The central arterial burden of the metabolic syndrome is similar in men and women: the SardiNIA Study

Chinese visceral adiposity index and its transition patterns: impact on cardiovascular and cerebrovascular diseases in a national cohort study

BACKGROUND

Obesity affects approximately 800 million people worldwide and may contribute to various diseases, especially cardiovascular and cerebrovascular conditions. Fat distribution and content represent two related yet distinct axes determining the impact of adipose tissue on health. Unlike traditional fat measurement indices, which often overlook fat distribution, the Chinese visceral adiposity index (CVAI) is a novel metric used to assess visceral fat accumulation and associated health risks. Our objective is to evaluate its association with the risk of cardiovascular and cerebrovascular diseases.

METHODS

A nationwide longitudinal study spanning 9 years was conducted to investigate both the effects of baseline CVAI levels (classified as low and high) and dynamic changes in CVAI over time, including maintenance of low CVAI, transition from low to high, transition from high to low, and maintenance of high CVAI. Continuous scales (restricted cubic spline curves) and categorical scales (Kaplan-Meier curves and multivariable Cox regression analyses) were utilized to evaluate the relationship between CVAI and cardiovascular and cerebrovascular diseases. Furthermore, subgroup analyses were conducted to investigate potential variations.

RESULTS

Totally 1761 individuals (22.82%) experienced primary outcomes among 7717 participants. In the fully adjusted model, for each standard deviation increase in CVAI, there was a significant increase in the risk of primary outcomes [1.20 (95%CI: 1.14-1.27)], particularly pronounced in the high CVAI group [1.38 (95%CI: 1.25-1.54)] compared to low CVAI group. Regarding transition patterns, individuals who consistently maintained high CVAI demonstrated the highest risk ratio compared to those who consistently maintained low CVAI [1.51 (95%CI: 1.31-1.74)], followed by individuals transitioning from low to high CVAI [1.22 (95% CI: 1.01-1.47)]. Analysis of restricted cubic spline curves indicated a positive dose-response relationship between CVAI and risk of primary outcomes (p for non-linear = 0.596). Subgroup analyses results suggest that middle-aged individuals with high CVAI face a notably greater risk of cardiovascular and cerebrovascular diseases in contrast to elderly individuals [1.75 (95% CI: 1.53-1.99)].

CONCLUSION

This study validates a significant association between baseline levels of CVAI and its dynamic changes with the risk of cardiovascular and cerebrovascular diseases. Vigilant monitoring and effective management of CVAI significantly contribute to early prevention and risk stratification of cardiovascular and cerebrovascular diseases.

Benefits of Puerarin on Metabolic Syndrome and Its Associated Cardiovascular Diseases in Rats Fed a High-Fat/High-Sucrose Diet

Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular diseases (CVDs) that has become a global public health problem. Puerarin (PUE), the principal active compound of Pueraria lobata, has the effects of regulating glucose and lipid metabolism and protecting against cardiovascular damage. This study aimed to investigate whether dietary supplementation with PUE could ameliorate MetS and its associated cardiovascular damage. Rats were randomly divided into three groups: the normal diet group (NC), the high-fat/high-sucrose diet group (HFHS), and the HFHS plus PUE diet group (HFHS-PUE). The results showed that PUE-supplemented rats exhibited enhanced glucose tolerance, improved lipid parameters, and reduced blood pressure compared to those on the HFHS diet alone. Additionally, PUE reversed the HFHS-induced elevations in the atherogenic index (AI) and the activities of serum lactate dehydrogenase (LDH) and creatine kinase (CK). Ultrasonic evaluations indicated that PUE significantly ameliorated cardiac dysfunction and arterial stiffness. Histopathological assessments further confirmed that PUE significantly mitigated cardiac remodeling, arterial remodeling, and neuronal damage in the brain. Moreover, PUE lowered systemic inflammatory indices including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII). In conclusion, dietary supplementation with PUE effectively moderated metabolic disorders, attenuated systemic inflammation, and minimized cardiovascular damage in rats with MetS induced by an HFHS diet. These results provide novel insights into the potential benefits of dietary PUE supplementation for the prevention and management of MetS and its related CVDs.

Glucose-6-phosphate dehydrogenase deficiency accelerates arterial aging in diabetes

AIMS

High glucose levels and Glucose-6-Phosphate Dehydrogenase deficiency (G6PDd) have both tissue inflammatory effects. Here we determined whether G6PDd accelerates arterial aging (information linked stiffening) in diabetes.

METHODS

Plasma glucose, interleukin 6 (IL6), and arterial stiffness (indexed as carotid-femoral Pulse Wave Velocity, PWV) and red blood cell G6PD activity were assessed in a large (4448) Sardinian population.

RESULTS

Although high plasma glucose in diabetics, did not differ by G6DP status (178.2 ± 55.1 vs 169.0 ± 50.1 mg/dl) in G6DPd versus non-G6PDd subjects, respectively, IL6, and PWV (adjusted for age and glucose) were significantly increased in G6PDd vs non-G6PDd subjects (PWV, 8.0 ± 0.4 vs 7.2 ± 0.2 m/sec) and (IL6, 6.9 ± 5.0 vs 4.2 ± 3.0 pg/ml). In non-diabetics, neither fasting plasma glucose, nor IL6, nor PWV were impacted by G6PDd.

CONCLUSION

G6PDd in diabetics is associated with increased inflammatory markers and accelerated arterial aging.

Comparing the association of two metabolic syndrome definitions, NCEP ATP III and IDF, with the risk of developing atherosclerotic cardiovascular disease: An analytical cross-sectional study

INTRODUCTION

Atherosclerotic cardiovascular diseases (ASCVD) are significant sources of mortality and morbidity with substantial economic implications and preventive measures play key roles in this regard. Metabolic syndrome (MetS) is a common condition, and its association with ASCVD and mortality has made it clinically important. However, controversies persist regarding the best definition for MetS. Here in, we investigated the ability of the International Diabetes Federation (IDF) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) in the prediction of ASCVD incidence.

METHODS

We conducted an investigation on individuals diagnosed with MetS as part of the "Kerman Coronary Artery Diseases Risk Factor Study" (KERCADRS). This study was a cohort study conducted on a population aged 15-75 years residing in Kerman, Iran to assess the risk of ASCVD. We employed ACC/AHA ASCVD Risk Estimator for predicting ASCVD occurrence in the future and then compared the results with different definitions of MetS including IDF and NCEP ATP III.

RESULTS

Patients with MetS consistent with NCEP ATP III had higher ASCVD risk scores than those with IDF (10.63 ± 10.989 vs. 9.50 ± 9.357). NCEP ATP III had better overall performance in terms of specificity, accuracy, sensitivity and positive and negative predictive values especially in higher ASCVD risk score categories. The agreement between IDF and NCEP ATP III was none to slight (Cohen's Kappa <0.2) except for IDF in the group of ASCVD >30%, which revealed no agreement (Cohen's Kappa = 0).

CONCLUSION

NCEP ATP III has better overall performance compared to IDF. The ability of NCEP ATP III increases as the ASCVD risk score goes higher. IDF may be useful in primary screening and patients with lower ASCVD risk scores.

The Level of Intima-Media Thickness in Patients with Metabolic Syndrome in Poland Depending on the Prevalence of Type 2 Diabetes

BACKGROUND

Metabolic syndrome (MetS), increasingly diagnosed among the Polish population, is a combination of factors that are associated with an increased risk of atherosclerosis and cardiovascular diseases. Intima-media thickness (IMT) of the common carotid artery has been suggested as, simply, a non-invasive and reproducible marker of the early stages of the atherosclerotic process. The carotid IMT can also be a strong predictor of future cerebral and cardiovascular events. The aim of our study was to evaluate atherosclerotic lesions in carotid vessels in patients with MetS depending on the presence of DMt2 and to assess which demographic factors affect the level of IMT. The study involved 335 subjects diagnosed with MetS, including 211 females (65%) and 124 males (37%) aged 37-82. The diagnosis of MetS was made on the basis of the International Diabetes Federation (IDF) criteria. The patients were divided into two subgroups: with DMt2 and without DMt2. The value of IMT depended on gender, education, and smoking status. We noticed that patients with DMt2 had the highest measurement of IMT compared with other groups (1.01 vs. 0.98). Additionally, a statistically significant difference between the subgroup with DMt2 and those without DMt2 was found (1.01 vs. 0.92; p < 0.005). Ultrasound assessment of the carotid IMT should be used more often in the diagnosis and monitoring of high cardiovascular risk and early progression of atherosclerosis, especially in patients with MetS with current DMt2.

Ambulatory and successive home-based heart rate targeted aerobic training improves arterial parameters: a follow-up study in people with metabolic syndrome

BACKGROUND

Studies demonstrated that outpatient aerobic exercise programs (aEP) can significantly decrease aortic stiffness in people with metabolic syndrome (MetS). There is some limited data that remotely supervised home-based aEP can also improve arterial stiffness in this population. We aimed to evaluate the changes in the arterial wall parameters after the 2-month ambulatory supervised aEP followed by the 6-month home-based aEP with and without targeting of heart rate (HR) by electrocardiogram (ECG) in people with MetS.

