1
|
Scott DA, Ponir C, Shapiro MD, Chevli PA. Associations between insulin resistance indices and subclinical atherosclerosis: A contemporary review. Am J Prev Cardiol 2024; 18:100676. [PMID: 38828124 PMCID: PMC11143894 DOI: 10.1016/j.ajpc.2024.100676] [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: 01/19/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 06/05/2024] Open
Abstract
Even in the absence of hyperglycemia or hyperlipidemia, it has been demonstrated that insulin resistance is an independent risk factor for atherosclerosis. Finding markers of insulin resistance that are associated with markers of atherosclerosis could help identify patients early in their disease course and allow for earlier initiation of preventative treatments. We reviewed available evidence regarding associations between known markers of insulin resistance and known markers of atherosclerosis. Serum triglycerides (TG), triglyceride-glucose index (TyG), and homeostasis model assessment (HOMA) were the insulin resistance markers reviewed. The coronary artery calcium score (CAC), carotid intimal medium thickness (cIMT), and pulse wave velocity (PWV) were reviewed as markers of atherosclerosis. TyG showed the most consistent association with CAC across broad demographic groups, though HOMA showed potential in obese individuals and those without diabetes. The data regarding cIMT and the reviewed insulin resistance markers did not yield any consistent associations, though very elevated TyG did appear to be associated with cIMT among normal weight individuals. Serum triglycerides showed a strong and consistent association with PWV across numerous studies and populations, though TyG index also demonstrated a strong association with PWV in a large systematic review. Of the insulin resistance markers reviewed, the TyG index appears to be most consistently associated with markers of atherosclerosis. TyG can be easily calculated with routine labwork and has the potential to inform decisions regarding early initiation of therapies in patients who would otherwise not be treated. Targeting insulin sensitivity prior to the development of T2DM has the potential to reduce development and progression of atherosclerosis, and patients without T2DM but who have elevated TyG index should be the topic of further research.
Collapse
Affiliation(s)
- Drake A. Scott
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Cynthia Ponir
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Michael D. Shapiro
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Parag A. Chevli
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| |
Collapse
|
2
|
Choudhary MK, Bouquin H, Hytönen J, Koskela JK, Niemelä O, Nevalainen PI, Mustonen J, Pörsti I. Blood Haemoglobin Concentration Is Directly and Independently Related with Pulse Wave Velocity, a Measure of Large Artery Stiffness. J Clin Med 2023; 12:7623. [PMID: 38137695 PMCID: PMC10743951 DOI: 10.3390/jcm12247623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
High haemoglobin level has been associated with metabolic syndrome, elevated blood pressure (BP), and increased mortality risk. In this cross-sectional study, we investigated the association of blood haemoglobin with haemodynamics in 743 subjects, using whole-body impedance cardiography and pulse wave analysis. The participants were allocated to sex-stratified haemoglobin tertiles with mean values 135, 144, and 154 g/L, respectively. The mean age was similar in all tertiles, while body mass index was higher in the highest versus the lowest haemoglobin tertile. The highest haemoglobin tertile had the highest erythrocyte and leukocyte counts, plasma C-reactive protein, uric acid, renin activity, and aldosterone. The lipid profile was less favourable and insulin sensitivity lower in the highest versus the lowest haemoglobin tertile. Aortic BP, cardiac output, and systemic vascular resistance were similar in all tertiles, while the pulse wave velocity (PWV) was higher in the highest versus the lowest haemoglobin tertile. In linear regression analysis, age (Beta 0.478), mean aortic BP (Beta 0.178), uric acid (Beta 0.150), heart rate (Beta 0.148), and aldosterone-to-renin ratio (Beta 0.123) had the strongest associations with PWV (p < 0.001 for all). Additionally, haemoglobin concentration was an explanatory factory for PWV (Beta 0.070, p = 0.028). To conclude, blood haemoglobin concentration had a small direct and independent association with a measure of large artery stiffness.
Collapse
Affiliation(s)
- Manoj Kumar Choudhary
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Heidi Bouquin
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Jere Hytönen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Jenni K. Koskela
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland;
| | - Pasi I. Nevalainen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| |
Collapse
|
3
|
Flores-Ramírez AG, Tovar-Villegas VI, Maharaj A, Garay-Sevilla ME, Figueroa A. Effects of L-Citrulline Supplementation and Aerobic Training on Vascular Function in Individuals with Obesity across the Lifespan. Nutrients 2021; 13:nu13092991. [PMID: 34578869 PMCID: PMC8466140 DOI: 10.3390/nu13092991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/20/2022] Open
Abstract
Children with obesity are at higher risk for developing cardiometabolic diseases that once were considered health conditions of adults. Obesity is commonly associated with cardiometabolic risk factors such as dyslipidemia, hyperglycemia, hyperinsulinemia and hypertension that contribute to the development of endothelial dysfunction. Endothelial dysfunction, characterized by reduced nitric oxide (NO) production, precedes vascular abnormalities including atherosclerosis and arterial stiffness. Thus, early detection and treatment of cardiometabolic risk factors are necessary to prevent deleterious vascular consequences of obesity at an early age. Non-pharmacological interventions including L-Citrulline (L-Cit) supplementation and aerobic training stimulate endothelial NO mediated vasodilation, leading to improvements in organ perfusion, blood pressure, arterial stiffness, atherosclerosis and metabolic health (glucose control and lipid profile). Few studies suggest that the combination of L-Cit supplementation and exercise training can be an effective strategy to counteract the adverse effects of obesity on vascular function in older adults. Therefore, this review examined the efficacy of L-Cit supplementation and aerobic training interventions on vascular and metabolic parameters in obese individuals.
Collapse
Affiliation(s)
- Anaisa Genoveva Flores-Ramírez
- Department of Medical Science, Division of Health Science, University of Guanajuato, Campus León, León 37320, Mexico; (A.G.F.-R.); (V.I.T.-V.)
| | - Verónica Ivette Tovar-Villegas
- Department of Medical Science, Division of Health Science, University of Guanajuato, Campus León, León 37320, Mexico; (A.G.F.-R.); (V.I.T.-V.)
| | - Arun Maharaj
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA;
| | - Ma Eugenia Garay-Sevilla
- Department of Medical Science, Division of Health Science, University of Guanajuato, Campus León, León 37320, Mexico; (A.G.F.-R.); (V.I.T.-V.)
- Correspondence: (M.E.G.-S.); (A.F.)
| | - Arturo Figueroa
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA;
- Correspondence: (M.E.G.-S.); (A.F.)
| |
Collapse
|
4
|
Bielecka-Dabrowa A, Bartlomiejczyk MA, Sakowicz A, Maciejewski M, Banach M. The Role of Adipokines in the Development of Arterial Stiffness and Hypertension. Angiology 2020; 71:754-761. [PMID: 32431166 DOI: 10.1177/0003319720927203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The study aimed to assess the role and the relationship of adipokines as well as parameters of arterial stiffness in newly diagnosed hypertension. Forty-nine newly diagnosed hypertensive cases (median age 47 ± 6 years) and 48 normotensive patients (median age 47 ± 6 years) were enrolled to this study. Patients underwent echocardiography, noninvasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med). The levels of the adipokines-leptin, adiponectin, and resistin-were investigated. The augmentation pressure, augmentation index, and pulse wave velocity (PWV) were higher in patients with hypertension compared with controls (Ps < .05). Patients with hypertension had higher E/E' ratio, higher diameter of left atrium, and lower tricuspid annular plane systolic excursion compared with the control group (Ps < .05). Patients with hypertension had significant higher levels of leptin (ng/mL) and lower levels of adiponectin (μg/mL) compared with normotensive patients. The multivariate analysis showed that PWV (odds ratio [OR] 1.95, 95% CI, 1.2-2.9; P = .002) and leptin level (OR 1.01, 95% CI, 1.004-1.031; P = .01) were significantly associated with hypertension. Arterial stiffness as determined by PWV and leptin are associated with newly diagnosed hypertension. Elevated serum leptin level may influence the potential mechanism leading to sympathetic activation.
Collapse
Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Hypertension, Medical University of Lodz, Poland.,Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | | | - Agata Sakowicz
- Department of Medical Biotechnology, Medical University of Lodz, Poland
| | - Marek Maciejewski
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland.,Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| |
Collapse
|
5
|
Poon AK, Meyer ML, Tanaka H, Selvin E, Pankow J, Zeng D, Loehr L, Knowles JW, Rosamond W, Heiss G. Association of insulin resistance, from mid-life to late-life, with aortic stiffness in late-life: the Atherosclerosis Risk in Communities Study. Cardiovasc Diabetol 2020; 19:11. [PMID: 31992297 PMCID: PMC6986071 DOI: 10.1186/s12933-020-0986-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background Insulin resistance may contribute to aortic stiffening that leads to end-organ damage. We examined the cross-sectional association and prospective association of insulin resistance and aortic stiffness in older adults without diabetes. Methods We analyzed 2571 men and women at Visit 5 (in 2011–2013), and 2350 men and women at repeat examinations from baseline at Visit 1 (in 1987–1989) to Visit 5 (in 2011–2013). Linear regression was used to estimate the difference in aortic stiffness per standard unit of HOMA-IR, TG/HDL-C, and TyG at Visit 5. Linear mixed effects were used to assess if high, as opposed to non-high, aortic stiffness (> 75th percentile) was preceded by a faster annual rate of change in log-HOMA-IR, log-TG/HDL-C, and log-TyG from Visit 1 to Visit 5. Results The mean age of participants was 75 years, 37% (n = 957) were men, and 17% (n = 433) were African American. At Visit 5, higher HOMA-IR, higher TG/HDL-C, and higher TyG were associated with higher aortic stiffness (16 cm/s per SD (95% CI 6, 27), 29 cm/s per SD (95% CI 18, 40), and 32 cm/s per SD (95% CI 22, 42), respectively). From Visit 1 to Visit 5, high aortic stiffness, compared to non-high aortic stiffness, was not preceded by a faster annual rate of change in log-HOMA-IR from baseline to 9 years (0.030 (95% CI 0.024, 0.035) vs. 0.025 (95% CI 0.021, 0.028); p = 0.15) or 9 years onward (0.011 (95% CI 0.007, 0.015) vs. 0.011 (95% CI 0.009, 0.013); p = 0.31); in log-TG/HDL-C from baseline to 9 years (0.019 (95% CI 0.015, 0.024) vs. 0.024 (95% CI 0.022, 0.026); p = 0.06) or 9 years onward (− 0.007 (95% CI − 0.010, − 0.005) vs. − 0.009 (95% CI − 0.010, − 0.007); p = 0.08); or in log-TyG from baseline to 9 years (0.002 (95% CI 0.002, 0.003) vs. 0.003 (95% CI 0.003, 0.003); p = 0.03) or 9 years onward (0 (95% CI 0, 0) vs. 0 (95% CI 0, 0); p = 0.08). Conclusions Among older adults without diabetes, insulin resistance was associated with aortic stiffness, but the putative role of insulin resistance in aortic stiffness over the life course requires further study.
