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Yue X, Chen L, Shi Y, Suo Y, Liao S, Cheang I, Gao R, Zhu X, Zhou Y, Yao W, Sheng Y, Kong X, Li X, Zhang H. Comparison of arterial stiffness indices measured by pulse wave velocity and pulse wave analysis for predicting cardiovascular and all-cause mortality in a Chinese population. Hypertens Res 2024; 47:767-777. [PMID: 38195990 DOI: 10.1038/s41440-023-01552-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024]
Abstract
Arterial stiffness measured by pulse wave velocity and pulse wave analysis has been widely studied in different populations in terms of its correlation with cardiovascular events and all-cause mortality. It remains unknown which arterial stiffness index is better for risk stratification in the general population. We included 4129 participants from Gaoyou County, Jiangsu Province, China, with a median follow-up of 11 years. The primary endpoint was cardiovascular mortality, and the secondary endpoint was all-cause mortality. Harrell's C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) based on the Cox proportional hazards regression model were evaluated to assess predictive discrimination and accuracy. The associations between the 4 indices and cardiovascular mortality remained significant after adjusting for the Framingham Risk Score (FRS) and/or associated risk factors. Considering reclassification based on the newly integrated models (FRS model combined with the 4 indices), NRI for cardiovascular mortality showed that haPWV and baPWV had more significant improvement in reclassification compared with C1 and C2 [NRI with 95% CI: haPWV 0.410 (0.293, 0.523); baPWV 0.447 (0.330, 0.553); C1 0.312 (0.182, 0.454); C2 0.328 (0.159, 0.463); all P < 0.05]. This study showed that pulse wave velocity (haPWV and baPWV) provides better discrimination of long-term risk than arterial elasticity indices (C1 and C2) in the general population.
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Affiliation(s)
- Xin Yue
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Lu Chen
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, 215002, China
| | - Yanping Shi
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, 215002, China
| | - Yifang Suo
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, 215002, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yanhui Sheng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, 215002, China.
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Szaló G, Hellgren MI, Allison M, Li Y, Råstam L, Rådholm K, Bollano E, Duprez DA, Jacobs DR, Lindblad U, Daka B. Impaired artery elasticity predicts cardiovascular morbidity and mortality- A longitudinal study in the Vara-Skövde Cohort. J Hum Hypertens 2024; 38:140-145. [PMID: 37794130 PMCID: PMC10844075 DOI: 10.1038/s41371-023-00867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
It is still debated whether arterial elasticity provides prognostic information for cardiovascular risk beyond blood pressure measurements in a healthy population. To investigate the association between arterial elasticity obtained by radial artery pulse wave analysis and risk for cardiovascular diseases (CVD) in men and women. In 2002-2005, 2362 individuals (men=1186, 50.2%) not taking antihypertensive medication were included. C2 (small artery elasticity) was measured using the HDI/Pulse Wave CR2000. Data on acute myocardial infarction or stroke, fatal or non-fatal, was obtained between 2002-2019. Cox- regression was used to investigate associations between C2 and future CVD, adjusting for confounding factors such as age, sex, systolic blood pressure, heart rate, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LDL- cholesterol, CRP (C-Reactive Protein), alcohol consumption, smoking and physical activity. At baseline, the mean age of 46 ± 10.6 years and over the follow-up period, we observed 108 events 70 events in men [event rate: 5.9%], 38 in women [event rate: 3.2%]. In the fully adjusted model, and for each quartile decrease in C2, there was a significant increase in the risk for incident CVD by 36%. (HR = 1.36, 95% CI: 1.01-1.82, p = 0.041). The results were accentuated for all men (HR = 1.74, 95% CI: 1.21-2.50, p = 0.003) and women over the age of 50 years (HR = 1.70, 95% CI: 0.69-4.20). We showed a strong and independent association between C2 and CVD in men. In women after menopause, similar tendencies and effect sizes were observed.
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Affiliation(s)
- Gábor Szaló
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Margareta I Hellgren
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Skaraborg Institute, Skövde, Sweden
| | - Matthew Allison
- Division of Preventive Medicine, Department of Family Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ying Li
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Råstam
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ulf Lindblad
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bledar Daka
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Vallée A. Added value of arterial stiffness index for the 10-year atherosclerotic cardiovascular disease risk determination in a middle-aged population-based study. Clin Res Cardiol 2023; 112:1679-1689. [PMID: 37650913 DOI: 10.1007/s00392-023-02267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/12/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Atherosclerotic cardiovascular disease (ASCVD) is considered the leading cause of mortality worldwide. Arterial stiffness, measured by arterial stiffness index (ASI), could be a main predictor in target damage of organs. Uncertainty remains regarding the contribution of ASI to estimated ASCVD risk. This study investigates the added value of ASI in ASCVD risk determination using the general UK Biobank middle-aged population. METHODS Among 100,598 participants from the UK Biobank population, ASI was assessed and associations between ASCVD risk were stratified by sex and estimated using multiple linear and logistic regressions adjusted for heart rate, physical activity, alcohol status, smocking pack years, BMI categories and CKD. RESULTS Males presented higher ASCVD risk than females (8.58% vs. 2.82%, p < 0.001) and higher ASI levels (9.50 m/s vs. 7.00 m/s, p < 0.001). The Youden index was determined at 9.70 m/s in males (p < 0.001) and 10.46 m/s in females (p < 0.001). Among females, participants with ASI > 10.46 m/s showed higher ASCVD risk than others (3.64% vs. 2.56%, p < 0.001), similar results were observed for males (9.92% vs. 7.21%, p < 0.001). In males, ASI showed significant added value information when including overall covariates (AUC = 0.695 vs. AUC = 0.663, p < 0.001). Similar results were observed in females (AUC = 0.693 vs. AUC = 0.687, p = 0.001). In both genders, for the association between ASI and ASCVD risk, nonlinear relationships were observed with higher accuracies than linear models. CONCLUSION Further studies should investigate ASCVD risk stratification management depending on ASI measurement.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France.
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Brumback LC, Andrews LIB, Jacobs DR, Duprez DA, Thepaksorn EH, Kaufman JD, Denenberg JO, Allison MA. The association between arterial compliance, as assessed by PTC1 and PTC2 from radial artery waveforms, and age, sex, and race/ethnicity. J Hypertens 2023; 41:1117-1126. [PMID: 37071438 PMCID: PMC10238654 DOI: 10.1097/hjh.0000000000003441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND There is limited literature on differences in arterial compliance, as assessed from arterial pressure waveforms, with age, sex, and race/ethnicity. PTC1 and PTC2 are indices of arterial compliance, which are derived from a Windkessel model of the waveform, relatively easy to obtain, and associated with cardiovascular disease. METHOD PTC1 and PTC2 were computed from radial artery waveforms from participants of the Multi-Ethnic Study of Atherosclerosis at baseline and again 10 years later. We evaluated the association of PTC1, PTC2, and 10-year change in PTC1 and PTC2 with age, sex, and race/ethnicity. RESULTS Among 6245 participants in 2000-2002 (mean ± SD of age was 62 ± 10 years; 52% female; 38% White, 12% Chinese, 27% Black, and 23% Hispanic/Latino), means ± SDs for PTC1 and PTC2 were 394 ± 334 and 94 ± 46 ms. After adjustment for cardiovascular disease risk factors, mean PTC2 was 1.1 ms (95% confidence interval: 1.0, 1.2) lower (arterial stiffness was greater) per year older age, was 22 ms (19, 24) lower for females, and varied by race/ethnicity ( P < 0.001; e.g., 5 ms lower for Blacks compared with Whites), although the differences were smaller at older ages ( P < 0.001 for age-sex, P < 0.001 for age-race/ethnicity interactions). Among 3701 participants with repeat measurements in 2010-2012, arteries had stiffened (mean ± SD 10-year decrease in PTC2: 13 ± 46 ms) consistent with cross-sectional age-trend and tended to stiffen less for females and Blacks consistent with cross-sectional age-interactions. CONCLUSION Differences in arterial compliance by age, sex, and race/ethnicity lend support to identify and act on societal factors that may drive health disparities.
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Affiliation(s)
- Lyndia C Brumback
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Leah I B Andrews
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth Hom Thepaksorn
- Sirindhorn College of Public Health, Trang, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Thailand
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington
| | - Julie O Denenberg
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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Brumback LC, Andrews LI, Jacobs DR, Duprez D, Hom Thepaksorn EK, Kaufman JD, Denenberg J, Allison M. Reproducibility of PTC1 and PTC2, indices of arterial compliance, from the radial artery waveform: The Multi-Ethnic Study of Atherosclerosis. Vasc Med 2023; 28:141-143. [PMID: 36721317 PMCID: PMC10578356 DOI: 10.1177/1358863x221151089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Lyndia C Brumback
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Leah Ib Andrews
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Duprez
- Department of Medicine, Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Julie Denenberg
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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Inter-arm systolic blood pressure difference: non-persistence and association with incident cardiovascular disease in the Multi-ethnic Study of Atherosclerosis. J Hum Hypertens 2023; 37:197-204. [PMID: 35296776 PMCID: PMC9477971 DOI: 10.1038/s41371-022-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/09/2022]
Abstract
We investigated inter-arm systolic blood pressure (sIAD) difference, reproducibility, and incident cardiovascular disease (CVD). We hypothesized that higher sIAD values have low prevalence and nonpersistence over years, but that CVD risk is higher starting from the time of first high absolute sIAD. In Multi-Ethnic Study of Atherosclerosis participants (n = 6725, 53% female, 45-84 years old), Doppler systolic blood pressure (SBP) measurements were made in both arms (10-minute interval) thrice over 9.5 years. Proportional hazards for CVD (coronary heart disease, heart failure, stroke, peripheral arterial disease (PAD)) over 16.4 years were tested according to time-varying absolute inter-arm difference with covariates: (1) age, gender, race, and clinic; (2) model 1 plus height, heart rate, BP, antihypertensives, BMI, smoking status, lipids, lipid lowering medication, and diabetes. High sIAD was not persistent across exams. Maximum absolute sIAD ≥ 15 mmHg was found at least once in 815 persons. Maximum absolute sIAD had a graded relationship with incident stroke or PAD: 6.2% events; model 2 hazard ratio per 10 mmHg 1.34 (95% CI, 1.15-1.56) and this risk was approximately doubled for maximum absolute sIAD ≥ 15 mmHg vs 0-4 mmHg. Total CVD risk (18.4% events) was increased only for maximum absolute sIAD ≥25 mmHg. Associations with incident CVD did not differ for higher SBP in left vs right arm. A higher maximum absolute sIAD at any exam was associated with greater risk for stroke and PAD especially for values ≥ 15 mmHg, and ≥25 mmHg for other CVD. Measuring SBP between arms may help identify individuals at risk for CVD.