METHODS

In this prospective study (ClinicalTrials.gov identifier: NCT05592704) 132 MetS subjects (mean age 52.44 ± 6.26 years, 54.55% female) were evaluated. At first, all subjects participated in the 2-month ambulatory supervised aEP, which consisted of 40 individual aerobic training sessions on a cycle ergometer 5 times/week for 40 min and received the recommendations for home-based training. Then the study (n = 66) and the control (n = 66) groups participated in the 6-month home-based aEP, but only the study group subjects targeted their HR using ECG monitor connected to the smartphone during workouts. Arterial stiffness parameters and carotid artery intima-media thickness (cIMT) were evaluated in all participants at baseline and after 8 months.

RESULTS

After 8 months, carotid-femoral pulse wave velocity (c-f PWV) significantly reduced in both groups (-12.22% in the study group vs. -7.85% in the control group, all p < .001) without a significant between-group difference (p = 0.144). A significant improvement of carotid-radial pulse wave velocity (c-r PWV) was observed only in the study group (-11.37%, p < .001, d = -0.671) with significant between-group difference (p < .001). The reduction of c-r PWV after 8 months of aEP occurred when c-r PWV at baseline was in the 2nd quartile (>7.90 m/s). A significant decrease of 3.32% in cIMT was present only in the study group (p = .032, d = -0.288).

CONCLUSIONS

The combination of 2-month ambulatory supervised aEP and successive 6-month home-based aEP targeted by HR monitoring using ECG improved arterial properties in MetS subjects more than the same combination without HR targeting, leading to the greater reduction of c-r PWV and cIMT.

Changes in Arterial Stiffness in Response to Various Types of Exercise Modalities: A Narrative Review on Physiological and Endothelial Senescence Perspectives

Arterial stiffness is a reliable independent predictor of cardiovascular events. Exercise training might enhance arterial compliance through improved metabolic health status. Different modes of exercise may have different effects on arterial stiffness. However, the interactions among different modes of exercise on endothelial senescence, the development of arterial vascular stiffness, and the associated molecular mechanisms are not completely understood. In this narrative review, we evaluate the current evidence focusing on the effects of various exercise modes on arterial stiffness and vascular health, and the known underlying physiological mechanisms are discussed as well. Here, we discuss the most recent evidence of aerobic exercise, high-intensity interval training (HIIT), and resistance exercise (RE) on arterial stiffness and endothelial senescence in physiological and cellular studies. Indeed, aerobic, HIIT, and progression RE-induced arterial compliance may reduce arterial stiffness by effectively promoting nitric oxide (NO) bioavailability and reducing endothelial senescence. However, the transient increase in inflammation and sympathetic activation may contribute to the temporary elevation in arterial stiffness following whole-body high-intensity acute resistance exercise.

Cardiometabolic risk profiles in a Sri Lankan twin and singleton sample

Introduction

Prevention of cardiovascular disease and diabetes is a priority in low- and middle-income countries, especially in South Asia where these are leading causes of morbidity and mortality. The metabolic syndrome is a tool to identify cardiometabolic risk, but the validity of the metabolic syndrome as a clinical construct is debated. This study tested the existence of the metabolic syndrome, explored alternative cardiometabolic risk characterisations, and examined genetic and environmental factors in a South Asian population sample.

Methods

Data came from the Colombo Twin and Singleton follow-up Study, which recruited twins and singletons in Colombo, Sri Lanka, in 2012–2015 (n = 3476). Latent class analysis tested the clustering of metabolic syndrome indicators (waist circumference, high-density lipoprotein cholesterol, triglycerides, blood pressure, fasting plasma glucose, medications, and diabetes). Regression analyses tested cross-sectional associations between the identified latent cardiometabolic classes and sociodemographic covariates and health behaviours. Structural equation modelling estimated genetic and environmental contributions to cardiometabolic risk profiles. All analyses were stratified by sex (n = 1509 men, n = 1967 women).

Results

Three classes were identified in men: 1) “Healthy” (52.3%), 2) “Central obesity, high triglycerides, high fasting plasma glucose” (40.2%), and 3) “Central obesity, high triglycerides, diabetes” (7.6%). Four classes were identified in women: 1) “Healthy” (53.2%), 2) “Very high central obesity, low high-density lipoprotein cholesterol, raised fasting plasma glucose” (32.8%), 3) “Very high central obesity, diabetes” (7.2%) and 4) “Central obesity, hypertension, raised fasting plasma glucose” (6.8%). Older age in men and women, and high socioeconomic status in men, was associated with cardiometabolic risk classes, compared to the “Healthy” classes. In men, individual differences in cardiometabolic class membership were due to environmental effects. In women, genetic differences predicted class membership.

Conclusion

The findings did not support the metabolic syndrome construct. Instead, distinct clinical profiles were identified for men and women, suggesting different aetiological pathways.

Which Clusters of Metabolic Syndrome Are the Most Associated with Serum Uric Acid?

Background and Objectives: Metabolic syndrome is defined as three or more of five components; therefore, there are 16 possible different clusters of metabolic risk factors that are under one diagnosis of metabolic syndrome. In this study, we evaluated the different clusters of metabolic syndrome (MetS) across serum uric acid (SUA) quartiles and analyzed the association of these clusters with SUA levels, respectively, in both men and women. Materials and Methods: A total of 606 subjects were recruited to a cross-sectional study from the ongoing Lithuanian High Cardiovascular Risk primary prevention program (LitHiR). All of the study subjects were diagnosed with MetS (according to the 2005 National Cholesterol Education Program Adult Treatment Panel III MetS definition). Results: In the middle-aged population of patients with MetS living in Lithuania, a high proportion of hyperuricaemia was detected—35.5% (95% Cl 31.7% to 39.4%). For women possessing all five MetS components, the chances of having hyperuricaemia are 2.807 higher than for women with three risk factors (p < 0.001). However, men do not have a statistically significantly higher chance of having hyperuricaemia, depending on the number of MetS components in our population. Using multivariable models, the statistically significant chance of having hyperuricaemia was observed only in women possessing all five MetS components (OR = 2.386, p < 0.0001), compared to any other of 15 MetS clusters. After adjustment for age and sex, the chance of having hyperuricaemia for individuals with the cluster of all five MetS components, compared to any other of 15 MetS clusters, remained (OR = 1.982, p = 0.001). Also, a lower probability (OR = 0.653, p = 0.039) of having hyperuricaemia was observed for individuals having the combination of abnormal plasma glucose, blood pressure, and waist circumference. Conclusions: Patients with the clustering of all five metabolic syndrome components are at higher risk for having hyperuricaemia than patients with any other combination of MetS clusters. This risk is even higher for women. It could be beneficial for patients presented with all five MetS components to be screened for SUA concentration in the primary CVD prevention program.

Potential of four definitions of metabolic syndrome to discriminate individuals with different 10-year cardiovascular disease risk scores: a cross-sectional analysis of an Iranian cohort

OBJECTIVE

We aimed to reveal the potential of four different metabolic syndrome (Mets) definitions to differentiate subjects according to 10-year risk of cardiovascular disease.

DESIGN

A cross-sectional analysis of a prospective cohort.

SETTING

This study used baseline data from the Shiraz Heart Study, a prospective cohort study in Shiraz, Iran. Participants were screened against Mets definitions including modified WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), American Heart Association (AHA) and International Diabetes Federation (IDF). Also, Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score were determined for each participant.

PARTICIPANTS

A total number of 7225 participants of both genders entered the study. They were selected through defined family physician centres in different geographical areas. Urban residents with no migration plan were included. Those who were far from study centres or with disabilities that made them incapable to cooperate were excluded.

RESULTS

Participants were 47.68% (N=3445) male with the mean age of 52.13±8.00 years. The number of subjects with Mets identified by WHO was the lowest (N=1676), while the percentage of subjects with high risk score was the highest, 17.1% (N=282) in FRS and 9.8% (N=162) in ASCVD risk score. There were statistically significant differences in the mean risk scores between participants with and without Mets according to AHA, WHO and NCEP ATP III definitions (p<0.001). In IDF definition, the risk scores of subjects with Mets were not statistically different compared with peers without Mets, neither based on FRS (p=0.247) nor ASCVD risk score (p=0.193).

CONCLUSIONS

IDF was not the appropriate definition for discrimination of subjects with Mets and/or those at high risk of future cardiovascular events. AHA, WHO and NCEP ATP III definitions were effective to discriminate subjects with Mets from peers without Mets.

Association between organ damage and visceral adiposity index in community-dwelling elderly Chinese population: the Northern Shanghai Study

BACKGROUND

The visceral adiposity index (VAI) is a newly developing indicator about visceral fat function and insulin resistance. This research aims to assess the association between organ damage and VAI in the community-dwelling elderly Chinese population.

