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Berbrier DE, Leone CA, Adler TE, Bender JR, Taylor HS, Stachenfeld NS, Usselman CW. Effects of androgen excess and body mass index on endothelial function in women with polycystic ovary syndrome. J Appl Physiol (1985) 2023; 134:868-878. [PMID: 36861670 DOI: 10.1152/japplphysiol.00583.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is associated with endothelial dysfunction; whether this is attributable to comorbid hyperandrogenism and/or obesity remains to be established. Therefore, we 1) compared endothelial function between lean and overweight/obese (OW/OB) women with and without androgen excess (AE)-PCOS and 2) examined androgens as potential modulators of endothelial function in these women. The flow-mediated dilation (FMD) test was applied in 14 women with AE-PCOS (lean: n = 7; OW/OB: n = 7) and 14 controls (CTRL; lean: n = 7, OW/OB: n = 7) at baseline (BSL) and following 7 days of ethinyl estradiol supplementation (EE; 30 µg/day) to assess the effect of a vasodilatory therapeutic on endothelial function; at each time point we assessed peak increases in diameter during reactive hyperemia (%FMD), shear rate, and low flow-mediated constriction (%LFMC). BSL %FMD was attenuated in lean AE-PCOS versus both lean CTRL (5.2 ± 1.5 vs. 10.3 ± 2.6%, P < 0.01) and OW/OB AE-PCOS (5.2 ± 1.5 vs. 6.6 ± 0.9%, P = 0.048). A negative correlation between BSL %FMD and free testosterone was observed in lean AE-PCOS only (R2 = 0.68, P = 0.02). EE increased %FMD in both OW/OB groups (CTRL: 7.6 ± 0.6 vs. 10.4 ± 2.5%, AE-PCOS: 6.6 ± 0.9 vs. 9.6 ± 1.7%, P < 0.01), had no impact on %FMD in lean AE-PCOS (5.17 ± 1.5 vs. 5.17 ± 1.1%, P = 0.99), and reduced %FMD in lean CTRL (10.3 ± 2.6 vs. 7.6 ± 1.2%, P = 0.03). Collectively, these data indicate that lean women with AE-PCOS exhibit more severe endothelial dysfunction than their OW/OB counterparts. Furthermore, endothelial dysfunction appears to be mediated by circulating androgens in lean but not in OW/OB AE-PCOS, suggesting a difference in the endothelial pathophysiology of AE-PCOS between these phenotypes.NEW & NOTEWORTHY We present evidence for marked endothelial dysfunction in lean women with androgen excess polycystic ovary syndrome (AE-PCOS) that is 1) associated with free testosterone levels, 2) impaired relative to overweight/obese women with AE-PCOS, and 3) unchanged following short-term ethinyl estradiol supplementation. These data indicate an important direct effect of androgens on the vascular system in women with AE-PCOS. Our data also suggest that the relationship between androgens and vascular health differs between phenotypes of AE-PCOS.
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Affiliation(s)
- Danielle E Berbrier
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Cheryl A Leone
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
| | - Tessa E Adler
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
| | - Jeffrey R Bender
- Departments of Internal Medicine (Cardiovascular Medicine) and Immunobiology, Yale School of Medicine, New Haven, Connecticut, United States
- Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, Connecticut, United States
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Nina S Stachenfeld
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Charlotte W Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
- McGill Research Centre for Physical Activity and Health, McGill University, Montreal, Quebec, Canada
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He Q, Sun Z, Li Y, Wang W, Wang RK. Spatiotemporal monitoring of changes in oxy/deoxy-hemoglobin concentration and blood pulsation on human skin using smartphone-enabled remote multispectral photoplethysmography. BIOMEDICAL OPTICS EXPRESS 2021; 12:2919-2937. [PMID: 34168907 PMCID: PMC8194624 DOI: 10.1364/boe.423160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
We propose a smartphone-enabled remote multispectral photoplethysmography (SP-rmPPG) system and method to realize spatiotemporal monitoring of perfusion changes and pulsations of the oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb) information of the effective blood volume within light interrogated skin tissue beds. The system is implemented on an unmodified smartphone utilizing its built-in camera and flashlight to acquire videos of the skin reflectance. The SP-rmPPG method converts the RGB video into multispectral cubes, upon which to decouple the dynamic changes in HbO2 and Hb information using a modified Beer-Lambert law and the selective wavelength bands of 500 nm and 650 nm. Blood pulsation amplitudes are then obtained by applying a window-based lock-in amplification on the derived spatiotemporal changes in HbO2 or Hb signals. To demonstrate the feasibility of proposed method, we conduct two experiments on the skin tissue beds that are conditioned by occlusive maneuver of supplying arteries: one using the popular blood cuff pressure maneuver on the upper arm, and another artificially inducing a transient ischemic condition on the facial skin tissue beds by finger pressing on the supplying external carotid artery. The cuff experiment shows that the measured dynamic information of HbO2 and Hb in the downstream agrees well with the parallel measurements of oxygenation saturation given by the standard pulse oximeter. We also observe the expected imbalance of spatiotemporal changes in the HbO2 and Hb between the right and left cheeks when the transient ischemic condition is induced in the one side of facial skin tissue beds. The results from the two experiments sufficiently demonstrate the feasibility of the proposed method to monitor the spatiotemporal changes in the skin hemodynamics, including blood oxygenation and pulsation amplitudes. Considering the ever-growing accessibility and affordability of the smartphone to the general public, the proposed strategy promises the early screening of vascular diseases and improving general public health particularly in rural areas with low resource settings.