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Garg PK, Guan W, Nomura S, Weir NL, Karger AB, Duprez D, Tsai MY. Associations of plasma omega-3 and omega-6 pufa levels with arterial elasticity: the multi-ethnic study of atherosclerosis. Eur J Clin Nutr 2022; 76:1770-1775. [PMID: 35680969 DOI: 10.1038/s41430-022-01172-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Literature examining the relationship of circulating omega-3 and omega-6 polyunsaturated fatty acids [n-3(ω-3) and n-6 (ω-6) PUFAs] and arterial elasticity in large cohort-based populations are lacking. We investigated the association of circulating ω-3and ω-6 PUFAs with large artery elasticity (LAE) and small artery elasticity (SAE) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS A total of 6124 participants (mean age 61.9; 52% female; 38% White, 27% Black, 22% Hispanic, and 13% Chinese-American) with plasma phospholipid PUFAs and arterial elasticity measured at baseline were included. LAE and SAE were derived from pulse contour analysis of the radial artery in all subjects in a supine position using tonometry. Linear regression models were used to determine associations for levels of (1) each circulating fatty acid, (2) total ω-3PUFAs, and (3) total ω-6 PUFAs with log-transformed LAE and SAE. RESULTS Each standard deviation (SD) increment in circulating levels of total ω-3 PUFAs, eicosapentaenoic acid, and docosahexaenoic acid were associated with a 0.017 ml/mmHg, 0.017 ml/mmHg, and 0.015 ml/mmHg higher LAE respectively (p values all <0.01). No significant trends were observed for ω-3 PUFAs levels with SAE.22 Similarly, no significant trends were observed for ω-6 PUFA levels with either LAE or SAE. CONCLUSIONS In a multi-ethnic cohort of individuals free of baseline cardiovascular disease, higher plasma levels of total and individual ω-3 PUFAs were associated with an increased LAE. Further understanding into differential associations of ω-6 PUFAs with LAE and SAE is needed.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Los Angeles, CA, USA.
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sarah Nomura
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Natalie L Weir
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Duprez
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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Wen D, Xu Z, An R, Ren J, Jia Y, Li J, Zheng M. Predicting haemodynamic significance of coronary stenosis with radiomics-based pericoronary adipose tissue characteristics. Clin Radiol 2021; 77:e154-e161. [PMID: 34852918 DOI: 10.1016/j.crad.2021.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/29/2021] [Indexed: 01/06/2023]
Abstract
AIM To investigate the diagnostic performance of the radiomics features of pericoronary adipose tissue (PCAT) in determining haemodynamically significant coronary artery stenosis as evaluated by fractional flow reserve (FFR). MATERIALS AND METHODS A total of 92 patients with clinically suspected coronary artery disease who underwent coronary computed tomography (CT) angiography (CCTA), invasive coronary angiography (ICA), and FFR examination within 1 month were included retrospectively, and 121 lesions were randomly assigned to the training and testing set. Based on manual segmentation of PCAT, 1,116 radiomics features were computed. After radiomics robustness assessment and feature selection, radiomics models were established using the different machine-learning algorithms. The area under the receiver operating characteristic (ROC) curve (AUC) and net reclassification index (NRI) were analysed to compare the discrimination and reclassification abilities of radiomics models. RESULTS Two radiomics features were selected after exclusions, and both were significantly higher in coronary arteries with FFR ≤0.8 than those with FFR >0.8. ROC analysis showed that the combination of CCTA and decision tree radiomics model achieved significantly higher diagnostic performance (AUC: 0.812) than CCTA alone (AUC: 0.599, p=0.015). Furthermore, the NRI of the combined model was 0.820 and 0.775 in the training and testing sets, respectively, suggesting the radiomics features of PCAT had were effective in classifying the haemodynamic significance of coronary stenosis. CONCLUSIONS Adding PCAT radiomics features to CCTA enabled identification of haemodynamically significant coronary artery stenosis.
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Affiliation(s)
- D Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi province, China
| | - Z Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi province, China
| | - R An
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi province, China
| | - J Ren
- GE Healthcare China, Daxing District, 1 Tongji South Road, Beijing, 100176, China
| | - Y Jia
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi province, China
| | - J Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi province, China
| | - M Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi province, China.
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Gao L, Lu D, Xia G, Zhang H. The relationship between arterial stiffness index and coronary heart disease and its severity. BMC Cardiovasc Disord 2021; 21:527. [PMID: 34743695 PMCID: PMC8573853 DOI: 10.1186/s12872-021-02350-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/26/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Arterial stiffness index (ASI) is closely related to coronary atherosclerosis. This study aims to explore whether ASI can predict coronary heart disease (CHD) and its severity. METHODS In this study, a total of 726 patients with suspected CHD were recruited. Based on coronary angiography results, the subjects were assigned into three groups: the control group (without obvious coronary artery disease), single-vessel disease group, and multi-vessel disease group (the number of vessels diseased ≥ 2). At the same time, according to the results of angiography, myocardial enzyme spectrum, electrocardiogram, color Doppler echocardiography and clinical manifestations, these patients were divided into four groups: the control group, stable angina (SA) Group, unstable angina (UA) group, and acute myocardial infarction (AMI) group. We have compared whether there were differences in ASI and related baseline data between groups. Receiver operating curve (ROC) analysis was conducted to determine whether ASI could predict CHD and evaluate the severity. RESULTS ASI was positively correlated with the number of diseased branches of coronary artery. The value of ASI was increased as the number of the diseased branches increased. The ASI value in the SA group was significantly higher compared with the control group. Furthermore, the ASI value in the UA and AMI groups was remarkably increased compared with the control and SA groups. The results of ROC analysis indicated that the sensitivity and specificity of ASI was 71.0% and 85.4% in diagnosing CHD, respectively. While ASI was used in predicting the severity of CHD, the sensitivity was 72.1% and specificity 57.9%. CONCLUSION ASI is of great value in the diagnosis of coronary heart disease and the prediction of its severity.
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Affiliation(s)
- Longjian Gao
- Department of Cardiology, Hebei Medical University, 361# Zhongshan east road, Shijiazhuang, 050017, Hebei Province, China
| | - Dasheng Lu
- Department of Cardiology, The Second Affiliated Hospital of Wannan Medical College, 10# Kangfu road, Wuhu, 241000, Anhui Province, China
| | - Guangwei Xia
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, 41# Taizhou Road, Yangzhou, 225000, Jiangsu Province, China
| | - Hao Zhang
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, 41# Taizhou Road, Yangzhou, 225000, Jiangsu Province, China.
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Brumback LC, Andrews LIB, Jacobs DR, Duprez DA, Shah SJ, Dougherty CM, Denenberg JO, Allison MA. The association between indices of blood pressure waveforms (PTC1 and PTC2) and incident heart failure. J Hypertens 2021; 39:661-666. [PMID: 33239550 PMCID: PMC8177733 DOI: 10.1097/hjh.0000000000002707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The radial artery pulse waveform is a continuous measure of pressure throughout the cardiac cycle, and thus can provide more information than just systolic and diastolic blood pressures. New indices based on a Windkessel model of the waveform, PTC1 and PTC2, are related to arterial compliance and add information for prediction of incident cardiovascular disease (coronary heart disease, stroke, myocardial infarction) but their association with heart failure is unknown. METHODS Among 6229 adults (mean age 62 years) from four race/ethnic groups who were initially free of clinical cardiovascular disease and heart failure in 2000-2002, we evaluated the associations of baseline PTC1 and PTC2 with incident heart failure. RESULTS Mean ± standard deviation PTC1 and PTC2 were 394 ± 334 and 94 ± 46 ms, respectively. During a median of 15.7 years follow-up, there were 357 heart failure events (148 with reduced, 150 with preserved, and 59 with unknown ejection fraction). After adjustment for traditional risk factors, the hazard ratio for heart failure per 1 standard deviation higher PTC2 was 0.73 (95% confidence interval: 0.63--0.85). Higher PTC2 was also significantly associated with lower risk of heart failure with reduced ejection fraction (hazard ratio = 0.67; 95% confidence interval: 0.56--0.80). There was no evidence of a significant association between PTC2 and heart failure with preserved ejection fraction or between PTC1 and heart failure. CONCLUSION The PTC2 measure of the radial artery pulse waveform may represent a novel phenotype related to heart failure, especially heart failure with reduced ejection fraction.
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Affiliation(s)
- Lyndia C Brumback
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Leah I B Andrews
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, and
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Julie O Denenberg
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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Szaló G, Hellgren M, Allison M, Råstam L, Lindblad U, Daka B. Longitudinal association between leisure-time physical activity and vascular elasticity indices. BMC Cardiovasc Disord 2021; 21:99. [PMID: 33593279 PMCID: PMC7885232 DOI: 10.1186/s12872-021-01911-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
AIM We investigated the association between levels of leisure-time physical activity and vascular stiffness in a longitudinal observational study from a representative Swedish population. METHOD A total of 2816 randomly selected individuals were examined at visit 1 (2002-2005, Men = 1400). After a mean follow-up of 9.7 ± 1.4 years, a representative sample of 1327 of the original participants were re-examined at visit 2. After excluding subjects with hypertension at baseline, 761 participants were included in the longitudinal analyses. Leisure-time physical (LTPA) activity was self-reported and dichotomized as high or low (level 3, 4 and level 1, 2, respectively). Large Arterial Elasticity Index (LAEI) and Small Arterial Elasticity Index (SAEI) were measured using the HDI/Pulse Wave™ CR2000. Multivariable general linear models were used to investigate the differences in changes SAEI and LAEI based on LTPA levels. RESULTS At visit 1, and after adjustment for possible confounders, participants in the high LTPA group had better small artery elasticity (SAEI) (SAEI in low-level LTPA: 7.89 ± 0.11, SAEI in high-level LTPA: 8.32 ± 0.15, ΔSAEI: 0.42, CI: 0.07-0.78; p = 0.020). SAEI decreased between the two assessments (Visit 1: SAEI 8.01 ± 3.37 ml/mmHg; Δ SAEI: 1.4, CI 1.2-1.6, p < 0.001). Participants with a higher LTPA at visit 1 had significantly better SAEI at visit 2 (ΔSAEI: 0.44, CI 0.03-0.85, p = 0.037). No significant associations were observed between LAEI and LTPA after adjustments. CONCLUSIONS High LTPA predicted higher small arterial compliance at visit 2 suggesting that positive effects of LTPA on arterial elasticity persists over time.
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Affiliation(s)
- Gábor Szaló
- The Skaraborg Institute, Skövde, Sweden.,Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Hellgren
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Lennart Råstam
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Ulf Lindblad
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bledar Daka
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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12
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Brumback LC, Jacobs DR, Duprez DA. PTC1 and PTC2: New Indices of Blood Pressure Waveforms and Cardiovascular Disease. Am J Epidemiol 2020; 189:726-734. [PMID: 31907510 PMCID: PMC7608079 DOI: 10.1093/aje/kwz280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022] Open
Abstract
Systolic and diastolic blood pressures provide information about cardiovascular disease (CVD) but are only extremes of the pressure waveform during the cardiac cycle. We developed summaries of the pressure decay, called PTC1 and PTC2, that are related to arterial compliance and to an existing proprietary summary that has been shown to predict CVD. We derived the summaries from a Windkessel model (consisting of a decaying exponential plus a dampened cosine, with an intercept so they are independent of calibration with blood pressure, unlike the proprietary measures), and we estimated them using nonlinear least squares with standard, free software. Among 6,228 adults from the Multi-Ethnic Study of Atherosclerosis, initially free of CVD in 2000-2002, mean PTC2 was 94 (standard deviation, 46) milliseconds. During median 15-year follow-up, there were 911 CVD events (including 609 incidents of coronary heart disease and 270 strokes). One-standard-deviation higher PTC2 was associated with 17% (95% confidence interval: 10, 24) lower CVD risk, after adjustment for traditional risk factors. Results were similar for PTC1. PTC1 and PTC2 are relatively straightforward to compute and add information beyond traditional risk factors for prediction of CVD. Our work enables others to replicate and extend our results with waveforms from any suitable device.
