Cardio-ankle vascular index (CAVI) for the monitoring of the atherosclerosis after heart transplantation

Association between measurements of arterial stiffness and target organ damage in a general Spanish population

INTRODUCTION

Little is known about the relationship between arterial stiffness and cardiovascular target organ damage (TOD) in the general population. The aim was to analyse the relationship between different measurements of arterial stiffness and TOD, in a general Spanish population without a history of cardiovascular event.

MATERIALS AND METHODS

Transversal descriptive study. Through stratified random sampling, a total of 501 individuals were included. Carotid-femoral pulse wave velocity (cf-PWV) was measured using a SphygmoCor System®, the cardio-ankle vascular index (CAVI) was determined with aVasera VS-1500® and brachial-ankle pulse wave velocity (ba-PWV)was calculated through a validated equation.

RESULTS

The average age was 55.84 ± 14.26.The percentage of vascular TOD, left ventricular hypertrophy (LVH) and renal TOD was higher in men (p < .001). A positive correlation was obtained between carotid intima-media thickness (c-IMT) and the measurements of vascular function. In the model 1 of the logistic regression analysis, cf-PWV was associated with vascular TOD (OR = 1.15, p = .040), ba-PWV was associated with vascular TOD (OR = 1.20, p = .010) and LVH (OR = 1.12, p = .047).

CONCLUSIONS

The different measurements of arterial stiffness are highly associated with each other. Moreover, cf-PWV and ba-PWV were associated with vascular TOD, and ba-PWV with LVH, although they disappear when adjusting for cardiovascular risk factors. Key Messages There is a strong correlation between the different measurements of vascular structure and function. Carotid-femoral and brachial-ankle pulse wave velocity were positively associated with vascular target organ damage, the latter was also positively associated with left ventricular hypertrophy. This associations disappear when adjusting for cardiovascular risk factors.

Evaluation of the Pulse wave in the face for the patients with rotary blood pump (RP) in the Outpatient clinic

Rotary blood pump (RP) is one of the most important devices in the treatment of profound heart failure and is known to reduce the pulse in the blood pressure waveform, especially when it is used for axial flow. In an outpatient clinic, checking the pulse of a patient implanted with an RP can help diagnose the patient's condition. For that purpose, animal experiments with healthy adult goats implanted with the EVAHEART system were carried out after obtaining ethical committee approval. Visual imaging of the goats' faces was recorded using a video camera. The pulse waves were clearly recorded using the newly developed pulse diagnosis system with video imaging and compared with laser Doppler flowmeter and time series data. Spectral analysis of the time series data showed the usefulness of video imaging from outside the body. Clinical applications are planned, and this newly developed method is expected to be a useful diagnostic method for evaluating the cardiac function in patients implanted with RPs in the future.

Assessment of Arterial Stiffness in Stable Heart Transplant Recipients

INTRODUCTION

Arterial stiffness depends on both genetic and environmental factors. The aim of this study was to assess arterial stiffness in patients after heart transplant.

METHODS

The study was conducted between May and June 2017. Fifty patients from the Transplantology Clinic of the Institute of Cardiology in Anin, Warsaw, Poland, were enrolled in the study. Pulse wave velocity (PWV), central systolic blood pressure (CSBP), and central diastolic blood pressure (CDBP) were measured and patients' medical records were also analyzed.

RESULTS

In the study, 50 patients aged 57.9 years on average were evaluated, of whom 88% were male patients, with average PWV of 8.94 m/s and an average time after transplant of 9.7 years. The study has shown that age (R = 0.77), total cholesterol concentration (R = 0.22, P = .017) and creatinine concentration (R = 0.34; P = .15) show positive correlation with PWV.

CONCLUSIONS

Our data indicates that age has significant impact on arterial stiffness and the type of immunosuppressive drugs and transplant rejection episodes do not impact an increase in arterial stiffness.

Carotid atherosclerosis is associated with left ventricular diastolic function

BACKGROUND

It has been reported that carotid intima-media thickness (IMT) correlates with the risk of stroke or cardiovascular disease. The purpose of this study was to analyze the relationships between echocardiographic findings and carotid atherosclerosis.

METHODS

A total of 234 patients (62 ± 15 years) were referred for echocardiography to evaluate the left ventricular (LV) function. The LV ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A), and the peak early diastolic mitral annular velocity (e') were obtained by echocardiography. The maximum IMT (Max-IMT) and plaque score (PS) were measured by carotid ultrasonography within 1 month of the echocardiographic examination.

RESULTS

The mean values of Max-IMT and carotid PS were 2.41 ± 1.23 mm and 8.5 ± 6.3, respectively. The decreased mean E/A (0.94 ± 0.39) and mitral e' (5.5 ± 1.9 cm/s) indicated LV diastolic dysfunction. A good correlation was observed between Max-IMT and PS (r = 0.83, p < 0.0001). It was shown that 2.8 mm of Max-IMT was equivalent to 10.1 of carotid PS, which indicated severe carotid atherosclerosis. In multiple logistic stepwise regression analysis, among the echocardiographic parameters, only e' was independently associated with severe carotid atherosclerosis (Max-IMT ≥ 2.8 mm or PS ≥ 10.1).

CONCLUSIONS

The present study demonstrated that decreased early diastolic mitral annular velocity relates to the parameter reflecting carotid atherosclerosis. Therefore, the presence of severe carotid atherosclerosis may affect LV diastolic dysfunction.