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Affiliation(s)
- Qinghua He
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Zhiyuan Sun
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Yuandong Li
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Wendy Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Department of Ophthalmology, University of Washington, Seattle, WA98105, USA
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Sørland K, Sandvik MK, Rekeland IG, Ribu L, Småstuen MC, Mella O, Fluge Ø. Reduced Endothelial Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-Results From Open-Label Cyclophosphamide Intervention Study. Front Med (Lausanne) 2021; 8:642710. [PMID: 33829023 PMCID: PMC8019750 DOI: 10.3389/fmed.2021.642710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) present with a range of symptoms including post-exertional malaise (PEM), orthostatic intolerance, and autonomic dysfunction. Dysfunction of the blood vessel endothelium could be an underlying biological mechanism, resulting in inability to fine-tune regulation of blood flow according to the metabolic demands of tissues. The objectives of the present study were to investigate endothelial function in ME/CFS patients compared to healthy individuals, and assess possible changes in endothelial function after intervention with IV cyclophosphamide. Methods: This substudy to the open-label phase II trial "Cyclophosphamide in ME/CFS" included 40 patients with mild-moderate to severe ME/CFS according to Canadian consensus criteria, aged 18-65 years. Endothelial function was measured by Flow-mediated dilation (FMD) and Post-occlusive reactive hyperemia (PORH) at baseline and repeated after 12 months. Endothelial function at baseline was compared with two cohorts of healthy controls (N = 66 and N = 30) from previous studies. Changes in endothelial function after 12 months were assessed and correlated with clinical response to cyclophosphamide. Biological markers for endothelial function were measured in serum at baseline and compared with healthy controls (N = 30). Results: Baseline FMD was significantly reduced in patients (median FMD 5.9%, range 0.5-13.1, n = 35) compared to healthy individuals (median FMD 7.7%, range 0.7-21, n = 66) (p = 0.005), as was PORH with patient score median 1,331 p.u. (range 343-4,334) vs. healthy individuals 1,886 p.u. (range 808-8,158) (p = 0.003). No significant associations were found between clinical response to cyclophosphamide intervention (reported in 55% of patients) and changes in FMD/PORH from baseline to 12 months. Serum levels of metabolites associated with endothelial dysfunction showed no significant differences between ME/CFS patients and healthy controls. Conclusions: Patients with ME/CFS had reduced endothelial function affecting both large and small vessels compared to healthy controls. Changes in endothelial function did not follow clinical responses during follow-up after cyclophosphamide IV intervention.
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Affiliation(s)
- Kari Sørland
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Ingrid Gurvin Rekeland
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Institute of Medicine, University of Bergen, Bergen, Norway
| | - Lis Ribu
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Olav Mella
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Institute of Medicine, University of Bergen, Bergen, Norway
| | - Øystein Fluge
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Institute of Medicine, University of Bergen, Bergen, Norway
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Dávida L, Pongrácz V, Mohamed EA, Szamosi S, Szücs G, Váncsa A, Tímár O, Csiki Z, Végh E, Soltész P, Szekanecz Z, Kerekes G. A prospective, longitudinal monocentric study on laser Doppler imaging of microcirculation: comparison with macrovascular pathophysiology and effect of adalimumab treatment in early rheumatoid arthritis. Rheumatol Int 2019; 40:415-424. [PMID: 31858209 DOI: 10.1007/s00296-019-04503-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022]
Abstract
Increased cardiovascular (CV) morbidity and mortality have been found in rheumatoid arthritis (RA). Tumour necrosis factor α (TNF-α) inhibitors may improve vascular function. In the first part of this study, we determined microcirculation during postoocclusive reactive hyperemia (PORH) representing endothelial function. In a nonselected population (n = 46) we measured flow-mediated vasodilation (FMD) of the brachial artery and laser Doppler flow (LDF) by ultrasound. Among LDF parameters, we determined TH1 (time to half before hyperemia), TH2 (time to half after hyperemia), Tmax (time to maximum) and total hyperemic area (AH). We measured von Willebrand antigen (vWF:Ag) by ELISA. In the second part of the study, we assessed the effects of adalimumab treatment on microcirculatory parameters in 8 early RA patients at 0, 2, 4, 8 and 12 weeks. We found significant positive correlations between FMD and LDF Tmax (R = 0.456, p = 0.002), FMD and TH2 (R = 0.435, p = 0.004), and negative correlation between vWF:Ag and Tmax (R = - 0.4, p = 0.009) and between vWF:Ag and TH2 (R = - 0.446, p = 0.003). Upon adalimumab therapy in early RA, TH2 times improved in comparison to baseline (TH2baseline = 26.9 s vs. TH24weeks = 34.7 s, p = 0,032), and this effect prolonged until the end of treatment (TH28weeks = 40.5, p = 0.026; TH212weeks = 32.1, p = 0.013). After 8 weeks of treatment, significant improvement was found in AHa (AHbaseline = 1599 Perfusion Units [PU] vs. AH8weeks = 2724 PU, p = 0.045). The PORH test carried out with LDF is a sensitive option to measure endothelial dysfunction. TH1 and TH2 may be acceptable and reproducible markers. In our pilot study, treatment with adalimumab exerted favorable effects on disease activity, endothelial dysfunction and microcirculation in early RA patients.
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Affiliation(s)
- László Dávida
- Intensive Care Unit, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Vanda Pongrácz
- Intensive Care Unit, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Emir Awad Mohamed
- Intensive Care Unit, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilvia Szamosi
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, 4032, Debrecen, Hungary
| | - Gabriella Szücs
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, 4032, Debrecen, Hungary
| | - Andrea Váncsa
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, 4032, Debrecen, Hungary
| | - Orsolya Tímár
- Intensive Care Unit, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, 4032, Debrecen, Hungary
| | - Zoltán Csiki
- Division of Clinical Immunology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edit Végh
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, 4032, Debrecen, Hungary
| | - Pál Soltész
- Intensive Care Unit, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Division of Angiology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, 4032, Debrecen, Hungary.
| | - György Kerekes
- Intensive Care Unit, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Menopausal hot flashing and endothelial function in two vascular beds: findings from a cross-sectional study of postmenopausal women. Menopause 2019; 26:1002-1009. [PMID: 31453962 DOI: 10.1097/gme.0000000000001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to examine the association of menopausal hot flashing with vascular reactivity in two different vascular beds in the same cohort of postmenopausal women and explore the relationship between hot flashing and cardiovascular disease (CVD) risk profile. METHODS A cross-sectional study of 79 healthy postmenopausal women, 23 of whom have never had menopausal hot flashes and 56 of whom have reported hot flashes. Endothelial function at a microvascular level was measured with Laser Doppler Imaging with Iontophoresis which assesses the response to both acetylcholine (Ach, endothelium dependent) and sodium-nitroprusside (SNP, endothelium independent). Reactive Hyperemia Index (RHI) was measured with peripheral arterial tonometry as a marker of endothelial function mainly at a macrovascular level. Metabolic biomarkers including insulin sensitivity were assessed. RESULTS Women with hot flashes had enhanced microvascular response to Ach by ∼30% (P = 0.04) and to SNP by ∼31% (P = 0.02), but lower RHI by ∼13% (P = 0.05) compared with women without flashes. Hot flashing was associated with enhanced response to SNP and lower RHI after adjustment for confounders and conventional CVD risk factors. Women with hot flashes were more insulin resistant than nonflashers (HOMAIR: 1.9 (1.2-2.6) vs 1.4 (0.8-1.9), P = 0.03). CONCLUSIONS Our data support the association of hot flashing with greater insulin resistance and lower macrovascular response. The paradoxical enhanced microvascular response in hot flashers could be the result of the net effect of thermoregulatory and nonnitric oxide-related pathways rather than of endothelial integrity.