Collapse
Affiliation(s)
- Anna K Poon
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA. .,, 1620 Tremont Street, OBC 3-34, Boston, MA, 02120, USA.
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - James Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Laura Loehr
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Joshua W Knowles
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, USA
| | - Wayne Rosamond
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| |
Collapse
|
6
|
Norton CE, Jacobsen NL, Sinkler SY, Manrique-Acevedo C, Segal SS. Female sex and Western-style diet protect mouse resistance arteries during acute oxidative stress. Am J Physiol Cell Physiol 2019; 318:C627-C639. [PMID: 31891519 DOI: 10.1152/ajpcell.00342.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A Western-style diet (WD; high in fat and carbohydrates) increases vascular oxidative stress. We hypothesized that vascular cells adapt to a WD by developing resilience to oxidative stress. Male and female C57BL/6J mice (4 wk of age) were fed a control diet (CD) or a WD for 16-20 wk. Superior epigastric arteries (SEAs; diameter, ~125 µm) were isolated and pressurized for study. Basal reactive oxygen species production was greatest in SEAs from males fed the WD. During exposure to H2O2 (200 μM, 50 min), propidium iodide staining identified nuclei of disrupted endothelial cells (ECs) and smooth muscle cells (SMCs). For mice fed the CD, death of SMCs (21%) and ECs (6%) was greater (P < 0.05) in SEAs from males than females (9% and 2%, respectively). WD consumption attenuated cell death most effectively in SEAs from males. With no difference at rest, H2O2 increased intracellular Ca2+ concentration ([Ca2+]i) to the greatest extent in SEAs from males, as shown by fura 2 fluorescence. Selective disruption of the endothelium (luminal air bubble) increased [Ca2+]i and SMC death during H2O2 exposure irrespective of sex; the WD reduced both responses most effectively in males. Nonselective transient receptor potential (TRP) channel inhibition (ruthenium red, 5 μM) attenuated the rise of [Ca2+]i, as did selective inhibition of TRP vanilloid type 4 (TRPV4) channels (HC-067047, 1 μM), which also attenuated cell death. In contrast, inhibition of voltage-gated Ca2+ channels (diltiazem, 50 μM) was without effect. Thus, for resistance arteries during acute oxidative stress: 1) ECs are more resilient than (and can protect) SMCs, 2) vessels from females are inherently more resilient than those from males, and 3) a WD increases vascular resilience by diminishing TRPV4 channel-dependent Ca2+ entry.
Collapse
Affiliation(s)
- Charles E Norton
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Nicole L Jacobsen
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Shenghua Y Sinkler
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Camila Manrique-Acevedo
- Department of Medicine, University of Missouri, Columbia, Missouri.,Research Services, Harry S Truman Memorial Veterans Hospital, Columbia, Missouri.,Dalton Cardiovascular Research Center, Columbia, Missouri
| | - Steven S Segal
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri.,Dalton Cardiovascular Research Center, Columbia, Missouri
| |
Collapse
|
7
|
Li H, Zhan J, Liao B, Wang Y, Liu Y. Plasma levels of adiponectin and chemerin are associated with early stage of atherosclerosis in older adults with type 2 diabetes mellitus. Aging Med (Milton) 2019; 2:198-206. [PMID: 34553107 PMCID: PMC8445043 DOI: 10.1002/agm2.12087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Adipokines, such as adiponectin and chemerin, regulate fat metabolism and are critical for the development of atherosclerosis. Investigating the correlations of adiponectin and chemerin with atherosclerosis in older adults with type 2 diabetes mellitus (T2DM) will shed light on the search for new markers for early diagnosis of diabetic atherosclerosis. METHODS A total of 120 older T2DM patients and nine healthy controls were enrolled in this study. The clinical parameters, such as brachial-ankle pulse wave velocity (ba-PWV), adiponectin, and chemerin, were examined and recorded. T2DM subjects were divided into three groups according to ba-PWV level (high, medium, or low). The data were processed and analyzed by identical methods. RESULTS Significantly higher chemerin and lower adiponectin levels were detected in the plasma of T2DM patients than in healthy controls. The plasma levels of chemerin and adiponectin were negatively correlated in T2DM patients. Moreover, chemerin and adiponectin were significantly correlated with body mass index, ankle-brachial index, insulin, and ba-PWV. Multiple linear regression analysis revealed that chemerin and adiponectin were independently affecting ba-PWV. CONCLUSION Adiponectin and chemerin are potential markers for diagnosis and monitoring of early stage of atherosclerosis in older adults with T2DM. Further clinical investigations are required to confirm these markers.
Collapse
Affiliation(s)
- Huahua Li
- Department of GeriatricsThe Hunan Provincial People's HospitalFirst Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Junkun Zhan
- Department of GeriatricsThe Second Xiang‐Ya HospitalInstitute of Aging and Geriatric ResearchCentral South UniversityChangshaChina
| | - Bin Liao
- Department of GeriatricsThe Hunan Provincial People's HospitalFirst Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Yanjiao Wang
- Department of GeriatricsThe Second Xiang‐Ya HospitalInstitute of Aging and Geriatric ResearchCentral South UniversityChangshaChina
| | - Youshuo Liu
- Department of GeriatricsThe Second Xiang‐Ya HospitalInstitute of Aging and Geriatric ResearchCentral South UniversityChangshaChina
| |
Collapse
|
8
|
Zhang ZZ, Wang P, Kong XL, Mao WL, Cui MY. Association of hemoglobin with arterial stiffness evaluated by carotid-femoral pulse wave velocity among Chinese adults. Chronic Dis Transl Med 2019; 5:122-128. [PMID: 31367701 PMCID: PMC6656875 DOI: 10.1016/j.cdtm.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Increased hemoglobin (Hb) levels are known to be associated with increased cardiovascular events and mortalities. Therefore, we assumed that high Hb levels were associated with arterial stiffness. Pulse wave velocity (PWV) is a simple and noninvasive method for measuring arterial stiffness to assess cardiovascular disease in general populations. Accordingly, we conducted a cross-sectional study to explore the association of Hb with PWV. Methods A total of 6642 adults aged 54.5 ± 11.2 years undergoing physical examinations were enrolled, 71.7% of whom were males. Arterial stiffness was evaluated by carotid-femoral PWV (cfPWV). Multivariable regression analyses were performed to determine the relationship between Hb and increased cfPWV. Results In this study, the mean Hb (per 10 g/L increase) was 144.7 ± 13.9 g/L, and the mean cfPWV was 15.1 ± 3.1 m/s. cfPWV was significantly higher in high hemoglobin groups ≥15.4 g/L (Quartile 4) than in the lowest hemoglobin group (Quartile 1 ≤ 13.6 g/L; P < 0.001). Multiple linear regression analysis revealed that Hb positively correlated with cfPWV (β = 0.16, P < 0.01). Univariate Logistic regression analysis revealed that Hb was associated with increased cfPWV, with an odd ratio (OR) of 1.46 (95% confidence interval [CI], 1.39–1.54). After adjusting for potential confounders, Hb and the highest Hb quartile group were also independently associated with increased cfPWV, with a fully adjusted OR of 1.11 (95% CI, 1.02–1.20) and 1.45 (95% CI, 1.01–2.08), respectively. Conclusion This study demonstrated that Hb levels significantly correlate with increased cfPWV.