METHODS

In total, 3363 elderly participants were recruited between June 2014 and August 2019. VAI was used to measure visceral adipose accumulation, and organ damage was measured with standardized methods, including arterial stiffness, lower extremity atherosclerosis, carotid hypertrophy, left ventricular hypertrophy, micro-albuminuria, and chronic kidney disease.

RESULTS

According to multivariable linear regression analysis, VAI was related to carotid-femoral pulse wave velocity (cf-PWV; β = 0.047, P = 0.024), urine albumin to creatinine ratio (UACR; β = 3.893, P = 0.008), estimated glomerular filtration rate (eGFR; β =  - 0.526, P = 0.003) and log_e(ankle-to-brachial index) (ABI; β = -0.003, P = 0.024). Using multivariable stepwise logistic regression model, higher VAI was found to be significantly related to cf-PWV > 10 m/s (OR 1.44, [95% CI 1.17-1.78]; P_{for trend} < 0.001), and chronic kidney disease (CKD; OR 1.54, [95% CI 1.09-2.20]; P_{for trend} = 0.015).

CONCLUSIONS

Since higher VAI is related to increased risk of arterial stiffness and CKD, it may serve as a useful index for the assessment of arteriosclerosis and CKD in elderly population.

TRIAL REGISTRATION

NSS, NCT02368938.

Association of incremental pulse wave velocity with cardiometabolic risk factors

We investigate the association of incremental pulse wave velocity (ΔC; the change in pulse wave velocity over a cardiac cycle) with cardiometabolic risk factors and report the first and (currently) the largest population-level data. In a cross-sectional study performed in a cohort of 1373 general population participants, ΔC was measured using clinically validated ARTSENS devices. There were 455 participants in the metabolic syndrome (MetS) group whose average ΔC was ~ 28.4% higher than that of the non-metabolic syndrome (Non-MetS) group. Females with MetS showed ~ 10.9% elevated average ΔC compared to males of the Non-MetS group. As the number of risk factors increased from 0 to 5, the average ΔC escalated by ~ 55% (1.50 ± 0.52 m/s to 2.33 ± 0.91 m/s). A gradual increase in average ΔC was observed across each decade from the younger (ΔC = 1.53 ± 0.54 m/s) to geriatric (ΔC = 2.34 ± 0.59 m/s) populations. There was also a significant difference in ΔC among the blood pressure categories. Most importantly, ΔC ≥ 1.81 m/s predicted a constellation of ≥ 3 risks with AUC = 0.615, OR = 2.309, and RR = 1.703. All statistical trends remained significant, even after adjusting for covariates. The study provides initial evidence for the potential use of ΔC as a tool for the early detection and screening of vascular dysfunction, which opens up avenues for active clinical and epidemiological studies. Further investigations are encouraged to confirm and establish the causative mechanism for the reported associations.

Association between arterial stiffness and the clustering of metabolic syndrome risk factors: a systematic review and meta-analysis

OBJECTIVES

Metabolic syndrome (MetS) is a cluster of different cardiometabolic risk factors (CMRFs), and its different combinations with other CMRFs, such as arterial stiffness have been hypothesized to explain, at least partially, increased risk of cardiovascular disease. Thus, in this systematic review and meta-analysis, we aimed to synthesize the evidence regarding the association between the clustering of MetS-related CMRFs and arterial stiffness measured using pulse wave velocity (PWV).

METHODS

Original studies analysing the association between arterial stiffness, measured using PWV, and MetS were systematically searched. Pooled effect size estimates and their respective 95% confidence intervals (CI) were calculated using the DerSimonian and Laird method for two separate analyses: the diagnosis of MetS and PWV values and the number of CMRFs and PWV values.

RESULTS

Moderate effect size estimates were observed between MetS and PWV (0.68, 95% CI: 0.54-0.82) with a slightly higher effect size for the low-risk compared with the high-risk population group (0.75, 95% CI: 0.58-0.92; and 0.51, 95% CI: 0.32-0.82, respectively). A trend between the number of MetS-related CMRFs and PWV was found with the pooled effect size nearly doubling as the number of MetS-related CMRFs increased, 0.11 (95% CI: 0.04-0.17) for one MetS-related CMRF, 0.26 (95% CI: 0.13-0.4) for two, and 0.4 (95% CI: 0.2-0.6) for three or more.

CONCLUSION

These results demonstrated a clinically relevant association between MetS and PWV and an increasing trend in PWV values, such as a MetS-related CMRF increase. Although these results should be considered cautiously because of the considerable heterogeneity, our findings reinforce the rationale of MetS as an aggregation of risk factors with common causes, which could provide additional useful information to guide clinical management.

Pilot Clinical Trial of Time-Restricted Eating in Patients with Metabolic Syndrome

Metabolic syndrome (MetS) and erratic eating patterns are associated with circadian rhythm disruption which contributes to an increased cardiometabolic risks. Restricting eating period (time-restricted eating, TRE) can restore robust circadian rhythms and improve cardiometabolic health. We describe a protocol of the Time-Restricted Eating on Metabolic and Neuroendocrine homeostasis, Inflammation, and Oxidative Stress (TREMNIOS) pilot clinical trial in Polish adult patients with MetS and eating period of ≥14 h/day. The study aims to test the feasibility of TRE intervention and methodology for evaluating its efficacy for improving metabolic, neuroendocrine, inflammatory, oxidative stress and cardiac biomarkers, and daily rhythms of behavior for such population. Participants will apply 10-h TRE over a 12-week monitored intervention followed by a 12-week self-directed intervention. Changes in eating window, body weight and composition, biomarkers, and rhythms of behavior will be evaluated. Dietary intake, sleep, activity and wellbeing will be monitored with the myCircadianClock application and questionnaires. Adherence to TRE defined as the proportion of days recorded with app during the monitored intervention in which participants satisfied 10-h TRE is the primary outcome. TREMNIOS will also provide an exploratory framework to depict post-TRE changes in cardiometabolic outcomes and behavior rhythms. This protocol extends previous TRE-related protocols by targeting European population with diagnosed MetS and including long-term intervention, validated tools for monitoring dietary intake and adherence, and comprehensive range of biomarkers. TREMNIOS trial will lay the groundwork for a large-scale randomized controlled trial to determine TRE efficacy for improving cardiometabolic health in MetS population.

Carotid Beta Stiffness Association with Thyroid Function

Background: Thyroid hormone modulation of cardiovascular function has been associated with cardiovascular disease. Recent evidence suggests that free thyroxine (FT4) levels are associated with an increase in systemic arterial stiffness, but little is known about the effects of FT4 at the local level of the common carotid artery. β-stiffness index is a local elastic parameter usually determined by carotid ultrasound imaging. Methods: We conducted a cross-sectional analysis in the ProgeNIA cohort, including 4846 subjects across a broad age range. For the purpose of this study, we excluded subjects with increased thyrotropin (TSH) levels and those treated with levothyroxine or thyrostatic. We assessed β stiffness, strain, wall–lumen ratio, carotid cross-sectional area (CSA), and stress and flow in the right common carotid artery. We tested whether FT4, heart rate, and their interactions were associated with carotid parameters. Results: FT4 was positively and independently associated with β stiffness index (β = 0.026, p = 0.041), and had a negative association with strain (β = −0.025, p = 0.009). After adding heart rate and the interaction between FT4 and heart rate to the model, FT4 was still associated with the β stiffness index (β = 0.186, p = 0.06), heart rate was positively associated with the stiffness index (β = 0.389, p < 0.001) as well as their interaction (β = 0.271, p = 0.007). Conclusion: This study suggests that higher FT4 levels increase arterial stiffness at the common carotid level, consistent with a detrimental effect on elastic arteries. The effect of FT4 is likely to be primarily attributable to its effect on heart rate.

The association of the metabolic syndrome with target organ damage: focus on the heart, brain, and central arteries

INTRODUCTION

The metabolic syndrome (MetS) is an adverse metabolic state composed of obesity, hyperglycemia/pre-diabetes, hypertension, and dyslipidemia. It substantially increases the risk of type 2 diabetes, cardiovascular disease (CVD) and mortality, and has a huge impact on public health.

AREA COVERED

The present review gives an update on the definition and prevalence of MetS, and its impact on cardiac structure and function as well as on the brain and central arteries. The association with CVD and mortality risk is discussed. Focus is mainly directed toward the subclinical target organ damage related to MetS. Data is also critically reviewed to provide evidence on the incremental prognostic value of overall MetS over its individual components.

EXPERT COMMENTARY

MetS is a clinical risk condition associated with subclinical and clinical CVD and mortality. Roughly, 30% of the world population suffer from MetS. As all components of the MetS are modifiable, optimal preventive and therapeutic measures should be initiated to improve CV risk control, particularly aggressively treating hypertension and hyperglycemia, and encouraging people to adopt healthy lifestyle as early as possible is of great importance.

