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Liang Y, Zhou R, Chen H, Cao B, Fan W, Liu K, Zhong Q, Huang Y, Wu X, Zou M. Associations of blood biomarkers with arterial stiffness in patients with diabetes mellitus: A population-based study. J Diabetes 2023; 15:853-865. [PMID: 37329140 PMCID: PMC10590681 DOI: 10.1111/1753-0407.13433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Arterial stiffness contributes to additional cardiovascular risks in diabetic patients by triggering the loss of vascular and myocardial compliance and promoting endothelial dysfunction. Thus, prevention of arterial stiffness is a public health priority, and the identification of potential biomarkers may provide benefits for early prevention. This study investigates the relationships between serum laboratory tests and pulse wave velocity (PWV) tests. We also investigated the associations between PWV and all-cause mortality. METHODS We examined a panel of 33 blood biomarkers among diabetic populations in the Atherosclerosis Risk in Communities Study. The carotid-femoral (cfPWV) and femoral-ankle PWV (faPWV) were measured using an automated cardiovascular screening device. The aortic-femoral arterial stiffness gradient (afSG) was calculated as faPWV divided by cfPWV. Biomarker levels were log-transformed and correlated with PWV. Cox proportional hazard models were employed for survival analysis. RESULTS Among 1079 diabetic patients, biomarkers including high-density lipoprotein cholesterol, glycated hemoglobin, high-sensitivity troponin T, cystatin C, creatinine, and albuminuria were significantly correlated with afSG (R = 0.078, -0.193, -0.155, -0.153, -0.116, and -0.137, respectively) and cfPWV (R = -0.068, 0.175, 0.128, 0.066, 0.202, and 0.062, respectively). Compared with the lowest tertile of afSG, the risk of all-cause mortality was lower in the highest tertile (hazard ratio 0.543; 95% confidence interval 0.328-0.900). CONCLUSION Certain biomarkers related to blood glucose monitoring, myocardial injury, and renal function significantly correlated with PWV, suggesting that these putative risk factors are likely to be important atherosclerosis mechanisms in diabetic patients. AfSG may be an independent predictor of mortality among diabetic populations.
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Affiliation(s)
- Yong‐Qi Liang
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Rui Zhou
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Hao‐Wen Chen
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Bi‐Fei Cao
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Wei‐Dong Fan
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Kuan Liu
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Qi Zhong
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Yi‐Ning Huang
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Xian‐Bo Wu
- Department of Epidemiology, School of Public HealthSouthern Medical UniversityGuangzhouChina
| | - Meng‐Chen Zou
- Department of Endocrinology and Metabolism, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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STONE K, FRYER S, FAULKNER J, MEYER ML, HEFFERNAN K, KUCHARSKA-NEWTON A, ZIEFF G, PATERSON C, MATSUSHITA K, HUGHES TM, TANAKA H, STONER L. The aortic-femoral arterial stiffness gradient is blood pressure independent in older adults: the atherosclerosis risk in communities (ARIC) study. J Hypertens 2021; 39:2361-2369. [PMID: 34343145 PMCID: PMC8570989 DOI: 10.1097/hjh.0000000000002937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic arterial stiffness is a strong independent predictor of cardiovascular disease (CVD); however, its dependence on mean arterial pressure (MAP) limits its clinical utility. The aortic-femoral arterial stiffness gradient (af-SG), a novel marker of CVD risk, may be a promising alternative, but its dependence on MAP is not known. The aim of this study was to determine the relationship between MAP and the af-SG in healthy older adults and those with established disease, including hypertension and diabetes. METHOD We evaluated the dependency of the af-SG on MAP in healthy older adults (n = 694, aged 74 ± 5 years), and adults with hypertension (n = 2040, aged 76 ± 5 years), and diabetes (n = 1405, aged 75 ± 5 years) as part of the community-based Atherosclerosis Risk in Communities (ARIC) Study. Carotid-femoral pulse-wave velocity (cfPWV), femoral-ankle PWV (faPWV) and blood pressure were measured using standardized protocols. The af-SG was calculated as faPWV divided by cfPWV. Multivariable regression analysis was performed to test the independent association of MAP with af-SG, with adjustments for known confounders, including age, sex, BMI, blood glucose and heart rate. RESULTS There was no significant relationship between the af-SG and MAP in healthy (β = 0.002, P = 0.301), hypertension (β = -0.001, P = 0.298) or diabetes (β = -0.001, P = 0.063) population groups, with MAP explaining less than 0.1, less than 0.1 and 0.2% of the variance in the af-SG, respectively. CONCLUSION These findings suggest that the af-SG may be regarded as a MAP independent index of arterial health and CVD risk in older adults.