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Jekell A, Kalani M, Kahan T. The interrelation of endothelial function and microvascular reactivity in different vascular beds, and risk assessment in hypertension: results from the Doxazosin-ramipril study. Heart Vessels 2018; 34:484-495. [PMID: 30244381 PMCID: PMC6373355 DOI: 10.1007/s00380-018-1265-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/14/2018] [Indexed: 12/14/2022]
Abstract
There are several non-invasive methods to study endothelial function, but their interrelation and association to cardiovascular risk have not been well evaluated. We studied macrovascular and microvascular endothelial function simultaneously in different vascular beds in relation to cardiovascular mortality risk (Systematic Coronary Risk Evaluation, SCORE) and hypertension induced cardiac organ damage, and their interrelationship. The study investigated 71 hypertensive patients by forearm post-ischemic flow-mediated vasodilation, pulse wave analysis (applanation tonometry) and beta 2-adrenoceptor agonist stimulation for changes in reflection index, skin microvascular reactivity by laser Doppler fluxmetry with iontophoresis and heat-induced hyperaemia, and coronary microvascular function by subendocardial viability ratio (derived from pulse wave analysis). Flow mediated vasodilation related inversely to SCORE (r = 0.34, P = 0.011). Adding microalbuminuria and pulse wave velocity strengthened the associations. Pulse wave reflection changes did not relate to SCORE. Skin microvascular reactivity related inversely to SCORE (peak flux change to sodium nitroprusside r = 0.29, P = 0.033, and to heating r = 0.31, P = 0.018). Subendocardial viability ratio did not relate to SCORE. Endothelial function indices showed no consistent relation to cardiac target organ damage. The agreement between the different methods for evaluating indices of macrovascular and microvascular endothelial function was weak. In conclusion, indices of macrovascular and microvascular endothelial function relate to cardiovascular mortality risk. Their use may improve cardiovascular risk prediction in hypertension. However, methods representing different vascular beds show little interrelationship and are not interchangeable, which may depend on different pathogenetic mechanisms representing different aspects of future cardiovascular risk. Trial registry: NCT02901977
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Affiliation(s)
- Andreas Jekell
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden. .,Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden.
| | - Majid Kalani
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden
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Reproducibility and agreement of different non-invasive methods of endothelial function assessment. Microvasc Res 2018; 117:50-56. [PMID: 29338981 DOI: 10.1016/j.mvr.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/21/2022]
Abstract
Flow-mediated dilatation (FMD) is an established, but investigator-demanding method, used to non-invasively determine nitric oxide (NO)-dependent endothelial function in humans. Local thermal hyperemia (LTH) or post-occlusive reactive hyperemia (PORH) of the skin measured with a laser Doppler flow imager may be a less demanding alternative of FMD. We investigated the reproducibility of the different measures of vascular function, their interrelationship and the NO-dependency of LTH. Measurements were performed twice in 27 healthy men (8 smokers), one week apart. Local application of NG-monomethyl-l-arginine (L-NMMA) by means of iontophoresis was used to determine the NO-dependency of LTH. Using L-NMMA, the peak and plateau responses of LTH were reduced by 31% (p < .001) and 65% (<0.001), respectively. For all measurements the coefficient of variation (CV) was higher in smokers than in non-smokers. For non-smokers the CV of FMD was 12%, of LTH peak response 17%, of LTH plateau response 12%, of PORH peak response 14% and of PORH area under the curve response 11%. FMD correlated weakly with the PORH peak and area under the curve response (r = 0.39 and 0.43, p < .05), whereas the LTH-plateau response correlated with the PORH peak response (r = 0.68, p < .01) in non-smokers, but FMD and LTH peak or plateau responses were unrelated. In conclusion, the LTH plateau response is for two-third NO-dependent, but unrelated to FMD. Furthermore, despite easy to perform the LTH responses are not more reproducible than FMD. Given the weak associations, the different methods of vascular function assessment are not interchangeable.
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Siddiqui MA, Ashraff S, Santos D, Carline T. An overview of AVF maturation and endothelial dysfunction in an advanced renal failure. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0123-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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9
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Martini D, Rossi S, Biasini B, Zavaroni I, Bedogni G, Musci M, Pruneti C, Passeri G, Ventura M, Di Nuzzo S, Galli D, Mirandola P, Vitale M, Dei Cas A, Bonadonna RC, Del Rio D. Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the framework of protection against oxidative damage and cardiovascular health. Nutr Metab Cardiovasc Dis 2017; 27:473-503. [PMID: 28434807 DOI: 10.1016/j.numecd.2017.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The high number of negative opinions from the European Food Safety Authority (EFSA) to the requests for authorization of health claims is largely due to the design of human intervention studies, including the inappropriate choice of outcome variables (OVs) and of their methods of measurement (MMs). The present manuscript reports the results of an investigation aimed to collect, collate and critically analyse the information in relation to claimed effects, OVs and MMs, in the context of protection against oxidative damage and cardiovascular health compliant with Regulation 1924/2006. METHODS AND RESULTS Claimed effects, OVs and the related MMs were collected from EFSA Guidance documents and applications for authorization of health claims under Articles 13.5 and 14. The OVs and their MMs were evaluated only if the claimed effect was sufficiently defined and was considered beneficial by EFSA. The collection, collation and critical analysis of the relevant scientific literature consisted in the definition of the keywords, the PubMed search strategies and the creation of databases of references. The critical analysis of the OVs and their MMs was performed on the basis of the literature review and was aimed at defining the appropriateness of OVs and MMs in the context of the specific claimed effects. CONCLUSIONS The information provided in this document could serve to EFSA for the development of further guidance on the scientific requirements for health claims, as well as to the stakeholders for the proper design of human intervention studies aimed to substantiate such health claims.
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Affiliation(s)
- D Martini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - S Rossi
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - B Biasini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - I Zavaroni
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - M Musci
- Department of Food and Drug, University of Parma, Parma, Italy
| | - C Pruneti
- Department of Medicine and Surgery, Clinical Psychology Unit, University of Parma, Medical School Building, Parma, Italy
| | - G Passeri
- Department of Medicine and Surgery, Building Clinica Medica Generale, University of Parma, Parma, Italy
| | - M Ventura
- Department of Chemistry, Life Sciences and Environmental Sustainability, Laboratory of Probiogenomics, University of Parma, Parma, Italy
| | - S Di Nuzzo
- Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy
| | - D Galli
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - P Mirandola
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - M Vitale
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - A Dei Cas
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - R C Bonadonna
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - D Del Rio
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy.