Effect of metabolically healthy obesity on the development of arterial stiffness: a prospective cohort study

Background

Metabolically healthy obesity (MHO) has been reported to be associated with the development of vascular damage by the carotid intima-media thickness, but the relationship between metabolic health and obesity phenotypes and arterial stiffness is still unknown. Our hypothesized that different metabolic health and obesity phenotypes might be associated with the development of arterial stiffness, and that subjects in MHO phenotype might not have increased risks of arterial stiffness compared with those in metabolically healthy nonobesity phenotype (MHNO), while metabolic unhealthy individuals might have increased risks of arterial stiffness.

Methods

A prospective cohort of 2076 participants (aged 36-48 years) who were enrolled in the Hanzhong Adolescent Hypertension Cohort Study in 2017 was analyzed in a cross-sectional analysis. A subgroup of 202 participants from 2005 to 2017 was selected by an isometric sampling method and was included in the final longitudinal analysis.

Results

We identified four metabolic health and obesity phenotypes for both the cross-sectional and longitudinal analyses as follows: MHNO, metabolically unhealthy nonobesity (MUNO), MHO, and metabolically unhealthy obesity (MUO). In the cross-sectional analysis, individuals with the MHO phenotype had the lowest brachial-ankle pulse wave velocity (baPWV) levels of the four phenotypes (P < 0.001), and participants with the MHO phenotype had a similar risk of arterial stiffness after fully adjustment [odds ratio (OR) = 0.99 (0.61-1.60)] as the MUNO subjects. Subjects with metabolically unhealthy status had a significantly higher risk of arterial stiffness than the MHNO individuals, particularly females (P < 0.005). In the longitudinal analysis, subjects with the MUNO and MUO phenotypes had a significantly higher risk of arterial stiffness than the MHNO individuals after adjustment for age and sex [OR = 5.21 (2.26-12.02), OR = 3.32 (1.18-9.32), respectively].

Conclusions

The MHO phenotype did not significantly increase the progression of arterial stiffness. Metabolically unhealthy individuals (MUNO, MUO), regardless of obesity status, showed a worse effect for the development of arterial stiffness, particularly females.

Trial registration

NCT02734472. Registered 12 April 2016 - Retrospectively registered, http:www.clinicaltrials.gov.

Objective and subjective socioeconomic status associated with metabolic syndrome severity among African American adults in Jackson Heart Study

PURPOSE

To assess independent associations between objective socioeconomic status (OSS) and subjective social status (SSS) with metabolic syndrome (MetS) severity and indicators among African American (AA) adults in the Jackson Heart Study (JHS) at baseline (2000-2004) and eight-year follow-up (2009-2013).

METHODS

Participants included 1724 AA adults from the JHS cohort (64.4 % women; mean age 53.4 ± 11.8). Associations of OSS (annual household income and school years completed) and SSS (measured with MacArthur Scales) with sex- and race/ethnic-specific MetS severity Z-score were examined after adjustment for demographics and MetS risk factors (i.e., nutrition, physical activity, smoking status, alcohol consumption, and depressive symptoms) at baseline and eight-year follow-up.

PRINCIPAL RESULTS

Independent of OSS, demographic, psychosocial, and lifestyle factors, individuals with lower US-society SSS had more severe MetS at baseline. A significant interaction existed between sex and US-society SSS such that women with lower perceived social status had more severe MetS severity at baseline, and for every one unit increase in US-society SSS, MetS severity Z-score is estimated to decrease by 0.04. Components of MetS driving the relationship between US-society SSS and MetS severity at baseline were the inverse associations of SSS with glucose levels and the positive associations of SSS with HDL-C. Physical activity was independently associated with MetS severity at baseline, but not at eight-year follow-up.

MAJOR CONCLUSIONS

Though subjective and objective measures of social status are independently associated with cardiometabolic risk factors and MetS severity among AA adults, SSS may be a stronger predictor of MetS severity than OSS, particularly among women. SSS should be considered in conjunction with OSS when exploring social determinants of cardiometabolic health.

Cardiac changes associated with vascular aging

Cardiovascular aging is a complex process of adaptive structural and functional changes over time. With advancing age, the arterial tree thickens and decreases in compliance, resulting in increased pulse wave velocity, systolic blood pressure, and left ventricular afterload. In response to these arterial changes, the myocardium remodels to maintain systolic function and diastolic filling. These adaptive mechanisms are not necessarily pathologic but increase the susceptibility for myocardial ischemia and heart failure in the presence of common age-associated comorbidities. This article reviews the pathophysiology of cardiovascular aging and discusses therapeutic interventions that may ameliorate these processes.

Characteristics of healthy vascular ageing in pooled population-based cohort studies: the global Metabolic syndrome and Artery REsearch Consortium

OBJECTIVE

Arterial ageing is characterized by increasing arterial stiffness as measured by pulse wave velocity (PWV). This process is enhanced in participants with early vascular ageing (EVA), but slowed in participants with healthy vascular ageing (HVA). We aimed to describe characteristics of EVA and HVA in a transcontinental study including 11 cohorts.

METHODS

In all, 18 490 participants from the global MARE Consortium, free of cardiovascular disease, participated with data on PWV and cardiometabolic risk factors. We defined HVA as the lowest 10% and EVA as the highest 10% of the standardized PWV distribution, adjusted for age intervals. HVA individuals were compared with the 90% of non-HVA individuals with ANCOVA, adjusted for age, sex and hypertension.

RESULTS

The 1723 HVA participants were at the same age as the rest of the population, more likely women (59.4 vs 57.0%), and with significantly lower levels of established cardiovascular risk factors (blood pressure, lipids, glucose). Similarly, the prevalence rate of obesity, diabetes mellitus, hypertension and the metabolic syndrome was lower in the HVA participants. In the presence of similar levels of cardiovascular risk factors, HVA participants in the 50-64 years of age group presented lower PWV 5.8 (SD 0.5) vs. 7.4 (1.4) m/s (P < 0.0001) than control individuals in the 35-49 years of age group, corresponding to an estimated difference in chronological age of 14 years.

CONCLUSION

Participants with healthy vascular ageing (HVA), belonging to the lowest end of the PWV distribution, are in general characterized by an up to 14 years estimated younger biological (vascular) age than those with higher PWV values, and have lower levels of risk factors.

Effects of metabolic syndrome on arterial function in different age groups: the Advanced Approach to Arterial Stiffness study

OBJECTIVE

The aim of the Advanced Approach to Arterial Stiffness study was to compare arterial stiffness measured simultaneously with two different methods in different age groups of middle-aged and older adults with or without metabolic syndrome (MetS). The specific effects of the different MetS components on arterial stiffness were also studied.

METHODS

This prospective, multicentre, international study included 2224 patients aged 40 years and older, 1664 with and 560 without MetS. Patients were enrolled in 32 centres from 18 European countries affiliated to the International Society of Vascular Health & Aging. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI) and the carotid-femoral pulse wave velocity (CF-PWV) in four prespecified age groups: 40-49, 50-59, 60-74, 75-90 years. In this report, we present the baseline data of this study.

RESULTS

Both CF-PWV and CAVI increased with age, with a higher correlation coefficient for CAVI (comparison of coefficients P < 0.001). Age-adjusted and sex-adjusted values of CF-PWV and CAVI were weakly intercorrelated (r = 0.06, P < 0.001). Age-adjusted and sex-adjusted values for CF-PWV but not CAVI were higher in presence of MetS (CF-PWV: 9.57 ± 0.06 vs. 8.65 ± 0.10, P < 0.001; CAVI: 8.34 ± 0.03 vs. 8.29 ± 0.04, P = 0.40; mean ± SEM; MetS vs. no MetS). The absence of an overall effect of MetS on CAVI was related to the heterogeneous effects of the components of MetS on this parameter: CAVI was positively associated with the high glycaemia and high blood pressure components, whereas lacked significant associations with the HDL and triglycerides components while exhibiting a negative association with the overweight component. In contrast, all five MetS components showed positive associations with CF-PWV.

CONCLUSION

This large European multicentre study reveals a differential impact of MetS and age on CAVI and CF-PWV and suggests that age may have a more pronounced effect on CAVI, whereas MetS increases CF-PWV but not CAVI. This important finding may be due to heterogeneous effects of MetS components on CAVI. The clinical significance of these original results will be assessed during the longitudinal phase of the study.

Visceral adiposity index as a useful tool for the assessment of cardiometabolic disease risk in women aged 65 to 74

BACKGROUND

The visceral adiposity index (VAI) is considered to be a reliable indicator of adipose tissue dysfunction and cardiometabolic disease risk. The aim of this study was to evaluate its usefulness in assessing cardiometabolic risk in a sample of elderly women living in a rural-urban community in central Poland.

METHODS

A total of 365 women aged 65 to 74 years were included in this cross-sectional study. All patients were interviewed to obtain their history of diabetes mellitus, myocardial infarction, stroke, and revascularization. For all participants, anthropometric measurements were performed, then body mass index (BMI) and waist/hip ratio were calculated. Blood pressure was measured on the arm and on both ankles, and the ankle/brachial index was calculated. Blood samples were collected for the assessment of glycemia, lipid profile, and creatinine level. In patients with elevated fasting glucose, the test was repeated, or an oral glucose tolerance test was performed where appropriate. Finally, carotid intima-media thickness was measured in all women.