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Affiliation(s)
- Lyndia C Brumback
- Correspondence to Dr. Lyndia C. Brumback, Collaborative Health Studies Coordinating Center, Building 29, Suite 210, University of Washington, Box 354922, 6200 NE 74th Street, Seattle, WA 98115 (e-mail: )
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13
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Costa EC, Boreskie KF, Scott Kehler D, Kent DE, Hay JL, Arora RC, Browne RAV, Duhamel TA. Immediate post-exercise blood pressure and arterial compliance in middle-aged and older normotensive females: A cross-sectional study. Sci Rep 2020; 10:9205. [PMID: 32514128 PMCID: PMC7280524 DOI: 10.1038/s41598-020-66104-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
This study examined whether immediate post-exercise systolic blood pressure (SBP) is associated with arterial compliance in middle-aged and older normotensive females. A total of 548 normotensive, non-frail females aged 55 years and older with no previous history of cardiovascular disease (CVD) participated in this cross-sectional study. Large and small arterial compliance were assessed by pulse wave analysis. Reduced arterial compliance was defined based on age and sex cutoffs. SBP was measured at rest and immediately following a 3-min moderate step-test. CVD risk factors were also assessed (e.g. resting systolic and diastolic BP, fasting glucose, triglycerides, cholesterol, body mass index). A total of 15.1% and 44.0% of the participants showed reduced large and small artery compliance, respectively. Immediate post-exercise SBP was associated with reduced large (OR 1.02 per 1 mmHg increase in post-exercise SBP, 95%CI 1.01–1.04; p = 0.010) and small (OR 1.02 per 1 mmHg increase in post-exercise SBP, 95%CI 1.00–1.03; p = 0.008) arterial compliance. Participants with highest immediate post-exercise SBP (quartile 4; i.e. ≥ 165 mmHg) showed increased odds ratios for reduced large (2.67, 95%CI 1.03–6.94; p = 0.043) and small (2.27, 95%CI 1.22–4.21; p = 0.010) arterial compliance compared to those with the lowest immediate post-exercise SBP (quartile 1; i.e. ≤ 140 mmHg), independent of other established CVD risk factors. Immediate post-exercise SBP following a brief moderate step-test seems to be able to discriminate reduced arterial compliance in middle-aged and older normotensive females.
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Affiliation(s)
- Eduardo C Costa
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil.
| | - Kevin F Boreskie
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - D Scott Kehler
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - David E Kent
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Jacqueline L Hay
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Rakesh C Arora
- Institute of Cardiovascular Sciences, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada.,Cardiac Sciences Program, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada.,Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Rodrigo A V Browne
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Todd A Duhamel
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada.,Cardiac Sciences Program, St-Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
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14
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Logan JG, Kang H, Kim S, Duprez D, Kwon Y, Jacobs DR, Forbang N, Lobo JM, Sohn MW. Association of obesity with arterial stiffness: The Multi-Ethnic Study of Atherosclerosis (MESA). Vasc Med 2020; 25:309-318. [PMID: 32484395 DOI: 10.1177/1358863x20918940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arterial stiffness (AS) and obesity are recognized as important risk factors of cardiovascular disease (CVD). The purpose of this study was to investigate the relationship between AS and obesity. AS was defined as high augmentation index (AIx) and low elasticity (C1, large artery elasticity; C2, small artery elasticity) in participants enrolled in the Multi-Ethnic Study of Atherosclerosis at baseline. We compared AIx, C1, and C2 by body mass index (BMI) (< 25, 25-29.9, 30-39.9, ⩾ 40 kg/m2) and waist-hip ratio (WHR) (< 0.85, 0.85-0.99, ⩾ 1). The obesity-AS association was tested across 10-year age intervals. Among 6177 participants (62 ± 10 years old, 52% female), a significant inverse relationship was observed between obesity and AS. After adjustments for CVD risk factors, participants with a BMI > 40 kg/m2 had 5.4% lower AIx (mean difference [Δ] = -0.82%; 95% CI: -1.10, -0.53), 15.4% higher C1 (Δ = 1.66 mL/mmHg ×10; 95% CI: 1.00, 2.33), and 40.2% higher C2 (Δ = 1.49 mL/mmHg ×100; 95% CI: 1.15, 1.83) compared to those with a BMI < 25 kg/m2 (all p for trend < 0.001). Participants with a WHR ⩾ 1 had 5.6% higher C1 (∆ = 0.92 mL/mmHg ×10; 95% CI: 0.47, 1.37) compared to those with a WHR < 0.85. The WHR had a significant interaction with age on AIx and C2, but not with BMI; the inverse relationships of the WHR with AIx and C2 were observed only in participants < 55 years between the normal (WHR < 0.85) and the overweight (0.85 ⩽ WHR < 0.99) groups. Different associations of WHR and BMI with arterial stiffness among older adults should be further investigated.
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Affiliation(s)
- Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Hyojung Kang
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Soyoun Kim
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Daniel Duprez
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Younghoon Kwon
- UVA Heart and Vascular Center Fontaine, University of Virginia, Charlottesville, VA, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Nketi Forbang
- Department of Family Medicine and Public Health, Division of Preventive Medicine, UC San Diego, La Jolla, CA, USA
| | - Jennifer Mason Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Min-Woong Sohn
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
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15
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Hu W, Wu X, Dong D, Cui LB, Jiang M, Zhang J, Wang Y, Wang X, Gao L, Tian J, Cao F. Novel radiomics features from CCTA images for the functional evaluation of significant ischaemic lesions based on the coronary fractional flow reserve score. Int J Cardiovasc Imaging 2020; 36:2039-2050. [DOI: 10.1007/s10554-020-01896-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/21/2020] [Indexed: 04/12/2023]
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16
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Duprez DA, Duval S, Hoke L, Florea N, Grandits G, Carlson C, Lee J, Cohn JN. Early cardiovascular structural and functional abnormalities as a guide to future morbid events. Eur J Prev Cardiol 2020; 28:1214-1221. [PMID: 34551082 DOI: 10.1177/2047487320901416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/16/2022]
Abstract
Abstract
Aims
Our aim was to evaluate the predictive value of a battery of 10 non-invasive tests of cardiovascular structural and functional health on the future risk of cardiovascular morbid events.
Methods and Results
A total of 1900 asymptomatic adults concerned about their risk for cardiovascular disease underwent non-invasive assessment with 10 tests of vascular and cardiac structure and function. A disease score (DS) was calculated for each individual based on these 10 tests. Follow-up (mean 9.2 years) for cardiovascular morbidity and mortality was available for 1442 individuals (mean age 53.2 years, 48.2% women). Those in the lowest DS tertile (0–2) experienced 0.16 cardiovascular events per 100 patient-years (PY), those in the middle tertile (3–5) experienced 0.86 events per 100 PY, and those in the highest tertile (6+) experienced 1.3 events per 100 PY (p < .001). Sensitivity analysis, assuming a neutral effect of DS on projected events in subjects not followed, did not alter statistical significance. Risk assessment using the Framingham risk score (FRS) also predicted morbid events but the two methods differed in identifying individuals at high risk. The net reclassification index was improved by 0.11 (p = 0.01) when DS was added to FRS.
Conclusions
Assessing the biological disease process in the arteries and heart of asymptomatic adults provides a guide to the risk of a future cardiovascular morbid event. Larger and longer studies are needed to determine whether risk factor algorithms, the severity of the biological process or some combination is the optimal method for identifying individuals in need of intervention to delay morbid events.
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Affiliation(s)
- Daniel A Duprez
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sue Duval
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lynn Hoke
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalia Florea
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Gregory Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Claire Carlson
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joy Lee
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jay N Cohn
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
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17
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Kasiske BL, Anderson-Haag TL, Duprez DA, Kalil RS, Kimmel PL, Pesavento TE, Snyder JJ, Weir MR. A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years. Kidney Int 2020; 98:168-175. [PMID: 32331703 DOI: 10.1016/j.kint.2020.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/06/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022]
Abstract
While there have been numerous studies of living kidney donors, most have been retrospective without suitable controls and have yielded conflicting results. To clarify this we studied 205 living donor candidates and 203 controls having no medical conditions precluding donation. Before and at six months, one, two, three, six, and nine years after donation we measured iohexol glomerular filtration rate, clinic blood pressure, urine protein excretion and metabolic parameters reported to be affected by kidney function. We measured 24 hour ambulatory blood pressure at three, six, and nine years and at six and nine years blood pressure after treadmill exercise, carotid-femoral pulse wave velocity and arterial elasticity. Between six months and nine years, the mean (95% confidence interval) change in glomerular filtration rate was significantly different among 133 donors 0·02 (-0·16-0·20) mL/min/1·73m2/year versus -1·26 (-1·52--1·00) mL/min/1·73m2/year in 113 healthy controls. Blood pressure, urine protein, urine albumin, glucose, hemoglobin A1c, insulin, and lipoproteins were not different in controls versus donors; but parathyroid hormone, homocysteine and uric acid remained higher at nine years. At six and nine years carotid-femoral pulse wave velocity was not different, but the mean small artery elasticity was significantly lower in 141 donors 6·1 mL/mmHg x100, versus 113 controls 7·1 mL/mmHg x100, and 6·1 mL/mmHg x100 in 137 donors versus 7·6 mL/mmHg x100 in 112 controls at six and nine years, respectively [significant adjusted difference of 1·1 mL/mmHg x100]. Thus, donors remain healthy with stable kidney function for the first nine years, but differences in metabolic and vascular parameters could be harbingers of adverse outcomes requiring future interventions.
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Affiliation(s)
- Bertram L Kasiske
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
| | | | - Daniel A Duprez
- Department of Medicine, Cardiology Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roberto S Kalil
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Todd E Pesavento
- Division of Nephrology, Ohio State University, Columbus, Ohio, USA
| | - Jon J Snyder
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Matthew R Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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18
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Karabulut M, Lopez JA, Karabulut U. Aerobic training session length affects arterial elasticity. Clin Physiol Funct Imaging 2019; 40:14-20. [PMID: 31552704 DOI: 10.1111/cpf.12596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/18/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to examine haemodynamic and arterial elasticity responses to aerobic exercise of varying durations. METHODS Eighteen male subjects (age = 23·4 ± 2·0) performed a maximal aerobic fitness (VO2max ) test. Participants met in the laboratory following an overnight fast for three randomly assigned sessions. Assessments for large and small arterial elasticity (SAE), systemic vascular resistance (SVR), total vascular impedance (TVI), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO), pulse pressure (PP) and cardiac ejection time (CET) were performed using applanation tonometry at the radial artery. Following baseline measurements, participants executed aerobic exercise on a treadmill at 65% of their respective VO2max for 30, 45 or 60 min on three different occasions. Postexercise measurements were performed immediately, 10, 20 and 40 min postexercise cessation. RESULTS The 60-min exercise bout resulted in significantly increased SAE values (P < 0·04) and decreased SVR values (P < 0·02) when compared with the 30-min exercise bout. The 60-min session also caused significantly higher HR values and significantly lower values for SV and DBP values following exercise (P < 0·04). CONCLUSIONS The results of this study emphasize that varying the length of moderate-intensity aerobic exercise bouts affects arterial elasticity response and total vascular resistance.
