1
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Cutruzzolà A, Parise M, Scavelli FB, Barone M, Gnasso A, Irace C. Time in Range Does Not Associate With Carotid Artery Wall Thickness and Endothelial Function in Type 1 Diabetes. J Diabetes Sci Technol 2022; 16:904-911. [PMID: 33615850 PMCID: PMC9264437 DOI: 10.1177/1932296821993178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with Type 1 diabetes (T1D) have an increased risk of developing atherosclerosis and complications as myocardial infarction and peripheral artery disease. The thickening of the carotid wall and the brachial artery dysfunction are early and preclinical manifestations of atherosclerosis. The standard marker of care for assessment of glycemic control, glycated hemoglobin, does not associate with early atherosclerosis. We have hypothesized that the emerging metric of glycemic control, as the time spent in the target range (TIR), might be associated with carotid thickening and endothelial dysfunction. According to the hypothesis, we have designed the present research with the aim to evaluate the association between TIR collected in the short and long term and the measures of arterial morphology and function in patients with T1D. METHODS In our study, 70 patients and 35 healthy controls underwent ultrasound vascular study to measure carotid artery intima-media thickness (IMT) and brachial artery endothelial function by the flow-mediated dilation (FMD) technique. TIR was collected by a continuous glucose monitoring system for 2 weeks, 3 months, and 6 months before the vascular study. RESULTS Patients with T1D showed a significantly higher carotid IMT (mean±SE, 644±19 vs. 568±29 µ; p= 0.04) and a significantly lower FMD (mean±SE, 7.6±0.4 vs. 9.8±0.6%; p=0.01) compared with control subjects. No significant relationship between IMT, FMD, and TIR collected in the short and long term emerged. CONCLUSIONS Young patients with T1D have early vascular abnormalities. The percent of TIR does not correlate with preclinical atherosclerosis. This finding underlines the complexity of the interplay between diabetes and atherosclerosis.
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Affiliation(s)
- Antonio Cutruzzolà
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Martina Parise
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Faustina B Scavelli
- Azienda Ospedaliero-Universitaria Mater
Domini, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Milena Barone
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Agostino Gnasso
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Concetta Irace
- Dipartimento di Scienze della Salute,
Università degli Studi Magna Græcia di Catanzaro, Italy
- Concetta Irace, Dipartimento di Scienze
della Salute, Università degli Studi Magna Græcia di Catanzaro, Viale Europa,
Località Germaneto, Catanzaro 88100, Italy.
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2
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Cutruzzolà A, Parise M, Vallelunga R, Lamanna F, Gnasso A, Irace C. Effect of Extra Virgin Olive Oil and Butter on Endothelial Function in Type 1 Diabetes. Nutrients 2021; 13:nu13072436. [PMID: 34371945 PMCID: PMC8308536 DOI: 10.3390/nu13072436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Post-prandial hyperglycemia can be relevant in developing early manifestations of atherosclerosis. EVOO (Extra Virgin Olive Oil), rich in saturated fatty acids and commonly used in the Mediterranean diet, seems to control post-prandial hyperglycemia better than butter. Subjects with type 1 diabetes are at higher risk of developing cardiovascular disease and show endothelial dysfunction, an early manifestation of atherosclerosis in the first years of the disease. Our study aims to evaluate whether EVOO and butter influence endothelial function in subjects with type 1 diabetes when added to a single high glycemic index (HGI) meal. In this exploratory cross-over study, 10 subjects with type 1 diabetes and 6 healthy subjects were scheduled to receive two types of HGI meals: one enriched with EVOO and one with butter. Before and after each test meal at different time points, all subjects underwent the evaluation of endothelial function by flow-mediated dilation technique, glucose and lipids measurements, and gastric emptying assessment by ultrasound. Flow-mediated dilation significantly increased after EVOO-enriched meal compared with butter in subjects with type 1 diabetes (two-way-repeated measurements ANOVA, p = 0.007). In patients with type 1 diabetes, the add-on of EVOO to HGI meal improves vascular function compared to butter, which has detrimental effects.
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Affiliation(s)
- Antonio Cutruzzolà
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Martina Parise
- Dipartimento di Scienze della Salute, University Magna Græcia, 88100 Catanzaro, Italy;
| | - Rosarina Vallelunga
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Francesco Lamanna
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Agostino Gnasso
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Concetta Irace
- Dipartimento di Scienze della Salute, University Magna Græcia, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-0961-3647039
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3
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Nowak KL, Jovanovich A, Farmer-Bailey H, Bispham N, Struemph T, Malaczewski M, Wang W, Chonchol M. Vascular Dysfunction, Oxidative Stress, and Inflammation in Chronic Kidney Disease. ACTA ACUST UNITED AC 2020; 1:501-509. [PMID: 33305290 DOI: 10.34067/kid.0000962019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Increased arterial stiffness and vascular endothelial dysfunction are important nontraditional cardiovascular risk factors evident in patients with CKD. Vascular oxidative stress and inflammation may contribute to vascular dysfunction in CKD, but direct evidence is lacking. Methods We assessed carotid-femoral pulse-wave velocity (arterial stiffness) and brachial artery flow-mediated dilation (vascular endothelial function) in participants with moderate-to-severe CKD (eGFR 15-59 ml/min per 1.73 m2) and in healthy controls. Change in brachial artery flow-mediated dilation after an acute infusion of ascorbic acid to inhibit vascular oxidative stress (versus saline) was also measured. Protein expression of vascular endothelial cells collected from a peripheral vein and ELISAs to assess circulating markers were also performed. Results A total of 64 participants with CKD (mean±SD, 65±8 years) and 17 healthy controls (60±5 years) were included. Carotid-femoral pulse-wave velocity was greater in participants with CKD compared with healthy controls (1071±336 versus 732±128 cm/s; P<0.001). Brachial artery flow-mediated dilation was lower in participants with CKD compared with healthy controls (3.5%±2.8% versus 5.5%±3.2%; P=0.02). Circulating inflammation markers (C-reactive protein and IL-6) were elevated in the CKD group (P≤0.02). Endothelial cell protein expression of NADPH (intensity versus human umbilical vein endothelial cell control, 1.48±0.28 versus 1.25±0.31; P=0.05) was greater in participants with CKD. However, ascorbic acid significantly improved brachial artery flow-mediated dilation in control participants (saline, 5.5±3.2; ascorbic acid, 6.8±3.6); as compared with participants with CKD (saline, 3.5±2.8; ascorbic acid, 3.6±3.2) (group×condition interaction P=0.04), suggesting vascular oxidative stress could not be overcome with ascorbic acid in participants with CKD. Conclusions Vascular oxidative stress is present in CKD, which cannot be overcome with acute infusion of ascorbic acid.