RESULTS

The VAI of participants was significantly correlated with a history of myocardial infarction, higher carotid intima-media thickness, diabetes, prediabetes, and impaired kidney function. Furthermore, VAI demonstrated a better correlation with these endpoints than BMI or waist circumference.

CONCLUSIONS

The VAI can be considered a useful tool for the assessment of cardiometabolic disease risk in elderly women, with a score of ≥2.71 representing the cut-off point for identifying females at high risk. In such patients, screening for cardiovascular disease, abnormal glucose metabolism, and impaired kidney function should be routine practice.

Comparison of coronary heart disease risk assessments among individuals with metabolic syndrome using three diagnostic definitions: a cross-sectional study from China

OBJECTIVE

Metabolic syndrome (MetS) is a notable risk factor of coronary heart disease (CHD). However, there are differences in the methods used to define MetS. The purpose of this study was to determine which MetS definition most fully reflects the 10-year probability of CHD based on the Framingham risk algorithm.

DESIGN

Cross-sectional study.

SETTING

Data were obtained from the China Health and Nutrition Survey and the Influencing Factors of Chronic Diseases Survey conducted among residents of Nanshan District in Shenzhen, China.

PARTICIPANTS

In total, 1721 participants aged 20-80 years were included in this study.

METHODS

MetS was diagnosed according to the criteria of the National Cholesterol Education Program's Adult Treatment Panel (revised NCEP-ATP III), the International Diabetes Federation (IDF) and the Chinese Diabetes Society (CDS). The NCEP-ATP III algorithm was used to calculate the Framingham risk score, and the Framingham risk score was used to define the probability of developing CHD within 10 years either as low (<6%), moderate (6%-10%), moderately high (10%-20%) or high (>20%). Chi-square tests with or without the Bonferroni correction were used to compare the differences in the distribution of the 10-year estimated risk of developing CHD among the three definitions.

RESULTS

Compared with the other definitions, the revised NCEP-ATP III criteria identified more participants (30.96%, 95% CI 28.8% to 33.2%) as having MetS, while the CDS criteria showed the highest 10-year probability of developing CHD. The 10-year probability of developing CHD in the participants with MetS was significantly higher than that in the participants without MetS (CDS: χ²=157.65, revised ATP III: χ²=45.17, IDF: χ²=306.15, all p<0.001), and all definitions more fully reflect the CHD risk in men than in women (revised NCEP-ATP III: χ²=72.83; IDF: χ²=63.60; CDS: χ²=23.84; all p<0.001).

CONCLUSIONS

This study demonstrates the differences in the prevalence and distribution of the 10-year estimated risk of developing CHD based on the definition of MetS. A significant finding of this study is that the MetS definitions have better performance for men than for women. Further studies in China, especially longitudinal studies, are needed to determine which definition of MetS is best suited for predicting CHD risk.

Association between the intima-media thickness of the extracranial carotid arteries and metabolic syndrome in ethnic Kyrgyzs

BACKGROUND

It is known that atherosclerosis is the leading cause of cardiovascular disease. We aimed to study the correlation between components of metabolic syndrome (MS) and subclinical carotid atherosclerosis in a group of ethnic Kyrgyzs.

METHODS

In а descriptive study we assessed 144 ethnic Kyrgyzs (69 males, 75 females) aged 36-73 years (average age 51.03 ± 8.2). All participants underwent a clinical investigation and an anthropometric evaluation (weight, height, waist circumference (WC)). Abdominal obesity (АО) was confirmed at WC ≥ 94 cm in males and ≥ 88 cm in females. Fasting plasma glucose and lipid spectrum tests were performed. An ultrasound assessment of carotid intima-media thickness (IMT) was performed using a 7.5 MHz transducer (Phillips-SD 800).

RESULTS

MS was revealed in 61 (42.4%; 47.8% in men and 37.3% in women) of the investigated patients. IMT was significantly increased with the presence of MS components in males (no components vs 2 components of MS: 0.67 ± 0.007 and 0.81 ± 0.009 respectively; р < 0.05) and females (no components vs 3 components of MS: 0.63 ± 0.007 and 0.76 ± 0.01 respectively; р < 0.01). IMT trended towards an increase in the presence of a greater number of MS components in patients with and without AO (р < 0.01). In order to identify independent factors affecting IMT we carried out a multifactorial logistic regression analysis. Arterial hypertension was found to have the greatest influence on the development of MS (OR = 3.81, p < 0.0001).

CONCLUSION

In the group of ethnic Kyrgyzs, a greater number of MS components, with AO or without AO, is associated with higher carotid IMT.

Resistance Training Augments Cerebral Blood Flow Pulsatility: Cross-Sectional Study

BACKGROUND

Increased central arterial stiffness and/or decreased compliance reduces buffer function and increases cerebral blood flow (CBF) pulsatility, which leads to increased cerebral microvascular damage, resulting in the augmentation of the risk of cerebrovascular diseases. Resistance-trained men showed higher central arterial stiffness and lower arterial compliance than age-matched, sedentary men. This study examined the effect of increased central arterial stiffness and/or decreased arterial compliance on CBF pulsatility.

METHODS

The study participants included 31 young healthy men (15 resistance-trained men, aged 21 ± 1 years; and 16 controls, aged 23 ± 1 years). β-Stiffness index and arterial compliance were measured in the right carotid artery as index of central arterial stiffness and compliance, respectively. The pulsatility index (PI) was measured in the middle cerebral artery as index of CBF pulsatility.

RESULTS

β-Stiffness index and PI were significantly higher in the resistance-trained group than in the control group (β-stiffness index: 5.3 ± 0.3 vs. 3.5 ± 0.3 a.u., P < 0.05, PI: 0.80 ± 0.02 vs. 0.70 ± 0.02, P < 0.05). The resistance-trained group showed significantly lower arterial compliance than the control group (0.16 ± 0.01 vs. 0.23 ± 0.01 mm2/mm Hg, P < 0.05). Positive and negative correlations were observed between β-stiffness index and PI (r = 0.39, P < 0.05), and between arterial compliance and PI (r = -0.59, P < 0.05), respectively.

CONCLUSIONS

The resistance-trained group showed higher central arterial stiffness and PI and lower arterial compliance. Central arterial stiffness and arterial compliance were associated with PI. Increased arterial stiffness and decreased arterial compliance with resistance training impair buffer function, resulting in increased CBF pulsatility.

CLINICAL TRIAL REGISTRATION

Trial Number UMIN000023816 URL: http://www.umin.ac.jp/icdr/index.html Official scientific title of the study: effect of increase arterial stiffness by resistance training on cerebral hemodynamic.

The reverse metabolic syndrome in the elderly: Is it a "catabolic" syndrome?

Traditional risk factors of cardiovascular death in the general population, including body mass index (BMI), serum cholesterol, and blood pressure are also found to relate to outcomes in the geriatric population, but in a differing direction. A higher body mass index, hypercholesterolemia and hypertension are not harmful but even permit better survival at advancing age. This phenomenon is called "reverse epidemiology" or "risk factor paradox" and is also detected in a variety of chronic disease states such as chronic heart failure. Accordingly, a low BMI, blood pressure and cholesterol values are associated with a worse prognosis. Several possible causes are hypothesized to explain this elderly paradox, but this phenomenon remains controversial and its underlying reasons are poorly understood. The aim of this review is to recognize the factors behind this intriguing phenomenon and analyse the consequences that it can bring in the management of the cardiovascular therapy in elderly patient. Finally, a new phenotype identified as "catabolic syndrome" has been postulated.

Lower Heart Rate Variability Is Associated with Lower Pulse Pressure Amplification: Role of Obesity

Background

Heart rate variability (HRV), pulse pressure amplification, and obesity represent risk factors for cardiovascular events. The aims of the present study are (1) to explore the impact of HRV on pulse pressure amplification and (2) to investigate whether the association between HRV and pulse pressure amplification differs in obese and lean subjects.

Methods

A total of 342 patients (age 61 ± 11 years) were enrolled. HRV was analyzed concerning both the frequency and time domain as well as concerning the HRV triangular index. Pulse pressure amplification was estimated as the ratio between brachial and carotid pulse pressure, the latter measured with SphygmoCor.

Results

Time domain HRV indices were directly correlated with pulse pressure amplification (the lower the HRV indices, the lower the pulse pressure amplification). This association was stronger in obese than in lean subjects after controlling for age and sex.

Conclusion

Larger controlled studies are needed to provide a more detailed insight into the relation between HRV and pulse pressure amplification and to determine which pathways are differentially activated in lean and obese subjects.