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Affiliation(s)
| | - Joe A Lopez
- University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Ulku Karabulut
- University of Texas Rio Grande Valley, Brownsville, TX, USA
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19
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Duprez DA, Forbang NI, Allison MA, Peralta CA, Shea S, Jacobs DR. Association of C2, a derivative of the radial artery pressure waveform, with new onset of type 2 diabetes mellitus: the MESA study. Cardiovasc Diabetol 2019; 18:62. [PMID: 31101116 PMCID: PMC6524236 DOI: 10.1186/s12933-019-0868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although microvascular dysfunction is known to result from diabetes, it might also lead to diabetes. Lower values of C2, a derivative of the radial artery pressure waveform, indicate microvascular dysfunction and predict hypertension and cardiovascular disease (CVD). We studied the association of C2 with incident diabetes in subjects free of overt CVD. METHODS Among multi-ethnic participants (n = 5214), aged 45-84 years with no diabetes, C2 was derived from the radial artery pressure waveform. Incident diabetes (N = 651) was diagnosed as new fasting glucose ≥ 126 mg/dL or antidiabetic medicine over ~ 10 years. The relative incidence density (RID) for incident diabetes per standard deviation (SD) of C2 was studied during ~ 10 years follow-up using four levels of adjustment. RESULTS Mean C2 at baseline was 4.58 ± 2.85 mL/mmHg × 100. The RID for incident diabetes per SD of C2 was 0.90 (95% CI 0.82-0.99, P = 0.03). After adjustment for demographics plus body size, the corresponding RID was 0.81 (95% CI 0.73-0.89, P < 0.0001); body mass index (BMI) was the dominant covariate here. After adjustment for demographics plus cardiovascular risk factors, the RID was 0.98 (95% CI 0.89, 1.07, P = 0.63). After adjustment for all the parameters in the previous models, the RID was 0.87 (95% CI 0.78, 0.96, P = 0.006). CONCLUSIONS In a multi-ethnic sample free of overt CVD and diabetes at baseline, C2 predicted incident diabetes after adjustment for demographics, BMI and CVD risk factors. Differences in arterial blood pressure wave morphology may indicate a long-term risk trajectory for diabetes, independently of body size and the classical risk factors.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, 420 Delaware St SE, MMC 508, Minneapolis, MN, 55455, USA.
| | - Nkete I Forbang
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Carmen A Peralta
- VA Medical Center, University of San Francisco, San Francisco, CA, USA
| | - Steven Shea
- Department of Medicine, Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, MN, USA
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20
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Zhu H, Gao Y, Cheng H, Lu Y, Cheang I, Xu D, Yao W, Xu T, Zhou F, Zhou Y, Xu F, Kong X, Li X, Zhang H. Comparison of arterial stiffness indices measured by pulse wave velocity and pulse wave analysis. Blood Press 2019; 28:206-213. [PMID: 30924384 DOI: 10.1080/08037051.2019.1598254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hongyan Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huiling Cheng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yichao Lu
- Department of Cardiology, The Affiliated Jiangyin People’s Hospital of Southeast University Medical College, Jiangyin, China
| | - IokFai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongxu Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tianbao Xu
- Department of Cardiology, The People’s Hospital of Kizilsu Kirghiz Autonomous Prefecture, Xinjiang, China
| | - Fang Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Cardiology, The People’s Hospital of Kizilsu Kirghiz Autonomous Prefecture, Xinjiang, China
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21
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Hall M, Ofili E, Lapu-Bula R, Alema-Mensah E, Miles-Richardson S. Living Arrangement: a Contributor to Vascular Disease in Asymptomatic African American Women. JOURNAL OF THE GEORGIA PUBLIC HEALTH ASSOCIATION 2019; 7:139-148. [PMID: 33907727 PMCID: PMC8075092 DOI: 10.20429/jgpha.2019.070220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diminished social support lias shown to lead to worse cardiovascular outcomes and since cardiovascular disease (CVD) is the leading cause of death in the United States (U.S.), it is critical to non-invasively study its precursor- vascular disease (VD). Assessing the impact social support lias on vascular outcomes can unveil potential CVD susceptibilities in at-risk populations. African American women exhibit the greatest burden of CVD morbidity and mortality; therefore, the purpose of tins study is to examine the association between living arrangement/social support and impaired vascular function in asymptomatic African American women. METHODS Vascular function was assessed by a non-invasive screening tool, HDI/PulseWave CR-2000, during screenings at community outreach events on participants clinically free of CVD. Vascular disease was defined as abnormal/impaired vascular function. Living arrangement, a binary variable (living with someone/living alone), was determined by survey responses (N=67) and represented social support. Multivariable analyses were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) to determine the association between living arrangement and vascular disease after controlling for confounders. Analyses were conducted using SAS 9.2. RESULTS Of those who lived alone, 82% had vascular disease (p=0.03). After adjusting for family CVD, and other CVD risk factors, those who lived with a spouse/partner or relative were 78% (p=0.04) less likely to develop vascular disease (AOR=0.22; 95% 0=0.05, 0.98). CONCLUSIONS Our study provides preliminary evidence to suggest that among African American women, clinically free of CVD, living arrangement is associated with vascular disease. While living alone may place individuals at an increased risk of CVD because of the association, living with a spouse/partner or relative may act as a protective factor against vascular disease and reduce the risk of CVD. Public health practitioners may use individuals' living arrangement as preventive measure for CVD risk.
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Affiliation(s)
- Meldra Hall
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA
| | - Elizabeth Ofili
- Clinical Research Center, Morehouse School of Medicine, Atlanta, GA
| | | | - Ernest Alema-Mensah
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA
- Clinical Research Center, Morehouse School of Medicine, Atlanta, GA
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Kwon Y, Jacobs DR, Lutsey PL, Brumback L, Chirinos JA, Mariani S, Redline S, Duprez DA. "Sleep disordered breathing and ECG R-wave to radial artery pulse delay, The Multi-Ethnic Study of Atherosclerosis". Sleep Med 2018; 48:172-179. [PMID: 29960211 PMCID: PMC6051731 DOI: 10.1016/j.sleep.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/14/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrocardiography R-wave to radial artery pulse delay (RRD) represents pulse transit time inclusive of pre-ejection period (PEP) and arterial pulse propagation time. RRD is proposed to largely reflect arterial stiffness when PEP is accounted for (shorter RRD = higher arterial stiffness). Sleep disordered breathing (SDB) causes intermittent hypoxemia and sympathetic activation, which negatively influences vascular function. We aimed to examine the association of measures of SDB with RRD. METHODS Our sample consisted of participants in the Multi-Ethnic Study of Atherosclerosis without prevalent cardiovascular disease who underwent a daytime arterial elasticity exam, cardiac magnetic resonance imaging (MRI), and overnight polysomnography. SDB measures of interest included apnea hypopnea index (AHI) and oxygen desaturation index (ODI) (N = 1173). RRD was regressed on each measure of SDB separately, with adjustment for other cardiovascular risk factors as well as for correlates of the PEP, another component of RRD, by including cardiac MRI measures of contractility and preload. RESULTS In multivariate analysis, among measures of SDB, ODI, a marker of intermittent hypoxemia, was inversely associated with RRD (β = -60.2 msec per SD [15.5/hr], p = 0.04). No significant association was found with AHI. In gender stratified analyses, ODI and AHI were predictive of RRD in men only (β = -111.3 msec per SD [15.5/hr], p = 0.01 and β = -100.3 msec per SD [16.1/hr], p = 0.02 respectively). CONCLUSION Severity of SDB as measured by ODI was associated with RRD, a marker of arterial stiffness. Thus, association of RRD with measures of SDB appears to be gender-dependent.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Lyndia Brumback
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Sara Mariani
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA, USA
| | - Daniel A. Duprez
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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23
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Madahar P, Duprez DA, Podolanczuk AJ, Bernstein EJ, Kawut SM, Raghu G, Barr RG, Gross MD, Jacobs DR, Lederer DJ. Collagen biomarkers and subclinical interstitial lung disease: The Multi-Ethnic Study of Atherosclerosis. Respir Med 2018; 140:108-114. [PMID: 29957270 PMCID: PMC6310068 DOI: 10.1016/j.rmed.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/02/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lung fibrosis is attributed to derangements in extracellular matrix remodeling, a process driven by collagen turnover. We examined the association of two collagen biomarkers, carboxy-terminal telopeptide of collagen type I (ICTP) and amino-terminal propeptide of type III procollagen (PIIINP), with subclinical interstitial lung disease (ILD) in adults. METHODS We performed a cross-sectional analysis of 3244 participants age 45-84 years in the Multi-Ethnic Study of Atherosclerosis. Serum ICTP and PIIINP levels were measured at baseline by radioimmunoassay. Subclinical ILD was defined as high attenuation areas (HAA) in the lung fields on baseline cardiac CT scans. Interstitial lung abnormalities (ILA) were measured in 1082 full-lung CT scans at 9.5 years median follow-up. We used generalized linear models to examine the associations of collagen biomarkers with HAA and ILA. RESULTS Median (IQR) for ICTP was 3.2 μg/L (2.6-3.9 μg/L) and for PIIINP was 5.3 μg/L (4.5-6.2 μg/L). In fully adjusted models, each SD increment in ICTP was associated with a 1.3% increment in HAA (95% CI 0.2-2.4%, p = 0.02) and each SD increment in PIIINP was associated with a 0.96% increment in HAA (95% CI 0.06-1.9%, p = 0.04). There was no association between ICTP or PIIINP and ILA. There was no evidence of effect modification by gender, race, smoking status or eGFR. CONCLUSIONS Higher levels of collagen biomarkers are associated with greater HAA independent of gender, race and smoking status. This suggests that extracellular matrix remodeling may accompany subclinical ILD prior to the onset of clinically evident disease.
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Affiliation(s)
- Purnema Madahar
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Daniel A Duprez
- Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Anna J Podolanczuk
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Steven M Kawut
- Department of Medicine and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Ganesh Raghu
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Myron D Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - David J Lederer
- Department of Medicine, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
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24
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Peterson TE, Huppler Hullsiek K, Wyman Engen N, Kumarasamy N, Lebech AM, Liappis A, Papadopoulos A, Polizzotto MN, Schreiner PJ, Duprez D, Baker JV. Inflammation Associates With Impaired Small Arterial Elasticity Early in HIV Disease. Open Forum Infect Dis 2018; 5:ofy117. [PMID: 29942822 PMCID: PMC6007791 DOI: 10.1093/ofid/ofy117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/17/2018] [Indexed: 01/26/2023] Open
Abstract
We estimated small arterial elasticity and used linear regression to evaluate its association with inflammatory biomarkers among antiretroviral therapy–naïve, HIV-positive patients with high CD4+ counts. After adjustment, high-sensitivity C-reactive protein and interleukin-6 were inversely associated with small arterial elasticity. These data suggest that systemic inflammation may contribute to vascular dysfunction even in very early HIV disease.
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Affiliation(s)
| | | | - Nicole Wyman Engen
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | | | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Angelike Liappis
- Section of Infectious Diseases, Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mark N Polizzotto
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | | | - Daniel Duprez
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jason V Baker
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Infectious Diseases, Hennepin County Medical Center, Minneapolis, Minesota
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25
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Benitez-Aguirre PZ, Januszewski AS, Cho YH, Craig ME, Jenkins AJ, Donaghue KC. Early changes of arterial elasticity in Type 1 diabetes with microvascular complications - A cross-sectional study from childhood to adulthood. J Diabetes Complications 2017; 31:1674-1680. [PMID: 28941950 DOI: 10.1016/j.jdiacomp.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023]
Abstract
AIM To examine the trajectory of small artery elasticity (SAE) and pulse pressure (PP) in people with Type 1 diabetes and non-diabetic controls across the lifespan, and explore associations with microvascular complications (CX+). METHODS This cross-sectional study included 477 Type 1 diabetes patients (188 with CX+, 289 without CX-) and 515 controls. Relationships between SAE and PP and age were evaluated using segmented linear regression. Logistic regression was used to assess the associations between microvascular complications (retinopathy and/or nephropathy) and SAE and PP. RESULTS SAE peaked significantly later among controls than diabetic patients CX- vs. CX+ (21.2 vs. 20.4 vs. 17.6 years respectively, p < 0.001). In adults, mean SAE was significantly lower in CX+ vs. CX- vs. controls (6.8 vs. 7.8 vs. 8.0 ml/mm Hg × 10; p < 0.0001), and mean PP was significantly higher in CX+ vs CX- and controls (60 vs. 55 vs. 53 mm Hg; p < 0.0001). CONCLUSION Type 1 diabetes CX+ subjects have an earlier peak and decline in SAE relative to CX- and controls, who did not differ. Lower SAE and higher PP were associated with increased odds of Type 1 diabetes complications in adults. These clinically applicable techniques demonstrate an association between accelerated vascular aging and vascular complications in diabetes.
