Sex differences in aortic augmentation index in adolescents

Influence of training status on cardiac and vascular functioning in young recreational and competitive male rowers

Introduction

The aim of the study was to investigate the influence of training status on cardiovascular function in young male recreational and competitive rowers.

Methods

Ejection duration in percentage to the heart rate period (ED%), subendocardial viability ratio (SEVR), augmentation index at 75 bpm (AIx75) and carotid to femoral pulse wave velocity (cf-PWV) of competitive rowers (CR) (age 17.6 ± 4.1 years), recreational rowers (RR) (age 16.7 ± 2.70 years) and athletes practicing other recreational sports (ORS) (age 15.3 ± 1.4 years) were assessed.

Results

ED% was lower in CR compared to ORS (31.9 ± 3.9% vs. 38.4 ± 4.8%; p = 0.026) and cf-PWV was higher in CR compared to ORS (5.5 ± 1.0 m/s vs. 4.7 ± 0.5 m/s; p = 0.032). SEVR was higher in CR compared to RR and ORS (165.8 ± 33.7% vs. 127.4 ± 30.4% and 128.3 ± 27.8%; p = 0.022) and AIx75 was lower in CR compared to RR and ORS (-15.7 ± 8.6% vs. 1.2 ± 9.9% and 1.5 ± 9.1; p = 0.001).

Discussion

Healthy, young competitive male rowers reported higher myocardial performance and better cardiovascular health than recreational athletes. Interpretations of cf-PWV in competitive rowers should be performed alongside other cardiovascular indicators.

Sex differences in pressure and flow waveform physiology across the life course

Cardiovascular disease (CVD) has long been deemed a disease of old men. However, in 2019 CVD accounted for 35% of all deaths in women and, therefore, remains the leading cause of death in both men and women. There is increasing evidence to show that risk factors, pathophysiology and health outcomes related to CVD differ in women compared with men, yet CVD in women remains understudied, underdiagnosed and undertreated. Differences exist between the sexes in relation to the structure of the heart and vasculature, which translate into differences in blood pressure and flow waveform physiology. These physiological differences between women and men may represent an important explanatory factor contributing to the sex disparity in CVD presentation and outcomes but remain understudied. In this review we aim to describe sex differences in arterial pressure and flow waveform physiology and explore how they may contribute to differences in CVD in women compared to men. Given that unfavourable alterations in the cardiovascular structure and function can start as early as in utero, we report sex differences in waveform physiology across the entire life course.

Predictors and reference equations for augmentation index, an arterial stiffness marker, in healthy children and adolescents

OBJECTIVES

To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents.

METHODS

This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains).

RESULTS

The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%).

CONCLUSION

In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.

Development of an Efficient, Non-Invasive Method for Cardiovascular Disease Risk Stratification in a Resource-Limited Setting

BACKGROUND

Augmentation Index (AIx) is considered as an important predictor of cardiovascular disease. So, quantification of AIx may provide a rapid cost-effective and non-invasive means of cardiovascular risk stratification. At present, WHO/ISH risk prediction charts are used to predict 10-year risk of a fatal or nonfatal major cardiovascular event, an assessment which requires laboratory support for blood chemistry and thus making it ill-suited for resource-limited settings.

OBJECTIVES

In this study, we examined the association of AIx with cardiovascular risk as determined by the WHO/ISH chart and identified AIx cut-offs to stratify patients into different risk categories.

METHODS

A case-control study with 162 cases and 61 controls was conducted in a tertiary care hospital in eastern India. Data were obtained for demographic, anthropometric, cardiovascular, and biochemical parameters. Cardiovascular risk assessment was carried out by WHO/ISH risk model in R. Statistical analysis was done for examining the association of AIx with WHO/ISH cardiovascular risk and for identifying AIx cut-offs to stratify patients into different risk categories.

RESULTS

Box and whisker plots for assessing the correlation between AIx and WHO/ISH cardiovascular risk showed an increase in the median value of AIx with increasing risk in both cases and controls. Heart rate corrected AIx showed a steady increase with increasing risk in males. AIx cutoffs showed good sensitivity and specificity for each risk category.

CONCLUSION

AIx is remarkably associated with cardiovascular risk as assessed by the WHO/ISH chart and the AIx cut-offs obtained in the study can be used as an efficient, non-invasive surrogate biomarker of cardiovascular risk even in resource-limited settings.

Weight Gain Trajectories from Birth to Adolescence and Cardiometabolic Status in Adolescence

OBJECTIVE

To assess the influence of the trajectory of weight gain from birth to adolescence on cardiovascular and metabolic risk. We studied childhood body mass index (BMI) trajectories from birth to age 14 years and cardiometabolic risk factors at age 14 years.

STUDY DESIGN

In total, 410 children with weight and height measurements were assessed from birth throughout childhood, from the Childhood Asthma Prevention Study, a prospective community-based cohort. BMI trajectory groups were determined by latent basis growth mixture models. Of these subjects, 190 had detailed cardiometabolic risk factors assessed at age 14 years.