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Affiliation(s)
- Kristen L Nowak
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Anna Jovanovich
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | | | - Nina Bispham
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Taylor Struemph
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | | | - Wei Wang
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Michel Chonchol
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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4
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Irace C, Cutruzzolà A, Parise M, Fiorentino R, Frazzetto M, Gnasso C, Casciaro F, Gnasso A. Effect of empagliflozin on brachial artery shear stress and endothelial function in subjects with type 2 diabetes: Results from an exploratory study. Diab Vasc Dis Res 2020; 17:1479164119883540. [PMID: 31726866 PMCID: PMC7510381 DOI: 10.1177/1479164119883540] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Empagliflozin reduces the risk of cardiovascular mortality in subjects with type 2 diabetes. We demonstrated that empagliflozin increases blood viscosity and carotid shear stress and decreases carotid wall thickness. Shear stress is the force acting on the endothelial surface and modulates arterial function. The current study evaluates the influence of empagliflozin on brachial artery shear stress and endothelial function compared to incretin-based therapy. The study is a nonrandomized, open, prospective cohort study including 35 subjects with type 2 diabetes administered empagliflozin or incretin-based therapy. Shear stress was calculated with a validated formula, and endothelial function was evaluated using the flow-mediated dilation technique. Both treatments resulted in comparable reductions in blood glucose and glycated haemoglobin. Brachial artery shear stress significantly increased exclusively in the empagliflozin group (61 ± 20 vs 68 ± 25 dynes/cm2, p = 0.04), whereas no significant difference was detected in the incretin-based therapy group (60 ± 20 vs 55 ± 12 dynes/cm2, p = not significant). Flow-mediated dilation significantly increased in the empagliflozin group (4.8 ± 4.5% vs 8.5 ± 5.6%, p = 0.03). Again, no change was detected in the incretin-based therapy group (5.1 ± 4.5% vs 4.7 ± 4.7%, p = not significant). The present findings demonstrate the beneficial effect of empagliflozin on shear stress and endothelial function in subjects with type 2 diabetes independent of the hypoglycaemic effect.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna
Græcia University, Catanzaro, Italy
- Concetta Irace, Department of Health
Science, Magna Græcia University, 88100 Catanzaro, Italy.
| | | | - Martina Parise
- Department of Clinical and Experimental
Medicine, Magna Græcia University, Catanzaro, Italy
| | | | - Marco Frazzetto
- School of Medicine, Magna Græcia
University, Catanzaro, Italy
| | - Chiara Gnasso
- School of Medicine, Magna Græcia
University, Catanzaro, Italy
| | | | - Agostino Gnasso
- Department of Clinical and Experimental
Medicine, Magna Græcia University, Catanzaro, Italy
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5
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Loader J, Khouri C, Taylor F, Stewart S, Lorenzen C, Cracowski JL, Walther G, Roustit M. The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta-analysis. Obes Rev 2019; 20:906-920. [PMID: 30887713 DOI: 10.1111/obr.12831] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 12/12/2022]
Abstract
This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (-0.41%, 95% CI, -0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (-4.26%, 95% CI, -4.97 to -3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.
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Affiliation(s)
- Jordan Loader
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,LAPEC EA4278, Avignon Université, Avignon, France
| | - Charles Khouri
- Inserm U1042, Université Grenoble Alpes, Grenoble, France.,Clinical Pharmacology, Grenoble Alpes University Hospital, Grenoble, France
| | - Frances Taylor
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Simon Stewart
- Hatter Institute for Reducing Cardiovascular Disease in Africa, The University of Cape Town, Cape Town, South Africa
| | - Christian Lorenzen
- School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - Jean-Luc Cracowski
- Inserm U1042, Université Grenoble Alpes, Grenoble, France.,Clinical Pharmacology, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Walther
- LAPEC EA4278, Avignon Université, Avignon, France.,School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - Matthieu Roustit
- Inserm U1042, Université Grenoble Alpes, Grenoble, France.,Clinical Pharmacology, Grenoble Alpes University Hospital, Grenoble, France
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6
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Hypoglycemia does not affect the progression of preclinical atherosclerosis in subjects with type 2 diabetes. PLoS One 2019; 14:e0212871. [PMID: 30835778 PMCID: PMC6400373 DOI: 10.1371/journal.pone.0212871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/11/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Intensive treatment aimed at achieving optimal metabolic control to prevent the development of chronic diabetic complications is often associated with an increased rate of hypoglycemic events. Hypoglycemia is believed to be responsible for acute fatal and nonfatal cardiovascular events likely as a consequence of the activation of pro-inflammatory and pro-atherothrombotic pathways. Hypoglycemia has been reported to influence the development of preclinical atherosclerosis. The present study was designed to prospectively evaluate whether hypoglycemia influences the function and the morphology of the arteries in subjects with type 2 diabetes without complications and uncontrolled diabetes. Material and methods Seventy-six subjects underwent a noninvasive evaluation of carotid wall thickness and brachial artery function at baseline and after one year of treatment with the intent of obtaining optimal glycemic control. At the end of the observation time, subjects were divided in two groups: with hypoglycemia (H-group) or without hypoglycemia (C-group). Results Baseline characteristic were comparable between groups. HbA1c significantly decreased in both groups, and fasting plasma glucose was only significant in the H-group. Subjects with hypoglycemia showed a significant reduction of carotid wall thickness after one-year of treatment (H-groups: right baseline 834±141 vs. 1-year 770±132 μ p<0.05; C-group: 757±162 vs. 767±135 μ p = ns). Endothelial function remained unchanged during the study for both groups. Discussion The present findings demonstrate that hypoglycemia does not affect endothelial function. Furthermore, subjects who experience more hypoglycemia show significant reduction of carotid wall thickness. Optimal metabolic control should be pursued as soon as possible.
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7
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Hwang CL, Bishop J, Ching J, Elokda A, da Silva ALG, Laddu D, Phillips SA. Precision Measurements to Assess Baseline Status and Efficacy of Healthy Living Medicine. Prog Cardiovasc Dis 2019; 62:55-59. [PMID: 30610884 DOI: 10.1016/j.pcad.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 01/07/2023]
Abstract
Precision medicine recently has gained popularity, calling for more individualized approaches to prevent and/or reduce chronic-disease risk and to reduce non-communicable diseases such as cardiovascular disease (CVD). Encompassed under Precision medicine initiatives is the concept of healthy living medicine (HLM), which emphasizes the promotion of lifestyle and behavioral practices including physical activity and healthy dietary pattern. Precision measurements have the potential to improve the understanding of how risk factors influence disease trajectory, and further inform on how to precisely tailor clinical strategies to manage risk factors to prevent disease manifestation, and refine therapies according the patient's demographic, environment, and disease etiology. The purpose of this review is to summarize the application of established and emerging measurements that may be used in HLM to manage and optimize care in CVD prevention.
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Affiliation(s)
- Chueh-Lung Hwang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Jennifer Bishop
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Jerry Ching
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ahmed Elokda
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, United States of America
| | - Andréa Lúcia Gonçalves da Silva
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Department of Physical Education and Health, Physiotherapy` Course at University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America.