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Affiliation(s)
- P Z Benitez-Aguirre
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - A S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
| | - Y H Cho
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - M E Craig
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Australia
| | - A J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
| | - K C Donaghue
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
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26
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Duprez DA, Florea N, Duval S, Koukol C, Cohn JN. Effect of nebivolol or atenolol vs. placebo on cardiovascular health in subjects with borderline blood pressure: the EVIDENCE study. J Hum Hypertens 2017; 32:20-25. [PMID: 29184167 DOI: 10.1038/s41371-017-0019-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/02/2017] [Accepted: 10/16/2017] [Indexed: 11/09/2022]
Abstract
Pharmacotherapy to protect the arteries may be appropriate for individuals with high-normal blood pressure who are at risk for future cardiovascular disease (CVD). Nebivolol (NEB) in contrast to atenolol (ATE) may have a beneficial effect on endothelial function and may be more effective than ATE in preventing CVD. Sixty subjects with preHTN or borderline BP and abnormal small artery elasticity (SAE) underwent evaluation with 10 tests, including large and small artery elasticity, resting and treadmill exercise BP, carotid intimal-media thickness, retinal vascular photography, micro-albuminuria, electrocardiography, echocardiography, and plasma B-type natriuretic peptide level. Each test scored as normal (0), borderline (1), or abnormal (2), and the total disease score (DS) was calculated by adding the test scores. Subjects were randomized double-blind to placebo (PLAC, n = 22), NEB 5/10 mg/day (n = 20), or ATE 25/50 mg/day (n = 18) once daily for 9 months. After 9 months, in the group receiving NEB the mean (standard deviation) DS decreased from baseline 4.3 (2.6) to 2.8 (2.4) (P < 0.007), with ATE from 5.4 (2.5) to 3.5 (1.9) (P = 0.0006), and with PLAC from 5.2 (3.0) to 4.5 (2.6) (P = 0.18). SAE increased in the NEB group from 6.0 (2.2) to 8.4 (3.4) ml/mmHg × 100 (P = 0.0001), whereas there was no significant change in the ATE and PLAC groups. Thus, nebivolol improves small artery function more than atenolol in asymptomatic subjects with preHTN or borderline BP, despite their similar BP-lowering effect.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Natalia Florea
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Catherine Koukol
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA
| | - Jay N Cohn
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA.
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27
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Wang L, Tan W, Wang F, Shen Y, Mei H, Wang Y, Ke Y, Gu L, Wang Q, Zhang M. Artery compliance in patients with rheumatoid arthritis: results from a case-control study. Clin Rheumatol 2017; 37:169-177. [PMID: 29134512 PMCID: PMC5754458 DOI: 10.1007/s10067-017-3899-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 01/02/2023]
Abstract
Atherosclerosis is one of the most common complications of rheumatoid arthritis (RA). The objective of this study is to evaluate differences in large artery compliance (C1) and small artery compliance (C2) between RA and controls and evaluating factors associated with reduced compliance in the RA population. The profiling of large and small arterial compliance was analyzed in 185 RA patients and 88 healthy controls using Cardiovascular Profiling Instrument. The correlations of arterial compliance and the relevant clinical data were determined in these subjects. Then correlation analysis and regression analysis were performed to find whether rheumatoid arthritis patients have more risk factors than healthy controls in artery compliance and to explore the possible element involved in RA patients including traditional cardiovascular risk factors, RA disease-related factors, and the therapy. Compared with healthy controls, levels of C1 and C2 were significantly decreased in RA patients. Having adjusted the traditional risk factors associated with atherosclerosis, C1 and C2 decline was still a significant indicator in RA patients [odds ratio = 7.411(95%CI 3.275, 16.771) and 10.184(95%CI 4.546, 22.817)]. Using multi-factor regression analysis to adjust traditional risk factors for arterial compliance, we found that the levels of ESR was correlated with the abnormal large artery compliance [odds ratio = 1.021(95%CI 1.007, 1.035)]. The HAQ values and the current usage of leflunomide were correlated with the abnormal small artery compliance in RA patients [odds ratio = 1.161(95%CI 1.046, 1.289) and 6.170(95%CI 1.510, 25.215)]. The values of C1 and C2 are indicators of artery compliance in RA patients. ESR, HAQ values, and the usage of leflunomide might be possible risk factors of artery compliance. The evaluation of artery compliance could be an easy and reliable test that could help us to screen and predict cardiovascular disorders in RA patients.
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Affiliation(s)
- Lei Wang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Wenfeng Tan
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Fang Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Youxuan Shen
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Huanping Mei
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yanyan Wang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yao Ke
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Lei Gu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Qiang Wang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Miaojia Zhang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China.
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28
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Teixeira AMNDC, Luzia LA, de Souza SJ, de Almeida Petrilli A, Pontilho PDM, de Souza JMP, Segurado AAC, Efraim P, Picone CDM, Rondo PHDC. The impact of dark chocolate intake on arterial elasticity in individuals with HIV/AIDS undergoing ART: a randomized, double-blind, crossover trial. Food Funct 2017; 8:2212-2219. [PMID: 28513635 DOI: 10.1039/c6fo01681b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An increase in the frequency of cardiovascular diseases has been observed in the HIV/AIDS population. Studies involving healthy subjects or subjects with other diseases have shown benefits of chocolate supplementation on endothelial function and vasodilation. We evaluate the impact of chocolate consumption on arterial elasticity in people living with human immunodeficiency virus - PLHIV. A double-blind, crossover trial including 110 PLHIV (19 to 59 years) on antiretroviral therapy - ART for at least 6 months and with a viral load of <500 copies per mL was conducted. All subjects were randomly assigned to 15-d dietary supplements containing dark chocolate or placebo with a 15-d washout period. Each participant received one of the two sequences: A (dark chocolate, placebo chocolate); B (placebo chocolate, dark chocolate). Arterial elasticity was measured using the HDI/PulseWave™ CR-2000 CardioVascular Profiling System®. Body composition, lipid profile, C-reactive protein, and thiobarbituric acid reactive substances were also assessed. Analysis of variance (ANOVA) for repeated measures using the Stata 11.0® program was used for cross-over analysis. Most subjects were men (59.0%) and Caucasian (46.1%) and the mean age was 44.6 ± 7.1 years. The mean time since diagnosis of HIV infection was 13.7 ± 5.3 years and the mean duration of ART was 12.9 ± 4.2 years. Chocolate consumption resulted in significant alterations in the large artery elasticity index - LAEI (p = 0.049) and the mean concentration of HDL-c was higher after supplementation with dark chocolate (p = 0.045). This is the first study to evaluate the effect of chocolate on arterial elasticity in PLHIV. The results showed that dark chocolate consumption for 15 days improved the elastic properties of the LAEI in PLHIV. These findings, added to the noninvasive method used, may expand the knowledge of CVDs in this population.
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29
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Blaes A, Beckwith H, Florea N, Hebbel R, Solovey A, Potter D, Yee D, Vogel R, Luepker R, Duprez D. Vascular function in breast cancer survivors on aromatase inhibitors: a pilot study. Breast Cancer Res Treat 2017; 166:541-547. [PMID: 28801846 DOI: 10.1007/s10549-017-4447-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Aromatase inhibitors (AI) have been shown to reduce breast cancer-related mortality in women with estrogen positive (ER+) breast cancer. The use of AIs, however, has been associated with higher rates of hypertension, hyperlipidemia, and cardiovascular (CV) events. METHODS A cross-sectional study of 25 healthy postmenopausal women and 36 women with curative intent breast cancer on an AI was performed to assess endothelial dysfunction, an indicator of risk for CV events. Consented subjects underwent vascular testing using the HDI/Pulse Wave CR-2000 Cardiovascular Profiling System and the EndoPAT2000 system. RESULTS Mean age was 61.7 and 59.6 years (cases, controls). Most subjects were Caucasian and overweight. Controls had a lower mean systolic blood pressure (128.6 mmHg vs. 116.2 mmHg, p = 0.004). Median estradiol levels were reduced in cases (2 vs. 15 pg/ml, p < 0.0001). EndoPAT ratio (0.8 vs. 2.7, p < 0.0001) was significantly reduced in cases as compared to controls. Median large artery elasticity (12.9 vs. 14.6 ml/mmHg × 10, p = 0.12) and small artery elasticity (5.2 vs. 7.0 ml/mmHg × 100, p = 0.07) were also reduced though not statistically significant. There was no correlation between use of chemotherapy, radiation therapy, type of AI, or duration of AI use and endothelial function. When adjusting for differences in blood pressure, results remained significant. CONCLUSION Breast cancer cases on AIs have reductions in endothelial function, a predictor of adverse CV disease. IMPACT Vascular function changes in breast cancer cases on AIs compared to postmenopausal women. Further work is needed to evaluate vascular changes over time.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA. .,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
| | - Heather Beckwith
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Natalia Florea
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Robert Hebbel
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
| | - Anna Solovey
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
| | - David Potter
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Douglas Yee
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Vogel
- Division of Gynecology/Oncology, University of Minnesota, Minneapolis, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Russell Luepker
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Duprez
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
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30
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A cross-sectional study of physical activity and arterial compliance: the effects of age and artery size. ACTA ACUST UNITED AC 2017; 11:92-100. [DOI: 10.1016/j.jash.2016.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/21/2016] [Accepted: 12/12/2016] [Indexed: 11/16/2022]
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31
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Hom EK, Duprez DA, Jacobs DR, Bluemke DA, Brumback LC, Polak JF, Peralta CA, Greenland P, Magzamen SL, Lima JAC, Redheuil A, Herrington DM, Stein JH, Vaidya D, Ouyang P, Kaufman JD. Comparing Arterial Function Parameters for the Prediction of Coronary Heart Disease Events: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Epidemiol 2016; 184:894-901. [PMID: 27923782 DOI: 10.1093/aje/kww113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 09/14/2016] [Indexed: 11/14/2022] Open
Abstract
Arterial dysfunction has been linked to decline in cardiac function and increased risk of cardiovascular disease events. We calculated the value of arterial function, measured at baseline (2000-2002), in predicting time to first coronary heart disease (CHD) event (median follow-up, 10.2 years) among participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Measures included the following: C1 and C2, derived from diastolic pulse contour analysis from the radial artery blood pressure waveform obtained by tonometry (n = 6,336); carotid distensibility and Young's elastic modulus at the carotid artery, derived from carotid artery ultrasonography (n = 6,531 and 6,528); and aortic distensibility, measured using cardiac magnetic resonance imaging (n = 3,677). After adjustment, the hazard ratio for a CHD event per standard-deviation increment in arterial function was 0.97 (95% confidence interval (CI): 0.86, 1.10) for C1, 0.73 (95% CI: 0.63, 0.86) for C2, 0.98 (95% CI: 0.86, 1.11) for carotid distensibility, 0.99 (95% CI: 0.90, 1.09) for Young's modulus, and 0.90 (95% CI: 0.74, 1.10) for aortic distensibility. We examined the area under the receiver operating characteristic curve for the model with full adjustment plus the addition of each measure individually. C2 provided additional discrimination for the prediction of CHD (area under the curve = 0.736 vs. 0.743; P = 0.04). Lower C2 was associated with a higher risk of future CHD events.