Collapse
Affiliation(s)
- Zhen-Zhen Zhang
- Taishan Medical University, Tai'an, Shandong 271000, China.,Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, China
| | - Ping Wang
- Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, China
| | - Xiang-Lei Kong
- Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, China
| | - Wen-Li Mao
- Taishan Medical University, Tai'an, Shandong 271000, China.,Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, China
| | - Mei-Yu Cui
- Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, China
| |
Collapse
|
9
|
Adeva-Andany MM, Ameneiros-Rodríguez E, Fernández-Fernández C, Domínguez-Montero A, Funcasta-Calderón R. Insulin resistance is associated with subclinical vascular disease in humans. World J Diabetes 2019; 10:63-77. [PMID: 30788044 PMCID: PMC6379732 DOI: 10.4239/wjd.v10.i2.63] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 02/05/2023] Open
Abstract
Insulin resistance is associated with subclinical vascular disease that is not justified by conventional cardiovascular risk factors, such as smoking or hypercholesterolemia. Vascular injury associated to insulin resistance involves functional and structural damage to the arterial wall that includes impaired vasodilation in response to chemical mediators, reduced distensibility of the arterial wall (arterial stiffness), vascular calcification, and increased thickness of the arterial wall. Vascular dysfunction associated to insulin resistance is present in asymptomatic subjects and predisposes to cardiovascular diseases, such as heart failure, ischemic heart disease, stroke, and peripheral vascular disease. Structural and functional vascular disease associated to insulin resistance is highly predictive of cardiovascular morbidity and mortality. Its pathogenic mechanisms remain undefined. Prospective studies have demonstrated that animal protein consumption increases the risk of developing cardiovascular disease and predisposes to type 2 diabetes (T2D) whereas vegetable protein intake has the opposite effect. Vascular disease linked to insulin resistance begins to occur early in life. Children and adolescents with insulin resistance show an injured arterial system compared with youth free of insulin resistance, suggesting that insulin resistance plays a crucial role in the development of initial vascular damage. Prevention of the vascular dysfunction related to insulin resistance should begin early in life. Before the clinical onset of T2D, asymptomatic subjects endure a long period of time characterized by insulin resistance. Latent vascular dysfunction begins to develop during this phase, so that patients with T2D are at increased cardiovascular risk long before the diagnosis of the disease.
Collapse
Affiliation(s)
- María M Adeva-Andany
- Internal Medicine Department, Hospital General Juan Cardona, Ferrol 15406, Spain
| | | | | | | | | |
Collapse
|
10
|
Kim DJK, Roe CA, Somani YB, Moore DJ, Barrett MA, Flanagan M, Kim-Shapiro DB, Basu S, Muller MD, Proctor DN. Effects of acute dietary nitrate supplementation on aortic blood pressures and pulse wave characteristics in post-menopausal women. Nitric Oxide 2019; 85:10-16. [PMID: 30668996 DOI: 10.1016/j.niox.2019.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/08/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Consumption of nitrate-rich beetroot juice can lower blood pressure in peripheral as well as central arteries and may exert additional hemodynamic benefits (e.g. reduced aortic wave reflections). The specific influence of nitrate supplementation on arterial pressures and aortic wave properties in postmenopausal women, a group that experiences accelerated increases in these variables with age, is unknown. Accordingly, the primary aim of this study was to determine the effect of consuming nitrate-rich beetroot juice on resting brachial and aortic blood pressures (BP) and pulse wave characteristics in a group of healthy postmenopausal women, in comparison to a true (nitrate-free beetroot juice) placebo. METHODS Brachial (oscillometric cuff) and radial (SphygmoCor) pressures and derived-aortic waveforms were measured during supine rest in thirteen healthy postmenopausal women (63 ± 1 yr) before and 100 min after consumption of 140 ml of either nitrate-rich (9.7 mmol, 0.6 gm NO3-) or nitrate-depleted beetroot juice on randomized visits approximately 10 days apart (cross-over design). Ten young premenopausal women (22 ± 1 yr) served as a reference (non-supplemented) cohort. RESULTS Brachial and derived-aortic variables showed the expected age-associated differences in these women (all p < 0.05). In post-menopausal women, nitrate supplementation reduced (p < 0.05 vs. placebo visit) brachial systolic BP (BRnitrate -4.9 ± 2.1 mmHg vs BRplacebo +1.1 ± 1.8 mmHg), brachial mean BP (BRnitrate -4.1 ± 1.7 mmHg vs BRplacebo +0.9 ± 1.3 mmHg), aortic systolic BP (BRnitrate -6.3 ± 2.0 mmHg vs BRplacebo +0.5 ± 1.7 mmHg) and aortic mean BP (BRnitrate -4.1 ± 1.7 mmHg vs BRplacebo +0.9 ± 1.3 mmHg), and increased pulse pressure amplification (BRnitrate +4.6 ± 2.0% vs BRplacebo +0.7 ± 2.5%, p = 0.04), but did not alter aortic pulse wave velocity or any other derived-aortic variables (e.g., augmentation pressure or index). CONCLUSIONS Dietary nitrate supplementation favorably modifies aortic systolic and mean blood pressure under resting conditions in healthy postmenopausal women. Acute supplementation of nitrate does not, however, appear to restore indices of aortic stiffness in this group. Future work should evaluate chronic, long-term effects of this non-pharmacological supplement.
Collapse
Affiliation(s)
| | - Carly A Roe
- Penn State University, University Park, PA, USA
| | | | | | | | - Michael Flanagan
- Penn State College of Medicine, Hershey, PA, USA; Penn State Hershey Family and Community Medicine, University Park, USA
| | | | - Swati Basu
- Wake Forest University, Winston-Salem, NC, USA
| | | | - David N Proctor
- Penn State College of Medicine, Hershey, PA, USA; Penn State University, University Park, PA, USA.
| |
Collapse
|
11
|
Syed-Abdul MM, Hu Q, Jacome-Sosa M, Padilla J, Manrique-Acevedo C, Heimowitz C, Parks EJ. Effect of carbohydrate restriction-induced weight loss on aortic pulse wave velocity in overweight men and women. Appl Physiol Nutr Metab 2018; 43:1247-1256. [DOI: 10.1139/apnm-2018-0113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Increased aortic stiffness, measured by carotid-to-femoral pulse wave velocity (PWV), is an independent predictor of cardiovascular disease, and past data have shown that low-fat and low-energy diets, fed for 8–24 weeks, lower PWV. The purpose of this study was to determine whether a reduction in PWV would be achieved by dietary carbohydrate (CHO) restriction, shown to bring about weight loss over a shorter timeframe. Men (n = 10, age: 41.8 ± 10.2 years, BMI: 34.2 ± 3.0 kg/m2 (mean ± SD)) and women (n = 10, age: 38.6 ± 6.1 years, BMI: 33.5 ± 3.8 kg/m2) with characteristics of insulin resistance and the metabolic syndrome consumed a structured, CHO-restricted diet for 4 weeks (energy deficit, 645 kcal/day). For the whole group, subjects lost 5.4% ± 0.5% (P < 0.001) of body weight and experienced significant reductions in blood pressure (6%–8%), plasma insulin (34%), and triglycerides (34%). PWV was reduced by 6% ± 2% (7.1 ± 0.2 m/s to 6.7 ± 0.2 m/s, P = 0.008) and surprisingly, in women, it fell significantly (from 7.2 ± 0.3 m/s to 6.3 ± 0.3 m/s, P = 0.028), while no changes were observed in men (7.2 ± 0.3 vs. 7.0 ± 0.3 m/s, P = 0.144). This is the first study to demonstrate that weight loss can improve PWV in as little as 4 weeks and that dietary CHO restriction may be an effective treatment for reducing aortic stiffness in women. Future studies are needed to establish the mechanisms by which dietary CHO restriction may confer more cardiovascular benefits to women than to men.
Collapse
Affiliation(s)
- Majid M. Syed-Abdul
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Qiong Hu
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Miriam Jacome-Sosa
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Camila Manrique-Acevedo
- Division of Endocrinology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | | | - Elizabeth J. Parks
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| |
Collapse
|
12
|
Omolekulo TE, Areola ED, Badmus OO, Michael OS, Kim I, Olatunji LA. Inhibition of adenosine deaminase and xanthine oxidase by valproic acid abates hepatic triglyceride accumulation independent of corticosteroids in female rats treated with estrogen-progestin. Can J Physiol Pharmacol 2018; 96:1092-1103. [PMID: 30001502 DOI: 10.1139/cjpp-2018-0231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Elevated circulating uric acid has been postulated to play an important pathophysiological role in estrogen-progestin combined oral contraceptive (COC)-induced hypertension and endothelial dysfunction. We hypothesized that disruption of glucoregulation and liver triglyceride (TG) accumulation induced by COC use would be abated by valproic acid (VPA) treatment through suppression of adenosine deaminase (ADA) and xanthine oxidase (XO) activities. Female Wistar rats aged 9-10 weeks were treated with a combination of estrogen-progestin COC steroids (1.0 μg ethinylestradiol and 5.0 μg levonorgestrel; p.o.) with or without VPA (100.0 mg/kg; p.o.) daily for 6 weeks. The result shows that the disrupted glucoregulation and associated elevated hepatic ADA activity, plasma and hepatic XO activity, uric acid (UA), TG/HDL-cholesterol, total cholesterol, and malondialdehyde induced by COC treatment were attenuated by VPA treatment. However, VPA did not have any effect on plasma aldosterone, corticosterone, ADA, circulating and hepatic free fatty acid. Our results demonstrate that suppression of plasma and hepatic XO activities, along with hepatic ADA activity and UA by VPA treatment, protects against disrupted glucoregulation and increased liver TG by COC independent of elevated corticosteroids. The findings imply that VPA would provide protection against the development of cardiometabolic disorder via inhibition of the ADA/XO/UA-mediated pathway.