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Affiliation(s)
- Keeron STONE
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Simon FRYER
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - James FAULKNER
- Department of Sport, Exercise & Health, University of Winchester, Winchester, UK
| | - Michelle L MEYER
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin HEFFERNAN
- Department of Exercise Science, Syracuse University, Syracuse, USA
| | - Anna KUCHARSKA-NEWTON
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Gabriel ZIEFF
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig PATERSON
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Kunihiro MATSUSHITA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy M. HUGHES
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Hirofumi TANAKA
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Lee STONER
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
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STONE K, FRYER S, MEYER ML, KUCHARSKA-NEWTON A, FAULKNER J, ZIEFF G, PATERSON C, CREDEUR D, MATSUSHITA K, HUGHES TM, TANAKA H, STONER L. The aortic-femoral arterial stiffness gradient: an atherosclerosis risk in communities (ARIC) study. J Hypertens 2021; 39:1370-1377. [PMID: 33560059 PMCID: PMC8217898 DOI: 10.1097/hjh.0000000000002808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aortic to femoral arterial stiffness gradient (af-SG) may be a novel measure of arterial health and cardiovascular disease (CVD) risk, but its association with CVD risk factors and CVD status, and whether or not they differ from the referent measure, carotid-femoral pulse-wave velocity (cfPWV), is not known. METHOD Accordingly, we compared the associations of the af-SG and cfPWV with (i) age and traditional CVD risk factors and (ii) CVD status. We evaluated 4183 older-aged (75.2 ± 5.0 years) men and women in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and femoral-ankle PWV (faPWV) were measured using an automated cardiovascular screening device. The af-SG was calculated as faPWV divided by cfPWV. Associations of af-SG and cfPWV with age, CVD risk factors (age, BMI, blood pressure, heart rate, glucose and blood lipid levels) and CVD status (hypertension, diabetes, coronary heart disease, heart failure, stroke) were determined using linear and logistic regression analyses. RESULTS (i) the af-SG and cfPWV demonstrated comparable associations with age and CVD risk factors, except BMI. (ii) a low af-SG was associated with diabetes, coronary heart disease, heart failure and stroke, whilst a high cfPWV was only associated with diabetes. CONCLUSION Although future studies are necessary to confirm clinical utility, the af-SG is a promising tool that may provide a unique picture of hemodynamic integration and identification of CVD risk when compared with cfPWV.
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Affiliation(s)
- Keeron STONE
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Simon FRYER
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Michelle L MEYER
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna KUCHARSKA-NEWTON
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - James FAULKNER
- Department of Sport, Exercise & Health, University of Winchester, Winchester, UK
| | - Gabriel ZIEFF
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig PATERSON
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Daniel CREDEUR
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kunihiro MATSUSHITA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy M. HUGHES
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Hirofumi TANAKA
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Lee STONER
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Climie RE, Gallo A, Picone DS, Di Lascio N, van Sloten TT, Guala A, Mayer CC, Hametner B, Bruno RM. Measuring the Interaction Between the Macro- and Micro-Vasculature. Front Cardiovasc Med 2019; 6:169. [PMID: 31824963 PMCID: PMC6882776 DOI: 10.3389/fcvm.2019.00169] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023] Open
Abstract
Structural and functional dysfunction in both the macro- and microvasculature are a feature of essential hypertension. In a healthy cardiovascular system, the elastic properties of the large arteries ensure that pulsations in pressure and flow generated by cyclic left ventricular contraction are dampened, so that less pulsatile pressure and flow are delivered at the microvascular level. However, in response to aging, hypertension, and other disease states, arterial stiffening limits the buffering capacity of the elastic arteries, thus exposing the microvasculature to increased pulsatile stress. This is thought to be particularly pertinent to high flow/low resistance organs such as the brain and kidney, which may be sensitive to excess pressure and flow pulsatility, damaging capillary networks, and resulting in target organ damage. In this review, we describe the clinical relevance of the pulsatile interaction between the macro- and microvasculature and summarize current methods for measuring the transmission of pulsatility between the two sites.
