoprotein cholesterol (HDL-C) are associated with increased risk for cardiovascular events. HDL-C has a variety of poorly understood atheroprotective effects, including altering lipid metabolism and reducing inflammation. Increased arterial stiffness is an important predictor of subsequent cardiovascular risk. Therefore, in this study, we sought to determine whether HDL-C levels are associated with carotid arterial stiffness. In addition, we examined potential correlates of this association, such as inflammatory factors, cardiorespiratory fitness and body fat percentage. Carotid artery beta-stiffness was measured by ultrasound in 47 (23 years old) healthy pre-hypertensive men. Low HDL-C was defined as <1.0 mmol l(-1). Body fat was measured by air displacement plethysmography. Cardiorespiratory fitness was measured using a maximal exercise test, with metabolic gas analysis and inflammatory markers consisting of C-reactive protein (CRP), white blood cell (WBC) count and absolute neutrophil count. Men with a low HDL-C had significantly higher carotid artery stiffness, CRP, WBC count, neutrophil count, body fat, fasting glucose and lower cardiorespiratory fitness (P<0.05). Co-varying for cardiorespiratory fitness, % body fat and glucose had no effect on group differences in carotid artery stiffness. Co-varying for inflammatory markers resulted in groups having similar carotid artery stiffness. Pre-hypertensive men with low HDL-C have a higher carotid artery stiffness when compared with those with higher HDL-C. The detrimental effects of low HDL-C on large artery stiffness in pre-hypertensive men may be mediated by inflammation and not by cardiorespiratory fitness or body fat levels.
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Ishii H, Tsukada T, Yoshida M. Angiotensin II type-I receptor blocker, candesartan, improves brachial-ankle pulse wave velocity independent of its blood pressure lowering effects in type 2 diabetes patients. Intern Med 2008; 47:2013-8. [PMID: 19043252 DOI: 10.2169/internalmedicine.47.1162] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Hypertension in diabetic patients has been shown to accelerate the progression of atherosclerosis and angiotensin II type-I (AT1) receptor blocker (ARB) has been shown to have anti-atherosclerosis action independent of its action on blood pressure. METHODS AND RESULTS Type 2 diabetic patients with hypertension received either ARB (candesartan), or a calcium channel blocker (CCB; amlodipine or nifedipine) for 12 weeks. Though clinical parameters such as blood glucose, HbA1c, and systolic and diastolic pressure were not significantly changed between the two groups, brachial-ankle pulse wave velocity (baPWV) was significantly reduced in the candesartan group when compared to CCB groups. Moreover, candesartan treatment exhibited a tendency of reduction in inflammation markers such as high sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6). CONCLUSION We conclude that candesartan may improve vascular inflammation independent of its effect on hypertension in diabetes, thus suggesting its efficacy in diabetic patients.
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Affiliation(s)
- Hideto Ishii
- Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo
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