Collapse
Affiliation(s)
- Tolulope Eniola Omolekulo
- a HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Damilare Areola
- a HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olufunto Olayinka Badmus
- a HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.,b Department of Public Health, Kwara State University, Malete, Nigeria
| | - Olugbenga Samuel Michael
- a HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.,c Cardiometabolic Research Unit, Department of Physiology, College of Health Sciences, Bowen University, Iwo, Nigeria
| | - Inkyeom Kim
- d Cardiovascular Research Institute and Department of Pharmacology, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Lawrence Aderemi Olatunji
- a HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| |
Collapse
|
13
|
Aroor AR, Manrique-Acevedo C, DeMarco VG. The role of dipeptidylpeptidase-4 inhibitors in management of cardiovascular disease in diabetes; focus on linagliptin. Cardiovasc Diabetol 2018; 17:59. [PMID: 29669555 PMCID: PMC5907287 DOI: 10.1186/s12933-018-0704-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 12/15/2022] Open
Abstract
Multiple population based analyses have demonstrated a high incidence of cardiovascular disease (CVD) and cardiovascular (CV) mortality in subjects with T2DM that reduces life expectancy by as much as 15 years. Importantly, the CV system is particularly sensitive to the metabolic and immune derangements present in obese pre-diabetic and diabetic individuals; consequently, CV dysfunction is often the initial CV derangement to occur and promotes the progression to end organ/tissue damage in T2DM. Specifically, diabetic CVD can manifest as microvascular complications, such as nephropathy, retinopathy, and neuropathy, as well as, macrovascular impairments, including ischemic heart disease, peripheral vascular disease, and cerebrovascular disease. Despite some progress in prevention and treatment of CVD, mainly via blood pressure and dyslipidemia control strategies, the impact of metabolic disease on CV outcomes is still a major challenge and persists in proportion to the epidemics of obesity and diabetes. There is abundant pre-clinical and clinical evidence implicating the DPP-4-incretin axis in CVD. In this regard, linagliptin is a unique DPP-4 inhibitor with both CV and renal safety profiles. Moreover, it exerts beneficial CV effects beyond glycemic control and beyond class effects. Linagliptin is protective for both macrovascular and microvascular complications of diabetes in preclinical models, as well as clinical models. Given the role of endothelial-immune cell interactions as one of the key events in the initiation and progression of CVD, linagliptin modulates these cell–cell interactions by affecting two important pathways involving stimulation of NO signaling and potent inhibition of a key immunoregulatory molecule.
Collapse
Affiliation(s)
- Annayya R Aroor
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA.,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Camila Manrique-Acevedo
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA.,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Vincent G DeMarco
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA. .,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA. .,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA. .,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA.
| |
Collapse
|
14
|
Lee SB, Ahn CW, Lee BK, Kang S, Nam JS, You JH, Kim MJ, Kim MK, Park JS. Association between triglyceride glucose index and arterial stiffness in Korean adults. Cardiovasc Diabetol 2018; 17:41. [PMID: 29562908 PMCID: PMC5863385 DOI: 10.1186/s12933-018-0692-1] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/19/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The triglyceride glucose (TyG) index has been suggested as a simple surrogate marker of insulin resistance. However, there are limited data regarding the association between the TyG index and arterial stiffness in adults. Therefore, we evaluated the relationship between the TyG index and arterial stiffness as measured based on brachial ankle pulse wave velocity (baPWV) in Korean adults. METHODS A total of 3587 subjects were enrolled in this study. Anthropometric and cardiovascular risk factors were measured. The TyG index was calculated as ln[fasting triglycerides(mg/dl) × fasting glucose(mg/dl)/2], and the insulin resistance index of homeostasis model assessment (HOMA-IR) was estimated. Arterial stiffness was determined by measuring baPWV. RESULTS The subjects were stratified into four groups based on the TyG index. There were significant differences in cardiovascular parameters among the groups; the mean baPWV increased significantly with increasing TyG index. According to the logistic regression analysis after adjusting for multiple risk factors, the odds ratio (95% CI) for increased baPWV (> 75th percentile) for the highest and lowest quartiles of the TyG index was 2.92 (1.92-4.44) in men and 1.84 (1.15-2.96) in women, and the odds ratio for increased baPWV for the highest and lowest quartiles of the HOMA-IR was 1.80 (1.17-2.78) in men and 1.46 (1.06-2.47) in women, respectively. CONCLUSION The TyG index is more independently associated with increased arterial stiffness than HOMA-IR in Korean adults.
Collapse
Affiliation(s)
- Sang Bae Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, South Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Woo Ahn
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, South Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Shinae Kang
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, South Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Sun Nam
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, South Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hong You
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, South Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Jin Kim
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, South Korea.,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Kyung Kim
- Division of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangdong-gu, Seoul, South Korea
| | - Jong Suk Park
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, South Korea. .,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.
| |
Collapse
|
15
|
Affiliation(s)
- Joseph C Galley
- From the Heart, Lung, Blood and Vascular Medicine Institute (J.C.G., A.C.S.) and Department of Pharmacology and Chemical Biology (J.C.G., A.C.S.), University of Pittsburgh, PA
| | - Adam C Straub
- From the Heart, Lung, Blood and Vascular Medicine Institute (J.C.G., A.C.S.) and Department of Pharmacology and Chemical Biology (J.C.G., A.C.S.), University of Pittsburgh, PA.
| |
Collapse
|
16
|
Lastra G, Manrique C, Jia G, Aroor AR, Hayden MR, Barron BJ, Niles B, Padilla J, Sowers JR. Xanthine oxidase inhibition protects against Western diet-induced aortic stiffness and impaired vasorelaxation in female mice. Am J Physiol Regul Integr Comp Physiol 2017; 313:R67-R77. [PMID: 28539355 DOI: 10.1152/ajpregu.00483.2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/25/2017] [Accepted: 05/16/2017] [Indexed: 12/21/2022]
Abstract
Consumption of a high-fat, high-fructose diet [Western diet (WD)] promotes vascular stiffness, a critical factor in the development of cardiovascular disease (CVD). Obese and diabetic women exhibit greater arterial stiffness than men, which contributes to the increased incidence of CVD in these women. Furthermore, high-fructose diets result in elevated plasma concentrations of uric acid via xanthine oxidase (XO) activation, and uric acid elevation is also associated with increased vascular stiffness. However, the mechanisms by which increased xanthine oxidase activity and uric acid contribute to vascular stiffness in obese females remain to be fully uncovered. Accordingly, we examined the impact of XO inhibition on endothelial function and vascular stiffness in female C57BL/6J mice fed a WD or regular chow for 16 wk. WD feeding resulted in increased arterial stiffness, measured by atomic force microscopy in aortic explants (16.19 ± 1.72 vs. 5.21 ± 0.54 kPa, P < 0.05), as well as abnormal aortic endothelium-dependent and -independent vasorelaxation. XO inhibition with allopurinol (widely utilized in the clinical setting) substantially improved vascular relaxation and attenuated stiffness (16.9 ± 0.50 vs. 3.44 ± 0.50 kPa, P < 0.05) while simultaneously lowering serum uric acid levels (0.55 ± 0.98 vs. 0.21 ± 0.04 mg/dL, P < 0.05). In addition, allopurinol improved WD-induced markers of fibrosis and oxidative stress in aortic tissue, as analyzed by immunohistochemistry and transmission electronic microscopy. Collectively, these results demonstrate that XO inhibition protects against WD-induced vascular oxidative stress, fibrosis, impaired vasorelaxation, and aortic stiffness in females. Furthermore, excessive oxidative stress resulting from XO activation appears to play a key role in mediating vascular dysfunction induced by chronic exposure to WD consumption in females.
Collapse
Affiliation(s)
- Guido Lastra
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri; .,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri
| | - Camila Manrique
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri
| | - Guanghong Jia
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri
| | - Annayya R Aroor
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri
| | - Melvin R Hayden
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri
| | - Brady J Barron
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri
| | - Brett Niles
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri
| | - Jaume Padilla
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Child Health, University of Missouri, Columbia, Missouri; and
| | - James R Sowers
- Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,Department of Medicine, Division of Endocrinology, University of Missouri, Columbia, Missouri.,University of Missouri, School of Medicine, Research Service Harry S. Truman Memorial Veterans Hospital, University of Missouri, Columbia, Missouri.,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| |
Collapse
|
17
|
Dipeptidyl peptidase-4 inhibition with linagliptin prevents western diet-induced vascular abnormalities in female mice. Cardiovasc Diabetol 2016; 15:94. [PMID: 27391040 PMCID: PMC4938903 DOI: 10.1186/s12933-016-0414-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/23/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Vascular stiffening, a risk factor for cardiovascular disease, is accelerated, particularly in women with obesity and type 2 diabetes. Preclinical evidence suggests that dipeptidylpeptidase-4 (DPP-4) inhibitors may have cardiovascular benefits independent of glycemic lowering effects. Recent studies show that consumption of a western diet (WD) high in fat and simple sugars induces aortic stiffening in female C57BL/6J mice in advance of increasing blood pressure. The aims of this study were to determine whether administration of the DPP-4 inhibitor, linagliptin (LGT), prevents the development of aortic and endothelial stiffness induced by a WD in female mice. METHODS C56Bl6/J female mice were fed a WD for 4 months. Aortic stiffness and ex vivo endothelial stiffness were evaluated by Doppler pulse wave velocity (PWV) and atomic force microscopy (AFM), respectively. In addition, we examined aortic vasomotor responses and remodeling markers via immunohistochemistry. Results were analyzed via 2-way ANOVA, p < 0.05 was considered as statistically significant. RESULTS Compared to mice fed a control diet (CD), WD-fed mice exhibited a 24 % increase in aortic PWV, a five-fold increase in aortic endothelial stiffness, and impaired endothelium-dependent vasodilation. In aorta, these findings were accompanied by medial wall thickening, adventitial fibrosis, increased fibroblast growth factor 23 (FGF-23), decreased Klotho, enhanced oxidative stress, and endothelial cell ultrastructural changes, all of which were prevented with administration of LGT. CONCLUSIONS The present findings support the notion that DPP-4 plays a role in development of WD-induced aortic stiffening, vascular oxidative stress, endothelial dysfunction, and vascular remodeling. Whether, DPP-4 inhibition could be a therapeutic tool used to prevent the development of aortic stiffening and the associated cardiovascular complications in obese and diabetic females remains to be elucidated.