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10
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Gozal D, Khalyfa A, Qiao Z, Smith DL, Philby MF, Koren D, Kheirandish-Gozal L. Angiopoietin-2 and soluble Tie-2 receptor plasma levels in children with obstructive sleep apnea and obesity. Obesity (Silver Spring) 2017; 25:1083-1090. [PMID: 28474375 PMCID: PMC5532873 DOI: 10.1002/oby.21859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a prevalent condition, especially in children with obesity, and is associated with increased risk for metabolic syndrome (MetS). Angiopoietins have been identified as potential biomarkers of endothelial dysfunction and MetS. In adults, angiopoietin-2 (Ang-2) and its soluble receptor (sTie-2) are associated with diabetes, hypertension, and obesity and could be increased in children with OSA and obesity, particularly those with evidence of cardiometabolic alterations. METHODS One hundred twenty-six children (7.4 ± 2.0 years) were consecutively recruited and underwent overnight polysomnography, as well as endothelial function and BMI z score assessments and a fasting blood draw the morning after the sleep study. In addition to lipid profile, glucose and insulin levels, and homeostatic model assessment of insulin resistance (HOMA-IR), Ang-2 and sTie-2 concentrations were determined. RESULTS Children with obesity and OSA had significantly elevated plasma Ang-2 and sTie-2 levels compared to corresponding controls with and without obesity. Furthermore, endothelial function (Tmax) and HOMA-IR were linearly and independently associated with Ang-2 and sTie-2 levels. In a small subset of children (n = 14), treatment of OSA by adenotonsillectomy resulted in reductions of Ang-2 and sTie-2 (P < 0.01). CONCLUSIONS Ang-2 and sTie-2 plasma levels are increased in pediatric OSA and obesity, particularly when endothelial dysfunction or insulin resistance is detectable, and appear to decrease upon OSA treatment.
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Affiliation(s)
- David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Abdelnaby Khalyfa
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Zhuanghong Qiao
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Dale L Smith
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Mona F Philby
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Dorit Koren
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
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Kheirandish-Gozal L, Philby MF, Qiao Z, Khalyfa A, Gozal D. Endothelial Dysfunction in Children With Obstructive Sleep Apnea Is Associated With Elevated Lipoprotein-Associated Phospholipase A2 Plasma Activity Levels. J Am Heart Assoc 2017; 6:e004923. [PMID: 28183716 PMCID: PMC5523777 DOI: 10.1161/jaha.116.004923] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/15/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent condition, especially in obese children, and has been associated with increased risk for endothelial dysfunction and dislipidemia, which are precursors of atherosclerosis. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is recognized as an independent risk factor for cardiovascular risk and atheromatous plaque activity. We hypothesized that Lp-PLA2 levels would be elevated in children with OSA, particularly among obese children who also manifest evidence of endothelial dysfunction. METHODS AND RESULTS One hundred sixty children (mean age 7.1±2.3 years), either nonobese with (n=40) and without OSA (n=40) or obese with (n=40) and without OSA (n=40) underwent overnight polysomnographic and postocclusive reperfusion evaluation and a fasting blood draw the morning after the sleep study. In addition to lipid profile, Lp-PLA2 plasma activity was assessed using a commercial kit. Obese children and OSA children had significantly elevated plasma Lp-PLA2 activity levels compared to controls. Furthermore, when both obesity and OSA were concurrently present or when endothelial function was present, Lp-PLA2 activity was higher. Treatment of OSA by adenotonsillectomy resulted in reductions of Lp-PLA2 activity (n=37; P<0.001). CONCLUSIONS Lp-PLA2 plasma activity is increased in pediatric OSA and obesity, particularly when endothelial dysfunction is present, and exhibits decreases on OSA treatment. The short-term and long-term significance of these findings in relation to cardiovascular risk remain undefined.
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Affiliation(s)
- Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL
| | - Mona F Philby
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL
| | - Zhuanghong Qiao
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL
| | - Abdelnaby Khalyfa
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL
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12
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Hellmann M, Roustit M, Cracowski JL. Skin microvascular endothelial function as a biomarker in cardiovascular diseases? Pharmacol Rep 2015; 67:803-10. [DOI: 10.1016/j.pharep.2015.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 11/17/2022]
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13
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Low-volume high-intensity interval training rapidly improves cardiopulmonary function in postmenopausal women. Menopause 2015; 21:1099-105. [PMID: 24552980 DOI: 10.1097/gme.0000000000000208] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study compared the effects of a 2-week program of low-volume high-intensity interval training (HIT) with the effects of higher-volume moderate-intensity continuous training (CT) on cardiopulmonary and vascular functions in postmenopausal women. METHODS Twenty-two postmenopausal women were randomly assigned to undertake six HIT (n = 12) or CT (n = 10) sessions for 2 weeks. HIT sessions consisted of ten 1-minute intervals of cycling exercise at 100% of peak power output separated by 1 minute of active recovery. CT sessions involved 40 minutes of continuous cycling at 65% of peak power output. Variables assessed at baseline and 2 weeks included cardiopulmonary function (ventilatory threshold, peak oxygen uptake), macrovascular endothelial function (flow-mediated dilation of the brachial artery), and microvascular function (reactive hyperemia and local thermal hyperemia of forearm skin). RESULTS Eighteen participants completed the study (HIT, 11; CT, 7). Adherence to the exercise programs was excellent, with 107 of 108 sessions completed. Despite substantially lower total time commitment (∼2.5 vs. ∼5 h) and training volume (558 vs. 1,237 kJ) for HIT versus CT, increases from baseline in peak oxygen uptake achieved significance (P = 0.01) for the HIT group only (Δ = 2.2 mL kg min; P for interaction = 0.688). Improvements in exercise test duration were observed in both groups (HIT, 13%; CT, 5%; P for interaction = 0.194). There were no significant changes in macrovascular or microvascular function in either group. CONCLUSIONS The findings suggest that low-volume HIT is feasible and can lead to rapid improvements in cardiopulmonary function in postmenopausal women.
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McGrogan DG, Maxwell AP, Khawaja AZ, Inston NG. Current tools for prediction of arteriovenous fistula outcomes. Clin Kidney J 2015; 8:282-9. [PMID: 26034589 PMCID: PMC4440466 DOI: 10.1093/ckj/sfv019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/05/2015] [Indexed: 12/28/2022] Open
Abstract
It remains challenging to accurately predict whether an individual arteriovenous fistula (AVF) will mature and be useable for haemodialysis vascular access. Current best practice involves the use of routine clinical assessment and ultrasonography complemented by selective venography and magnetic resonance imaging. The purpose of this literature review is to describe current practices in relation to pre-operative assessment prior to AVF formation and highlight potential areas for future research to improve the clinical prediction of AVF outcomes.