Reproducibility of oscillometrically measured arterial stiffness indices: Results of the SAPALDIA 3 cohort study

BACKGROUND

There is an increasing interest in oscillometric arterial stiffness measurement for cardiovascular risk stratification. We assessed reproducibility of the cuff-based arterial stiffness measures cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (baPWV) and peripheral augmentation index (pAI) in a subsample of the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3).

METHODS

CAVI, baPWV and pAI were measured twice within 90 days in a representative subsample (n = 105) of SAPALDIA 3 with a mean age of 63 years (52.4% female).

RESULTS

The mean coefficient of variation for CAVI was 4.4%, baPWV 3.9%, and pAI 7.4%. The intraclass correlation coefficient ranged from 0.6 for pAI to 0.8 for CAVI, and 0.9 for baPWV. The mixed linear model revealed that 68.7%/80.1%/55.0% of the CAVI/baPWV/pAI variance was accounted for by the subject, 5.2%/8.1%/ < 0.01% by the fieldworker, 6.7%/7.8%/28.5% by variation between measurement days, and 19.4%/4%/16.5% by measurement error. Bland-Altman plots showed no particular dispersion patterns except for pAI.

CONCLUSIONS

Oscillometric arterial stiffness measurement by CAVI and baPWV has proved to be highly reproducible in Caucasians. Results of the pAI showed lower reproducibility. CAVI and baPWV can be implemented as easy-to-apply arterial stiffness measures in population wide cardiovascular risk assessment in Caucasians.

Effects of amlodipine and candesartan on arterial stiffness estimated by cardio-ankle vascular index in patients with essential hypertension: A 24-week study

BACKGROUND

Aortic stiffness assessed by brachio-ankle pulse wave velocity (baPWV) can be used to predict cardiovascular events. However, baPWV is dependent on blood pressure. Antihypertensive drugs have been reported to reduce baPWV; but it is difficult to determine if this effect is associated with lowered blood pressure or reduced arterial stiffness.

OBJECTIVES

The primary end point of this study was to assess whether antihypertensive drugs reduce arterial stiffness as estimated by cardio-ankle vascular index (CAVI). The secondary end point was to compare the effects of 2 widely used drugs, the calcium-channel blocker amlodipine and the angiotensin II receptor blocker candesartan, on arterial stiffness.

METHODS

Between October 2005 and September 2006, consecutive Japanese outpatients with essential hypertension (EHT) (defined as using antihypertensive drugs at screening, systolic blood pressure [SBP] > 140 mm Hg, or diastolic BP [DBP] >90 mm Hg) were assigned to treatment for 24 weeks with either amlodipine (5-10 mg/d) or candesartan (8-12 mg/d). Arterial stiffness was evaluated with CAVI before and after 24 weeks of treatment. Relative change in arterial stiffness from baseline was also compared. The evaluator was blinded to treatment.

RESULTS

Twenty patients (11 men, 9 women; mean [SD] age, 62 [10] years) were included in the study. There were no significant differences in clinical characteristics between the 2 groups. At baseline, mean (SD) CAVI was not significantly different in the amlodipine group compared with the candesartan group (8.93 [0.93] vs 8.46 [1.34], respectively). During the 24-week treatment period, mean SBP and DBP decreased significantly in both the amlodipine (14/10 mm Hg; P = 0.006 and P = 0.005) and the candesartan groups (13/11 mm Hg; P = 0.033 and P = 0.005). Amlodipine was associated with a significant change in CAVI from baseline (8.93 [0.93] vs 8.60 [1.50]; P = 0.017), whereas candesartan was not (8.46 [1.34] vs 8.81 [1.20]). The percentage change in CAVI was significantly different in the amlodipine group compared with the candesartan group (-7.14 [8.83] vs 5.85 [16.0], respectively; P = 0.038). After 24 weeks of treatment, the CAVI of the amlodipine group was still numerically larger than baseline CAVI of the candesartan group, although the difference was not statistically significant. Furthermore, there was no significant difference in absolute CAVI between the 2 groups after 24 weeks, but the relative change from baseline was significant in favor of amlodipine. Logistic regression analysis revealed that amlodipine improved CAVI independent of its antihypertensive effect.

CONCLUSION

These data suggest that amlodipine and candesartan had different effects on aortic stiffness estimated by CAVI, despite similar effects on brachial blood pressure after 24 weeks of treatment in these Japanese patients with EHT.

Cardioankle vascular index evaluations revealed that cotreatment of ARB Antihypertension medication with traditional Chinese medicine improved arterial functionality

Qian Yang He Ji (QYHJ) is a traditional Chinese medicine composed of Digitalis purpurea, Uncaria gambir, Fructus tribuli terrestris, and Ligustrum lucidum. Here, we explored whether combining an antihypertensive angiotensin II receptor blocker (ARB) therapy with QYHJ can improve the arterial functionality of hypertensive patients. One hundred and eight hypertensive patients were randomized into 2 groups; 1 group (n = 53) was treated with ARB and the other group (n = 55) was treated with ARB combined with QYHJ. Each of the 2 groups included 3 subgroups (pure hypertension, hypertension with diabetes, and hypertension with coronary heart disease) and was further divided into patients with and without complications. The cardioankle vascular index and intima-media thickness and pulse pressure were the outcome evaluation parameter. Combined QYHJ and ARB treatment reduced the values of cardioankle vascular index, systolic blood pressure, diastolic blood pressure, and pulse pressure to significantly lower levels than ARB treatment alone did in hypertension patients after 6 months of treatment. ARB improves hypertension, but a combined QYHJ treatment can additionally ameliorate the arterial functionality not only in solely hypertensive patients but also in hypertensive patients with diabetes and coronary heart disease complications. QYHJ coapplication might be a choice to further improve the arterial functionality during an ARB hypertension treatment.