Collapse
|
18
|
Manrique C, Lastra G, Ramirez-Perez FI, Haertling D, DeMarco VG, Aroor AR, Jia G, Chen D, Barron BJ, Garro M, Padilla J, Martinez-Lemus LA, Sowers JR. Endothelial Estrogen Receptor-α Does Not Protect Against Vascular Stiffness Induced by Western Diet in Female Mice. Endocrinology 2016; 157:1590-600. [PMID: 26872089 PMCID: PMC4816732 DOI: 10.1210/en.2015-1681] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Consumption of a diet high in fat and refined carbohydrates (Western diet [WD]) is associated with obesity and insulin resistance, both major risk factors for cardiovascular disease (CVD). In women, obesity and insulin resistance abrogate the protection against CVD likely afforded by estrogen signaling through estrogen receptor (ER)α. Indeed, WD in females results in increased vascular stiffness, which is independently associated with CVD. We tested the hypothesis that loss of ERα signaling in the endothelium exacerbates WD-induced vascular stiffening in female mice. We used a novel model of endothelial cell (EC)-specific ERα knockout (EC-ERαKO), obtained after sequential crossing of the ERα double floxed mice and VE-Cadherin Cre-recombinase mice. Ten-week-old females, EC-ERαKO and aged-matched genopairs were fed either a regular chow diet (control diet) or WD for 8 weeks. Vascular stiffness was measured in vivo by pulse wave velocity and ex vivo in aortic explants by atomic force microscopy. In addition, vascular reactivity was assessed in isolated aortic rings. Initial characterization of the model fed a control diet did not reveal changes in whole-body insulin sensitivity, aortic vasoreactivity, or vascular stiffness in the EC-ERαKO mice. Interestingly, ablation of ERα in ECs reduced WD-induced vascular stiffness and improved endothelial-dependent dilation. In the setting of a WD, endothelial ERα signaling contributes to vascular stiffening in females. The precise mechanisms underlying the detrimental effects of endothelial ERα in the setting of a WD remain to be elucidated.
Collapse
Affiliation(s)
- Camila Manrique
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Guido Lastra
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Francisco I Ramirez-Perez
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Dominic Haertling
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Vincent G DeMarco
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Annayya R Aroor
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Guanghong Jia
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Dongqing Chen
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Brady J Barron
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Mona Garro
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Jaume Padilla
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - Luis A Martinez-Lemus
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| | - James R Sowers
- Division of Endocrinology, Diabetes and Metabolism (V.G.D., G.L., G.J., A.R.A., C.M., J.R.S., D.H., D.C., B.J.B., M.G.), Department of Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri 65212; Department of Medical Pharmacology and Physiology (65212) (V.G.D., F.I.R.-P., L.A.M.-L., J.R.S.) and Research Service (V.G.D., J.R.S.), Harry S Truman Memorial Veterans Hospital, Columbia, Missouri 65201; Dalton Cardiovascular Research Center (F.I.R.-P., L.A.M.-L., J.P.), University of Missouri, Columbia, Missouri 65201; Department of Nutrition and Exercise Physiology (J.P.), University of Missouri, Columbia, Missouri 65211; and Departments of Child Health (65201) (J.P.) and Biological Engineering (L.A.M.-L., F.I.R.-P.), University of Missouri, Columbia, Missouri 65211
| |
Collapse
|
19
|
Abstract
Adipokines are hormones produced by adipocytes and have been involved in multiple pathologic pathways, including inflammatory and cardiovascular complications in essential hypertension. Arterial stiffness is a frequent vascular complication that represents increased cardiovascular risk in hypertensive patients. Adipokines, such as adiponectin, leptin and resistin, might be implicated in hypertension, as well as in vascular alterations associated with this condition. Arterial stiffness has proven to be a predictor of cardiovascular events. Obesity and target-organ damage such as arterial stiffness are features associated with hypertension. This review aims to update the association between adipokines and arterial stiffness in essential and resistant hypertension (RHTN).
Collapse
|
20
|
Palombo C, Kozakova M. Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications. Vascul Pharmacol 2015; 77:1-7. [PMID: 26643779 DOI: 10.1016/j.vph.2015.11.083] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/25/2015] [Accepted: 11/26/2015] [Indexed: 12/14/2022]
Abstract
Arterial stiffness results from a degenerative process affecting mainly the extracellular matrix of elastic arteries under the effect of aging and risk factors. Changes in extracellular matrix proteins and in the mechanical properties of the vessel wall related to arterial stiffening may activate number of mechanisms involved also in the process of atherosclerosis. Several noninvasive methods are now available to estimate large artery stiffness in the clinical setting, including carotid-femoral pulse wave velocity, the reference for aortic stiffness estimate, and local distensibility measures of superficial arteries, namely carotid and femoral. An independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been established. Thus, arterial stiffness is emerging as an interesting tissue biomarker for cardiovascular risk stratification and estimation of the individual "biological age". This paper overviews the mechanisms accounting for development and progression of arterial stiffness and for associations between arterial stiffness, atherosclerotic burden and incident cardiovascular events, summarizes the evidence and caveat for clinical use of stiffness as surrogate marker of cardiovascular risk, and briefly outlines some emerging methods for large artery stiffness characterization.
Collapse
Affiliation(s)
- Carlo Palombo
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Italy.
| | - Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| |
Collapse
|
21
|
Shah AS, Wadwa RP, Dabelea D, Hamman RF, D’Agostino R, Marcovina S, Daniels SR, Dolan LM, Fino NF, Urbina EM. Arterial stiffness in adolescents and young adults with and without type 1 diabetes: the SEARCH CVD study. Pediatr Diabetes 2015; 16:367-74. [PMID: 25912292 PMCID: PMC4712021 DOI: 10.1111/pedi.12279] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Arterial stiffness is a useful parameter to predict future cardiovascular disease. OBJECTIVE We sought to compare arterial stiffness in adolescents and young adults with and without type 1 diabetes (T1D) and explore the risk factors associated with the differences observed. SUBJECTS AND METHODS Carotid-femoral pulse wave velocity (PWV), augmentation index (AI75), and brachial distensibility (BrachD) were measured in 402 adolescents and young adults with T1D (age 18.8 ± 3.3 yr, T1D duration 9.8 ± 3.8 yr) and 206 non-diabetic controls that were frequency-matched by age, sex, and race/ethnicity in a cross-sectional study. General linear models were used to explore variables associated with an increase in arterial stiffness after adjustment for demographic and metabolic covariates. RESULTS T1D status was associated with a higher PWV (5.9 ± 0.05 vs. 5.7 ± 0.1 m/s), AI75 (1.3 ± 0.6 vs. -1.9 ± 0.7%), and lower BrachD (6.2 ± 0.1 vs. 6.5 ± 0.1%Δ/mmHg), all p < 0.05. In multivariate models, age, sex, race, adiposity, blood pressure, lipids, and the presence of microalbuminuria were found to be independent correlates of increased arterial stiffness. After adjustment for these risk factors, T1D status was still significantly associated with arterial stiffness (p < 0.05). CONCLUSIONS Peripheral and central subclinical vascular changes are present in adolescents and young adults with T1D compared to controls. Increased cardiovascular risk factors alone do not explain the observed differences in arterial stiffness among cases and controls. Identifying other risk factors associated with increased arterial stiffness in youth with T1D is critical to prevent future vascular complications.
Collapse
Affiliation(s)
- Amy S. Shah
- Department of Pediatrics, Cincinnati Children’s Hospital and University of Cincinnati, Cincinnati, OH, USA
| | - R. Paul Wadwa
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Richard F. Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Ralph D’Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Santica Marcovina
- Northwest Lipid Research Laboratories, University of Washington, Seattle, WA, USA
| | - Stephen R. Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lawrence M. Dolan
- Department of Pediatrics, Cincinnati Children’s Hospital and University of Cincinnati, Cincinnati, OH, USA
| | - Nora F. Fino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Elaine M. Urbina
- Department of Pediatrics, Cincinnati Children’s Hospital and University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
22
|
Impact of L-citrulline supplementation and whole-body vibration training on arterial stiffness and leg muscle function in obese postmenopausal women with high blood pressure. Exp Gerontol 2015; 63:35-40. [PMID: 25636814 DOI: 10.1016/j.exger.2015.01.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/13/2014] [Accepted: 01/25/2015] [Indexed: 01/15/2023]
Abstract
Aging is associated with increased arterial stiffness (pulse wave velocity, PWV) and muscle strength/mass loss. Exercise training alone is not always effective to improve PWV and lean mass (LM) in older women. To investigate the independent and combined effects of whole-body vibration training (WBVT) and L-citrulline supplementation on PWV and muscle function in women, forty-one postmenopausal women aged 58 ± 3 years and body mass index (34 ± 2 kg/m(2)) were randomly assigned to the following groups: WBVT, L-citrulline, and WBVT + L-citrulline for 8 weeks. WBVT consisted of four leg exercises three times weekly. Aortic (cfPWV) and leg (faPWV) PWV, leg LM index, leg strength, and body fat percentage (BF%) were measured before and after the interventions. WBVT + L-citrulline decreased cfPWV (-0.91 ± 0.21 m/s, P < 0.01) compared to both groups. All interventions decreased faPWV (P < 0.05) similarly. Leg LM index increased (2.7 ± 0.5%, P < 0.001) after WBVT + L-citrulline compared with L-citrulline. Both WBVT interventions increased leg strength (~37%, P < 0.001) compared to L-citrulline while decreased BF% (~2.0%, P < 0.01). Reductions in cfPWV were correlated with increases in leg LM index (r = -0.63, P < 0.05). Our findings suggest that leg muscle strength and arterial stiffness can be improved after WBVT, but its combination with L-citrulline supplementation enhanced benefits on aortic stiffness and leg LM. Therefore, WBVT + L-citrulline could be an intervention for improving arterial stiffness and leg muscle function in obese postmenopausal women with prehypertension or hypertension, thereby reducing their cardiovascular and disability risk.