The comorbidity of increased arterial stiffness and microalbuminuria in a survey of middle-aged adults in China

BACKGROUND

Increased arterial stiffness (iAS) and microalbuminuria (MAU), which may occur simultaneously or separately in the general population and share similar risk factors, are markers of macro- and microvascular injuries. Our research investigated the comorbidity of iAS and MAU in the middle-aged population and examined the heterogeneous effects of metabolic risk factors on iAS and MAU.

METHODS

We selected 11,911 individuals aged 45 to 60 years who underwent a health examination at the 3rd Xiangya Hospital between 2010 and 2014. Metabolic syndrome (MetS) was determined according to IDF/NHLBI/AHA-2009 criteria. Multinomial logistic regression was applied to evaluate the influence of MetS, components of MetS and clusters of MetS on the co-occurrence (MAU(+)/iAS(+)) or non-co-occurrence (MAU(+)/iAS(-) and MAU(-)/iAS(+)) of MAU and iAS.

RESULTS

Reference group was MAU(-)/iAS(-). A positive effect of MetS on the presence of MAU(+)/iAS(-), MAU(-)/iAS(+), or MAU(+)/iAS(+) is listed in ascending order based on odds ratios (ORs = 2.11, 2.41, 4.61, respectively; P < 0.05). Compared with MAU(+)/iAS(-), Elevated blood pressure (BP) (OR = 1.62 vs. 4.83, P < 0.05), triglycerides(TG) (OR = 1.20 vs. 1.37, P < 0.05) were more strongly associated with MAU(-)/iAS(+), whereas fasting blood glucose (FBG) was less associated (OR = 1.37 vs. 1.31, P < 0.05). Decreased high-density lipoprotein cholesterol(HDL-c) (OR = 1.84, P < 0.01) and elevated waist circumference(WC) (OR = 1.28 P < 0.01) were the most strongly associated with MAU(+)/iAS(-). Compared with the individuals without MetS, individuals with the elevated BP, FBG, TG and decreased HDL-c cluster had the greatest likelihood of presenting a MAU(-)/iAS(+) (OR = 5.98, P < 0.01) and MAU(+)/iAS(+) (OR = 13.17, P < 0.01), these likelihood was even greater than the cluster with simultaneous alteration in all five MetS components (OR = 3.89 and 10.77, respectively, P < 0.01), which showed the most strongly association with MAU(+)/iAS(+) (OR = 5.22, P < 0.01).

CONCLUSION

Based on the heterogeneous influences of MetS-related risk factors on MAU and iAS, these influences could be selectively targeted to identify different types of vascular injuries.

New Common and Rare Variants Influencing Metabolic Syndrome and Its Individual Components in a Korean Population

To identify novel loci for susceptibility to MetS, we conducted genome-wide association and exome wide association studies consisting of a discovery stage cohort (KARE, 1946 cases and 6427 controls), and a replication stage cohort (HEXA, 430 cases and 3,264 controls). For finding genetic variants for MetS, with its components, we performed multivariate analysis for common and rare associations, using a standard logistic regression analysis for MetS. From the discovery and replication GWA studies, we confirmed 21 genome-wide signals significantly associated with MetS. Of these 21, four were previously unreported to associate with any MetS components: rs765547 near LPL; rs3782889 in MYL2; and rs11065756 and rs10849915 in CCDC63. Using exome chip variants, gene-based analysis of rare variants revealed three genes, CETP, SH2B1, and ZFP2, in the discovery stage, among which only CETP was confirmed in the replication stage. Finally, CETP D442G (rs2303790) associated, as a less common variant, with decreased risk of MetS. In conclusion, we discovered a total of five new MetS-associated loci, and their overlap with other disease-related components, suggest roles in the various etiologies of MetS, and its possible preventive strategies.

Mismatch between stiffness in elastic and muscular arteries as a predictor of vascular calcification in dialysis patients

BACKGROUND

Vascular calcification is one of the risk factors for arterial stiffness in patients with chronic kidney disease. We hypothesized that a mismatch between elastic and muscular arteries, represented as pulse wave velocity (PWV) ratio, could depict the extent of vascular calcification in end-stage renal disease. We also aimed to compare the predictive PWV ratio value to other factors possibly related to vascular calcification in dialysis population.

METHODS

In this cross-sectional study, in 60 chronic dialysis patients without previous cerebrovascular events, cardiovascular disease and events or clinically evident peripheral artery disease (ankle-brachial index >0.9), carotid-femoral and carotid-radial PWV as well as central hemodynamic parameters were measured by applanation tonometry (SphygmoCor). The PWV ratio using carotid-femoral PWV divided by carotid-radial PWV was calculated. Each patient underwent blood tests and chest X-ray for aortic arch calcification scoring. Two experienced radiologists blinded to patient's medical data evaluated chest X-rays (Cohen's kappa coefficient 0.76) and calculated how many sectors were calcified (Ogawa et al. in Hemodial Int 13:301-306, 2009). Differently scored chest X-rays were repeatedly reviewed and a consensus was reached.

RESULTS

The study population consisted of 31 (51.7%) males and 29 (48.3%) females, mean age 52.73 ± 13.76 years. Increased risk for aortic arch calcification was associated with higher PWV ratio even after adjustment for age, height, heart rate, ferritin level and C-reactive protein level (OR 2.59E+04, 95% CI 2.43E+01, 2.65E+09, p = 0.021). PWV ratio together with above-mentioned variables could predict the presence of aortic arch calcification with specificity of 93% (95% CI 78, 99%) and sensitivity of 53% (95% CI 34, 72%).

CONCLUSION

The elastic and muscular arteries' stiffness mismatch was strongly associated with the extent of aortic arch calcification in this dialysis population and had better calcification predictive value compared to other demographic, hemodynamic and biochemical markers.

Age affects the prognostic impact of diabetes in chronic heart failure

AIMS

Increasing age is an established prognostic determinant in chronic heart failure (HF). Diabetes often complicates HF in its course and appears to worsen HF prognosis. A differential impact of diabetes depending on patients' age was not yet studied. We evaluated the impact of diabetes in the mortality of HF patients according to their age.

METHODS

We studied a cohort of chronic ambulatory HF patients prospectively recruited. Patients were on optimized evidence-based therapy, and they were excluded if on renal replacement therapy or if they had any therapy modification or hospitalizations in the previous 2 months. Patients were followed for up to 5 years; all-cause mortality was analyzed. Mortality predictors were assessed using a Cox regression. Analysis was stratified according to patient's age: cutoff 75 years. Multivariate models were built. Interaction between diabetes and age was formally tested.

RESULTS

We studied 283 chronic HF patients; mean age was 69 years and 70.3% were male; 58.0% had severe systolic dysfunction; 105 (37.1%) were diabetic. In patients with less than 75 years, the coexistence of diabetes predicted a multivariate adjusted 1.98 (95% CI 1.13-3.46) 5-year death risk while in older patients (≥ 75 years) no significant association was reported. Age interacted with the prognostic impact of diabetes, p for interaction = 0.04.

CONCLUSIONS

The prognostic impact of diabetes in chronic HF depends on patient's age. In patients < 75 years, the coexistence of diabetes predicts an almost double risk of 5-year mortality; no such association exists in patients with 75 years or above. Diabetes predicts mortality only in younger HF patients.

Aerobic Training Effect on Arterial Stiffness in Metabolic Syndrome

BACKGROUND

Metabolic syndrome, physical inactivity, and central obesity contribute to early vascular aging, which leads to increased risk of cardiovascular disease. This study aimed to assess the effect of heart rate (HR)-targeted aerobic exercise training on the indices of early vascular aging, in particular, arterial stiffness, and on anthropometric and clinical profile of metabolic syndrome subjects.

METHODS

There were 126 metabolic syndrome subjects randomly selected. Anthropometric parameters, blood pressure (BP), blood sample, and arterial wall functional and structural parameters were obtained prior to and after the 8-week (84 patients) supervised training program. The age- and sex-matched control group (42 patients) followed the same protocol, except for the HR-targeted training program.

RESULTS

In the study group, HR-targeted training was associated with decreased aortic pulse wave velocity (8.47 ± 1.40 vs 8.01 ± 1.06 m/s; P = .005), HR (P < .001), systolic (P < .015) and diastolic (P < .004) BP, waist circumference (P < .004), total and low-density-lipid cholesterol (respectively, 6.42 ± 1.41 vs 5.89 ± 1.32, P = .003 and 4.2 ± 1.18 vs 3.8 ± 1.21, P = .002), and an increase in aerobic capacity (P < .001). In the control group there were no statistically significant changes of arterial stiffness parameters. Multivariate analysis revealed that reduction of arterial stiffness was BP dependent.

CONCLUSIONS

In subjects with metabolic syndrome, HR-targeted exercise training is associated with BP-dependent decrease in aortic stiffness and improvement of metabolic and fitness parameters.

The association between brain-derived neurotrophic factor and central pulse pressure after an oral glucose tolerance test

BACKGROUND

Arterial stiffening blunts postprandial vasodilatation. We hypothesized that brain-derived neurotrophic factor (BDNF) may modulate postprandial central pulse pressure, a surrogate marker for arterial stiffening.