Cardio-ankle vascular index in subjects with dyslipidaemia and other cardiovascular risk factors

AIM

The cardio-ankle vascular index (CAVI) is a novel non-invasive marker of arterial stiffness and atherosclerosis. The aim of this work was to examine whether the CAVI value in patients with dyslipidaemia (DLP) is increased by the presence of other cardiovascular risk factors: hypertension, diabetes mellitus, and smoking.

METHODS

A total of 392 subjects with DLP (166 male, 226 female), with a median age of 58.5 and 5-95 percentile range 32.2-73.9 years were examined. CAVI was measured using the VaSera 1500 system.

RESULTS

CAVI correlated significantly with age (p<0.001) and both systolic (p<0.001) and diastolic (p=0.002) blood pressure; higher values were found in men (p=0.034) than in women in the 56-65 age group. There was no significant difference in CAVI between smokers and non-smokers (p= 0.217) and between subjects with and without diabetes mellitus (p= 0.424). CAVI was significantly higher in subjects with hypertension than in the normotensive group (p<0.001) and in statin-treated subjects than in those without statins (p<0.001); however, CAVI values adjusted for age and sex did not differ significantly between these groups. Adjusted CAVI values were higher only in smokers than in non-smokers (former smokers) (p<0.001).

CONCLUSION

The study proves conclusively that the CAVI value in DLP patients is not significantly affected by hypertension and diabetes mellitus, but it is increased by smoking.

Reduced arterial stiffness in patients with acromegaly: non-invasive assessment by the cardio-ankle vascular index (CAVI)

In patients with acromegaly, cardiovascular diseases are the most common cause of death. Arterial stiffness is increasingly recognized as a valuable surrogate marker for predicting cardiovascular events. To evaluate the vascular status of acromegalic patients, we used the cardio-ankle vascular index (CAVI) to reflect the arterial stiffness from the heart to the ankles. We analyzed 21 acromegalic patients, comprising five patients with untreated active acromegaly, one patient treated with medication and 15 patients who underwent transsphenoidal surgery. Among the 15 patients with surgery, 10 received additional therapies with dopamine agonists and/or somatostatin analogs. All patients with acromegaly unexpectedly showed significant reductions in the CAVI, indicating reduced arterial stiffness, compared with age- and sex-matched controls, regardless of whether they underwent surgery. There was a significant negative correlation between the CAVI and the serum insulin-like growth factor (IGF)-I level in these patients. Active acromegalic patients were associated with lower CAVI than controlled patients. Sequential measurements of the CAVI and serum IGF-I before and after treatment with octreotide and transsphenoidal surgery revealed that a reduced IGF-I level after treatment was accompanied by CAVI elevation. The present findings indicate that the CAVI is negatively correlated with the serum IGF-I level in acromegaly. These findings are consistent with previous reports indicating that the GH/IGF-I axis reduces peripheral vascular resistance. This non-invasive assessment can reflect the present vascular status and would be a useful marker for evaluation of therapeutic effects in patients with acromegaly.

Relationship between smoking and a new index of arterial stiffness, the cardio-ankle vascular index, in male workers: a cross-sectional study

BACKGROUND

Cigarette smoking is one of the major factors that increases arterial stiffness. The purpose of this study was to examine further the relationship between smoking status and arterial stiffness using a new index, the cardio-ankle vascular index (CAVI), in male Japanese workers.

METHODS

This cross-sectional study included 4,729 male Japanese workers undergoing annual health checkups. CAVI was measured at the time of the annual health checkup between April 2007 and March 2008. The subjects were divided into three groups, smokers (n = 1,913), former smokers (n = 1,481) and non-smokers (n = 1,348) according to their responses to a questionnaire. We compared the CAVI in the three groups after adjusting for age. Multiple regression analysis was used to examine the association between CAVI and the number of cigarettes smoked per day in order to examine whether there was a dose-response relationship between smoking and CAVI.

RESULTS

The mean CAVI for each group was 7.81 ± 0.02 for smokers, 7.70 ± 0.02 for former smokers and 7.64 ± 0.02 for non-smokers. A significant difference was observed between each group. According to the results of multiple regression analysis, the standardized β of the number of cigarettes smoked per day was 0.09 (p < 0.01). This confirmed a positive association with CAVI.

CONCLUSIONS

Our study demonstrated that there is a significant association between the number of cigarettes smoked per day and arterial stiffness, as measured by CAVI.

Cardio-ankle vascular index in heterozygous familial hypercholesterolemia

AIM

The cardio-ankle vascular index (CAVI) is a new non-invasive marker of arterial stiffness and atherosclerosis. The purpose of this study was to compare CAVI in patients with heterozygous familial hypercholesterolemia (FH) and in healthy controls.

METHODS

82 FH subjects (27 males, 65 females), aged 53.7±13.6 years without clinical symptoms of cardiovascular diseases and 359 healthy controls (121 males, 238 females), aged 43.9±14.9 years, were examined. CAVI was measured using the system VaSera® 1500.