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8
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Irace C, De Rosa S, Tripolino C, Ambrosio G, Covello C, Abramo E, Carallo C, Mongiardo A, Spaccarotella C, Torella D, Gnasso A, Indolfi C. Delayed flow-mediated vasodilation and critical coronary stenosis. J Investig Med 2018; 66:1-7. [PMID: 29550752 DOI: 10.1136/jim-2017-000644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2018] [Indexed: 11/04/2022]
Abstract
Endothelial dysfunction, wall thickening and plaque are progressive manifestations of atherosclerosis. Delayed or absent brachial artery dilation after ischemic stimulus has been associated with severity of extracoronary and coronary atherosclerosis. In the current study, we aimed to verify if delayed or absent dilation associates with critical coronary stenosis. We also evaluated the association between coronary stenosis, carotid artery wall thickness and peripheral artery disease. Endothelial function was investigated by flow-mediated dilation of the brachial artery up to 3 min after ischemia, and patients classified as early, late or no dilators. Coronary angiography was performed through transradial or femoral artery approach. Computerized quantitative angiography was used to obtain percent stenosis of all lesions, while the Gensini score was used to evaluate the severity of coronary atherosclerosis. Seventy-four patients were enrolled. Carotid wall thickness and plaque, and peripheral artery disease were detected by ultrasound. Subjects with critical coronary stenosis showed a higher prevalence of delayed or absent dilation (coronary stenosis ≥70 per cent: late dilators 50 per cent, no dilators 35 per cent; coronary stenosis ≤70 per cent : late dilators 27 per cent, no dilators 6 per cent). The Gensini score was progressively higher in late dilators and no dilators compared with early dilators (early: 4.5±13.5; late 17.5±27.1; no 39.7±55.0; P<0.02). Carotid atherosclerosis and peripheral artery disease were more prevalent in subjects with critical coronary stenosis. Delayed or absent dilation associates with coronary stenosis and different degree of coronary atherosclerosis. The kinetic of arterial dilation seems to be relevant as the magnitude of dilation.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Cesare Tripolino
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | | | - Caterina Covello
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Ennio Abramo
- Azienda Ospedaliero-universitaria Mater Domini, Catanzaro, Italy
| | - Claudio Carallo
- Azienda Ospedaliero-universitaria Mater Domini, Catanzaro, Italy
| | | | | | - Daniele Torella
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
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9
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Irace C, Messiniti V, Tassone B, Cortese C, Barrett EJ, Gnasso A. Evidence for congruent impairment in micro and macrovascular function in type 1 diabetes. PLoS One 2017; 12:e0187525. [PMID: 29131837 PMCID: PMC5683560 DOI: 10.1371/journal.pone.0187525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/21/2017] [Indexed: 01/22/2023] Open
Abstract
Diabetes affects large and small vessels through mechanisms only partially known. In the present study, we evaluated the function of capillaries and large arteries in subjects with type 1 diabetes mellitus (T1DM) to study the effect of chronic hyperglycemia in the absence of other cardiovascular risk factors. Twenty-five subjects with T1DM and 12 healthy age-matched controls were enrolled. Nine patients had mild or moderate retinopathy. Contrast enhanced ultrasound was used to measure perfusion of the deep forearm flexor muscle of the non-dominant arm at rest (baseline) and after an ischemic stimulus (reactive hyperemia). Perfusion was expressed as Video Intensity (VI) in arbitrary unit (a.u.)/mm2. The time to reach peak VI after ischemia was also recorded. The function of large arteries was evaluated using flow-mediated vasodilation (FMD). VI was significantly lower in T1DM compared to control subjects both at baseline (0.22±0.16 vs 0.44±0.35 a.u./mm2, p<0.05), and after ischemia (0.33±0.24 vs 0.68±0.46 a.u./mm2, p<0.05). The time to reach peak VI after ischemia was markedly longer in T1DM (5.6±2.2 vs 4.0±1.7 seconds, p<0.02). These differences were more marked in T1DM subjects with retinopathy. FMD was lower in TIDM patients compared to controls (5.4±6.4 vs 10.7±4.5%, p<0.01). The present findings demonstrate that T1DM patients have defective peripheral skeletal muscle perfusion both at rest and after ischemia compared with control subjects. Low muscle perfusion associates with low FMD of the brachial artery. Furthermore, T1DM subjects with retinopathy have the least muscle perfusion and blunted response to hyperemia compared to T1DM without retinopathy.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Valentina Messiniti
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Bruno Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Claudio Cortese
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Eugene J. Barrett
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States of America
| | - Agostino Gnasso
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
- * E-mail:
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10
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Children With Type 1 Diabetes Have Delayed Flow-Mediated Dilation. Can J Diabetes 2017; 42:276-280. [PMID: 28754435 DOI: 10.1016/j.jcjd.2017.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Children with type 1 diabetes have accelerated atherosclerosis with early endothelial dysfunction as measured by reduced flow-mediated dilation (FMD) at 60 seconds postischemic stress (early FMD). Delayed dilation may also occur in the presence of cardiovascular risk factors and may be a more sensitive marker. No data exist that evaluate FMD beyond 60 seconds (delayed FMD) in children with type 1 diabetes. We aimed to compare early and delayed FMD in children with type 1 diabetes and in healthy children. METHODS We studied 66 children 13.5±2.8 years of age; 29 were males. Of the 66 children, 38 had type 1 diabetes, and 28 were healthy age- and gender-matched controls. Evaluation of brachial artery FMD was performed at 60 seconds (FMD60s) and 120 seconds (FMD120s) postischemic stress. Early FMD was defined as peak FMD60s and delayed FMD as peak FMD120s. RESULTS: Children with type 1 diabetes had diabetes durations of 5.4±4.6 years and median glycated hemoglobin levels of 8.8 (6.6 to 14)% (73 [49 to 130] mmol/mol). Of the children, 8 with type 1 diabetes and 1 healthy child had delayed FMD; a relationship was seen between the prevalence of early FMD and delayed FMD in children with type 1 diabetes and healthy children, respectively (p=0.019). Children with type 1 diabetes and delayed FMD had lower FMD60s than children without delayed FMD (2.50±3.61 vs. 6.14±3.83 percentage units; p=0.02). Children with type 1 diabetes had lower FMD60s than healthy children (5.38±4.0 percentage units; p=0.03) but not FMD120s (7.56±3.5 percentage units; p=0.47). CONCLUSIONS Delayed FMD patterns occur in children with type 1 diabetes and detect children who have more severe vascular abnormalities. The standard FMD60s remains the better marker to identify children at increased risk for cardiovascular disease.