METHODS

A total of 82 non-diabetic subjects received a 75-g oral glucose tolerance test (OGTT) after overnight fasting. Serum BDNF concentrations were determined at 0, 30, and 120min to calculate the area under the curve (AUC). Brachial and central blood pressures were measured using a noninvasive central blood pressure monitor before blood withdrawals at 0 and 120min.

RESULTS

With the median AUC of BDNF of 45(ng/ml)∗h as the cutoff value, the central pulse pressure after glucose intake was significantly higher in the subjects with a low BDNF than in those with a high BDNF (63±16 vs. 53±11mmHg, P=0.003), while the brachial pulse pressure was not significantly different between the 2 groups (P=0.099). In a multivariate linear regression model, a lower AUC of BDNF was an independent predictor of a higher central pulse pressure after oral glucose intake (linear regression coefficient-0.202, 95% confidence interval-0.340 to -0.065, P=0.004).

CONCLUSION

After oral glucose challenge, a lower serum BDNF response is significantly associated with a higher central pulse pressure.

Gender-specific association of metabolic syndrome and its components with arterial stiffness in the general Chinese population

OBJECTIVES

Metabolic syndrome (MS) is considered to be a cluster of interrelated risk factors for metabolism, which may increase arterial stiffness and cardiovascular morbidity. The cardio-ankle vascular index (CAVI) is a reliable indicator of arterial stiffness and early arteriosclerosis. The main objective of this study is to evaluate the gender-specific relationship between MS and CAVI in the general Chinese population.

METHODS

A total of 1,301 subjects aged 20 to 60 years participated in this study. CAVI was measured noninvasively using a Vasera VS-1000 device. Blood samples and waist circumference were examined to identify metabolic syndrome according to the criteria set forth in the 2009 Joint Scientific Statement.

RESULTS

The prevalence of MS in the study subjects was 17.4% (30.7% in males and 7.0% in females, P < 0.001). CAVI values were significantly higher in MS subjects than in non-MS subjects and increased linearly as the number of MS components increased in females, but not in males. Using multiple regression analysis, we found that BMI was correlated with CAVI in the overall population and in both genders, and that high-density lipoprotein cholesterol (HDL-C) was associated with CAVI in males, while the number of MS components was related to CAVI in females. CAVI values increased linearly with age in both genders (P-trend < 0.001 for both), and this correlation was stronger in males than in females.

CONCLUSIONS

There are gender-specific differences in the association of MS and CAVI. First, the effects of the number of MS components on CAVI are stronger in females than in males. Second, the effect of each MS component on arterial stiffness may differ in relation to gender. In addition, aging affects arterial stiffness more severely in males, and the increase in arterial stiffness tends to occur at a younger age in males than in females. Larger samples and longitudinal studies are needed to further confirm our results in the future.

Mapping cerebral pulse pressure and arterial compliance over the adult lifespan with optical imaging

Cerebrovascular health is important for maintaining a high level of cognitive performance, not only in old age, but also throughout the lifespan. Recently, it was first demonstrated that diffuse optical imaging measures of pulse amplitude and arterial compliance can provide estimates of cerebral arterial health throughout the cortex, and were associated with age, estimated cardiorespiratory fitness (eCRF), neuroanatomy and cognitive function in older adults (aged 55-87). The current study replicates and extends the original findings using a broader age range (a new adult sample aged 18-75), longer recording periods (360 s), and a more extensive optical montage (1536 channels). These methodological improvements represent a 5-fold increase in recording time and a 4-fold increase in coverage compared to the initial study. Results show that reliability for both pulse amplitude and compliance measures across recording blocks was very high (r(45) = .99 and .75, respectively). Pulse amplitude and pulse pressure were shown to correlate with age across the broader age range. We also found correlations between arterial health and both cortical and subcortical gray matter volumes. Additionally, we replicated the correlations between arterial compliance and age, eCRF, global brain atrophy, and cognitive flexibility. New regional analyses revealed that higher performance on the operation span (OSPAN) working memory task was associated with greater localized arterial compliance in frontoparietal cortex, but not with global arterial compliance. Further, greater arterial compliance in frontoparietal regions was associated with younger age and higher eCRF. These associations were not present in the visual cortex. The current study not only replicates the initial one in a sample including a much wider age range, but also provides new evidence showing that frontoparietal regions may be especially vulnerable to vascular degeneration during brain aging, with potential functional consequences in cognition.

Arterial stiffness and its association with clustering of metabolic syndrome risk factors

BACKGROUND

Metabolic syndrome (MetS) is associated with structural and functional vascular abnormalities, which may lead to increased arterial stiffness, more frequent cardiovascular events and higher mortality. However, the role played by clustering of risk factors and the combining pattern of MetS risk factors and their association with the arterial stiffness have yet to be fully understood. Age, hypertension and diabetes mellitus seem to be strongly associated with increased pulse wave velocity (PWV). This study aimed at determining the clustering and combining pattern of MetS risk factors and their association with the arterial stiffness in non-diabetic and non-hypertensive patients.

METHODS

Recently diagnosed and untreated patients with MetS (n = 64, 49 ± 8 year, 32 ± 4 kg/m²) were selected, according to ATP III criteria and compared to a control group (Control, n = 17, 49 ± 6 year, 27 ± 2 kg/m²). Arterial stiffness was evaluated by PWV in the carotid-femoral segment. Patients were categorized and analyzed according MetS risk factors clustering (3, 4 and 5 factors) and its combinations.

RESULTS

Patients with MetS had increased PWV when compared to Control (7.8 ± 1.1 vs. 7.0 ± 0.5 m/s, p < 0.001). In multivariate analysis, the variables that remained as predictors of PWV were age (β = 0.450, p < 0.001), systolic blood pressure (β = 0.211, p = 0.023) and triglycerides (β = 0.212, p = 0.037). The increased number of risk factors reflected in a progressive increase in PWV. When adjusted to systolic blood pressure, PWV was greater in the group with 5 risk factors when compared to the group with 3 risk factors and Control (8.5 ± 0.4 vs. 7.5 ± 0.2, p = 0.011 and 7.2 ± 0.3 m/s, p = 0.012). Similarly, the 4 risk factors group had higher PWV than the Control (7.9 ± 0.2 vs. 7.2 ± 0.3, p = 0.047).

CONCLUSIONS

The number of risk factors seems to increase arterial stiffness. Notably, besides age and increased systolic blood pressure, alterations in the triglycerides worsened the stiffness of large vessels, emphasizing the importance in addressing this risk factor in MetS patients.

The relationship between the metabolic syndrome and arterial wall thickness: A mosaic still to be interpreted

BACKGROUND AND AIMS

We aimed to identify clusters of metabolic syndrome (MetS) components, risky for extremely high intima-media thickness.

METHODS

We studied 41,513 volunteers (men and women) from eleven cohorts worldwide, participating in the MARE (Metabolic syndrome and Artery REsearch) Consortium.

RESULTS

Specific clusters of MetS components - high triglycerides-high blood pressure-abdominal obesity (TBW), low HDL cholesterol-high blood pressure-abdominal obesity (HBW), high glucose-high blood pressure-abdominal obesity (GBW) - were accompanied by a 50-90% significantly greater likelihood of presenting extremely high intima-media thickness (via ultrasound of carotid artery, CCA IMT), after controlling for age, sex, smoking, non-HDL cholesterol, and presence of diabetes mellitus. This likelihood is comparable to the effect of being 7-8 years older or of being a cigarette smoker or of having non-HDL cholesterol 50 mg/dl higher.

CONCLUSIONS

The consistent association of specific clusters of MetS components with extremely thick (older) large artery cross-culturally suggests that identification of those clusters in clinical practice will facilitate a personalized health care and a better - i.e. more healthy and cost-effective - prevention of major cardiovascular (CV) events.

Association of metabolic syndrome and its components with arterial stiffness in Caucasian subjects of the MARK study: a cross-sectional trial

BACKGROUND

The cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV) can reflect both central and peripheral arterial stiffness. Metabolic syndrome (MetS) and its components may increase arterial stiffness and the risk of cardiovascular diseases. However, the correlation of MetS and its components with arterial stiffness is still not clear. The primary aim of this study is thus the relationship using baPWV and CAVI in Caucasian adults with intermediate cardiovascular risk. The secondary aim is to analyze sex differences.

METHODS

This study analyzed 2351 subjects aged 35-74 years (mean, 61.4 ± 7.7 years) comprising 61.7 % males and enrolled in the improving interMediAte Risk management (MARK) study. CAVI was measured using a VaSera VS-1500 ^® device, and baPWV was calculated using a validated equation. MetS was defined based on the Joint Scientific Statement National Cholesterol Education Program III. Waist circumference, blood pressure, fasting plasma glucose, and lipid profile were measured.