Collapse
|
23
|
Fontes-Carvalho R, Ladeiras-Lopes R, Bettencourt P, Leite-Moreira A, Azevedo A. Diastolic dysfunction in the diabetic continuum: association with insulin resistance, metabolic syndrome and type 2 diabetes. Cardiovasc Diabetol 2015; 14:4. [PMID: 25582424 PMCID: PMC4298953 DOI: 10.1186/s12933-014-0168-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/27/2014] [Indexed: 12/14/2022] Open
Abstract
Background Diabetes increases the risk of heart failure but the underlying mechanisms leading to diabetic cardiomyopathy are poorly understood. Left ventricle diastolic dysfunction (LVDD) is one of the earliest cardiac changes in these patients. We aimed to evaluate the association between LVDD with insulin resistance, metabolic syndrome (MS) and diabetes, across the diabetic continuum. Methods Within a population-based study (EPIPorto), a total of 1063 individuals aged ≥45 years (38% male, 61.2 ± 9.6 years) were evaluated. Diastolic function was assessed by echocardiography, using tissue Doppler analysis (E’ velocity and E/E’ ratio) according to the latest consensus guidelines. Insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score. Results The HOMA-IR score correlated to E’ velocity (ρ = −0.20;p < 0.0001) and E/E’ ratio (ρ = 0.20; p < 0.0001). There was a progressive worsening in E’ velocity (p for trend < 0.001) and in E/E’ ratio across HOMA-IR quartiles (p for trend <0.001). Individuals in the highest HOMA-IR quartile were more likely to have LVDD, even after adjustment for age, sex, blood pressure and body mass index (adjusted OR: 1.82; 95% CI: 1.09-3.03). From individuals with no MS, to patients with MS and no diabetes, to patients with diabetes, there was a progressive decrease in E’ velocity (11.2 ± 3.3 vs 9.7 ± 3.1 vs 9.2 ± 2.8 cm/s; p < 0.0001), higher E/E’ (6.9 ± 2.3 vs 7.8 ± 2.7 vs 9.0 ± 3.6; p < 0.0001) and more diastolic dysfunction (adjusted OR: 1.62; 95% CI: 1.12-2.36 and 1.78; 95% CI: 1.09-2.91, respectively). Conclusions HOMA-IR score and metabolic syndrome were independently associated with LVDD. Changes in diastolic function are already present before the onset of diabetes, being mainly associated with the state of insulin resistance. Electronic supplementary material The online version of this article (doi:10.1186/s12933-014-0168-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ricardo Fontes-Carvalho
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal. .,Cardiology Department, Gaia Hospital Center, Vila Nova Gaia, Portugal. .,Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ricardo Ladeiras-Lopes
- Cardiology Department, Gaia Hospital Center, Vila Nova Gaia, Portugal. .,Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Paulo Bettencourt
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal. .,Department of Internal Medicine, Centro Hospitalar São João, Porto, Portugal.
| | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. .,Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal.
| | - Ana Azevedo
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal. .,Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| |
Collapse
|
24
|
Ormseth MJ, Oeser AM, Cunningham A, Bian A, Shintani A, Solus J, Tanner SB, Stein CM. Reversing vascular dysfunction in rheumatoid arthritis: improved augmentation index but not endothelial function with peroxisome proliferator-activated receptor γ agonist therapy. Arthritis Rheumatol 2014; 66:2331-8. [PMID: 24782291 DOI: 10.1002/art.38686] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 04/25/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the hypothesis that improving insulin sensitivity improves vascular function in rheumatoid arthritis (RA). METHODS We performed a 20-week, single center, randomized, double-blind, placebo-controlled crossover study. Patients with RA (n = 34) with moderate disease activity who were receiving stable disease-modifying antirheumatic drug therapy were randomized to drug sequence, receiving either pioglitazone 45 mg/day or matching placebo for 8 weeks, followed by a 4-week washout period and the alternative treatment for 8 weeks. We measured changes in vascular stiffness (augmentation index and aortic pulse wave velocity [PWV]), endothelial function (reactive hyperemia index), and blood pressure. High-sensitivity C-reactive protein levels and the homeostatic model assessment of insulin resistance were also measured. The treatment effect of pioglitazone on outcomes was analyzed using linear mixed-effects models. RESULTS Pioglitazone treatment resulted in a change in augmentation index of -4.7% units (95% confidence interval [95% CI] -7.9, -1.5) (P = 0.004) and in diastolic blood pressure of -3.0 mm Hg (95% CI -5.7, -0.2) (P = 0.03), but did not significantly change aortic PWV (P = 0.33) or reactive hyperemia index (P = 0.46). The improvements in augmentation index and diastolic blood pressure were not mediated by the effect of pioglitazone on insulin resistance or inflammation. CONCLUSION Our findings indicate that pioglitazone improves some indices of vascular function, including augmentation index and diastolic blood pressure, in patients with RA. This is not mediated by improved insulin sensitivity.
Collapse
|
25
|
Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype. J Hypertens 2014; 31:1998-2004. [PMID: 24107731 DOI: 10.1097/hjh.0b013e3283630362] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The metabolic dysfunction accompanying the polycystic ovary syndrome (PCOS) may increase the risk of hypertension and cardiovascular disease (CVD). Although menopause per se may be an additional risk factor of CVD, the association between PCOS in postmenopausal women and cardiovascular risk has not been adequately investigated. We aimed to evaluate the effect of PCOS on markers of subclinical atherosclerosis in nondiabetic postmenopausal women. METHODS This cross-sectional study included 286 postmenopausal women with intact ovaries. PCOS phenotype was defined if three of the following were present: insulin resistance, current hyperandrogenism or history of clinical androgen excess, history of infertility, central obesity and history of irregular menses. Traditional CVD risk factors, as well as indices of arterial structure (intima-media thickness, atheromatous plaques presence) and function [flow-mediated dilation, pulse wave velocity (PWV), augmentation index] were compared between women with a PCOS phenotype and the rest of the sample, who served as controls. RESULTS Women with the PCOS phenotype (N=43) had higher SBP and triglycerides and lower high-density lipoprotein (HDL)-cholesterol than controls. Mean values of PWV differed significantly between PCOS cases and controls (9.46±1.74 vs. 8.60±1.51 m/s, P=0.001, univariate). Multivariate regression analysis showed that the PCOS phenotype, age and SBP were the only independent predictors of PWV. CONCLUSION Arterial stiffness is increased in asymptomatic, nondiabetic women with a putative PCOS phenotype, independently of age, BMI or blood pressure. This might present one mechanism through which PCOS increases the risk of CVD and hypertension later in life.
Collapse
|
26
|
Whole-body vibration exercise training reduces arterial stiffness in postmenopausal women with prehypertension and hypertension. Menopause 2014; 21:131-6. [DOI: 10.1097/gme.0b013e318294528c] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
27
|
Figueroa A, Wong A, Hooshmand S, Sanchez-Gonzalez MA. Effects of watermelon supplementation on arterial stiffness and wave reflection amplitude in postmenopausal women. Menopause 2014; 20:573-7. [PMID: 23615650 DOI: 10.1097/gme.0b013e3182733794] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Postmenopausal women have increased arterial stiffness (brachial-ankle pulse wave velocity [baPWV]) and wave reflection. L-Citrulline supplementation reduces baPWV but not brachial blood pressure. Peripheral vasodilators decrease wave reflection amplitude or second systolic peak (SBP2) in radial artery and aorta, which are related to aortic systolic blood pressure (SBP). We examined the effects of L-citrulline-rich watermelon supplementation on baPWV, wave reflection characteristics, and aortic SBP in postmenopausal women. METHODS In a randomized cross-over study, 12 postmenopausal women (mean [SE] age, 57 [1] y; mean [SE] body mass index, 38.1 [2.1] kg/m; mean [SE] SBP, 153 [4] mm Hg) were assigned to watermelon supplementation (L-citrulline/L-arginine 6 g/d) or placebo supplementation for 6 weeks. Before and after each intervention, baPWV, aortic SBP, aortic diastolic blood pressure, aortic SBP2, radial SBP2, and aortic and radial augmentation indices were measured using applanation tonometry. RESULTS baPWV (-1.2 [0.3] m/s, P < 0.001), aortic SBP (-10 [3] mm Hg, P < 0.01), and aortic diastolic blood pressure (-7 [1] mm Hg, P < 0.001) decreased after watermelon supplementation compared with placebo. Although radial and aortic augmentation indices were unaffected, radial and aortic SBP2 decreased (-10 [3] mm Hg, P < 0.01) after watermelon supplementation compared with placebo. The reduction in aortic SBP was correlated with reductions in radial SBP2 (r = 0.99, P < 0.001) and aortic SBP2 (r = 0.98, P < 0.001). The decreases in baPWV correlated with reductions in radial SBP2 (r = 0.57, P < 0.01) and aortic SBP2 (r = 0.64, P < 0.01). CONCLUSIONS Watermelon supplementation reduces arterial stiffness and aortic SBP by reducing pressure wave reflection amplitude in obese postmenopausal women with hypertension.