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11
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Yaguchi T, Cong Y, Shimo K, Kurokawa T, Sugita S, Nagayama K, Masuda H, Matsumoto T. A Novel Apparatus for the Multifaceted Evaluation of Arterial Function Through Transmural Pressure Manipulation. Ann Biomed Eng 2017; 45:1487-1495. [PMID: 28194660 DOI: 10.1007/s10439-017-1810-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 02/04/2017] [Indexed: 11/28/2022]
Abstract
A novel apparatus for the multifaceted evaluation of artery function was developed. It measures endothelial and smooth muscle functions and the pressure-strain elastic modulus (E p). A rigid airtight chamber with an ultrasound probe was attached to the upper arm to manipulate the transmural pressure of the brachial artery. Endothelial function was measured via a standard flow-mediated dilation (FMD) protocol. Smooth muscle function was evaluated via a myogenic contraction of the artery following the application of negative pressure to the chamber and was named pressure-mediated contraction (PMC). E p was obtained by measuring the instantaneous increase in the artery diameter following the negative pressure application. The PMC and FMD values had a significant negative correlation with age, indicating that the age-related decrease in FMD is caused by the decay of endothelial and smooth muscle function. A consideration of PMC may help improve the accuracy of artery function measurement. E p in subjects aged >40 years was found to be significantly higher in the supra-physiological pressure range than in the physiological one (p = 0.02); this did not occur in younger subjects. Artery stiffening may begin in the supra-physiological range, and this stiffness may also be used for the diagnosis of atherosclerosis.
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Affiliation(s)
- Toshiyuki Yaguchi
- Biomechanics Laboratory, Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan. .,Division of Electronic and Mechanical Engineering, Department of Science and Engineering, School of Science and Engineering, Tokyo Denki University, Hikigun, 350-0394, Japan.
| | - Yalin Cong
- Biomechanics Laboratory, Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan
| | - Kenji Shimo
- Biomechanics Laboratory, Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan
| | - Takahiro Kurokawa
- Biomechanics Laboratory, Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan
| | - Shukei Sugita
- Biomechanics Laboratory, Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan
| | - Kazuaki Nagayama
- Biomechanics Laboratory, Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan.,Department of Intelligent Systems Engineering, College of Engineering, Ibaraki University, Hitachi, 316-8511, Japan
| | | | - Takeo Matsumoto
- Biomechanics Laboratory, Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan. .,Biomechanics Laboratory, Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University, Nagoya, 464-8603, Japan.
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12
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Slattery DJ, Stuckless TJR, King TJ, Pyke KE. Impaired handgrip exercise-induced brachial artery flow-mediated dilation in young obese males. Appl Physiol Nutr Metab 2016; 41:528-37. [PMID: 26985988 DOI: 10.1139/apnm-2015-0459] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Flow mediated dilation (FMD) stimulated by different shear stress stimulus profiles may recruit distinct transduction mechanisms, and provide distinct information regarding endothelial function. The purpose of this study was to determine whether obesity influences brachial artery FMD differently depending on the shear stress profile used for FMD assessment. The FMD response to a brief, intermediate, and sustained shear stress profile was assessed in obese (n = 9) and lean (n = 19) young men as follows: brief stimulus, standard reactive hyperemia (RH) following a 5 min forearm occlusion (5 min RH); intermediate stimulus, RH following a 15 min forearm occlusion (15 min RH); sustained stimulus, 10 min of handgrip exercise (HGEX). Brachial artery diameter and mean shear stress were assessed using echo and Doppler ultrasound, respectively, during each FMD test. There was no group difference in HGEX shear stress (p = 0.390); however, the obese group had a lower HGEX-FMD (5.2 ± 3.0% versus 11.5 ± 4.4%, p < 0.001). There was no group difference in 5 min RH-FMD (p = 0.466) or 15 min RH-FMD (p = 0.181); however, the shear stress stimulus was larger in the obese group. After normalization to the stimulus the 15 min RH-FMD (p = 0.002), but not the 5 min RH-FMD (p = 0.118) was lower in the obese group. These data suggest that obesity may have a more pronounced impact on the endothelium's ability to respond to prolonged increases in shear stress.
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Affiliation(s)
- David J Slattery
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.,Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Troy J R Stuckless
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.,Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Trevor J King
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.,Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Kyra E Pyke
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.,Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
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13
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Irace C, Tripolino C, Scavelli FB, Carallo C, Gnasso A. Brachial Low-Flow-Mediated Constriction is Associated with Delayed Brachial Flow-Mediated Dilation. J Atheroscler Thromb 2015; 23:355-63. [PMID: 26581241 DOI: 10.5551/jat.32060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Flow-mediated vasodilation (FMD) of the brachial artery measures the ability of the artery to dilate after a forearm ischemia lasting for 5 min. During ischemia, and therefore in conditions of low flow, constriction of the brachial artery (L-FMC) has sometimes been reported. The meaning of L-FMC is still unclear. The aims of our study were to establish the prevalence of subjects with L-FMC, to determine whether the magnitude of L-FMC correlates with magnitude of FMD, and to determine whether L-FMC can be used to predict FMD timing. METHODS A total of 179 outpatients were studied, and the brachial artery diameter was measured every minute during the 5 min forearm ischemia. Subjects who had at least one measurement showing a constriction of > 1% during ischemia were defined as constrictors. FMD was evaluated at 50 s, 2 min, and 3 min after cuff release. On the basis of time, the subjects in whom maximal dilation had occurred were divided into Early, Late, or No dilators. RESULTS The brachial artery diameter of 70 subjects (39%) constricted during ischemia. Higher the constriction during ischemia, lower was the dilation after ischemia. Constrictors were more likely to have Late (OR 2.6; ICs 95% 1.19-5.81, p=0.02) or No dilation (OR 4.8; ICs 95% 1.90-12-16, p=0.02) compared with no constrictors. CONCLUSIONS The present study reveals that almost 40% of the subjects had brachial artery L-FMC and a more pronounced constriction during ischemia correlated with a lower dilation after ischemia. Finally, the prevalence of subjects showing L-FMC was significantly higher among subjects with delayed or no vasodilation, suggesting that L-FMC may be a marker of endothelial dysfunction.
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Affiliation(s)
- Concetta Irace
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine; "Magna Græcia" University
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14
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Tripolino C, Gnasso A, Carallo C, Scavelli FB, Irace C. Difference in carotid artery elasticity in subjects with different brachial artery kinetic of vasodilatation. J Hum Hypertens 2015; 30:493-7. [PMID: 26467820 DOI: 10.1038/jhh.2015.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/02/2015] [Accepted: 09/16/2015] [Indexed: 01/13/2023]
Abstract
Increased carotid stiffness and impaired brachial artery flow-mediated dilatation (FMD) associate with cardiovascular events. We have previously reported three FMD patterns based on the time of maximal dilatation. The aim of the present study was to verify whether different FMD patterns associate with carotid artery stiffness. In all, 133 subjects were enrolled. All participants underwent complete clinical examination, blood sampling and ultrasound study. FMD was used as a measure of endothelial function. Based on the maximal brachial artery FMD, subjects were divided into Early dilators (peak FMD at 50 s), Late dilators (peak FMD over 50 s) and No dilators. Echo-Doppler evaluation of carotid arteries was performed in order to calculate elastic indexes (strain, β-stiffness index and distensibility). In all, 64 subjects were classified as Early FMD, 36 as Late FMD and 33 as No dilators. Age, gender and cardiovascular risk factors were comparable among three groups. Early FMD had higher values of strain compared with both Late and no Dilators (P<0.001). Furthermore, Early dilators showed a significantly lower stiffness and higher distensibility compared with Late and No dilators. No significant differences between Late FMD and No Dilators were detected. Our results demonstrate that common carotid artery elasticity indexes significantly differ among Early, Late and No dilators. Subjects with delayed or absent brachial artery dilatation have stiffer common carotid arteries compared with subjects with early dilatation. In conclusion, our research suggests that the assessment of the kinetics of FMD in a clinical setting might represent a useful screening tool to improve the cardiovascular risk stratification.