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Affiliation(s)
- Damian G McGrogan
- Department of Vascular Access and Renal Transplantation , University Hospitals Birmingham, Queen Elizabeth Hospital , Birmingham B15 2TH , UK
| | - Alexander P Maxwell
- Regional Nephrology Unit, Belfast Health and Social Care Trust , Belfast City Hospital , Belfast BT9 7AB , UK ; School of Medicine, Dentistry and Biomedical Sciences , Health Sciences Building , Belfast BT9 7BL , UK
| | - Aurang Z Khawaja
- Department of Vascular Access and Renal Transplantation , University Hospitals Birmingham, Queen Elizabeth Hospital , Birmingham B15 2TH , UK
| | - Nicholas G Inston
- Department of Vascular Access and Renal Transplantation , University Hospitals Birmingham, Queen Elizabeth Hospital , Birmingham B15 2TH , UK
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Assessment of Ventricular-Vascular Function by Echocardiography. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Murphy MSQ, Vignarajah M, Smith GN. Increased microvascular vasodilation and cardiovascular risk following a pre-eclamptic pregnancy. Physiol Rep 2014; 2:2/11/e12217. [PMID: 25428950 PMCID: PMC4255821 DOI: 10.14814/phy2.12217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Women who develop pre-eclampsia are at high-risk for premature cardiovascular disease and death. The aim of this study was to assess microvascular function and cardiovascular risk in the early postpartum period for women who did/did not have a pregnancy complicated by pre-eclampsia. Peripheral microvascular function was assessed in women in the third trimester of uncomplicated pregnancies, with re-evaluation at 2 and 6 months postpartum. The effect of pre-eclampsia on postpartum microvascular function was assessed 2 and 6 months after delivery. Never-pregnant, naturally cycling women served for comparison. Cutaneous microvascular reactivity to acetylcholine and sodium nitroprusside, delivered locally by iontophoresis, was measured by laser Doppler flowmetry. 30-year and lifetime risk estimates for cardiovascular disease were established. Acetylcholine-mediated vasodilation was enhanced by normotensive pregnancy, and declined to nonpregnant levels by 6 months postpartum. Acetylcholine-mediated vasodilation remained high in pre-eclamptic subjects from 2 to 6 months postpartum compared to normotensive and never-pregnant controls. Pre-eclamptic subjects exhibited elevated 30-year and lifetime risk at 6 months postpartum. This study provides in vivo evidence of microvascular and cardiovascular risk implications of pre-eclampsia as early as 6 months postpartum, and suggests that the development of pre-eclampsia may be used to identify women at risk and eligible for risk screening and intervention.
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Affiliation(s)
- Malia S Q Murphy
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Meera Vignarajah
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Graeme N Smith
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
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Ray S, Miglio C, Eden T, Del Rio D. Assessment of vascular and endothelial dysfunction in nutritional studies. Nutr Metab Cardiovasc Dis 2014; 24:940-946. [PMID: 24925123 DOI: 10.1016/j.numecd.2014.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 02/05/2023]
Abstract
Vascular and endothelial dysfunction (VED) is emerging as a potential set of early markers of cardiovascular disease risk and tests for its measurement have been widely used in clinical research. The aim of this viewpoint is to describe and discuss the current usage of these measures in well-designed nutritional trials, using the potential relationship between fruit juice intake and VED as example. A search was conducted using the NHS evidence portal including studies published in English between January 1980 and October 2013. Only 10 suitable studies were selected, which investigated the effect of fruit juice intake on VED, among which 4 interventions used flow-mediated dilatation, 2 arterial stiffness, 2 a combination of arterial stiffness and flow-mediated dilatation, 2 carotid intimal media thickness and 1 iontophoresis with laser Doppler. Despite minimal effects reported on classical CVD markers, such as lipids, 8 out of the 10 identified studies reported an effect on endothelial function following juice consumption, indicating that VED tests can be effectively used in human dietary interventions to identify relationships between bioactive compounds from fruit and CVD risk. However, paucity of available data, scarcity of compound bioavailability and metabolism information, strong heterogeneity among experimental methodologies and a number of limitations to study designs, still limit the interpretation of the results obtained through these measures. Future, well-designed studies with greater attention to consider use of VED measures are needed to strengthen the utility of VED tests in nutrition research such as those investigating the impact of polyphenol-rich juices and CVD risk.
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Affiliation(s)
- S Ray
- Medical Research Council (MRC) Human Nutrition Research (HNR), Cambridge, United Kingdom.
| | - C Miglio
- The Need for Nutrition Education/Innovation Programme (NNEdPro), c/o MRC HNR, Cambridge, United Kingdom
| | - T Eden
- The Need for Nutrition Education/Innovation Programme (NNEdPro), c/o MRC HNR, Cambridge, United Kingdom
| | - D Del Rio
- LS9 Bioactives and Health, Interlab Group, Department of Food Science, University of Parma, Parma, Italy
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Noninvasive Transcutaneous Monitoring in Long-Term Follow-Up of Patients With Thromboangiitis Obliterans Treated With Intravenous Iloprost. Angiology 2014; 66:531-8. [DOI: 10.1177/0003319714541800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the effectiveness of intravenous iloprost (IVI) in outpatients with thromboangiitis obliterans (TAO) and lower limb noninvasive transcutaneous monitoring (TCM) at follow-up (FU). Ten consecutive patients with TAO underwent IVI therapy. Transcutaneous oxygen (TcPo2) and carbon dioxide (TcPco2) determination and laser Doppler flowmetry (LDF) were performed before and after IVI at 3, 6, and 12 months of FU. Clinical response was positive in 7 patients, whereas 3 nonresponders underwent a second IVI cycle with 1 showing a late positive clinical response. After 12 months of FU, all patients were alive without amputations. Supine and dependent TcP2 levels significantly improved ( P < .005). Hallux LDF values showed significant change with the maximal hyperemic test at 44°C ( P < .005). Forefoot maximal hyperemic test at 44°C LDF ( P < .005) and improved venous arterial reflex ( P < .05) showed statistically significant time evolution. We demonstrated some degree of IVI effectiveness and evaluated TCM in patients with TAO.