Collapse
Affiliation(s)
- Arturo Figueroa
- Department of Nutrition, Food, and Exercise Sciences, The Florida State University, Tallahassee, FL 323306-1493, USA.
| | | | | | | |
Collapse
|
28
|
Fang FS, Liu MY, Cheng XL, Zhong WW, Miao XY, Li J, Li CL, Tian H. Insulin resistance correlates with the arterial stiffness before glucose intolerance. Intern Med 2014; 53:189-94. [PMID: 24492686 DOI: 10.2169/internalmedicine.53.0690] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The elevated plasma glucose level and/or insulin resistance in diabetes or impaired glucose tolerance play important roles in the pathogenesis of arterial stiffness. The present study investigated whether insulin resistance correlated with arterial stiffness before the development of glucose intolerance. METHODS We conducted a cross-sectional analysis in 872 young to middle-age individuals with normal glucose tolerance (aged 36.2±8.5 years, BMI 24.6±3.1 kg/m2 [mean±SD]). The homeostasis model assessment (HOMA) index was used as a quantitative assessment of the fasting insulin resistance (FIR), and the plasma insulin level after glucose loading was adopted as an index of the post-challenge insulin resistance (PIR). The Matsuda index [ISI (composite)] was used as a measurement of the insulin sensitivity. The arterial stiffness assessed by the brachial-ankle pulse wave velocity (baPWV) was adopted to quantify its independent associations with insulin resistance. RESULTS The univariate linear regression analysis indicated that the fasting plasma glucose level (FPG, β = 68.2; 95% CI 40.9, 95.6; p<0.001), post-challenge plasma glucose level (PPG, β = 25.3; 95% CI 15.6, 35.0; p<0.001), FIR (β = 24.5; 95% CI 14.1, 35.0; p<0.001), PIR (β=1.30; 95% CI 0.87, 1.73; p<0.001) and ISI (composite) (β = -3.55; 95% CI -5.02, -2.07; p<0.001) were all significantly correlated with the baPWV. After adjustment for sex, age, BMI, heart rate, smoking, systolic blood pressure, total cholesterol, LDL-cholesterol and family history of diabetes, the multivariate linear regression analysis demonstrated that the PIR (model 1, β = 0.39, p=0.038; model 2, β = 0.39, p=0.035; model 3, β = 0.39, p=0.035) was an independent contributor to the baPWV, while the FIR, FPG, PPG and ISI (composite) failed to show any significant contribution. CONCLUSION The insulin resistance correlated with the arterial stiffness before glucose intolerance.
Collapse
Affiliation(s)
- Fu-Sheng Fang
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, China
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Effect of Cardio-Metabolic Risk Factors Clustering with or without Arterial Hypertension on Arterial Stiffness: A Narrative Review. Diseases 2013. [DOI: 10.3390/diseases1010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
30
|
Casiglia E, Tikhonoff V, Boschetti G, Giordano N, Mazza A, Caffi S, Palatini P. Arterial stiffness and related variables across menopausal status: an epidemiologic study. J Womens Health (Larchmt) 2013; 22:75-84. [PMID: 23305219 DOI: 10.1089/jwh.2012.3666] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine if postmenopausal women have different arterial stiffness, blood pressure (BP) values, or metabolic patterns in comparison to fertile women and to men at a population level. METHODS This is a population-based epidemiologic study of 1853 representative men and women aged 18-95 years. Clinostatic humeral BP was measured using Omron 705CP. Aortic BP, augmentation index (AI), and pulse wave velocity (PWV) were determined using applanation tonometry. Body mass index (BMI) and subscapular skinfold thickness were used as measures of adiposity. Fasting and postload blood glucose, homeostasis model assessment (HOMA), low-density and high-density lipoprotein serum cholesterol (LDL-C and HDL-C) and triglycerides were assessed. RESULTS Age was higher in postmenopausal women than in fertile women (68.8 ± 9.5 vs. 35.7 ± 10.2 years, p<0.001), and BMI was 16% higher (p<0.01) in the postmenopausal women after age adjustment. Humeral and aortic BP, carotid and radial AI, carotid-femoral PWV, BMI, LDL-C, LDL-C/HDL ratio, triglycerides, glucose tolerance, HOMA, and skinfold thickness were apparently higher in postmenopausal than in fertile women. Using multivariate analysis, however, all these differences were abolished after adjusting for confounders (age and, when appropriate, BMI), except for LDL-C, which remained 19% higher (p<0.01) in postmenopausal women than in fertile women after adjusting for many confounders (age, BMI, cholesterol, ethanol intake, caloric intake, and triiodothyronine). CONCLUSIONS Only LDL-C increases in postmenopausal women, whereas other differences attributed to menopause, including BP and arterial stiffness, seem to be confounding effects of age and BMI.
Collapse
|
31
|
Figueroa A, Vicil F, Sanchez-Gonzalez MA, Wong A, Ormsbee MJ, Hooshmand S, Daggy B. Effects of diet and/or low-intensity resistance exercise training on arterial stiffness, adiposity, and lean mass in obese postmenopausal women. Am J Hypertens 2013; 26:416-23. [PMID: 23382493 DOI: 10.1093/ajh/hps050] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity and aging are associated with increased arterial stiffness as indicated by an increased pulse-wave velocity (PWV). We evaluated the independent and combined effects on PWV and body composition of a hypocaloric diet and low-intensity resistance exercise training (LIRET) with slow movement. METHODS Forty-one postmenopausal women (mean age, 54±6 years; body mass index (BMI), 33.8±0.5kg/m(2)) were randomly assigned to LIRET (n = 14), diet (n = 13), or diet + LIRET (n = 14) for 12 weeks. The women's PWV, mean arterial pressure (MAP), body composition by dual-en ergy x-ray absorptiometry (DXA), and plasma adipokine and insulin levels were measured before and after the interventions. RESULTS Body weight (P = 0.0001), trunk-fat mass (FM, P = 0.0001), and the serum concentration of leptin (P = 0.02 and P = 0.004) decreased similarly with diet and diet + LIRET, but not with LIRET alone. Leg lean mass (LM) decreased (P = 0.02) with diet, but did not change with diet + LIRET or with LIRET alone. Leg muscle strength increased similarly with LIRET (P = 0.001) and diet + LIRET (P = 0.0001), but did not change with diet alone. Brachial-ankle PWV (baPWV) decreased with diet (P = 0.04) and diet + LIRET (P = 0.01), whereas femoral-ankle PWV (legPWV) decreased only with diet (P = 0.01). Mean arterial pressure (MAP) decreased after LIRET (P = 0.03), diet (P = 0.04), and diet + LIRET (P = 0.004). Carotid-femoral PWV, serum adiponectin concentration, and insulin were not significantly affected by the interventions examined in the study. The reductions in baPWV and legPWV were correlated with one another (r = 0.73, P = 0.0001), and the reductions in legPWV and trunk FM were also correlated with one another (r = 0.36, P = 0.03). CONCLUSIONS A hypocaloric diet decreases baPWV mainly by reducing legPWV, and this reduction is related to the loss of truncal fat. Although LIRET alone does not affect PWV or body composition, LIRET combined with diet improves baPWV and muscle strength while preventing loss of lean body mass in obese postmenopausal women.
Collapse
Affiliation(s)
- Arturo Figueroa
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, FL, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Kaya MG, Calapkorur B, Karaca Z, Yildirim S, Celik A, Akpek M, Unluhizarci K, Kelestimur F. The effects of treatment with drospirenone/ethinyl oestradiol alone or in combination with metformin on elastic properties of aorta in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2012; 77:885-92. [PMID: 22563947 DOI: 10.1111/j.1365-2265.2012.04436.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a heterogeneous clinical condition. Oral contraceptive pills (OCPs) have conventionally been the mainstay of treatment for the amelioration of hyperandrogenism and regulation of menstrual cycles in women with PCOS. Metformin has beneficial effects on insulin resistance and endothelial functions. To our knowledge, the effect of metformin/OCP combination treatment on aortic stiffness has not been studied so far. OBJECTIVE The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl oestradiol (E/E) alone or in combination with metformin on the elastic properties of the aorta in women with PCOS. METHODS Thirty-seven women with PCOS were enrolled in the study. The first treatment arm, which was treated with OCP alone, was described as the OCP group (19 patients, mean age: 23·2 ± 5·4); the other treatment arm, which was treated with OCP and metformin, was described as the combination group (18 patients, mean age: 23·0 ± 4·5). The elastic parameters of the aorta namely 'aortic strain', 'aortic distensibility', 'aortic diameter alteration' and 'aortic stiffness index' were calculated by the appropriate formulae. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months of treatment, echocardiographic measurements and laboratory tests were also obtained. RESULTS After 6 months of treatment, significant weight loss and decrease in body mass index (BMI) were observed in the combination group (75·3 ± 13·3 kg to 72·3 ± 13·5 kg and 31·7 ± 7·3 kg/m² vs 30·4 ± 7·3 kg/m², P = 0·001 and P = 0·001, respectively). Conversely in the OCP group, BMI and weight were not significantly different after 6 months of treatment (68·8 ± 18·3 kg to 71·6 ± 21·2 kg and 26·4 ± 6·2 kg/m² to 27·4 ± 6·9 kg/m², P = 0·159 and P = 0·149, respectively). In addition, there were no significant differences in aortic strain, distensibility (7·7 ± 4·2 to 7·8 ± 3·6 and 7·2 ± 4·1 to 7·7 ± 3·6, P = 0·926 and P = 0·593, respectively) and stiffness index in the OCP group (8·8 ± 7·4 to 8·2 ± 6·7, P = 0·772). However, in the combination group, the adjusted values of the aortic stiffness index decreased significantly at the 6 months' follow-up (10·0 ± 1·5 to 6·7 ± 0·3, P = 0·021) and aortic distensibility and strain increased but not significantly (7·0 ± 4·3 to 9·3 ± 3·3 and 6·8 ± 3·9 to 9·4 ± 3·5, P = 0·163 and P = 0·071, respectively) at the 6 months' follow-up. CONCLUSION We demonstrated an improvement in the elastic parameters of the aorta by adding metformin to OCP treatment. We suggest that metformin plus OCP treatment may decrease cardiovascular disease risk in women with PCOS.