RESULTS

CAVI in FH patients was significantly higher (8.0±1.4) than in healthy subjects (7.5±1.3) p = 0.002; however, age, sex and BMI adjusted CAVI did not differ significantly (p = 0.061) between the FH group (7.5, CI: 7.3; 7.7) and control group (7.7, CI: 7.6; 7.7).

CONCLUSION

The study showed no significant difference in CAVI between heterozygous FH and healthy controls.

Relationship between cardio-ankle vascular index (CAVI) and coronary artery calcification (CAC) in patients with type 2 diabetes mellitus

Early detection of atherosclerosis is important for patients with type 2 diabetes mellitus because cardiovascular disease (CVD) is a main cause of death in these people. In this study, we investigated the relationship between an arterial stiffness parameter called cardio-ankle vascular index (CAVI) and coronary artery calcification (CAC). We performed a cross-sectional study in 371 type 2 diabetic patients with clinical suspicion of coronary heart disease (CHD). We evaluated the relationships between CAVI and CAC score determined by multislice computed tomography as well as major cardiovascular risk factors, including age, body mass index, hemoglobinA1c and the Framingham CHD risk score. CAVI was correlated with age (r = 0.301, p < 0.0001), uric acid (r = 0.236, p < 0.0001), estimated glomerular filtration rate (r = -0.145, p = 0.0166), CHD risk score (r = 0.327, p < 0.0001) and log (CAC + 1) (r = 0.303, p < 0.0001). The area under the receiver operating characteristic curve for CAVI was higher than that of CHD risk score in predicting CAC >0, CAC >100, CAC >400, or CAC >1000. CAVI is positively correlated with CAC, and is considered to be a useful method to detect CAC.

Influence of blood pressure on cardio-ankle vascular index (CAVI) examined based on percentage change during general anesthesia

Cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV) are non-invasive methods for estimating arterial distensibility. The purpose of this study is to evaluate whether CAVI as an index of true arterial stiffness is superior to baPWV based on the percentage change in hemodynamics under general anesthesia. CAVI (segment from heart to ankle), k-CAVI (heart to knee) and baPWV (brachial to ankle) in 30 oral surgery patients were measured to compare the decreased blood pressure (BP) after 10 min of tracheal intubation during general anesthesia with the control BP (after 5 min of rest). General anesthesia was performed under endotracheal intubation through intravenous injection of propofol, fentanyl and vecuronium or rocuronium. In both the elderly (65 years) and middle-aged (<65 years) groups, CAVI and k-CAVI did not change during general anesthesia, whereas baPWV and systolic BP (SBP) showed a statistically significant decrease. Thus, the changes in CAVI (ΔCAVI) and k-CAVI (Δk-CAVI) showed no significant correlations with those of SBP (ΔSBP), whereas the changes in baPWV (ΔbaPWV) were significantly correlated with ΔSBP. ΔCAVI and Δk-CAVI showed no significant differences between the two groups, whereas ΔbaPWV and ΔSBP in the elderly group was much higher than that in the middle-aged group. Measurement of CAVI was not affected by the decrease in BP during general anesthesia. In contrast, baPWV was significantly influenced by changes in BP. These findings suggest that CAVI is a useful index of true arterial stiffness and is superior to baPWV.

Improvement of postprandial hyperglycemia and arterial stiffness upon switching from premixed human insulin 30/70 to biphasic insulin aspart 30/70

Postprandial hyperglycemia is known to be associated with increasing cardiovascular mortality in type 2 diabetes mellitus patients. Cardio-ankle vascular index (CAVI) reflects arterial stiffness and is more useful for predicting coronary atherosclerosis than intima-media thickness. Premixed human insulin 30/70 (BHI30) containing rapid-acting insulin has been used conventionally as a biphasic insulin. Recently, a biphasic insulin analogue preparation, biphasic insulin aspart 30/70 (BIAsp30), containing ultrarapid-acting insulin has been approved and expected to improve postprandial hyperglycemia. The aim of this study was to clarify the effects of switching the biphasic insulin from BHI30 to BIAsp30 on arterial stiffness in type 2 diabetes mellitus patients. Twenty-six type 2 diabetes mellitus patients (glycosylated hemoglobin >6.5%) who were already receiving biphasic insulin therapy with BHI30 twice daily were observed for 3 months. Afterward, BHI30 was switched to BIAsp30. At 3 months after switching, relative mobility of the peak of LDL fraction decreased significantly (from 0.3462 ± 0.041 to 0.3356 ± 0.035, P < .01); and CAVI also decreased significantly (from 9.77 ± 1.11 to 9.35 ± 1.17 m/s, P < .005). A significant negative correlation was observed between the change in CAVI and change in 1,5-anhydroglucitol (1,5-AG) (r = -0.3929, P < .05). A stronger correlation between change in CAVI and change in 1,5-AG was observed in the subgroup of patients whose 1,5-AG levels were elevated after switching (r = -0.6261, P < .05) compared with all subjects. These results suggest that switching biphasic insulin from BHI30 to BIAsp30 improves arterial stiffness, and the improvement of arterial stiffness may be associated with improvement of postprandial hyperglycemia.