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20
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Fedorovich AA, Rogoza AN, Chikhladze NM. Characteristics of functional state of arteriolar and venular skin microvessels in patients with essential arterial hypertension. Microvasc Res 2014; 93:105-13. [DOI: 10.1016/j.mvr.2014.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/11/2014] [Accepted: 04/12/2014] [Indexed: 11/30/2022]
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Hedvall Kallerman P, Hagman E, Edstedt Bonamy AK, Zemack H, Marcus C, Norman M, Westerståhl M. Obese children without comorbidities have impaired microvascular endothelial function. Acta Paediatr 2014; 103:411-7. [PMID: 24372596 DOI: 10.1111/apa.12549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/04/2013] [Accepted: 12/18/2013] [Indexed: 01/18/2023]
Abstract
AIM The aim was to test acetylcholine-induced endothelium-dependent vasodilatation in obese children without comorbidities, compared with normal weight controls, and to analyse associations between vasodilatation and other potential risk factors. METHODS Endothelium-dependent vasodilatation was induced by transdermal iontophoresis of acetylcholine in 54 obese children (8.3-18.2 years old, 41% girls) and 44 normal weight controls (7.5-20.2 years old, 82% girls), and the subsequent change in perfusion was measured with laser Doppler flowmetry. In a subgroup of the obese children, associations between acetylcholine-induced vasodilatation and blood lipids, glucose/insulin metabolism, inflammation, 24-h ambulatory blood pressure (ABP), cardiovascular fitness and duration of obesity were evaluated. RESULTS We found a lower endothelium-dependent vasodilatory response to acetylcholine in the obese children than the controls (p < 0.001). The peak perfusion response was 33% lower in obese children (p = 0.001). There was a trend towards lower vasodilatation in obese children with higher levels of triglycerides (p = 0.07). Children with the shortest duration of obesity exhibited the lowest vasodilatation (p = 0.03). No associations were found between 24-h ABP, cardiovascular fitness, inflammation and glucose/insulin metabolism. CONCLUSION Obese children without comorbidities have significantly impaired microvascular endothelial function. The children who had been obese for a longer time seemed less affected.
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Affiliation(s)
- P Hedvall Kallerman
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - E Hagman
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - A-K Edstedt Bonamy
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - H Zemack
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - C Marcus
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- National Childhood Obesity Center; Karolinska University Hospital Huddinge; Stockholm Sweden
| | - M Norman
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - M Westerståhl
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Division of Clinical Physiology; Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
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22
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Pienaar PR, Micklesfield LK, Levitt NS, Gooding K, Shore AC, Goedecke JH, Gill JMR, Lambert EV. Insulin resistance is associated with lower acetylcholine-induced microvascular reactivity in nondiabetic women. Metab Syndr Relat Disord 2014; 12:178-84. [PMID: 24460367 DOI: 10.1089/met.2013.0126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association between insulin resistance and microvascular dysfunction is well established in obese individuals with type 2 diabetes. It is unclear whether this relationship is dependent on obesity and body fat in insulin-resistant persons. This study investigated acetylcholine (ACh)-induced microvascular reactivity in apparently healthy women (n=37, 20-45 years), with and without insulin resistance. METHODS Body fat mass (dual X-ray absorptiometry), waist circumference (WC), blood pressure, fasting glucose, insulin, and free fatty acid concentrations were measured. Insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR), and subjects were divided into insulin-resistant (IR, n=16) and insulin-sensitive (IS, n=21) groups. ACh-induced forearm microvascular reactivity was measured by laser Doppler imagery using iontophoresis of ACh and compared between groups adjusting for WC and skin resistance (SR). RESULTS The IR group had a higher body mass index (BMI) (30.7 ± 6.4 vs. 22.9 ± 7.3 kg/m(2), P < 0.01), fat mass (34.7 ± 11.9 vs. 19.7 ± 9.6 kg, P < 0.01), WC (89.9 ± 13.6 vs. 74.4 ± 9.7 cm, P < 0.01), and a lower SR (0.24 ± 0.08 vs. 0.32 ± 0.08 Ω, P < 0.05) than the IS group. Microvascular reactivity, expressed as percentage increase in perfusion from baseline, was significantly lower in IR subjects after adjusting for differences in WC and SR (420.9 ± 166.5 vs. 511.6 ± 214.8%, P < 0.05). There were associations between microvascular reactivity and SR (r=-0.34, P < 0.05) and systolic blood pressure (r=-0.36, P < 0.05), but not BMI, body fat mass, WC, or HOMA-IR. CONCLUSION ACh-induced microvascular reactivity was different between IR and IS apparently healthy, nondiabetic women once differences in WC and SR were accounted for.
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Affiliation(s)
- Paula R Pienaar
- 1 UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town , Cape Town, South Africa
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Yun JS, Ko SH, Kim JH, Moon KW, Park YM, Yoo KD, Ahn YB. Diabetic retinopathy and endothelial dysfunction in patients with type 2 diabetes mellitus. Diabetes Metab J 2013; 37:262-9. [PMID: 23991404 PMCID: PMC3753491 DOI: 10.4093/dmj.2013.37.4.262] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/19/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We investigated the relationship between endothelial dysfunction and diabetic retinopathy (DR) in patients with type 2 diabetes. METHODS We used a cross-sectional design to examine 167 patients with type 2 diabetes mellitus. All patients underwent biochemical and ophthalmological examination. We assessed endothelial dysfunction by a flow-mediated vasodilation method of the brachial artery. Changes in vasodilation (flow-mediated vasodilatation, %FMD) were expressed as percent change over baseline values. RESULTS The mean±standard deviation of patient age was 54.1±8.6 years. The %FMD was significantly lower in patients with DR than without DR. The prevalence of retinopathy decreased across increasing tertiles of %FMD. After adjusting for patients' age, sex, diabetes duration, use of insulin, use of antihypertensive, antiplatelet, and lipid lowering medications, systolic blood pressure, fasting plasma glucose, 2-hour plasma glucose, glycated hemoglobin, and urinary albumin excretion, participants with a reduced %FMD were more likely to have DR (odds ratio, 11.819; 95% confidence interval, 2.201 to 63.461; P=0.004, comparing the lowest and highest tertiles of %FMD). CONCLUSION Endothelial dysfunction was associated with DR, which was most apparent when the endothelial dysfunction was severe. Our study provides insights into the possible mechanism of the influence of endothelial dysfunction on the development of DR.
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Affiliation(s)
- Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Ji-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Kun-Woong Moon
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yong-Moon Park
- Department of Preventive Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
- Department of Epidemiology and Biostatistics, Arnold School of Public health, University of South Carolina, Columbia, SC, USA
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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Pistrosch F, Köhler C, Schaper F, Landgraf W, Forst T, Hanefeld M. Effects of insulin glargine versus metformin on glycemic variability, microvascular and beta-cell function in early type 2 diabetes. Acta Diabetol 2013; 50:587-95. [PMID: 23430192 PMCID: PMC3778903 DOI: 10.1007/s00592-012-0451-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/19/2012] [Indexed: 12/21/2022]
Abstract
We investigated whether basal insulin as first-line treatment in recently diagnosed type 2 diabetes (T2D) can improve glucose control, microvascular function and preserve insulin secretion in comparison with metformin (MET). In this open-label, randomized, prospective 36-week study, 75 patients (44 m, 31 f, mean age 60.7 ± 9.2 year) were allocated to treatment with either MET 1,000 mg b.i.d. (n = 36) or insulin glargine (GLA) at bedtime (n = 39). At baseline and study end, we performed a continuous glucose monitoring for assessment of interstitial glucose (IG) and measured microvascular function using Laser-Doppler fluxmetry. GLA versus MET treatment resulted in a more pronounced reduction in FPG (Δ: 3.1 ± 2.5 vs. 1.4 ± 1.5 mmol/l; p < 0.001) and overall IG (Δ AUC. 671 ± 507 vs. 416 ± 537 mmol/l min; p = 0.04). Postprandial PG and IG differences after a standardized test meal did not reach significance. Proinsulin/C-peptide and HOMA B as marker of endogenous insulin secretion were significantly more improved by GLA. Microvascular blood flow improved only in MET-treated patients. Early basal insulin treatment with GLA in T2D patients provided a better control of FPG, overall IG load and biomarker of beta-cell function compared to the standard treatment with MET. MET treatment resulted in an improvement of microvascular function. Studies of longer duration are needed to evaluate the durability of glucose control and β cell protection with early GLA treatment.