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Affiliation(s)
- Rachel E Climie
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Antonio Gallo
- Cardiovascular Prevention Unit, Department of Endocrinology and Metabolism, Pitié-Salpêtrière Hospital, Paris, France.,Laboratoire d'imagerie Biomédicale, INSERM 1146 - CNRS 7371, Sorbonne University, Paris, France
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Thomas T van Sloten
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Bernhard Hametner
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Rosa Maria Bruno
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France
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Picone DS, Schultz MG, Peng X, Black JA, Dwyer N, Roberts-Thomson P, Chen CH, Cheng HM, Pucci G, Wang JG, Sharman JE. Discovery of New Blood Pressure Phenotypes and Relation to Accuracy of Cuff Devices Used in Daily Clinical Practice. Hypertension 2018; 71:1239-1247. [DOI: 10.1161/hypertensionaha.117.10696] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/04/2018] [Accepted: 02/27/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Dean S. Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Martin G. Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Xiaoqing Peng
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.)
| | - J. Andrew Black
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.)
- Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Nathan Dwyer
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.)
- Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Philip Roberts-Thomson
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.)
- Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan (C.-H.C., H.-M.C.)
- Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., H.-M.C.)
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan (C.-H.C., H.-M.C.)
- Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., H.-M.C.)
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.)
| | - Ji-Guang Wang
- and Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, China (J.G.W.)
- and Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.G.W.)
| | - James E. Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.)
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6
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Fortier C, Desjardins MP, Agharazii M. Aortic-Brachial Pulse Wave Velocity Ratio: A Measure of Arterial Stiffness Gradient Not Affected by Mean Arterial Pressure. Pulse (Basel) 2017; 5:117-124. [PMID: 29761086 DOI: 10.1159/000480092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/04/2017] [Indexed: 11/19/2022] Open
Abstract
Background Aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is used for the prediction of cardiovascular risk. This mini-review describes the nonlinear relationship between cf-PWV and operational blood pressure, presents the proposed methods to adjust for this relationship, and discusses a potential place for aortic-brachial PWV ratio (a measure of arterial stiffness gradient) as a blood pressure-independent measure of vascular aging. Summary PWV is inherently dependent on the operational blood pressure. In cross-sectional studies, PWV adjustment for mean arterial pressure (MAP) is preferred, but still remains a nonoptimal approach, as the relationship between PWV and blood pressure is nonlinear and varies considerably among individuals due to heterogeneity in genetic background, vascular tone, and vascular remodeling. Extrapolations from the blood pressure-independent stiffness parameter β (β0) have led to the creation of stiffness index β, which can be used for local stiffness. A similar approach has been used for cardio-ankle PWV to generate a blood pressure-independent cardio-ankle vascular index (CAVI). It was recently demonstrated that stiffness index β and CAVI remain slightly blood pressure-dependent, and a more appropriate formula has been proposed to make the proper adjustments. On the other hand, the negative impact of aortic stiffness on clinical outcomes is thought to be mediated through attenuation or reversal of the arterial stiffness gradient, which can also be influenced by a reduction in peripheral medium-sized muscular arteries in conditions that predispose to accelerate vascular aging. Arterial stiffness gradient, assessed by aortic-brachial PWV ratio, is emerging to be at least as good as cf-PWV for risk prediction, but has the advantage of not being affected by operating MAP. Key Messages The negative impacts of aortic stiffness on clinical outcomes are proposed to be mediated through attenuation or reversal of arterial stiffness gradient. Aortic-brachial PWV ratio, a measure of arterial stiffness gradient, is independent of MAP.
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Affiliation(s)
- Catherine Fortier
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Marie-Pier Desjardins
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, and Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
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