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Affiliation(s)
- C Tripolino
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - A Gnasso
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - C Carallo
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - F B Scavelli
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - C Irace
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
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15
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Flow-mediated dilation: can new approaches provide greater mechanistic insight into vascular dysfunction in preeclampsia and other diseases? Curr Hypertens Rep 2015; 16:487. [PMID: 25182159 DOI: 10.1007/s11906-014-0487-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Endothelial dysfunction is a key feature of preeclampsia and may contribute to increased cardiovascular disease risk years after pregnancy. Flow-mediated dilation (FMD) is a non-invasive endothelial function test that predicts cardiovascular event risk. New protocols allow researchers to measure three components of the FMD response: FMD, low flow-mediated constriction, and shear stimulus. This review encourages researchers to think beyond "low FMD" by examining how these three components may provide additional insights into the mechanisms and location of vascular dysfunction. The review then examines what FMD studies reveal about vascular dysfunction in preeclampsia while highlighting opportunities to gain greater mechanistic insight from new protocols. Studies using traditional protocols show that FMD is low in mid-pregnancy prior to preeclampsia, at diagnosis, and for 3 years post-partum. However, FMD returns to normal by 10 years post-partum. Studies using new protocols are needed to gain more mechanistic insight.
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16
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Irace C, Tripolino C, Scavelli F, Messiniti V, Tassone B, Della Valle E, Carallo C, Gnasso A. Blood viscosity but not shear stress associates with delayed flow-mediated dilation. Eur J Appl Physiol 2014; 115:747-53. [PMID: 25428725 DOI: 10.1007/s00421-014-3058-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/17/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE Flow-mediated dilation (FMD) is a complex mechanism involving several mediators, and different hemodynamic forces. Temporally distinct FMD patterns can be elicited by ischemic stimulus. Some subjects dilate early after cuff release, while others dilate later or do not dilate at all. Aim of the present research was to verify if hemorheological and hemodynamic factors might influence different FMD pattern. METHODS 148 free-living subjects were studied. FMD was measured at 50 s, 2 min and 3 min. Blood viscosity was measured and shear stress calculated. Shear stress stimulus was quantified as the area under the curve after ischemia (SSAUC) over the first 40-s post-occlusion. RESULTS Based on the timing or absence of arterial dilation, 82 subjects were classified as Early dilators, 37 as Late dilators and 29 as No dilators. Peak FMD was 7.9 ± 4.3 % in Early dilators, and 9.1 ± 5.7 in Late dilators (p = NS). SSAUC was not significantly different among three groups, while blood viscosity was significantly higher in Late FMD subjects. Regression analyses showed the independent predictive role of age and blood viscosity on FMD patterns, and the lack of any association between FMD pattern and the magnitude of SS. CONCLUSIONS The present study demonstrates that age and blood viscosity but not the magnitude of SS explain the different timing of the dilatory response to ischemia.
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Affiliation(s)
- Concetta Irace
- Department of Clinical and Experimental Medicine, Magna Græcia University, University Campus "Salvatore Venuta", Viale Europa, Località Germaneto, 88100, Catanzaro, Italy
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17
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Irace C, Padilla J, Carallo C, Scavelli F, Gnasso A. Delayed vasodilation is associated with cardiovascular risk. Eur J Clin Invest 2014; 44:549-56. [PMID: 24738967 DOI: 10.1111/eci.12268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/11/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Flow-mediated dilation (FMD) of the brachial artery is widely used to assess cardiovascular risk. In recent years, much attention has been paid to the kinetics of vasodilation in an attempt to better characterize the endothelial function. Here, we investigated whether FMD magnitude and/or latency are most related to individual cardiovascular risk. MATERIALS AND METHODS Four hundred subjects were recruited. Individual risk prediction was estimated by Framingham cardiovascular risk score and CUORE project calculator. Subjects were divided into Early dilators (peak FMD at 50 s), Late dilators (peak FMD over 50 s) and No dilators. RESULTS Cardiovascular risk was highest in No dilators and significantly higher in Late than Early dilators despite comparable peak FMD. When divided according to peak FMD quintiles, Early and Late dilators showed decreased cardiovascular risk with increasing magnitude of vasodilation. However, subjects in the first three quintiles of Late dilators had a markedly higher risk score despite a peak vasodilation similar to that of Early dilators. CONCLUSION These results suggest that the magnitude of the FMD and its latency are both important for identifying patients at risk of cardiovascular disease. Subjects with a delayed though significant vasodilation associated with a blunted early response exhibit the highest cardiovascular risk.
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Affiliation(s)
- Concetta Irace
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
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18
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Empen K, Lorbeer R, Völzke H, Reffelmann T, Schipf S, Nauck M, Kerner W, Wallaschofski H, Felix SB, Dörr M. Do patients with type 1 and type 2 diabetes really have an impaired endothelial function? A population-based propensity score matching analysis. Cardiovasc Diabetol 2013; 12:174. [PMID: 24305508 PMCID: PMC4234402 DOI: 10.1186/1475-2840-12-174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/02/2013] [Indexed: 01/22/2023] Open
Abstract
Background Previous studies suggested an impaired endothelial function in patients with diabetes. However, the validity of this finding may be limited by the lack of adequate adjustment for further cardiovascular confounders. We assessed endothelial function as measured by flow-mediated dilation (FMD) of the brachial artery in patients with either type 1 or type 2 diabetes in comparison with non-diabetic controls. Methods The study population comprised 1487 subjects including 122 subjects with type 2 diabetes, aged 25 to 85, from the population-based Study of Health in Pomerania, and 65 outpatients, aged 23 to 75, with type 1 diabetes. FMD measurements were performed using standardized ultrasound techniques. Subjects with type 1 and type 2 diabetes were matched 1:4 to healthy controls using propensity score matching. Results Neither type 1 diabetes (β = 0.142; SE = 0.568, p = 0.803) nor type 2 diabetes (β = 0.107; SE = 0.340, p = 0.752) were significantly associated with FMD in comparison with their non-diabetic controls after adjustment for major cardiovascular confounders like age, gender, body mass index, smoking status, hypertension, antihypertensive medication, LDL and HDL cholesterol levels. Conclusions In this population-based study comparing adjusted FMD values of diabetic individuals with adequately matched controls, propensity score analyses revealed no association between diabetes and endothelial function. Since these findings are in discordance with the majority of previous reports, we suggest performing similar analyses using data from other population-based studies.