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Affiliation(s)
- F Pistrosch
- Study Centre Prof. Hanefeld, GWT, Technical University Dresden, Dresden, Germany,
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Laser Doppler assessment of dermal circulatory changes in people with coronary artery disease. Microvasc Res 2012; 84:55-9. [DOI: 10.1016/j.mvr.2012.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 12/19/2011] [Accepted: 02/01/2012] [Indexed: 11/21/2022]
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Anania C, Norman M, Heimburger M, Gustafsson T, Jogestrand T, Hafström I, Frostegård J. Microcirculation as determined by iontophoresis in SLE-patients and controls. Lupus 2012; 21:815-20. [DOI: 10.1177/0961203312439117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: The risk of cardiovascular disease (CVD), microangiopathy and prevalence of atherosclerotic plaques are increased in Systemic Lupus Erythematosus (SLE). As systemic endothelial dysfunction is one of the earliest signs of these vascular outcomes in the general population we assessed skin microvascular endothelial function in SLE patients. Methods: Endothelial function in skin was tested with local application of acetylcholine (inducing endothelium-dependent vasodilatation) and any concomitant increase in skin perfusion was measured with Laser Doppler Fluxmetry (LDF) in 84 SLE-patients (83% women, mean age 47 years) and 81 age and sex matched controls. Common carotid intima-media thickness (cIMT) and plaque occurrence were also determined using B-mode ultrasound. Results: There were no significant differences in skin microvascular endothelial function between SLE-patients and controls. In the SLE group, endothelial function did not vary in relation to skin manifestations, Raynaud's phenomenon, nephritis or plaque occurrence. In SLE patients with CVD, however, endothelial function was impaired. Conclusion: Skin microvascular endothelial function is associated with CVD but not with early signs of atherosclerosis in SLE-patients. The endothelial function is not different in SLE-patients as compared to controls.
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Affiliation(s)
- C Anania
- Department of Medicine, at the Karolinska Institute, Stockholm, Sweden
| | - M Norman
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - M Heimburger
- Department of Medicine, at the Karolinska Institute, Stockholm, Sweden
| | - T Gustafsson
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - T Jogestrand
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - I Hafström
- Department of Medicine, at the Karolinska Institute, Stockholm, Sweden
| | - J Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Borges JP, Tibiriçá E, Soares PPS, Benedito B, Lima DB, Gomes MB, Farinatti PTV. Assessment of vascular function in HIV-infected patients. HIV CLINICAL TRIALS 2011; 12:215-21. [PMID: 22044857 DOI: 10.1310/hct1204-215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The vascular function in HIV-infected persons under HAART and non-HIV-infected persons was investigated. METHOD 18 HIV-positive patients and 23 HIV-negative subjects (14 younger group and 9 older group) were evaluated for microvascular vasodilatation during postocclusive reactive hyperemia (PORH) and during prolonged local thermal hyperemia; overall microvascular flux increase induced by iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) and large artery stiffness (SI(DVP)). RESULTS Cutaneous vascular conductance (CVC) responses to ACh were lower in HIV patients compared to both HIV-negative groups (mean [SEM]) (HIV positive: 878.2 [99.5]; older HIV negative: 1129.3 [231.6]; younger HIV negative: 1366.5 [172.6] % baseline). Regarding SNP iontophoresis, HIV-positive and older HIV-negative groups showed lower CVC responses than younger HIV-negative group (HIV positive: 1043.0 [164.6]; older HIV-negative: 980.8 [108.3]; younger HIV-negative: 1757.3 [245.1] % baseline). Vasodilatation induced by thermal hyperemia (HIV positive: 1.63 [0.11]; older HIV negative: 1.48 [0.08]; younger HIV negative: 1.85 [0.27] perfusion units/mm Hg) and PORH (HIV positive: 0.374 [0.025]; older HIV negative: 0.326 [0.025]; younger HIV negative: 0.326 [0.037] PU/mm Hg) were similar between all groups. SIDVP was greater in HIV and older healthy groups than younger healthy group (HIV positive: 9.17 [0.42]; older HIV negative: 8.19 [0.43]; younger HIV negative: 6.42 [0.22] m/s). CONCLUSION HIV-infected patients under HAART exhibited slight but nonsignificant lower microvascular reactivity to pharmacological stimuli and increased arterial stiffness compared to age-matched HIV-negative subjects. Comparison of both HIV-positive and older HIV-negative groups with younger HIV-negative subjects suggests that age plays a major role in microvascular reactivity regardless the HIV-infection.