Improvement of cardio-ankle vascular index by glimepiride in type 2 diabetic patients

AIMS

Glimepiride, a third generation sulfonylurea (SU), is known to have extrapancreatic effects, but its vascular effect is unclear. We investigated the efficacy of glimepiride in improving arterial stiffness assessed by cardio-ankle vascular index (CAVI) in type 2 diabetic patients, compared with glibenclamide, a conventional SU.

METHODS

Forty type 2 diabetic patients were randomly assigned to two groups. One group was administered glimepiride 1.5 mg/day, and the other group was administered glibenclamide 1.25 mg/day for 6 months.

RESULTS

No significant difference in hypoglycaemic effect was observed between two groups. CAVI significantly decreased only in glimepiride group (9.4 ± 1.4→8.9 ± 0.8, p < 0.05). Decrease in CAVI was greater in glimepiride group than in glibenclamide group (-0.50 ± 0.98 vs. -0.04 ± 0.57, p = 0.048). Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) decreased in glimepiride group and increased in glibenclamide group, and the changes were significantly different between groups (-1.5 ± 3.5 vs. + 1.8 ± 3.6, p = 0.009); whereas serum lipoprotein lipase mass increased in glibenclamide group and decreased in glibenclamide group, and the changes tended to be different between groups (+ 2.1 ± 19.1 vs. -7.4 ± 19.2, p = 0.096). Change in urinary 8-OHdG was a significant independent predictor for change in CAVI in all subjects.

CONCLUSIONS

These results suggest that glimepiride improves CAVI compared with glibenclamide. Reduced oxidative stress and improved insulin resistance may contribute to the improvement of CAVI by glimerpiride.

Effects of metabolic syndrome on cardio-ankle vascular index in middle-aged and elderly Chinese

Metabolic syndrome is characterized by multiple risk factors and is associated with increased risk of diabetes and cardiovascular disease. The rapid change in the lifestyle and food habits of Chinese people has resulted in metabolic syndrome becoming one of the most widespread health challenges in China. Recently, the cardio-ankle vascular index (CAVI) was developed as a new parameter reflecting arterial stiffness and providing an index of vascular status. The purpose of this study was to investigate the effect of metabolic syndrome on CAVI. A total of 222 Chinese subjects aged 50-92 years participated in this study. We measured CAVI and examined blood samples to define metabolic syndrome according to the International Diabetes Federation criteria. CAVI in the subjects with abnormal waist circumference was significantly higher than that obtained in the normal subjects (P < 0.01). In the abnormal high-density lipoprotein cholesterol (HDL-C) group, CAVI was significantly increased (P < 0.01) compared to the normal HDL-C group. CAVI showed a positive correlation with waist circumference and increased significantly with the number of metabolic syndrome components. In conclusion, subjects with metabolic syndrome have a high CAVI that indicated arterial stiffness and is closely associated with an increase in the number of metabolic syndrome risk factors. Elevated abdominal obesity and low HDL-C are the main players affecting arterial stiffness in the middle-aged and elderly Chinese. These findings suggest that interaction of the individual components of metabolic syndrome plays a role in the relationship between metabolic syndrome and arterial stiffness.

Effect of ezetimibe monotherapy on lipid metabolism and arterial stiffness assessed by cardio-ankle vascular index in type 2 diabetic patients

AIM

High cholesterol absorption in the small intestine has been proposed to be a risk factor of atherosclerosis. In this study, we evaluated the effect of ezetimibe monotherapy on arterial stiffness in type 2 diabetic patients.

METHODS

Forty type 2 diabetes mellitus patients with high serum low-density lipoprotein cholesterol (LDL-C) were enrolled and treated with ezetimibe 10 mg/day for 6 months. HbA1c, serum lipids, remnant-like particle-cholesterol (RLP-C), serum lipoprotein lipase mass (LPL mass) and the cardio-ankle vascular index (CAVI) were measured before and after ezetimibe treatment.

RESULTS

After 6 months of ezetimibe treatment, significant decreases in LDL-C, RLP-C and CAVI were observed. In the group that achieved the LDL-C goal of <120 mg/dL after 6 months of ezetimibe treatment, the pretreatment CAVI was markedly high, and CAVI decreased significantly after ezetimibe treatment.

CONCLUSIONS

In type 2 diabetic patients, ezetimibe monotherapy may have the potential to ameliorate arterial stiffness in addition to lowering LDL-C and RLP-C.

Effects of personal exposure to particulate matter and ozone on arterial stiffness and heart rate variability in healthy adults

The effects on heart rate variability (HRV) and arterial stiffness from exposure to ambient particulate matter and ozone have not been studied simultaneously. The aim of this study was to analyze these effects with refined exposure estimates from personal measurements of ozone and size-resolved particulate matter mass concentrations. The authors recruited 17 mail carriers in a panel study in Taipei County, Taiwan, during February-March, 2007, and each subject was followed for 5-6 days. Personal ozone and size-fractionated particulate matter exposures were monitored during working hours while carriers delivered mail outdoors. Cardiovascular effects were evaluated with heart rate variability (HRV) indices and an arterial stiffness index, the cardio-ankle vascular index (CAVI). The authors used linear mixed models to examine the association between personal exposure data and the HRV index and CAVI. They found that an interquartile range increase in personal exposure to ozone and particulate matter of between 1.0 and 2.5 microm was associated with a 4.8% and 2.5% increase in CAVI, respectively, in the single-pollutant models. In contrast, the personal exposure data showed no significant effects on HRV. In 2-pollutant models, personal ozone exposure remained significantly associated with the CAVI measurements. The study results indicate that vascular function may be more sensitive to air pollutants than the autonomic balance.