RESULTS

Three BMI trajectory groups were identified; normal BMI, "early rising" excess BMI from 2 years, and "late rising" excess BMI from 5 years. Differences were found between normal and excess BMI in children at 14 years of age. In addition, children with an early rising BMI trajectory had statistically significantly higher central adiposity and a more atherogenic lipoprotein profile at age 14 years than children with a late rising BMI trajectory (P < .05). No differences between BMI trajectory groups in vascular structure or function was identified at age 14 years.

CONCLUSIONS

Earlier onset of an elevated BMI trajectory persisting from birth to age 14 years results in an unfavorable cardiometabolic risk profile at age 14 years, including central adiposity and more atherogenic lipoproteins, independent of achieved BMI.

Vascular characteristics in young women-Effect of extensive endurance training or a sedentary lifestyle

AIM

To explore whether high-level endurance training in early age has an influence on the arterial wall properties in young women.

METHODS

Forty-seven athletes (ATH) and 52 controls (CTR), all 17-25 years of age, were further divided into runners (RUN), whole-body endurance athletes (WBA), sedentary controls (SC) and normally active controls (AC). Two-dimensional ultrasound scanning of the carotid arteries was conducted to determine local common carotid artery (CCA) geometry and wall distensibility. Pulse waves were recorded with a tonometer to determine regional pulse wave velocity (PWV) and pulse pressure waveform.

RESULTS

Carotid-radial PWV was lower in WBA than in RUN (P < .05), indicating higher arterial distensibility along the arm. Mean arterial pressure was lower in ATH than in CTR and in RUN than in WBA (P < .05). Synthesized aortic augmentation index (AI@75) was lower among ATH than among CTR (-12.8 ± 1.6 vs -2.6 ± 1.2%, P < .001) and in WBA than in RUN (-16.4 ± 2.5 vs -10.7 ± 2.0%, P < .05), suggesting a diminished return of reflection waves to the aorta during systole. Carotid-femoral PWV and intima-media thickness (IMT), lumen diameter and radial distensibility of the CCA were similar in ATH and CTR.

CONCLUSION

Elastic artery distensibility and carotid artery IMT are not different in young women with extensive endurance training over several years and in those with sedentary lifestyle. On the other hand, our data suggest that long-term endurance training is associated with potentially favourable peripheral artery adaptation, especially in sports where upper body work is added. This adaptation, if persisting later in life, could contribute to lower cardiovascular risk.

Positive correlation of the serum angiopoietin-like protein 3 levels with the aortic augmentation index in patients with coronary artery disease

Purpose

Angiopoietin-like protein 3 (ANGPTL3) plays an important role in lipid metabolism and angiogenesis and is elevated in familial hypercholesterolemia, metabolic syndrome, and insulin resistance. This study aims to evaluate the relationship between the fasting serum ANGPTL3 levels and the aortic augmentation index (AIx) in patients with coronary artery disease (CAD).

Materials and methods

Fasting blood samples were obtained from 100 patients with CAD. The AIx was measured using a validated tonometry system (SphygmoCor). The serum ANGPTL3 levels were assessed using a commercial enzyme-linked immunosorbent assay kit.

Results

The aortic AIx values were higher in female patients with CAD (P=0.003) than those in male patients with CAD. The univariate linear analysis of the aortic AIx values reveals that the height (r=−0.363; P<0.001) and body weight (r=−0.350; P<0.001) were negatively correlated, whereas the age (r=0.202; P=0.044) and logarithmically transformed ANGPTL3 (log-ANGPTL3, r=0.357; P<0.001) were positively correlated with the aortic AIx values in patients with CAD. The multivariate forward stepwise linear regression analysis of the factors significantly associated with the aortic AIx revealed that the height (β=−0.269; adjusted R² change=0.123; P=0.007) and serum log-ANGPTL3 level (β=0.259; adjusted R² change=0.051; P=0.010) were independent predictors of the aortic AIx values in patients with CAD.

Conclusion

The fasting serum ANGPTL3 level positively correlated with the aortic AIx values among patients with CAD.

Arterial Flow, Pulse Pressure and Pulse Wave Velocity in Men and Women at Various Ages

The increase in pulse pressure (PP) that occurs with advancing age is predominantly due to reduced arterial distensibility leading to decreased aortic compliance, particularly in the elderly, in whom high blood pressure mainly manifests as isolated systolic hypertension. Since age-related changes in stroke volume are minimal compared with changes in PP, PP is often considered a surrogate measure of arterial stiffness. However, since PP is determined by both cardiac and arterial function, a more precise and reliable means of assessment of arterial stiffness is arterial pulse wave velocity (PWV), a parameter that is only dependent on arterial properties. Arterial stiffness as measured by PWV has been found to be a powerful pressure-related indicator for cardiovascular morbidity and mortality. We analyzed PP and PWV in men and women of various age groups in healthy volunteers as well as cardiac patients with different types of diseases. The findings identified several striking sex-specific differences which demand consideration in guidelines for diagnostic procedures, for epidemiological analysis, and in evaluation of therapeutic interventions.