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32
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Chan DC, Pang J, Barrett PHR, Sullivan DR, Mori TA, Burnett JR, van Bockxmeer FM, Watts GF. Effect of omega-3 fatty acid supplementation on arterial elasticity in patients with familial hypercholesterolaemia on statin therapy. Nutr Metab Cardiovasc Dis 2016; 26:1140-1145. [PMID: 27614801 DOI: 10.1016/j.numecd.2016.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Increased arterial stiffness is closely linked with raised blood pressure that contributes substantially to enhanced risk of coronary heart disease in high risk individuals with familial hypercholesterolaemia (FH). Omega-3 fatty acid (ω3-FA) supplementation has been demonstrated to lower blood pressure in subjects with a high cardiovascular disease risk. Whether ω3-FA supplementation improves arterial stiffness in FH subjects, on background statin therapy, has yet to be investigated. METHOD AND RESULTS We carried out an 8-week randomized, crossover intervention trial to test the effect of 4 g/d ω3-FA supplementation (46% eicosapentaenoic acid and 38% docosahexaenoic acid) on arterial elasticity in 20 adults with FH on optimal cholesterol-lowering therapy. Large and small artery elasticity were measured by pulse contour analysis of the radial artery. ω3-FA supplementation significantly (P < 0.05 in all) increased large artery elasticity (+9%) and reduced systolic blood pressure (-6%) and diastolic blood pressure (-6%), plasma triglycerides (-20%), apoB concentration (-8%). In contrast, ω3-FAs had no significant effect on small artery elasticity. The change in large artery elasticity was not significantly associated with changes in systolic blood pressure or plasma triglyceride concentration. CONCLUSIONS ω3-FA supplementation improves large arterial elasticity and arterial blood pressure independent of statin therapy in adults with FH. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.com/NCT01577056.
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Affiliation(s)
- D C Chan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - J Pang
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - P H R Barrett
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Faculty of Engineering, Computing and Mathematics, University of Western Australia, Perth, Western Australia, Australia
| | - D R Sullivan
- Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, Australia
| | - T A Mori
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - J R Burnett
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Australia
| | - F M van Bockxmeer
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Australia; School of Surgery, University of Western Australia, Perth, Australia
| | - G F Watts
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
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Baker JV, Hullsiek KH, Engen NW, Nelson R, Chetchotisakd P, Gerstoft J, Jessen H, Losso M, Markowitz N, Munderi P, Papadopoulos A, Shuter J, Rappoport C, Pearson MT, Finley E, Babiker A, Emery S, Duprez D. Early Antiretroviral Therapy at High CD4 Counts Does Not Improve Arterial Elasticity: A Substudy of the Strategic Timing of AntiRetroviral Treatment (START) Trial. Open Forum Infect Dis 2016; 3:ofw213. [PMID: 27942541 PMCID: PMC5144656 DOI: 10.1093/ofid/ofw213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 05/10/2016] [Indexed: 12/27/2022] Open
Abstract
Background. Both human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Vascular function assessments can be used to study CVD pathogenesis. We compared the effect of immediate versus deferred ART initiation at CD4 counts >500 cells/mm3 on small arterial elasticity (SAE) and large artery elasticity (LAE). Methods. Radial artery blood pressure waveforms were recorded noninvasively. Small arterial elasticity and LAE were derived from analysis of the diastolic pulse waveform. Randomized treatment groups were compared with linear models at each visit and longitudinal mixed models. Results. Study visits involved 332 participants in 8 countries: mean (standard deviation [SD]) age 35 (10), 70% male, 66% nonwhite, 30% smokers, and median CD4 count 625 cells/mm3 and 10-year Framingham risk score for CVD 1.7%. Mean (SD) SAE and LAE values at baseline were 7.3 (2.9) mL/mmHg × 100 and 16.6 (4.1) mL/mmHg × 10, respectively. Median time on ART was 47 and 12 months in the immediate and deferred ART groups, respectively. The treatment groups did not demonstrate significant within-person changes in SAE or LAE during the follow-up period, and there was no difference in mean change from baseline between treatment groups. The lack of significant differences persisted after adjustment, when restricted to early or late changes, after censoring participants in deferred group who started ART, and among subgroups defined by CVD and HIV risk factors. Conclusions. Among a diverse global population of HIV-positive persons with high CD4 counts, these randomized data suggest that ART treatment does not have a substantial influence on vascular function among younger HIV-positive individuals with preserved immunity.
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Affiliation(s)
- Jason V Baker
- Department ofMedicine and; Infectious Diseases, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | | - Ray Nelson
- Division of Biostatistics, University of Minnesota , Minneapolis
| | | | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet University of Copenhagen , Denmark
| | - Heiko Jessen
- Praxis Jessen2 + Kollegen, ID, Teaching Practice of Medical School , Charité, Berlin , Germany
| | - Marcelo Losso
- HIV Unit, Hospital GA JM Ramos Mejia and Coordinacion de Investigacion Clinica Academica en Latinoamerica , Buenos Aires, Argentina
| | - Norman Markowitz
- Department of Medicine, Henry Ford Hospital and Wayne State University , Detroit, Michagan
| | | | - Antonios Papadopoulos
- Department of Internal Medicine, University General Hospital "ATTIKON'', Medical School, National and Kapodistrian University of Athens , Greece
| | - Jonathan Shuter
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine , Bronx, New York
| | - Claire Rappoport
- Division of HIV, Infectious Diseases and Global Medicine, University of California , San Francisco
| | - Mary T Pearson
- Center for Health and Infectious Disease Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen , Demark
| | - Elizabeth Finley
- Infectious Diseases, Veterans Affairs Medical Center , Washington, District of Columbia
| | - Abdel Babiker
- Medical Research Council Clinical Trials Unit, University College London , United Kingdom
| | - Sean Emery
- Kirby Institute, University of New South Wales , Sydney , Australia
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Danziger J, Young RL, Shea KM, Duprez DA, Jacobs DR, Tracy RP, Ix JH, Jenny NS, Mukamal KJ. Circulating Des-gamma-carboxy prothrombin is not associated with cardiovascular calcification or stiffness: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2016; 252:68-74. [PMID: 27508317 DOI: 10.1016/j.atherosclerosis.2016.07.924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/09/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Vitamin K-dependent protein (VKDP) activity may have a role in preventing cardiovascular calcification, but has not previously been studied in large, generally healthy populations. METHODS Using an elevated ankle-brachial index (ABI) as a measure of medial vascular calcification, we performed a case-cohort analysis within the Multi-Ethnic Study of Atherosclerosis, measuring Des-gamma-carboxy prothrombin (DCP) to estimate VKDP activity. In secondary analyses of the weighted subcohort, we examined the cross-sectional associations between DCP and prevalent vascular calcification of the coronary vessels, aortic and mitral valves, and aortic wall, and with vascular stiffness. RESULTS In adjusted analysis, cases (n = 104) had 0.21 ng/ml (-0.94-0.52) lower DCP concentrations than the subcohort (n = 613). Furthermore, amongst the 717 participants in the weighted cohort, VKDP activity was not associated with coronary artery, mitral valve, aortic valve or aortic wall calcification, nor was it associated with vascular stiffness. CONCLUSIONS Our negative results do not support a role of circulating VKDP activity in cardiovascular calcification in community-dwelling adults.
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Affiliation(s)
- John Danziger
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
| | | | - Kyla M Shea
- Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
| | - Daniel A Duprez
- Division of Cardiology, University of Minnesota, United States
| | - David R Jacobs
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, United States
| | - Russell P Tracy
- College of Medicine, University of Vermont, Burlington, VT, United States
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Nancy S Jenny
- Department of Pathology, University of Vermont, Burlington, VT, United States
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Casanegra AI, Stoner JA, Tafur AJ, Pereira HA, Rathbun SW, Gardner AW. Differences in galectin-3, a biomarker of fibrosis, between participants with peripheral artery disease and participants with normal ankle-brachial index. Vasc Med 2016; 21:437-444. [PMID: 27155290 DOI: 10.1177/1358863x16644059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine if galectin-3 levels were different between participants with peripheral artery disease (PAD) and controls, and to describe its relationship with markers of early atherosclerosis. Sixty participants were recruited into two groups: a PAD group (n=31), ankle-brachial index (ABI) ⩽0.90 and a normal ABI group (n=29), ABI 1.0-1.4. PAD participants were older (68.6 vs 61.8 years, p=0.037), more commonly men (68% vs 38%, p=0.02), and with more cardiovascular risk factors (p<0.001). Galectin-3 was 22% higher in PAD participants (mean±SD: 17.6±4.7 vs 14.4±4.1 ng/mL, p<0.01). The odds ratio for galectin-3 in PAD to be 1 ng/mL higher than the participants with normal ABI was 1.19, after adjusting by age and gender (p=0.014). High-sensitivity C-reactive protein (hs-CRP) and homeostatic model assessment (HOMA) were positively associated with galectin-3 in the age- and gender-adjusted model, while arterial elasticity and microalbuminuria were not. In conclusion, galectin-3 levels were higher in participants with PAD.
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Affiliation(s)
- Ana I Casanegra
- Vascular Medicine Program, Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Alfonso J Tafur
- Vascular Medicine, Northshore University Health System, Evanston, IL, USA
| | - H Anne Pereira
- Department of Pharmaceutical Sciences, Department of Cell Biology and Department of Pathology, Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Suman W Rathbun
- Vascular Medicine Program, Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
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Jacobs DR, Duprez DA, Shimbo D. Invited Commentary: Hypertension and Arterial Stiffness--Origins Remain a Dilemma. Am J Epidemiol 2016; 183:609-12. [PMID: 26960705 DOI: 10.1093/aje/kwv276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022] Open
Abstract
In this issue of the Journal, Chen et al. (Am J Epidemiol. 2016;183(7):599-608) present repeated measures of aorto-femoral pulse wave velocity, capacitive compliance (C1), and oscillatory compliance (C2) in the Bogalusa Heart Study, with the purpose of addressing which comes first: blood pressure elevation or arterial stiffening. After an average follow-up period of 7 years (2000-2010), the authors found that blood pressure at a mean age of 36 years predicted change in arterial stiffening by a mean age of 43 years, but not the reverse. Essential hypertension results from a mosaic of pathological mechanisms. It has been theorized that biological pathways involving increased sympathetic tone, insulin resistance, renin-angiotensin-aldosterone activation, and inflammation lead to hyperkinetic circulation, volume overload, and vascular remodeling. The resultant accelerated vascular aging may be assessed by determining the degree of arterial stiffness. The findings of Chen et al. add important empirical information to the literature but do not solve the dilemma regarding the origins of essential hypertension, partly because there are many techniques for estimating the many aspects of arterial stiffness which are not fully understood. Mathematical features of estimates might not be uniform across the age range. There is a need for tracking blood pressure and different aspects of arterial stiffness from childhood onward, with an aim of preventing hypertension in adult life.
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Chen W, Li S, Fernandez C, Sun D, Lai CC, Zhang T, Bazzano L, Urbina EM, Deng HW. Temporal Relationship Between Elevated Blood Pressure and Arterial Stiffening Among Middle-Aged Black and White Adults: The Bogalusa Heart Study. Am J Epidemiol 2016; 183:599-608. [PMID: 26960706 DOI: 10.1093/aje/kwv274] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/23/2015] [Indexed: 11/12/2022] Open
Abstract
This study assessed the temporal relationship between elevated blood pressure (BP) and arterial stiffness in a biracial (black-white) cohort of middle-aged adults aged 32-51 years from the semirural community of Bogalusa, Louisiana. Measurements of aortic-femoral pulse wave velocity (afPWV; n = 446) and large- and small-arterial compliance (n = 381) were obtained at 2 time points between 2000 and 2010, with an average follow-up period of 7 years. A cross-lagged path analysis model was used to examine the temporal relationship of elevated BP to arterial stiffness and elasticity. The cross-lagged path coefficients did not differ significantly between blacks and whites. The path coefficient (ρ2) from baseline BP to follow-up afPWV was significantly greater than the path coefficient (ρ1) from baseline afPWV to follow-up BP (ρ2 = 0.20 vs. ρ1 = 0.07 (P = 0.048) for systolic BP; ρ2 = 0.19 vs. ρ1 = 0.05 (P = 0.034) for diastolic BP). The results for this 1-directional path from baseline BP to follow-up afPWV were confirmed, although marginally significant, by using large- and small-artery elasticity measurements. These findings provide strong evidence that elevated BP precedes large-artery stiffening in middle-aged adults. Unlike the case in older adults, the large-arterial wall is not stiff enough in youth to alter BP levels during young adulthood.