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Affiliation(s)
- Klaus Empen
- Department of Internal Medicine, Medizinische Klinik B, Universitätsmedizin, Greifswald, Sauerbruchstrasse, D-17475, Germany.
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19
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Fernandes IA, Sales ARK, Rocha NG, Silva BM, Vianna LC, da Nóbrega ACL. Preserved flow-mediated dilation but delayed time-to-peak diameter in individuals with metabolic syndrome. Clin Physiol Funct Imaging 2013; 34:270-6. [PMID: 24119214 DOI: 10.1111/cpf.12092] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/16/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Inconsistent evidences of the metabolic syndrome (MetS) impact on vascular reactivity raise questions on flow-mediated dilation (FMD) discriminatory power for disturbances induced by this clustering of risk factors. Previous reports, however, suggest that covariates such as the follow-up of the artery diameter changes, the arterial size and shear stress affect FMD responses and consequently its discriminatory power for distinctive clinical profiles. OBJECTIVE To determine the impact of MetS on traditional, arterial size- and shear-rate-adjusted FMD, the follow-up-derived time-to-peak diameter (TP), as well as their power for discriminating subjects with this clustering of risk factors from a sample of healthy individuals. METHODS Twenty-one MetS and ten healthy subjects underwent an assessment of endothelial function via FMD. RESULTS Traditional and allometrically scaled FMD did not differ between groups (P>0·05) as well as the approach in which the covariate was the peak diameter shear rate. In the existence of MetS, TP was longer (67·7 ± 16·4 s versus healthy 42·1 ± 16·3 s, P = 0·001). ROC curve analysis indicated that TP (AUC = 0·871 [95% CI, 0·718-1·000]) had greater power of discrimination for MetS than FMD approaches. In addition, TP presented a moderate and significant association with sE-selectin (r = 0·458, P = 0·048). CONCLUSION Time-to-peak diameter (TP) rather than FMD distinguished MetS from a healthy profile. Therefore, at least in subjects with MetS, TP may provide insights into the impact of this clustering of risk factors on the vascular phenotype.
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Affiliation(s)
- Igor A Fernandes
- Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro
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20
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Irace C, Marini H, Bitto A, Altavilla D, Polito F, Adamo EB, Arcoraci V, Minutoli L, Di Benedetto A, Di Vieste G, de Gregorio C, Gnasso A, Corrao S, Licata G, Squadrito F. Genistein and endothelial function in postmenopausal women with metabolic syndrome. Eur J Clin Invest 2013; 43:1025-31. [PMID: 23899172 DOI: 10.1111/eci.12139] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/06/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous data have suggested that genistein could exert beneficial effects on endothelial function and on predictors of cardiovascular risk in healthy postmenopausal women. In a randomized clinical trial, we studied the effects of genistein on endothelial function in postmenopausal women with metabolic syndrome (MS). METHODS Twenty postmenopausal women with MS, according to modified NCEP-ATP III criteria were randomly assigned to receive placebo or genistein (54 mg/day) for 6 months, along with a Mediterranean-style diet. Postmenopausal women without MS (n = 15), served as controls. The primary goal was the assessment of endothelial function by flow-mediated vasodilation (FMD) of brachial artery; moreover, time-to-peak dilation in the FMD response has been evaluated. Secondary outcomes were fasting glucose, fasting insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, visfatin, adiponectin and homocysteine blood levels. Data on adverse events were also recorded. RESULTS After 6 months of treatment, FMD at 50s and peak FMD significantly increased in genistein recipients compared with placebo. Moreover, genistein significantly decreased the blood levels of total cholesterol, triglycerides, homocysteine and visfatin compared with placebo, while blood adiponectin levels were increased. Genistein recipients neither experienced more side-adverse effects than placebo nor discontinued the study. CONCLUSIONS Six months of treatment with genistein effectively improves brachial artery flow-mediated vasodilation in postmenopausal women with metabolic syndrome.
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Affiliation(s)
- Concetta Irace
- Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro, Italy
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Findlay BB, Gupta P, Szijgyarto IC, Pyke KE. Impaired brachial artery flow-mediated vasodilation in response to handgrip exercise-induced increases in shear stress in young smokers. Vasc Med 2013; 18:63-71. [PMID: 23548859 DOI: 10.1177/1358863x13480259] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Smoking is an established risk factor for cardiovascular disease. It has also been shown to result in endothelial dysfunction as assessed by flow-mediated dilation (FMD) in response to reactive hyperemia (RH)-induced increases in shear stress. Handgrip exercise (HGEX) is an emerging alternative method to increase shear stress for FMD assessment (HGEX-FMD) and the purpose of this study was to identify the impact of smoking on HGEX-FMD in young healthy subjects. Brachial artery RH-FMD and HGEX-FMD (10-minute bout of HGEX) was assessed in eight smokers (S) and 14 non-smokers (NS) (age 21 ± 2 years). Brachial artery diameter and mean blood velocity were assessed with echo and Doppler ultrasound, respectively. Shear stress was estimated by shear rate (SR = brachial artery blood velocity/diameter). The SR stimulus did not differ between groups for either test (RH-FMD (SR area under the curve until peak diameter measurement), p = 0.897; HGEX-FMD (average SR over 10-minute exercise bout), p = 0.599). The RH-FMD magnitude was not significantly different between groups (S: 7.7 ± 2.2% vs NS: 7.9 ± 2.4%, p = 0.838); however, the HGEX-FMD magnitude was significantly impaired in smokers (S: 6.1 ± 3.4% vs NS: 9.6 ± 3.6%, p = 0.037). In conclusion, HGEX-FMD assessment detected vascular dysfunction in young healthy smokers while RH-FMD did not. This suggests that HGEX-FMD may be useful in the early detection of smoking-induced impairments in endothelial function. Further research is required to explore this phenomenon in other populations and to isolate underlying mechanisms.
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Affiliation(s)
- Briar B Findlay
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
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22
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Carallo C, De Franceschi MS, Tripolino C, Figliuzzi M, Irace C, Fortunato L, Gnasso A. Common carotid and brachial artery hemodynamic alterations in periodontal disease. J Clin Periodontol 2013; 40:431-6. [PMID: 23517219 DOI: 10.1111/jcpe.12099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 11/28/2022]
Abstract
AIM In patients affected by periodontal disease, hypertension and systemic inflammation might cause an arterial hemodynamic derangement; this, in turn, can act as a mediator of the atherogenic process often seen in these patients. This study aimed at a comprehensive hemodynamic evaluation in periodontal patients. METHODS Fourty-eight subjects participating to a cardiovascular prevention programme were enrolled. Periodontitis, classical risk factors for atherosclerosis, and shear and tensile forces in both carotid and brachial arteries were evaluated. Calculated periodontal indexes were plaque, gingival and pocket deep (PD) indexes. Simple and multiple regression analyses were performed. Afterwards, 30 of them with normal PD index were compared with 30 carefully - matched patients with periodontitis. RESULTS Brachial and carotid parietal tension were significantly associated with periodontal indexes, especially PD-Sum, in both simple (r = 0.42, p < 0.001 for carotid artery and r = 0.36, p < 0.02 for brachial artery) and multiple regression analyses. Shear stress gave similar results. In case-control analysis, shear stress was lower by 15% and 30%, respectively, in carotid and brachial artery in patients with high PD; common carotid parietal tension was higher. Arterial stiffness resulted not associated with periodontitis. CONCLUSIONS Periodontal disease is associated to a complex atherosclerotic prone hemodynamic derangement, particularly in large elastic arteries.