Effects of olmesartan, an angiotensin II receptor blocker, and amlodipine, a calcium channel blocker, on Cardio-Ankle Vascular Index (CAVI) in type 2 diabetic patients with hypertension

AIM

Recently, a novel device for measuring the cardio-ankle vascular index (CAVI) as an arterial stiffness parameter has been developed. In this study, we evaluated the effect of angiotensin II receptor blocker (ARB) and calcium channel (Ca) blocker on CAVI in type 2 diabetic patients with hypertension.

METHODS

Seventy type 2 diabetes mellitus patients with hypertension were enrolled and randomly divided into two groups. One group was administered olmesartan medoxomil 20 mg/day [DOSAGE ERROR CORRECTED] for 12 months (ARB group), and the other group was administered amlodipine besilate 5 mg/day for 12 months (Ca blocker group).

RESULTS

In the ARB group, a significant decrease in CAVI was observed after 12 months; however, no significant change in CAVI was observed in the Ca blocker group although changes in blood pressure were almost the same. By simple regression analyses, CAVI changes correlated positively with 8-OHdG changes.

CONCLUSIONS

Olmesartan, an ARB, improved arterial stiffness more than amlodipine, and this effect might be due to not only the blood pressure-lowering effect but also to reducing the potential of oxidative stress recognized in olmesartan.

Detection of increased arterial stiffness in a patient with early stage of large vessel vasculitis by measuring cardio-ankle vascular index

Large vessel vasculitis leads to arterial wall thickening and stiffening because of chronic inflammatory changes. The cardio-ankle vascular index (CAVI) is recently utilized for assessing arterial stiffening caused by atherosclerosis-related diseases, including hypertension and diabetes, as well as aging. CAVI is mathematically calculated from stiffness index beta, which is established as a parameter of arterial stiffness independent of blood pressure. However, there are no data regarding arterial stiffness assessed by CAVI for large vessel vasculitis. We describe a patient with large vessel vasculitis who showed aortic wall thickening and increased CAVI without hypertension. A 68-year-old woman presented at our hospital with recurrent fever of 2-month duration, fatigue, neck pain, and weight loss. The images of 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) demonstrated significant 18FDG uptake (indicating increased metabolic activity and presence of inflammation) in the aorta and its major branches, including the carotid and subclavian arteries. Contrast-enhanced magnetic resonance imaging demonstrated wall thickening of the thoracic aorta. These imaging findings resulted in the diagnosis of large vessel vasculitis. The patient showed normal brachial blood pressure (right, 122/72 and left, 121/66 mmHg). However, CAVIs on both sides (right, 10.3 and left, 10.4) were elevated (normal value for her age, 9.1 +/- 0.8). In conclusion, arterial stiffness in patients with large vessel vasculitis may be increased because of the arterial wall thickening and inflammatory changes. Thus, CAVI may be promising for detection of increased arterial stiffness in patients with large vessel vasculitis in the early stage, in which blood pressure is normal.

Baroreflex sensitivity of an arterial wall during rotary blood pump assistance

It is well known that the baroreflex system is one of the most important indicators of the pathophysiology in hypertensive patients. We can check the sensitivity of the baroreflex by observing heart rate (HR) responses; however, there is no simple diagnostic method to measure the arterial behavior in the baroreflex system. Presently, we report the development of a method and associated hardware that enables the diagnosis of baroreflex sensitivity by measuring the responses of both the heart and the artery. In this system, the measurements are obtained by monitoring an electrocardiogram and a pulse wave recorded from the radial artery or fingertip. The arterial responses were measured in terms of the pulse wave velocity (PWV) calculated from the pulse wave transmission time (PTT) from the heart to the artery. In this system, the HR change corresponding to the blood pressure change in time series sequence was observed. Slope of the changes in blood pressure and HR indicated the sensitivity of the baroreflex system of the heart. This system could also measure the sensitivity of the baroreflex system of an artery. Changes in the PWV in response to the blood pressure changes were observed. Significant correlation was observed in the time sequence between blood pressure change and PWV change after calculating the delay time by cross-correlation. The slope of these parameter changes was easily obtained and it demonstrated the sensitivity of the baroreflex system of an artery. We evaluated this method in animal experiments using rotary blood pump (RBP) with undulation pump ventricular assist device, and PTT elongation was observed in response to increased blood pressure with RBP assistance. Furthermore, when tested clinically, decreased sensitivity of the baroreflex system in hypertensive patients was observed. This system may be useful when we consider the ideal treatment and follow-up of patients with hypertension.

Protective effects of efonidipine, a T- and L-type calcium channel blocker, on renal function and arterial stiffness in type 2 diabetic patients with hypertension and nephropathy

AIM

The three types of calcium channel blocker (CCB), L-, T- and N-type, possess heterogeneous actions on endothelial function and renal microvascular function. In the present study, we evaluated the effects of two CCBs, efonidipine and amlodipine, on renal function and arterial stiffness.

METHODS

Forty type 2 diabetic patients with hypertension and nephropathy receiving angiotensin receptor II blockers were enrolled and randomly divided into two groups: the efonidipine group was administered efonidipine hydrochloride ethanolate 40 mg/day and the amlodipine group was admin-istered amlodipine besilate 5 mg/day for 12 months. Arterial stiffness was evaluated by the cardio-ankle vascular index (CAVI).