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Odegaard AO, Jacobs DR, Sanchez OA, Goff DC, Reiner AP, Gross MD. Oxidative stress, inflammation, endothelial dysfunction and incidence of type 2 diabetes. Cardiovasc Diabetol 2016; 15:51. [PMID: 27013319 PMCID: PMC4806507 DOI: 10.1186/s12933-016-0369-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/15/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Oxidative stress, inflammation and endothelial dysfunction are interrelated factors in the etiology of cardiovascular disease, but their linkage to type 2 diabetes is less clear. We examined the association of these biomarkers with incident type 2 diabetes (T2D). METHODS Analysis of 2339 participants in the community-based coronary artery risk development in young adults (CARDIA) study. Participants (age 40.1 ± 3.6 years, 44 % Black, 58 % women) were free of diabetes, and were followed 10 years. Cox regression was used to estimate hazard ratios (HRs) for incident T2D adjusting for the other biomarkers under study, demographic and lifestyle measures, dietary biomarkers, BMI (kg/m(2)) and metabolic syndrome components. RESULTS F2-isoprostanes and oxidized LDL (oxidative stress) were positively associated with incident T2D, but the associations were attenuated by adjustment for BMI. C-reactive protein was positively associated with T2D even with full adjustment: HR (95 % CI) = 2.21 (1.26-3.88) for quartile 4 (Q4) v. quartile 1 (Q1). The HR (95 % CI) for T2D for biomarkers of endothelial dysfunction ICAM-1 and E-selectin for Q4 v. Q1 were 1.64 (0.96-2.81) and 1.68 (1.04-2.71) respectively, with full adjustment. Including these two markers in a common risk score incorporating BMI and clinical measures improved the prediction probability of T2D: relative risk for the average person classified up compared to the average person classified down: 1.09, (1.06-1.13), P < 0.0001. CONCLUSIONS Biomarkers of inflammation and endothelial dysfunction were positively associated with incident T2D. ICAM-1 and E-selectin add to the prediction of T2D beyond a common risk score.
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Affiliation(s)
- Andrew O. Odegaard
- />Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine, CA 92697-7550 USA
| | - David R. Jacobs
- />Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Otto A. Sanchez
- />Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
| | - David C. Goff
- />Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, USA
| | - Alexander P. Reiner
- />Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Myron D. Gross
- />Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
- />Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, USA
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Watts A, Honea RA, Billinger SA, Rhyner KT, Hutfles L, Vidoni ED, Burns JM. A combined measure of vascular risk for white matter lesions. J Alzheimers Dis 2016; 45:187-93. [PMID: 25690663 DOI: 10.3233/jad-142085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Though hypertension is a commonly studied risk factor for white matter lesions (WMLs), measures of blood pressure may fluctuate depending on external conditions resulting in measurement error. Indicators of arterial stiffening and reduced elasticity may be more sensitive indicators of risk for WMLs in aging; however the interdependent nature of vascular indicators creates statistical complications. OBJECTIVE The purpose of the study was to determine whether a factor score comprised of multiple vascular indicators would be a stronger predictor of WMLs than traditional measures of blood pressure. METHODS In a sample of well-characterized nondemented older adults, we used a factor analytic approach to account for variance common across multiple vascular measures while reducing measurement error. The result was a single factor score reflecting arterial stiffness and reduced elasticity. We used this factor score to predict white matter lesion volumes acquired via fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging. RESULTS The combined vascular factor score was a stronger predictor of deep WML (β = 0.42, p < 0.001) and periventricular WML volumes (β = 0.49, p < 0.001). After accounting for the vascular factor, systolic and diastolic blood pressure measurements were not significant predictors. CONCLUSIONS This suggests that a combined measure of arterial elasticity and stiffening may be a stronger predictor of WMLs than systolic and diastolic blood pressure accounting for the multicollinearity associated with a variety of interrelated vascular measures.
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Affiliation(s)
- Amber Watts
- Department of Clinical Psychology, University of Kansas, Lawrence, KS, USA
| | - Robyn A Honea
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
| | - Sandra A Billinger
- Department of Physical Therapy & Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kathleen T Rhyner
- Department of Clinical Psychology, University of Kansas, Lawrence, KS, USA
| | - Lewis Hutfles
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
| | - Eric D Vidoni
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
| | - Jeffrey M Burns
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
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Still CH, Ferdinand KC, Ogedegbe G, Wright JT. Recognition and Management of Hypertension in Older Persons: Focus on African Americans. J Am Geriatr Soc 2016; 63:2130-8. [PMID: 26480975 DOI: 10.1111/jgs.13672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
UNLABELLED Hypertension is the most commonly diagnosed condition in persons aged 60 and older and is the single most important risk factor for cardiovascular disease (ischemic heart disease, heart failure, and stroke), kidney disease, and dementia. More than half of individuals with hypertension in the United States are aged 60 and older. Hypertension disproportionately affects African Americans, with all age groups, including elderly adults, having a higher burden of hypertension-related complications than other U.S. POPULATIONS Multiple clinical trials have demonstrated the beneficial effects of blood pressure (BP) reduction on cardiovascular morbidity and mortality, with most of the evidence in individuals aged 60 and older. Several guidelines have recently been published on the specific management of hypertension in individuals aged 60 and older, including in high-risk groups such as African Americans. Most recommend careful evaluation, thiazide diuretics and calcium-channel blockers for initial drug therapy in most African Americans, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in those with chronic kidney disease or heart failure. Among the areas of controversy is the recommended target BP in African Americans aged 60 and older. A recent U.S. guideline recommended raising the systolic BP target from less than 140 mmHg to less than 150 mmHg in this population. This article will review the evidence and current guideline recommendations for hypertension treatment in older African Americans, including the rationale for continuing to recommend a SBP target of less than 140 mmHg in this population.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.,Clinical Hypertension Program, Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Cleveland, Ohio
| | | | - Gbenga Ogedegbe
- New York University School of Medicine, Department of Population Health, Center for Healthful Behavior Change, New York, New York
| | - Jackson T Wright
- Clinical Hypertension Program, Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Park M, Shlipak MG, Vittinghoff E, Katz R, Siscovick D, Sarnak M, Lima JA, Hsu CY, Peralta CA. Associations of kidney injury markers with subclinical cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Clin Nephrol 2015; 84:358-63. [PMID: 26558369 PMCID: PMC4776253 DOI: 10.5414/cn108668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/31/2015] [Indexed: 01/19/2023] Open
Abstract
No abstract available.
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Affiliation(s)
- Meyeon Park
- University of California San Francisco, Department of Medicine, Division of Nephrology
| | - Michael G. Shlipak
- University of California San Francisco, Department of Medicine, Division of Nephrology
- San Francisco VA Medical Center, Division of General Internal Medicine
| | - Eric Vittinghoff
- University of California San Francisco, Department of Medicine, Division of Nephrology
| | | | | | | | - Joao A. Lima
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chi-yuan Hsu
- University of California San Francisco, Department of Medicine, Division of Nephrology
| | - Carmen A. Peralta
- University of California San Francisco, Department of Medicine, Division of Nephrology
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Ballard KD, Bruno RS. Protective role of dairy and its constituents on vascular function independent of blood pressure-lowering activities. Nutr Rev 2015; 73:36-50. [PMID: 26024056 DOI: 10.1093/nutrit/nuu013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Greater intakes of dairy are frequently associated with reduced risk of cardiovascular disease. These observational studies have served as the basis for controlled interventions aimed at defining the cardioprotective mechanisms of dairy. Understanding these relationships is of public health importance because most of the US population fails to meet dietary recommendations for dairy, suggesting that many individuals could lower their cardiovascular disease risk by relatively simple dietary modification. Clinical studies investigating the acute ingestion of dairy or its constituents, including short-term (≤2 week) supplementation studies or those assessing postprandial responses, have largely shown benefits on vascular function without concomitant improvements in blood pressure. Chronic interventions have been less conclusive, with some showing benefits and others indicating a lack of improvement in vascular function regardless of blood pressure changes. Vasoprotective activities of dairy are likely mediated through improvements in nitric oxide bioavailability, oxidative stress, inflammation, and insulin resistance. Future controlled studies are needed to determine if these health benefits are mediated directly by dairy or indirectly by displacing other dietary components that otherwise impair vascular health.
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Affiliation(s)
- Kevin D Ballard
- K.D. Ballard is with the Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut, USA. R.S. Bruno is with the Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Richard S Bruno
- K.D. Ballard is with the Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut, USA. R.S. Bruno is with the Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA.
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Baker JV, Engen NW, Huppler Hullsiek K, Stephan C, Jain MK, Munderi P, Pett S, Duprez D. Assessment of arterial elasticity among HIV-positive participants with high CD4 cell counts: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:109-18. [PMID: 25711329 DOI: 10.1111/hiv.12239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Both HIV infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Assessments of vascular function and structure can be used to study the pathogenesis and progression of CVD, including the effects of ART and other interventions. The objective of this report is to understand methods to assess vascular (dys)function and report our experience in the Arterial Elasticity Substudy in the Strategic Timing of AntiRetroviral Treatment (START) trial. METHODS We review literature and analyze baseline data from the Arterial Elasticity Substudy, which estimated vascular (dys)function through analysis of the diastolic blood pressure (BP) waveform. Linear regression was used to study cross-sectional associations between baseline clinical factors and small or large arterial elasticity. RESULTS Arterial elasticity measurement was chosen for its improved measurement reproducibility over other methodologies and the potential of small arterial elasticity to predict clinical risk. Analysis of baseline data demonstrates that small artery elasticity is impaired (lower) with older age and differs by race and between geographical regions. No HIV-specific factors studied remained significantly associated with arterial elasticity in multivariate models. CONCLUSIONS Longitudinal analyses in this substudy will provide essential randomized data with which to study the effects of early ART initiation on the progression of vascular disease among a diverse global population. When combined with future biomarker analyses and clinical outcomes in START, these findings will expand our understanding of the pathogenesis of HIV-related CVD.
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Affiliation(s)
- J V Baker
- Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
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Forbang NI, Allison MA, Ix JH, Criqui MH, Vaidya D, Yeboah J, Duprez DA, Jacobs DR. Associations of body composition measures and C2, a marker for small artery elasticity: The MESA. Obesity (Silver Spring) 2015; 23:2294-8. [PMID: 26373903 PMCID: PMC4633382 DOI: 10.1002/oby.21221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Lower C2, a continuous blood pressure waveform characteristic asserted to represent small artery elasticity, predicts future cardiovascular disease events. It is hypothesized that the paradoxical positive association between body mass index (BMI) and C2 may reflect muscle instead of excess fat. METHODS In a multi-ethnic, community-living cohort of 1,960 participants, computed tomography scans of the abdomen were used to measure visceral adipose tissue (VAT) and total abdominal muscle tissue (TAMT), and applanation tonometry of the radial arteries was used to assess C2. The period cross-sectional associations between BMI, TAMT, and VAT with C2 were ascertained. RESULTS The mean age was 62 ± 9 years and 51% were male. After adjustments for age, gender, ethnicity, pack years smoking cigarettes, diabetes, hypertension, and total and HDL cholesterol, higher BMI (standardized beta = 0.09, P-value < 0.01) and more TAMT (standardized beta = 0.12, P-value < 0.01) were significantly associated with higher C2. In contrast, more VAT (standardized beta = -0.09, P-value < 0.01) was associated with lower C2. CONCLUSIONS In multivariable analysis, VAT, in contrast to TAMT and BMI, was associated with less compliant small arteries. Visceral fat may be a better marker for detrimental excess body fat than BMI.