RESULTS

MetS was found in 51.9 % of the subjects. All MetS components except reduced HDL-cholesterol (p = 0.578) were associated with CAVI. High density lipoprotein cholesterol (p = 0.075) and waist circumference (p = 0.315) were associated with baPWV. The different MetS components that assess dyslipidemia using the stiffness measures show different associations according to patient sex. The high blood pressure component had a greater odds ratio (OR) for both baPWV ≥ 17.5 m/sec (OR = 6.90, 95 % CI 3.52-13.519) and CAVI ≥ 9 (OR = 2.20, 95 % CI 1.63-1.90).

CONCLUSIONS

MetS and all its components (except HDL-cholesterol with baPWV and CAVI and WC with baPWV) were associated with baPWV and CAVI. However, there were sex differences in the association of MetS and its components with baPWV and CAVI. Data from this study suggest a greater association of CAVI and baPWV values with MetS components in males than in females and indicate greater arterial stiffness in the event of simultaneously elevated blood pressure, fasting plasma glucose, and waist circumference. Trial Registration Clinical Trials.gov Identifier: https://clinicaltrials.gov/ct2/show/ NCT01428934. Registered 2 September 2011. Last updated September 8, 2016.

Circumferential strain of carotid arteries does not differ between patients with advanced coronary artery disease and group without coronary stenoses

PURPOSE

Speckle tracking echocardiography is widely used for the analysis of myocardial function. Recently, circumferential strain (CS) of carotid arteries was postulated as novel indicator of vascular function. Our aim was to characterize and compare CS of carotid arteries in patients with advanced coronary artery disease and controls without significant coronary stenoses.

PATIENTS/METHODS

We compared CS of both common carotid arteries (CCA) in the 25 patients with three-vessel coronary artery disease (3VD) (mean age 69±9 years, 9 male) and in 16 age-matched subjects without significant coronary lesions (C) (69±8 years, 7 male). Additionally in 11 patients we estimated pulse wave velocity (PWV) and assessed the correlation between PWV and CS. Short-axis images of arteries were acquired for strain analysis with linear probe of echocardiograph. The assessment of CS was performed off-line by two observers.

RESULTS

The intraobserver variability for the CS (coefficient of variation) were 4.9 and 5.4% for left and right CCA and interobserver variability were 11.7% and 12.5%, respectively. The mean CS for left and right CCA did not differ between compared groups. We did not find correlation between CS strain and PWV. The only difference was related to the more prevalent plaque presence and thicker intima-media complex (IMT) in 3VD (p=0.0039 for IMT of left CCA and p=0.016 for IMT of right CCA).

CONCLUSIONS

The global CS of CCA, contrary to IMT, did not allow for differentiation between 3VD and C subjects. Despite good feasibility and concordance of CS measurements its clinical significance remains to be established.

No evidence of association between subclinical thyroid disorders and common carotid intima medial thickness or atherosclerotic plaque

BACKGROUND AND AIMS

Increased carotid artery intima-media thickness (IMT) and the presence of plaques have been shown to be predictors of cardiovascular disease. The cardiovascular risk in patients with overt thyroid diseases is related to increased risk of atherosclerosis, but there has been no clear evidence about subclinical disorders. We have assessed whether subclinical thyroid dysfunction is associated with arterial thickening and plaque.

METHODS AND RESULTS

The SardiNIA study is a population-based survey on the Italian island of Sardinia. We reviewed data from 5815 subjects (aged 14-102 years), none of whom had overt hyperthyroidism or hypothyroidism or was taking thyroid medication. Serum thyrotropin (TSH), free thyroxine, together with carotid ultrasound IMT and the presence of common carotid plaques were analysed in all subjects. Possible association of IMT and carotid plaques with thyroid parameters was evaluated by univariate and multivariate analyses. IMT was significantly associated with age, sex, smoking, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol, pulse pressure (PP), history of arterial hypertension, diabetes, and previous cardiovascular events (p = 0.001 or lower, R(2) = 0.47). Carotid plaques were predicted by age, sex, LDL, PP, history of diabetes, previous cardiovascular events, and the use of statins (p = 0.029 or lower). Thyroid hormone was not predictive of carotid atherosclerosis when adjusted for confounders.

CONCLUSION

Thyroid hormone is not associated with increased IMT or with the presence of carotid artery plaque. Our data do not support the idea that treating subclinical disorders might help to prevent arterial remodelling or carotid atherosclerosis.

Executive dysfunction assessed by Clock-Drawing Test in older non-demented subjects with metabolic syndrome is not mediated by white matter lesions

AIMS

Metabolic syndrome (MetS) has been associated with greater occurrence of white matter hyperintensities (WMH). It remains uncertain whether MetS as a construct is associated with poorer cognitive performances. This study explores whether MetS is associated with poorer performances in global and domain-specific cognitive tests in older non-demented subjects independently of its individual components, WMH severity and other variables.

METHODS

MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III definition. Brain magnetic resonance studies (1.5T) were performed. Deep and periventricular WMH were graded using the Fazekas scale. Subjects underwent the Mini-Mental State Examination, the Babcock Short Story Recall test and the Clock-Drawing Test (CDT).

RESULTS

Eighty community-dwellers aged 67-91 years were studied. Subjects with MetS (n = 35) had more severe WMH, and poorer performances on the CDT (P = 0.003) and the Babcock Short Story Recall test (P = 0.027). After multiple adjustment, MetS was inversely associated with CDT scores (B = -1.285; 95% confidence interval = -1.996--0.575; P = 0.001) but not with episodic memory. Results were not affected by WMH severity. Interestingly, none of the individual components of MetS predicted poorer cognitive performances.

CONCLUSIONS

Impairment in executive functions assessed by CDT may represent an early and specific sign of cognitive decline in older individuals with MetS. Future longitudinal studies are needed to better establish the predictive role of MetS on dementia and to demonstrate the possibility of dementia prevention by targeting MetS.

Metabolic syndrome across Europe: different clusters of risk factors

BACKGROUND

Metabolic syndrome (MetS) remains a controversial entity. Specific clusters of MetS components - rather than MetS per se - are associated with accelerated arterial ageing and with cardiovascular (CV) events. To investigate whether the distribution of clusters of MetS components differed cross-culturally, we studied 34,821 subjects from 12 cohorts from 10 European countries and one cohort from the USA in the MARE (Metabolic syndrome and Arteries REsearch) Consortium.

METHODS

In accordance with the ATP III criteria, MetS was defined as an alteration three or more of the following five components: elevated glucose (G), fasting glucose ≥110 mg/dl; low HDL cholesterol, < 40mg/dl for men or <50 mg/dl for women; high triglycerides (T), ≥150 mg/dl; elevated blood pressure (B), ≥130/≥85 mmHg; abdominal obesity (W), waist circumference >102 cm for men or >88 cm for women.

RESULTS

MetS had a 24.3% prevalence (8468 subjects: 23.9% in men vs. 24.6% in women, p < 0.001) with an age-associated increase in its prevalence in all the cohorts. The age-adjusted prevalence of the clusters of MetS components previously associated with greater arterial and CV burden differed across countries (p < 0.0001) and in men and women (p < 0.0001). In details, the cluster TBW was observed in 12% of the subjects with MetS, but was far more common in the cohorts from the UK (32.3%), Sardinia in Italy (19.6%), and Germany (18.5%) and less prevalent in the cohorts from Sweden (1.2%), Spain (2.6%), and the USA (2.5%). The cluster GBW accounted for 12.7% of subjects with MetS with higher occurrence in Southern Europe (Italy, Spain, and Portugal: 31.4, 18.4, and 17.1% respectively) and in Belgium (20.4%), than in Northern Europe (Germany, Sweden, and Lithuania: 7.6, 9.4, and 9.6% respectively).

CONCLUSIONS

The analysis of the distribution of MetS suggested that what follows under the common definition of MetS is not a unique entity rather a constellation of cluster of MetS components, likely selectively risky for CV disease, whose occurrence differs across countries.

Metabolic syndrome in hypertensive patients: An unholy alliance

For many years, it has been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance and hyperuricemia. This constellation of various conditions has been transformed from a pathophysiological concept to a clinical entity, which has been defined metabolic syndrome (MetS). The consequences of the MetS have been difficult to assess without commonly accepted criteria to diagnose it. For this reason, on 2009 the International Diabetes Federation, the American Heart Association and other scientific organizations proposed a unified MetS definition. The incidence of the MetS has been increasing worldwide in parallel with an increase in overweight and obesity. The epidemic proportion reached by the MetS represents a major public health challenge, because several lines of evidence showed that the MetS, even without type 2 diabetes, confers an increased risk of cardiovascular morbidity and mortality in different populations including also hypertensive patients. It is likely that the enhanced cardiovascular risk associated with MetS in patients with high blood pressure may be largely mediated through an increased prevalence of preclinical cardiovascular and renal changes, such as left ventricular hypertrophy, early carotid atherosclerosis, impaired aortic elasticity, hypertensive retinopathy and microalbuminuria. Indeed, many reports support this notion, showing that hypertensive patients with MetS exhibit, more often than those without it, these early signs of end organ damage, most of which are recognized as significant independent predictors of adverse cardiovascular outcomes.