RESULTS

Changes in blood pressure during the study were almost the same in the two groups. Sig-nificant increases in serum creatinine and urinary albumin and a significant decrease in the esti-mated glomerular filtration rate were observed in the amlodipine group, but not in the efonidipine group. On the other hand, significant decreases in plasma aldosterone, urinary 8-hydroxy-2'-deoxy-guanosine and CAVI were observed after 12 months in the efonidipine group, but not in the amlo-dipine group.

CONCLUSIONS

These results suggest that efonidipine, which is both a T-type and L-type calcium chan-nel blocker, has more favorable effects on renal function, oxidative stress and arterial stiffness than amlodipine, an L-type calcium channel blocker.

Early detection of hypertension in a patient treated with sunitinib by measuring cardio-ankle vascular index

Cardio-ankle vascular index (CAVI) has been established as a marker of arterial stiffness, which is increased in hypertensive patients. CAVI reflects the stiffness of the aorta, femoral artery, and tibial artery. Sunitinib, multi-targeted tyrosine kinase inhibitor with both anti-angiogenic and anti-tumor activities, has been proved effective in patients with gastrointestinal stromal tumors. However, the treatment with sunitinib is often complicated by side effects such as hypertension. We describe an 84-year-old woman with gastrointestinal stromal tumor, who showed changes in arterial stiffness preceding the appearance of hypertension in the early phase after sunitinib initiation. The patient received sunitinib (50 mg given daily) for gastrointestinal stromal tumor. We assessed the influence of sunitinib on arterial stiffness every 7 days by measuring CAVI. The CAVI, which reflects arterial stiffness, was increased from 9.95 at baseline to 11.65 at 7 days after the initiation of sunitinib, whereas the blood pressure remained unchanged (117/72 and 119/76 mmHg). At 14 days after sunitinib initiation, the blood pressure was increased to 159/89 mmHg, indicating the occurrence of hypertension, while the CAVI was 11.90, the similar level detected at 7 days. Subsequently, sunitinib treatment was discontinued, because of the marked decrease in blood platelets. Both blood pressure and CAVI, together with blood platelets, were restored to the baseline values at 12 days after cessation of sunitinib. In conclusion, the increase in the CAVI preceded the appearance of sunitinib-induced hypertension. Arterial stiffness assessed by CAVI may be useful for early detection of sunitinib-induced hypertension.

Tissue Doppler echocardiography for predicting arterial stiffness assessed by cardio-ankle vascular index

It has been reported that left ventricular (LV) diastolic functional parameters assessed by conventional Doppler echocardiography, which measures blood flow velocities in cardiac cavity, correlate with arterial stiffness assessed by the cardio-ankle vascular index (CAVI) and are markers for increased risk of cardiovascular events. Recently, tissue Doppler echocardiography, which measures velocities of regional cardiac wall, has been widely used for assessment of LV diastolic function because of more accuracy than conventional Doppler echocardiography. However, there are no data regarding the ability of tissue Doppler echocardiography for predicting increased arterial stiffness. We investigated the correlation of LV diastolic functional parameters from tissue Doppler echocardiography to CAVI in order to clarify the ability of tissue Doppler echocardiography for predicting increased arterial stiffness in patients with cardiovascular risk factors. Enrolled in the study were 70 patients (69 +/- 8 years) who had no overt heart disease, but had at least one of hypertension, diabetes, and dyslipidemia. The peak early diastolic mitral annular velocity (E') was measured as an index of LV diastolic function using tissue Doppler echocardiography. The E' was correlated with CAVI (r = -0.518, p < 0.001). The optimal cut-off point for the detection of abnormal CAVI (> or = 8.81) was 5.6 cm/s for E' (sensitivity 71%, specificity 71%). The decrease in E' correlated with both LV diastolic dysfunction and increased arterial stiffness. Therefore, the LV diastolic dysfunction assessed by tissue Doppler echocardiography may be useful for predicting increased arterial stiffness and cardiovascular events in the patients with risk factors.

Relationship of cardio-ankle vascular index (CAVI) to carotid and coronary arteriosclerosis

BACKGROUND

The cardio-ankle vascular index (CAVI) has been recently reported as a new index of aortic stiffness, which is less influenced by blood pressure than pulse wave velocity (PWV). The present study investigated the relationship between the levels of CAVI and carotid and coronary arteriosclerosis.

METHODS AND RESULTS

The 443 consecutive patients who underwent CAVI, carotid sonography, and coronary angiography in hospital were examined. Intima-media thickness (IMT) and carotid plaque were evaluated by ultrasonography. The severity of coronary artery disease (CAD) was evaluated by coronary angiography and the subjects were divided into 4 groups (0, no significant organic stenosis: 1, 1-vessel disease: 2, 2-vessel disease: 3, 3-vessel disease). Univariate analyses showed that both CAVI and brachial-ankle PWV (baPWV) were associated with IMT and the presence of carotid plaque. Multiple stepwise regression analyses revealed that CAVI (p=0.0427), but not baPWV, was associated with the IMT. Both CAVI (p<0.0001) and baPWV (p=0.0140) were significantly associated with the severity of CAD. Multiple logistic analyses revealed that CAVI (p=0.0342), but not baPWV (p=0.8027), was associated with the presence of multivessel disease.