Collapse
Affiliation(s)
- Mehmet G Kaya
- Department of Cardiology, Erciyes University, Kayseri, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Hughes TM, Althouse AD, Niemczyk NA, Hawkins MS, Kuipers AL, Sutton-Tyrrell K. Effects of weight loss and insulin reduction on arterial stiffness in the SAVE trial. Cardiovasc Diabetol 2012; 11:114. [PMID: 22998737 PMCID: PMC3468408 DOI: 10.1186/1475-2840-11-114] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/20/2012] [Indexed: 12/29/2022] Open
Abstract
Background Chronic arterial stiffness contributes to the negative health effects of obesity and insulin resistance, which include hypertension, stroke, and increased cardiovascular and all-cause mortality. Weight loss and improved insulin sensitivity are individually associated with improved central arterial stiffness; however, their combined effects on arterial stiffness are poorly understood. The purpose of this study was to determine how insulin levels modify the improvements in arterial stiffness seen with weight loss in overweight and obese young adults. Methods To assess the effects of weight loss and decreased fasting insulin on vascular stiffness, we studied 339 participants in the Slow the Adverse Effects of Vascular Aging (SAVE) trial. At study entry, the participants were aged 20–45, normotensive, non-diabetic, and had a body-mass index of 25–39.9 kg/m2. Measures of pulse wave velocity (PWV) in the central (carotid-femoral (cfPWV)), peripheral (femoral-ankle (faPWV)), and mixed (brachial-ankle (baPWV)) vascular beds were collected at baseline and 6 months. The effects of 6-month change in weight and insulin on measures of PWV were estimated using multivariate regression. Results After adjustment for baseline risk factors and change in systolic blood pressure, 6-month weight loss and 6-month change in fasting insulin independently predicted improvement in baPWV but not faPWV or cfPWV. There was a significant interaction between 6-month weight change and change in fasting insulin when predicting changes in baPWV (p < 0.001). Individuals experiencing both weight loss and insulin reductions showed the greatest improvement in baPWV. Conclusions Young adults with excess weight who both lower their insulin levels and lose weight see the greatest improvement in vascular stiffness. This improvement in vascular stiffness with weight loss and insulin declines may occur throughout the vasculature and may not be limited to individual vascular beds. Trial registration NCT00366990
Collapse
Affiliation(s)
- Timothy M Hughes
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Kawamoto R, Tabara Y, Kohara K, Miki T, Kusunoki T, Katoh T, Ohtsuka N, Takayama S, Abe M. A Slightly Low Hemoglobin Level Is Beneficially Associated with Arterial Stiffness in Japanese Community-Dwelling Women. Clin Exp Hypertens 2011; 34:92-8. [DOI: 10.3109/10641963.2011.618202] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
35
|
Niacin-bound chromium increases life span in Zucker Fatty Rats. J Inorg Biochem 2011; 105:1344-9. [DOI: 10.1016/j.jinorgbio.2011.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/06/2011] [Accepted: 01/10/2011] [Indexed: 11/18/2022]
|
36
|
Cuadros JL, Fernández-Alonso AM, Cuadros AM, Chedraui P, Pérez-López FR. Body mass index and its correlation to metabolic and hormone parameters in postmenopausal Spanish women. Gynecol Endocrinol 2011; 27:678-84. [PMID: 21133833 DOI: 10.3109/09513590.2010.521269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess body weight composition in postmenopausal women and determine correlations with metabolic and hormonal parameters. METHODS Medical records of 574 postmenopausal Caucasian Spanish women first time attending a menopause clinic were retrospectively reviewed. Retrieved information included general demographic data, type of menopause, time since menopause onset and baseline hormonal and metabolic parameters. A body mass index (BMI) value of >28.8 kg/m(2) was used to define obesity. The metabolic syndrome (METS) was diagnosed with three or more criteria: fasting glycemia ≥ 100 mg/dL, high density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides (TG) ≥ 150 mg/dL, blood pressure ≥ 130/85 mmHg and obesity (as defined above). RESULTS Mean age of the whole cohort was 49.9 ± 6.1 years, with 66% having a natural menopause. A 38.9% and 23.1% of all women were obese or had the METS, respectively. Obese women were older, had a higher parity, smoked less, had more time since menopause onset and a higher rate of surgical menopause as compared to non-obese ones (p = 0.001). BMI values positively correlated with age, time since menopause, parity, and glucose, TG and systolic blood pressure levels; displaying an inverse correlation with HDL-C and SHBG levels. SHBG levels inversely correlated with glucose, TG, HDL-C and systolic blood pressure levels. CONCLUSION In this Spanish postmenopausal population BMI significantly increased with age, time since menopause and parity displaying significant correlations with hormonal and metabolic parameters.
Collapse
Affiliation(s)
- José L Cuadros
- Obstetrics and Gynecology Service, Faculty of Medicine, University of Granada, Hospital San Cecilio, Granada, Spain
| | | | | | | | | |
Collapse
|
37
|
Konrad T, Bär F, Schneider F, Franke S, Böhles H, Vetter G, Balkau B. Factors influencing endothelial function in healthy pre- and post-menopausal women of the EU-RISC study. Diab Vasc Dis Res 2011; 8:229-36. [PMID: 21746771 DOI: 10.1177/1479164111416139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We studied the impact of lifestyle, body composition, different insulin sensitivity indices and the first insulin response in healthy pre- and post-menopausal women with a low cardiovascular risk profile (the EU-RISC study, 'Relationship between Insulin Sensitivity and Cardiovascular Disease' (n = 51, 47 ± 4 years, body mass index 23.6 ± 3.7 kg/m(2), waist girth 79.2 ± 10.3 cm) on endothelial function (flow mediated arterial dilatation (FMD)), an early marker for atherosclerosis. RESULTS Waist circumference (p = 0.06), tobacco consumption (p = 0.02) and leucocyte count (p = 0.09) were inversely related with FMD in both pre- and post-menopausal women. Neither insulin sensitivity nor first insulin response indices were correlated with FMD. In pre-menopausal women (n = 24), waist (p < 0.02), waist-to-hip ratio (p < 0.02), HDL cholesterol (p < 0.01) and smoking habits (p < 0.03) were significantly correlated with endothelial function. In postmenopausal women (n = 27) age (r = -0.17, p = 0.04) was related with FMD. CONCLUSION Smoking and waist circumference, a simple marker of visceral adiposity, were related with endothelial function in healthy pre- and post-menopausal women.
Collapse
Affiliation(s)
- Thomas Konrad
- Institute for Metabolic Research, University Frankfurt am Main, Germany.
| | | | | | | | | | | | | |
Collapse
|
38
|
Association of insulin resistance with arterial stiffness in nondiabetic peritoneal dialysis patients. Int Urol Nephrol 2011; 44:255-62. [DOI: 10.1007/s11255-011-9984-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/22/2011] [Indexed: 01/06/2023]
|
39
|
Dinh W, Lankisch M, Nickl W, Scheyer D, Scheffold T, Kramer F, Krahn T, Klein RM, Barroso MC, Füth R. Insulin resistance and glycemic abnormalities are associated with deterioration of left ventricular diastolic function: a cross-sectional study. Cardiovasc Diabetol 2010; 9:63. [PMID: 20950415 PMCID: PMC2964598 DOI: 10.1186/1475-2840-9-63] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 10/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LVDD) is considered a precursor of diabetic cardiomyopathy, while insulin resistance (IR) is a precursor of type 2 diabetes mellitus (T2DM) and independently predicts heart failure (HF). We assessed whether IR and abnormalities of the glucose metabolism are related to LVDD. METHODS We included 208 patients with normal ejection fraction, 57 (27%) of whom had T2DM before inclusion. In subjects without T2DM, an oral glucose tolerance test (oGTT) was performed. IR was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The lower limit of the top quartile of the HOMA-IR distribution (3.217) was chosen as threshold for IR. LVDD was verified according to current guidelines. RESULTS IR was diagnosed in 38 (18%) patients without a history of diabetes. The prevalence of LVDD was 92% in subjects with IR vs. 72% in patients without IR (n = 113), respectively (p = 0.013). In the IR group, the early diastolic mitral inflow velocity (E) in relation to the early diastolic tissue Doppler velocity (averaged from the septal and lateral mitral annulus, E'av) ratio (E/E'av) was significantly higher compared to those without IR (9.8 [8.3-11.5] vs. 8.1 [6.6-11.0], p = 0.011). This finding remains significant when patients with IR and concomitant T2DM based on oGTT results were excluded (E/E'av ratio 9.8 [8.2-11.1)] in IR vs. 7.9 [6.5-10.5] in those without both IR and T2DM, p = 0.014). There were significant differences among patients with and without LVDD regarding the HOMA-IR (1.71 [1.04-3.88] vs. 1.09 [0.43-2.2], p = 0.003). The HOMA-IR was independently associated with LVDD on multivariate logistic regression analysis, a 1-unit increase in HOMA-IR value was associated with an odds ratio for prevalent LVDD of 2.1 (95% CI 1.3-3.1, p = 0.001). Furthermore, the E/E'av ratio increases along the glucose metabolism status from normal glucose metabolism (7.6 [6.2-10.1]) to impaired glucose tolerance (8.8 [7.4-11.0]) and T2DM (10.5 [8.1-13.2]), respectively (p < 0.001). CONCLUSIONS Insulin resistance is independently associated with LVDD in subjects without overt T2DM. Patients with IR and glucose metabolism disorders might represent a target population to prevent the development of HF. Screening programs for glucose metabolism disturbances should address the assessment of diastolic function and probably IR.
Collapse
Affiliation(s)
- Wilfried Dinh
- Institute for Heart and Circulation Research, University Witten/Herdecke, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|