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Affiliation(s)
- Nketi I Forbang
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Joachim H Ix
- Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | | | - Joseph Yeboah
- Wake Forest University, Winston-Salem, North Carolina, USA
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van Rooyen Y, Schutte AE, Huisman HW, Eloff FC, Du Plessis JL, Kruger A, van Rooyen JM. Inflammation as Possible Mediator for the Relationship Between Lung and Arterial Function. Lung 2015; 194:107-15. [DOI: 10.1007/s00408-015-9804-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/18/2015] [Indexed: 11/28/2022]
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Still CH, Craven TE, Freedman BI, Van Buren PN, Sink KM, Killeen AA, Bates JT, Bee A, Contreras G, Oparil S, Pedley CM, Wall BM, White S, Woods DM, Rodriguez CJ, Wright JT. Baseline characteristics of African Americans in the Systolic Blood Pressure Intervention Trial. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:670-9. [PMID: 26320890 PMCID: PMC4573272 DOI: 10.1016/j.jash.2015.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 01/13/2023]
Abstract
The Systolic Blood Pressure Intervention Trial (SPRINT) will compare treatment to a systolic blood pressure goal of <120 mm Hg to treatment to the currently recommended goal of <140 mm Hg for effects on incident cardiovascular, renal, and neurologic outcomes including cognitive decline. The objectives of this analysis are to compare baseline characteristics of African American (AA) and non-AA SPRINT participants and explore factors associated with uncontrolled blood pressure (BP) by race. SPRINT enrolled 9361 hypertensive participants aged older than 50 years. This cross-sectional analysis examines sociodemographics, baseline characteristics, and study measures among AAs compared with non-AAs. AAs made up 31% of participants. AAs (compared with non-AAs) were younger and less frequently male, had less education, and were more likely uninsured or covered by Medicaid. In addition, AAs scored lower on the cognitive screening test when compared with non-AAs. Multivariate logistic regression analysis found BP control rates to <140/90 mm Hg were higher for AAs who were male, had higher number of chronic diseases, were on diuretic treatment, and had better medication adherence. SPRINT is well poised to examine the effects of systolic blood pressure targets on clinical outcomes as well as predictors influencing BP control in AAs.
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Affiliation(s)
- Carolyn H Still
- Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, OH, USA; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
| | - Timothy E Craven
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Peter N Van Buren
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kaycee M Sink
- Wake Forest School of Medicine, Section on Geriatrics and Gerontology, Winston-Salem, NC, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Alberta Bee
- Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gabriel Contreras
- Nephrology Department, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carolyn M Pedley
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Barry M Wall
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Suzanne White
- Department of Internal Medicine, Northeast Ohio Neighborhood Health Services, Inc, Cleveland, OH, USA
| | - Delia M Woods
- Department of Medicine, Nephrology Division, Vanderbilt University, Nashville, TN, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, OH, USA; Department of Nephrology and Hypertension, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
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Ho M, Benitez-Aguirre PZ, Donaghue KC, Mitchell P, Baur LA, Jenkins AJ, Craig ME, Cowell CT, Garnett SP. Arterial elasticity in obese adolescents with clinical features of insulin resistance. Diab Vasc Dis Res 2015; 12:62-9. [PMID: 25381349 DOI: 10.1177/1479164114554610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether arterial elasticity differs between obese adolescents with clinical insulin resistance (IR), type 1 diabetes (T1D) and healthy non-obese controls. METHODS This cross-sectional study evaluated 69 adolescents with clinical IR, 91 with T1D and 63 age-matched (10- to 18-year-old) controls. Arterial elasticity was measured using radial tonometry pulse-wave analysis. Stepwise multiple regression analyses were performed to assess the determinants of the small and large arterial elasticity indices (SAEI and LAEI). RESULTS SAEI and LAEI raw values were higher in the IR group than the controls, and these did not differ between the T1D and control groups. Weight and diastolic blood pressure (DBP) were significant predictors of SAEI. After adjustment for weight and DBP, SAEI decreased by 0.65 mL/mmHg × 100 for each 1-year increase in age in the IR group. SAEI was not different across the groups after controlling for weight and DBP. Height was the strongest predictor of LAEI which remained higher in the IR group after controlling for height and blood pressure. CONCLUSION Obese adolescents with clinical IR have a higher SAEI, which declines with age; this may reflect a pathway to an increased risk of premature cardiovascular disease.
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Affiliation(s)
- Mandy Ho
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Paul Z Benitez-Aguirre
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kim C Donaghue
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Paul Mitchell
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Alicia J Jenkins
- St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Maria E Craig
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Chris T Cowell
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sarah P Garnett
- Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Gupta DK, Skali H, Claggett B, Kasabov R, Cheng S, Shah AM, Loehr LR, Heiss G, Nambi V, Aguilar D, Wruck LM, Matsushita K, Folsom AR, Rosamond WD, Solomon SD. Heart failure risk across the spectrum of ankle-brachial index: the ARIC study (Atherosclerosis Risk In Communities). JACC. HEART FAILURE 2014; 2:447-54. [PMID: 25194293 PMCID: PMC4194157 DOI: 10.1016/j.jchf.2014.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 05/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to describe the relationship between ankle brachial index (ABI) and the risk for heart failure (HF). BACKGROUND The ABI is a simple, noninvasive measure associated with atherosclerotic cardiovascular disease and death; however, the relationship between ABI and risk for HF is less well characterized. METHODS Between 1987 and 1989 in the ARIC (Atherosclerosis Risk In Communities) study, an oscillometric device was used to measure blood pressure in a single upper and randomly chosen lower extremity to determine the ABI. Incident HF events were defined by the first hospitalization with an International Classification of Diseases, Ninth Revision, code of 428.x through 2008. The risk for HF was assessed across the ABI range using restricted cubic splines and Cox proportional hazards models. RESULTS ABI was available in 13,150 participants free from prevalent HF. Over a mean 17.7 years of follow-up, 1,809 incident HF events occurred. After adjustment for traditional HF risk factors, prevalent coronary heart disease, subclinical carotid atherosclerosis, and interim myocardial infarction, compared with an ABI of 1.01 to 1.40, participants with ABIs ≤0.90 were at increased risk for HF (hazard ratio: 1.40; 95% confidence interval: 1.12 to 1.74), as were participants with ABIs of 0.91 to 1.00 (hazard ratio: 1.36; 95% confidence interval: 1.17 to 1.59). CONCLUSIONS In a middle-age community cohort, an ABI ≤1.00 was significantly associated with an increased risk for HF, independent of traditional HF risk factors, prevalent coronary heart disease, carotid atherosclerosis, and interim myocardial infarction. Low ABI may reflect not only overt atherosclerosis but also pathologic processes in the development of HF beyond epicardial atherosclerotic disease and myocardial infarction alone. A low ABI, as a simple, noninvasive measure, may be a risk marker for HF.
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Affiliation(s)
- Deepak K Gupta
- Vanderbilt Heart and Vascular Institute, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Hicham Skali
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Claggett
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rumen Kasabov
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amil M Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura R Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Vijay Nambi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - David Aguilar
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Lisa Miller Wruck
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kals J, Lieberg J, Kampus P, Zagura M, Eha J, Zilmer M. Prognostic impact of arterial stiffness in patients with symptomatic peripheral arterial disease. Eur J Vasc Endovasc Surg 2014; 48:308-15. [PMID: 24962743 DOI: 10.1016/j.ejvs.2014.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Arterial stiffness (AS) is increasingly recognized as an independent risk factor in different high-risk populations. Whether changes in AS can predict prognosis in patients with symptomatic peripheral arterial disease (PAD) has never been investigated. The aim of the present study was to test the hypothesis that AS is an independent predictor of all-cause and cardiovascular disease (CVD) mortality in patients with symptomatic PAD. METHODS A cohort of 117 symptomatic PAD patients (aged 62.3 ± 7.7 years) were prospectively recruited from the Department of Vascular Surgery, Tartu University Hospital, between 2002 and 2010. The AS was measured using pulse wave analysis and assessment of pulse wave velocity (PWV). RESULTS During the follow-up period (mean 4.1 ± 2.2 years) there were 32 fatal events. Kaplan-Meier analysis showed that the probability of all-cause and CVD mortality decreased with increasing small artery elasticity (SAE), as estimated by the log-rank test (p = .004; p = .005, respectively). By contrast, large artery elasticity, augmentation index, and aortic and brachial PWV were not significantly related to mortality. In a Cox proportional hazard model, SAE above the median was associated with decreased all-cause and CVD mortality after adjustment for confounding factors: relative risk (RR), 0.37; 95% confidence interval (CI), 0.17-0.81; p = .01; RR, 0.11; 95% CI, 0.01-0.86; p = .04, respectively). CONCLUSIONS This study provides the first evidence, obtained from an observational study, that decreased small artery elasticity is an independent predictor of all-cause and CVD mortality in patients with symptomatic PAD.
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Affiliation(s)
- J Kals
- Institute of Biomedicine and Translational Medicine, Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia; Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia.
| | - J Lieberg
- Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia; Department of Surgery, University of Tartu, Tartu, Estonia
| | - P Kampus
- Institute of Biomedicine and Translational Medicine, Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia; Department of Cardiology, University of Tartu, Tartu, Estonia
| | - M Zagura
- Institute of Biomedicine and Translational Medicine, Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia
| | - J Eha
- Endothelial Centre, University of Tartu, Tartu, Estonia; Department of Cardiology, University of Tartu, Tartu, Estonia
| | - M Zilmer
- Institute of Biomedicine and Translational Medicine, Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia
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50
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Hsu JJ, Katz R, Ix JH, de Boer IH, Kestenbaum B, Shlipak MG. Association of fibroblast growth factor-23 with arterial stiffness in the Multi-Ethnic Study of Atherosclerosis. Nephrol Dial Transplant 2014; 29:2099-105. [PMID: 24782533 DOI: 10.1093/ndt/gfu101] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Serum fibroblast growth factor-23 (FGF-23) is associated with cardiovascular disease (CVD), yet the mechanisms remain uncertain. Our objective was to determine whether higher FGF-23 concentrations are associated with arterial stiffness. METHODS In this cross-sectional study, serum FGF-23 concentrations were measured in 5977 participants without known CVD in the Multi-Ethnic Study of Atherosclerosis. The primary outcomes of interest were large (LAE) and small artery elasticity (SAE), pulse pressure and ankle-brachial index (ABI) > 1.30. LAE and SAE were measured by pulse contour analysis of the radial artery. Pulse pressure was measured with an automated sphygmomanometer using the average of two resting blood pressure measurements. ABI was calculated as the ratio of the ankle and brachial systolic blood pressures. RESULTS Serum FGF-23 concentrations were not significantly associated with LAE [relative difference (RD) per doubling: 0%; 95% confidence interval (CI): -2-1%], SAE (RD per doubling: 0%; 95% CI: -3-2%), pulse pressure (β per doubling: 0.44; 95% CI: -0.31-1.19), or a high ABI (odds ratio per doubling: 1.14; 95% CI: 0.84-1.55). Findings were similar irrespective of chronic kidney disease status. CONCLUSIONS Higher serum FGF-23 concentrations are not associated with arterial stiffness, as measured by pulse pressure, LAE, SAE or high ABI, in a community-based population without CVD.
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Affiliation(s)
- Jeffrey J Hsu
- Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, CA, USA
| | - Ronit Katz
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Joachim H Ix
- Division of Nephrology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Ian H de Boer
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael G Shlipak
- Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, CA, USA
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