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Affiliation(s)
- Claudio Carallo
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
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23
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Irace C, De Luca S, Shehaj E, Carallo C, Loprete A, Scavelli F, Gnasso A. Exenatide improves endothelial function assessed by flow mediated dilation technique in subjects with type 2 diabetes: results from an observational research. Diab Vasc Dis Res 2013; 10:72-7. [PMID: 22732108 DOI: 10.1177/1479164112449562] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The GLP-1 receptor agonist exenatide has been approved for adjunctive treatment of type 2 diabetes. Continuous GLP-1 infusion improves endothelial function in vivo; no evidence about a beneficial effect of exenatide on vascular function has been published. The aim of our observational study was to evaluate whether exenatide would improve brachial artery function evaluated by the flow mediated dilation (FMD) technique, compared with glimepiride, in subjects with type 2 diabetes. FMD time course was assessed by ultrasound, after 5 min forearm ischaemia, at baseline and after 16-week treatment. At the end of the study FMD was significantly higher in subjects who assumed exenatide compared with glimepiride (9.1 ± 3.6 vs. 5.6 ± 1.0, p = 0.01). Even if limited by the small number of studied subjects, who were not matched in the two treatment groups, this research study represents the first FMD evidence suggesting that chronic administration of exenatide improves arterial dilation.
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Affiliation(s)
- Concetta Irace
- Department of Clinical and Experimental Medicine, University Magna Græcia Catanzaro, University Campus Salvatore Venuta, Viale Europa, 88100 Catanzaro, Italy
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24
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Irace C, Carallo C, Loprete A, Tripolino C, Scavelli F, Gnasso A. Delayed flow-mediated vasodilation and carotid atherosclerosis. Eur J Clin Invest 2013; 43:49-55. [PMID: 23145798 DOI: 10.1111/eci.12016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In a previous study, we identified temporally distinct postischaemic flow-mediated dilation (FMD) patterns comparing the standard clinical measurement time of 50s postcuff release with measurement at 2 min. The comparison revealed a cohort with the highest FMD at 50s (Early FMD), another cohort with the highest FMD at 2 min (Late FMD) and a third cohort with no FMD (Absent FMD). The aim of this study was to examine whether these temporally distinct FMD patterns associated with different degrees of carotid atherosclerosis. MATERIALS AND METHODS One hundred and twenty-four free-living white subjects, participating in a cardio-vascular disease prevention campaign, were enrolled. FMD was measured at 50s, 2 min and 3 min after forearm ischaemia. The intima-media thickness (IMT) of the common carotid artery was measured, and the artery was evaluated for the presence and number of carotid plaques. RESULTS Fifty-seven subjects had Early FMD, 34 had Late FMD and 33 had Absent FMD. The three groups were comparable for age, sex and cardiovascular risk factors. The number of plaques in the carotid arteries, and IMT, increased progressively from Early, to Late, and to Absent FMD (P < 0·03), indicating that the FMD pattern is an independent predictive variable for IMT and carotid atherosclerosis. CONCLUSIONS The present study demonstrates that temporal patterns associated with the degree of atherosclerosis of the carotid arteries. Patients with delayed vasodilation (Late FMD) had a higher degree of atherosclerosis than those with early vasodilation (Early FMD), and subjects with no postischaemic vasodilation (Absent FMD) had the most atherosclerosis.
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Affiliation(s)
- Concetta Irace
- Dipartimento di Medicina Sperimentale e Clinica G. Salvatore, Magna Graecia University, Catanzaro, Italy.
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Barone Gibbs B, Dobrosielski DA, Bonekamp S, Stewart KJ, Clark JM. A randomized trial of exercise for blood pressure reduction in type 2 diabetes: effect on flow-mediated dilation and circulating biomarkers of endothelial function. Atherosclerosis 2012; 224:446-53. [PMID: 22889573 PMCID: PMC3459298 DOI: 10.1016/j.atherosclerosis.2012.07.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the effect of an exercise intervention on flow-mediated dilation (FMD) and circulating endothelial biomarkers in adults with type 2 diabetes (T2DM). METHODS Sedentary adults (n = 140), aged 40-65, with T2DM and untreated pre or Stage I hypertension or treated hypertension were randomized to a 6-month, supervised, exercise program (3× week) or a sedentary control. Assessments included BMI, body and visceral fat, blood pressure, lipids, HbA1c, insulin sensitivity (QUICKI), fitness, FMD, E-selectin, P-selectin, intracellular and vascular cellular adhesion molecules (ICAM, VCAM), and tissue plasminogen activator (tPA). Intervention effects were compared by t-tests. Pearson's correlations were calculated between changes in cardiovascular risk factors and endothelial outcomes. RESULTS Exercisers significantly improved BMI (-0.6 kg/m(2)), body fat % (-1.4%), HbA1c (-0.5%), and fitness (2.9 mL/kg min) vs. controls (p < 0.05). However, there were no differences between groups in changes in FMD, E-selectin, P-selectin, ICAM, VCAM, or tPA. Among exercisers, changes in cardiovascular risk factors correlated with several biomarkers. Decreased P-selectin correlated with decreased BMI (r = 0.29, p = 0.04) and increased HDL cholesterol (r = -0.36, p = 0.01). Decreased ICAM correlated with decreased triglycerides and HbA1c (r = 0.30, p = 0.04; r = 0.31, p = 0.03) and increased QUICKI (r = - 0.28, p = 0.05). Decreased tPA correlated with decreased total body and visceral fat (r = 0.28, p = 0.05; r = 0.38, p = 0.008) and increased QUICKI (r = -0.38, p = 0.007). CONCLUSIONS While exercise resulted in improved fitness, body composition, and glycemic control, there were no changes in FMD or circulating endothelial biomarkers. The associations of changes in cardiovascular risk factors and endothelial biomarkers suggest that improvement in risk factors could mediate the exercise-induced improvements in endothelial function seen in prior studies.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Gibbs BB, Dobrosielski DA, Lima M, Bonekamp S, Stewart KJ, Clark JM. The association of arterial shear and flow-mediated dilation in diabetes. Vasc Med 2011; 16:267-74. [PMID: 21708874 PMCID: PMC4397901 DOI: 10.1177/1358863x11411361] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