CONCLUSION

High CAVI implies progression of carotid and coronary arteriosclerosis. CAVI may be more closely linked with arteriosclerosis than baPWV.

Availability of cardio-ankle vascular index (CAVI) as a screening tool for atherosclerosis

BACKGROUND

A novel index, the cardio-ankle vascular index (CAVI), which reflects the stiffness of the aorta, femoral artery, and tibial artery, was recently developed by measuring brachial - ankle pulse wave velocity and blood pressure.

METHODS AND RESULTS

In the present study 1,014 Japanese adults from the general population were screened to clarify the correlation between CAVI and other existing markers related to atherosclerosis, including carotid intima - media thickness (CIMT) and homocysteine (HCY). CAVI was strongly associated with age in both men and women. After adjustment for age and sex, CAVI was correlated with systolic and diastolic blood pressures. In addition, CAVI was significantly correlated with total cholesterol hemoglobin A(1c) and total HCY, as well as CIMT.

CONCLUSION

CAVI is an appropriate screening tool for atherosclerosis, but further studies are needed to establish a convenient and effective screening system using it.

Relationship between cardio-ankle vascular index (CAVI) and carotid atherosclerosis in patients with essential hypertension

Aortic stiffness measured by aorta-iliac or carotid-femoral pulse wave velocity (PWV) predicts all-cause and cardiovascular mortality. Brachial-ankle PWV (baPWV) has been developed as a more convenient assessment of arterial stiffness. However, the problem with clinical use of baPWV is that the index itself is closely dependent on blood pressure. Recently, a new method, termed the cardio-ankle vascular index (CAVI), has been proposed in Japan to overcome the disadvantages associated with measuring PWV. However, its clinical usefulness has not yet been fully clarified. In the present study, we compared the usefulness of CAVI with that of ultrasound for evaluating atherosclerosis in patients with essential hypertension. CAVI was measured in 70 hypertensive patients. The intima-media thickness (IMT), cross-sectional distensibility coefficient (CSDC), stiffness parameter beta, and mean diastolic (V(d)) and systolic (V(s)) flow velocities were evaluated by carotid ultrasound. The V(d)/V(s) ratio, an index of peripheral arterial resistance, was also calculated. CAVI was positively correlated with IMT (r=0.360, p=0.0022) and stiffness beta (r=0.270, p=0.0239) and negatively correlated with V(d)/V(s) (r=-0.471, p<0.0001) and CSDC (r=-0.315, p=0.0079). Stepwise regression analysis revealed that age (r=0.475, p<0.0001) and pulse pressure (r=0.492, r<0.0001) were independent determinants of CAVI. These results suggest that CAVI is a useful clinical marker for evaluating atherosclerosis and arteriolosclerosis in patients with essential hypertension.

Postchallenge hyperglycaemic spike associate with arterial stiffness

Several large-scale epidemiological and intervention studies strongly indicate that postchallenge hyperglycaemia is the main factor associated with increasing the risk of morbidity and mortality in type 2 diabetes. However, the mechanisms that increase the risk of cardiovascular disease remain unclear. We aimed to study the relationship between postchallenge hyperglycaemia and arterial stiffness. We recruited 40 healthy subjects from a physical examination in 2005. Cardio-ankle vascular index (CAVI) was automatically calculated by VaSera VS-1000. For the reliability study, we performed the baseline study in the first 20 subjects who were returned to receive repeated measurements of CAVI 2 weeks later. The determinants of mean CAVI at different timings of oral glucose tolerance test (OGTT) study were analysed by constructing multivariate linear regression models. In reliability test, the inter-observer correlation coefficient was 0.82 for right CAVI, 0.87 for left CAVI and 0.85 for mean CAVI. Age, systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose levels at 60 min (Glu60) and glucose area under the curve of OGTT (GluAUC) are found to be significantly and positively correlated to right CAVI, left CAVI and mean CAVI (p < 0.05). After adjustment for age, gender and SBP, Glu60 and GluAUC are still independent determinants of CAVI. In subjects without clinical diagnosis of type 2 diabetes, postchallenge hyperglycaemic spike is highly associated with CAVI, a good parameter of aortic stiffness, independent of age, gender and blood pressure.

Evaluation of cardiovascular risk factors and related clinical markers in healthy young Japanese adults

BACKGROUND

Since atherosclerosis is a slowly progressive process at a young age, effective preventive measures should be taken early in life to prevent future events associated with cardiovascular disease.

METHODS

The study population comprised 132 young Japanese adults (mean age 21.4 years, range 18-31 years). We screened plasma total homocysteine and serum folate levels and evaluated mean carotid intima-media thickness and cardio-ankle vascular index.

RESULTS

Multiple regression analysis after adjustment for age and sex revealed that only folate levels were significantly correlated with plasma total homocysteine levels (beta=-0.37, p=0.028). Carotid intima-media thickness adjusted for age and sex and compared between quintiles of total homocysteine levels was significantly increased in the highest quintile compared with other quintiles. Cardio-ankle vascular index increased with age in both women and men, but no additional determinants were identified in young adults.

CONCLUSION

Serum folate is an independent determinant of plasma total homocysteine levels, and mild hyperhomocysteinemia may represent a risk factor for increased carotid intima-media thickness, even in young adults. Comprehensive health education from the early period of life, including the suggestion of appropriate dietary measures, is important for effective prevention of future atherosclerosis.