Relationship between fitness and arterial stiffness according to hypertensive state

Association Between Cardiorespiratory Fitness and Trend of Age-Related Rise in Arterial Stiffness in Individuals With and Without Hypertension or Diabetes

BACKGROUND

This study aimed to investigate whether higher cardiorespiratory fitness (CRF) can modify the trend of age-related rise in arterial stiffness in individuals with and without hypertension (HTN) or diabetes.

METHODS

The study included 4,935 participants who underwent maximal cardiopulmonary exercise testing with respiratory gas analysis in a health screening program. CRF was directly measured using peak oxygen uptake during the cardiopulmonary exercise test, while arterial stiffness was evaluated using brachial-ankle pulse wave velocity (baPWV).

RESULTS

Participants with high CRF levels had significantly lower baPWV compared with those with low CRF levels, regardless of HTN or diabetes status (P < 0.05). The trend of baPWV increased with age, but the rate of age-related increase in baPWV was lower in individuals with moderate-to-high CRF levels compared with those with low CRF levels, regardless of HTN or diabetes status. Joint association analysis indicated that the trend of age-related increase in baPWV was the lowest in fit individuals without HTN or diabetes compared with unfit individuals with HTN or diabetes (P < 0.01). However, the trend of age-related increase in baPWV was not attenuated in fit with HTN or diabetes compared with unfit with HTN or diabetes.

CONCLUSIONS

These findings suggest that higher CRF levels may mitigate the trend of age-related rise in arterial stiffness in individuals with and without HTN or diabetes. However, this attenuating trend appears more pronounced in individuals without HTN or diabetes.

Arterial Stiffness and Cardiorespiratory Fitness Impairment in the Community

Background During exercise, a healthy arterial system facilitates increased blood flow and distributes it effectively to essential organs. Accordingly, we sought to understand how arterial stiffening might impair cardiorespiratory fitness in community-dwelling individuals. Methods and Results Arterial tonometry and maximum effort cardiopulmonary exercise testing were performed on Framingham Heart Study participants (N=2898, age 54±9 years, 53% women, body mass index 28.1±5.3 kg/m2). We related 5 arterial stiffness measures (carotid-femoral pulse wave velocity [CFPWV]: a measure of aortic wall stiffness; central pulse pressure, forward wave amplitude, characteristic impedance: measures of pressure pulsatility; and augmentation index: a measure of relative wave reflection) to multidimensional exercise responses using linear models adjusted for age, sex, resting heart rate, habitual physical activity, and clinical risk factors. Greater CFPWV, augmentation index, and characteristic impedance were associated with lower peak oxygen uptake (VO2; all P<0.0001). We observed consistency of associations of CFPWV with peak oxygen uptake across age, sex, and cardiovascular risk profile (interaction P>0.05). However, the CFPWV-peak oxygen uptake relation was attenuated in individuals with obesity (P=0.002 for obesity*CFPWV interaction). Higher CPFWV, augmentation index, and characteristic impedance were also related to cardiopulmonary exercise testing measures reflecting adverse O2 kinetics and lower stroke volume and peripheral O2 extraction but not to ventilatory efficiency, a prognostic measure of right ventricular-pulmonary vascular performance. Conclusions Our findings delineate relations of arterial stiffness and cardiorespiratory fitness in community-dwelling individuals. Future studies are warranted to evaluate whether the physiological measures implicated here may represent potential targets for improving cardiorespiratory fitness in the general population.

Relationship between physical fitness and arterial stiffness in Korean older adults

Pulse-wave velocity (PWV) is a widely used clinical marker of arterial stiffness. Associations between several physical fitness measures and arterial stiffness have been examined. However, these results were inconsistent. Therefore, we conducted a cross-sectional study to assess the relationship between various physical fitness parameters and arterial stiffness in older adults. From January 2014 to December 2015, 1500 participants (men, n = 587; mean age, 71.78 ± 5.10 years) in South Korea were enrolled in the study. Koreans aged >65 years who agreed to participate in the study were enrolled. Individuals who were unable to exercise because of underlying conditions were excluded. VO2 max (mL/kg/min), handgrip strength (kg), handgrip strength (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were measured. The brachial-ankle pulse wave velocity (baPWV) was measured using a VP-1000 instrument. VO2 max (mL/kg/min), handgrip (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were significantly inversely associated with baPWV. This association was consistent even after adjusting for confounding factors. Our study revealed a significant association between various aspects of physical fitness and arterial stiffness. This study suggests that physical fitness is a useful predictor of arterial stiffness in older adults.

Predictive Performance and Optimal Cut-Off Points of Blood Pressure for Identifying Arteriosclerosis among Adults in Eastern China

This study aimed to assess the predictive performance and establish optimal cut-off points of blood pressure for identifying arteriosclerosis in eastern Chinese adults. Brachial–ankle pulse wave velocity (baPWV) was utilized to evaluate arteriosclerosis. The predictive performance of blood pressure for arteriosclerosis was determined by the area under the curve (AUC) of receiver operating characteristics; the optimal blood pressure cut-off points were determined by Youden’s index. A logistic regression model was used to acquire the odds ratio (OR) of blood pressure for arteriosclerosis. The AUCs of blood pressure for identifying arteriosclerosis were 0.868 (95%CI: 0.860–0.875) for systolic blood pressure (SBP) and 0.835 (95%CI: 0.827–0.843) for diastolic blood pressure (DBP), both p < 0.01. The AUCs of women were higher than that of men (0.903 vs. 0.819 for SBP; 0.847 vs. 0.806 for DBP; Z test p < 0.05). The AUCs in the 18–39.9-years group were higher than that in the 40–59.9-years and 60–84-years groups (0.894 vs. 0.842 and 0.818 for SBP; 0.889 vs. 0.818 and 0.759 for DBP; Z test p < 0.05). The total optimal cut-off points of blood pressure for predicting arteriosclerosis were 123.5/73.5 mmHg (SBP/DBP) overall; 123.5/73.5 and 126.5/79.5 mmHg for women and men, respectively; and 120.5/73.5, 123.5/76.5, and 126.5/75.5 mmHg for 18–39.9-years, 40–59.9-years, and 60–84-years groups, respectively. Blood pressure indexes had a high predictive performance for identifying arteriosclerosis with the optimal cut-off point of 123.5/73.5 mmHg (SBP/DBP) in eastern Chinese adults. Women or the younger population have a higher predictive performance and lower cut-off points to identify arteriosclerosis.