While adjusting flow-mediated dilation (FMD), a measure of vascular function, for shear rate may be important when evaluating endothelial-dependent vasodilation, the relationship of FMD with shear rate in study populations with cardiovascular risk factors is unclear. We aimed to investigate the association of four measures of shear rate (peak shear rate (SR(peak)) and shear rate area under the curve through 30 seconds (SR(AUC 0-30)), 60 seconds (SR(AUC 0-60)), and time to peak dilation (SR(AUC 0-ttp))) with FMD in 50 study subjects with type 2 diabetes and mild hypertension undergoing baseline FMD testing for an exercise intervention trial. Associations among measures of shear rate and FMD were evaluated using Pearson's correlations and R(2). The four measures of shear rate were highly correlated within subjects, with Pearson's correlations ranging from 0.783 (p < 0.001) to 0.972 (p < 0.001). FMD was associated with each measure of shear rate, having a correlation of 0.576 (p < 0.001) with SR(AUC 0-30), 0.529 (p < 0.001) with SR(AUC 0-60), and 0.512 (p < 0.001) with SR(peak). Nine of 50 subjects (18%) did not dilate following the shear stimulus. Among the 41 responders, FMD had a correlation of 0.517 (p < 0.001) with SR(AUC 0-ttp) and similar correlations to those found in the full sample for SR(AUC 0-30), SR(AUC 0-60), and SR(peak). In conclusion, shear rate appears to explain up to a third of between-person variability in FMD response and our results support the reporting of shear rate and FMD with and without adjustment for shear rate in similar clinical populations with CVD risk factors.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Hillegass WB, Brott BC, Dobbs JC, Papapietro SE, Misra VK, Zoghbi GJ. Oral antiplatelet therapy in diabetes mellitus and the role of prasugrel: an overview. Vasc Health Risk Manag 2011; 7:445-59. [PMID: 21822392 PMCID: PMC3148418 DOI: 10.2147/vhrm.s4746] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diabetics have a prothrombotic state that includes increased platelet reactivity. This contributes to the less favorable clinical outcomes observed in diabetics experiencing acute coronary syndromes as well as stable coronary artery disease. Many diabetics are relatively resistant to or have insufficient response to several antithrombotic agents. In the setting of percutaneous coronary intervention, hyporesponsiveness to clopidogrel is particularly common among diabetics. Several strategies have been examined to further enhance the benefits of oral antiplatelet therapy in diabetics. These include increasing the dose of clopidogrel, triple antiplatelet therapy with cilostazol, and new agents such as prasugrel. The large TRITON TIMI 38 randomized trial compared clopidogrel to prasugrel in the setting of percutaneous coronary intervention for acute coronary syndromes. The diabetic subgroup (n = 3146) experienced considerable incremental benefit with a 4.8% reduction in cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke at 15-month follow-up with prasugrel treatment. Among diabetics on insulin this combined endpoint was reduced by 7.9% at 15 months. Major bleeding was not increased in the diabetic subgroup. This confirms the general hypothesis that more potent oral antiplatelet therapy can partially overcome the prothrombotic milieu and safely improve important clinical outcomes in diabetics.
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Affiliation(s)
- Daniel J. Green
- From the Research Institute for Sport and Exercise Science (D.J.G., D.H.J.T.), Liverpool John Moores University, Liverpool, United Kingdom; School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Crawley, Western Australia, Australia; Department of Physiology (D.H.J.T.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Dick H.J. Thijssen
- From the Research Institute for Sport and Exercise Science (D.J.G., D.H.J.T.), Liverpool John Moores University, Liverpool, United Kingdom; School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Crawley, Western Australia, Australia; Department of Physiology (D.H.J.T.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Thijssen DHJ, Tinken TM, Hopkins N, Dawson EA, Cable NT, Green DJ. The impact of exercise training on the diameter dilator response to forearm ischaemia in healthy men. Acta Physiol (Oxf) 2011; 201:427-34. [PMID: 21054809 DOI: 10.1111/j.1748-1716.2010.02213.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM Recent studies found differences between groups in the rate of diameter increase following the flow-mediated dilation (FMD). Whilst exercise training alters the magnitude of the FMD, little is known about the impact of exercise training on the rate of diameter increase. The aim of this study is to examine post-cuff deflation changes in brachial artery diameter following 5 min forearm ischaemia every 2 weeks across 8-weeks of a handgrip exercise training regimen. METHODS Post-deflation changes in brachial artery diameter following 5-min of ischaemia were examined before, after and every 2-weeks across an 8-week handgrip training programme in healthy young men (n = 11) using echo-Doppler. RESULTS The magnitude of dilation increased at week 2-4-6, but returned towards baseline values at week 8 (anova: P = 8.001). The time-to-peak diameter (42 ± 15s) demonstrated a significant prolongation at week 4 (77 ± 32s), but returned towards baseline values at weeks 6 and 8 (anova: P < 0.001). The rate of diameter increase did not differ across the intervention. CONCLUSION Exercise training in healthy subjects is initially characterized by a larger dilation. Since the rate of dilation did not change, a longer time-to-peak dilation was necessary to achieve the increase in magnitude of dilation. As exercise training continues, the timing and magnitude of the peak diameter response returns to near baseline levels.
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Affiliation(s)
- D H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom.
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Quinton AE, Peek MJ, Cook CM, Kirby A. Flow-Mediated Dilatation Assessment in Women with Preeclampsia Compared to Women with Gestational Hypertension. Hypertens Pregnancy 2010; 31:377-86. [DOI: 10.3109/10641955.2010.525282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thijssen DHJ, Black MA, Pyke KE, Padilla J, Atkinson G, Harris RA, Parker B, Widlansky ME, Tschakovsky ME, Green DJ. Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. Am J Physiol Heart Circ Physiol 2010; 300:H2-12. [PMID: 20952670 DOI: 10.1152/ajpheart.00471.2010] [Citation(s) in RCA: 1068] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction is now considered an important early event in the development of atherosclerosis, which precedes gross morphological signs and clinical symptoms. The assessment of flow-mediated dilation (FMD) was introduced almost 20 years ago as a noninvasive approach to examine vasodilator function in vivo. FMD is widely believed to reflect endothelium-dependent and largely nitric oxide-mediated arterial function and has been used as a surrogate marker of vascular health. This noninvasive technique has been used to compare groups of subjects and to evaluate the impact of interventions within individuals. Despite its widespread adoption, there is considerable variability between studies with respect to the protocols applied, methods of analysis, and interpretation of results. Moreover, differences in methodological approaches have important impacts on the response magnitude, can result in spurious data interpretation, and limit the comparability of outcomes between studies. This review results from a collegial discussion between physiologists with the purpose of developing considered guidelines. The contributors represent several distinct research groups that have independently worked to advance the evidence base for improvement of the technical approaches to FMD measurement and analysis. The outcome is a series of recommendations on the basis of review and critical appraisal of recent physiological studies, pertaining to the most appropriate methods to assess FMD in humans.
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Affiliation(s)
- Dick H J Thijssen
- Research Inst. for Sport and Exercise Science, Henry Cotton Campus, Liverpool John Moores Univ., 15-21 Webster St., Liverpool, L3 2ET, UK.
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