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Newton DJ, Kennedy G, Chan KKF, Lang CC, Belch JJF, Khan F. Large and small artery endothelial dysfunction in chronic fatigue syndrome. Int J Cardiol 2011; 154:335-6. [PMID: 22078396 DOI: 10.1016/j.ijcard.2011.10.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 10/18/2011] [Indexed: 11/18/2022]
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THOMPSON ABBYK, PRZEMSKA AGNIESZKA, VASILOPOULOU DAFNI, NEWENS KATIEJ, WILLIAMS CHRISTINEM. Combined Oral Contraceptive Pills Containing Desogestrel or Drospirenone Enhance Large Vessel and Microvasculature Vasodilation in Healthy Premenopausal Women. Microcirculation 2011; 18:339-46. [DOI: 10.1111/j.1549-8719.2011.00094.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sandoo A, Carroll D, Metsios GS, Kitas GD, Veldhuijzen van Zanten JJCS. The association between microvascular and macrovascular endothelial function in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2011; 13:R99. [PMID: 21693023 PMCID: PMC3218914 DOI: 10.1186/ar3374] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 05/27/2011] [Accepted: 06/21/2011] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD). One of the earliest manifestations of CVD is endothelial dysfunction (ED). ED can occur in both the microcirculation and the macrocirculation, and these manifestations might be relatively independent of each other. Little is known about the association between endothelial function in the microcirculation and the macrocirculation in RA. The objectives of the present study were to examine the relationship between microvascular and macrovascular endothelial function in patients with RA. METHODS Ninety-nine RA patients (72 females, mean age (± SD) 56 ± 12 years), underwent assessments of endothelial-dependent (acetylcholine) and endothelial-independent (sodium nitroprusside) microvascular vasodilatory function (laser Doppler imaging with iontophoresis), as well as endothelial-dependent (flow-mediated dilation) and endothelial-independent (glyceryl trinitrate-mediated dilation) macrovascular vasodilatory function. Vasodilatory function was calculated as the percentage increase after each stimulus was applied relative to baseline values. RESULTS Pearson correlations showed that microvascular endothelial-dependent function was not associated with macrovascular endothelial-dependent function (r (90 patients) = 0.10, P = 0.34). Similarly, microvascular endothelial-independent function was not related to macrovascular endothelial-independent function (r (89 patients) = 0.00, P = 0.99). CONCLUSIONS Microvascular and macrovascular endothelial function were independent of each other in patients with RA, suggesting differential regulation of endothelial function in these two vascular beds. Assessments of both vascular beds may provide more meaningful clinical information on vascular risk in RA, but this hypothesis needs to be confirmed in long-term prospective studies.
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Affiliation(s)
- Aamer Sandoo
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, West Midlands, UK.
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CLOUGH GERALDINEF, NORMAN MIKAEL. The Microcirculation: A Target for Developmental Priming. Microcirculation 2011; 18:286-97. [DOI: 10.1111/j.1549-8719.2011.00087.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ciccone MM, Favale S, Scicchitano P, Mangini F, Mitacchione G, Gadaleta F, Longo D, Iacoviello M, Forleo C, Quistelli G, Taddei S, Resta O, Carratù P. Reversibility of the endothelial dysfunction after CPAP therapy in OSAS patients. Int J Cardiol 2011; 158:383-6. [PMID: 21353713 DOI: 10.1016/j.ijcard.2011.01.065] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 01/14/2011] [Accepted: 01/23/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The obstructive sleep apnoea syndrome (OSAS) is a common airways disease which often involves cardiovascular structures, causing vessel inflammation as well as hypoxia, induced by difficulties in the passage of air through the upper airways. Aim of our research is to evaluate the effects of Continuous Positive Airway Pressure (CPAP) on the syndrome itself and the patients cardiovascular risk profile, practically adopting Flow-Mediated Vasodilation (FMD) technique to evaluate endothelial function. METHODS AND RESULTS We enrolled 63 patients (49 males and 14 female, mean age: 54 ± 10 years) subdivided into four groups: high cardiovascular risk factors, no CPAP therapy, CPAP therapy started less- and more than 3 months before. The patients underwent FMD of the brachial artery using a high resolution ultrasonograph connected to an image analysis system. The maximum recovery value was calculated as the ratio (maximum-baseline) of the change in diameter over the baseline value. Data obtained from this study demonstrate the significant reversibility of FMD in patients treated for more than 3 months with CPAP therapy (Group 4). CONCLUSIONS Our study shows the importance of administering CPAP therapy for more than 3 months in patients suffering from OSAS to improve EF to a level equal to high cardiovascular risk subjects probably due to a recovery from the systemic hypoxia. Besides, our work points out the importance of FMD as a "clinical" tool able to point out any improvement or regression after therapies.
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Bengtsson C, Andersson SE, Edvinsson L, Edvinsson ML, Sturfelt G, Nived O. Effect of Medication on Microvascular Vasodilatation in Patients with Systemic Lupus Erythematosus. Basic Clin Pharmacol Toxicol 2010; 107:919-24. [DOI: 10.1111/j.1742-7843.2010.00604.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jones ID, Fuentes VL, Fray TR, Vallance C, Elliott J. Evaluation of a flow-mediated vasodilation measurement technique in healthy dogs. Am J Vet Res 2010; 71:1154-61. [DOI: 10.2460/ajvr.71.10.1154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Debbabi H, Bonnin P, Ducluzeau PH, Leftheriotis G, Levy BI. Noninvasive assessment of endothelial function in the skin microcirculation. Am J Hypertens 2010; 23:541-6. [PMID: 20168305 DOI: 10.1038/ajh.2010.10] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The structure and function of blood vessels varies along the vascular tree. Endothelial dysfunction is a hallmark of increased cardiovascular (CV) risk that can be assessed by several methods, some of which are invasive and of restricted application. The aim of this study was to determine whether the laser Doppler response of skin microcirculation to acetylcholine, reflects that of conduit artery assessed by brachial artery flow-mediated dilation (FMD). METHODS Noninvasive measurement of endothelium-dependent vasodilation in the skin microcirculation by laser Doppler flowmetry (LDF) in response to a local transdermal iontophoretic application of acetylcholine (Ach-SkBF) is an operator-independent method. Ach-SkBF and FMD were measured in the nondominant upper limb of 55 unselected consecutive patients admitted in our department for evaluation of CV risk factors. RESULTS Ach-SkBF was (mean +/- s.d. (min-max)) 490 +/- 414%, (10-1667%) and FMD was 3.77 +/- 3.01% (0.91-10.91). A strong linear relationship was found between Ach-SkBF and FMD: Ach-SkBF = 122.7 FMD + 25.8 (r = 0.92, P < 0.0001). CONCLUSIONS Endothelial dilatory response to increased blood flow and to acetylcholine are similar in large arteries and in the skin microvasculature. Thus, measurement of blood flow changes in the skin microcirculation using LDF coupled with acetylcholine iontophoresis represents a technically challenging and reliable noninvasive method for the assessment of endothelial function within a large range of normal and altered endothelium responses.
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Sauvet F, Leftheriotis G, Gomez-Merino D, Langrume C, Drogou C, Van Beers P, Bourrilhon C, Florence G, Chennaoui M. Effect of acute sleep deprivation on vascular function in healthy subjects. J Appl Physiol (1985) 2010; 108:68-75. [DOI: 10.1152/japplphysiol.00851.2009] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sleep disorders are associated with inflammation and sympathetic activation, which are suspected to induce endothelial dysfunction, a key factor in the increased risk of cardiovascular disease. Less is known about the early effects of acute sleep deprivation on vascular function. We evaluated microvascular reactivity and biological markers of endothelial activation during continuous 40 h of total sleep deprivation (TSD) in 12 healthy men (29 ± 3 yr). The days before [ day 1 (D1)] and during TSD (D3), at 1200 and 1800, endothelium-dependent and -independent cutaneous vascular conductance was assessed by iontophoresis of acetylcholine and sodium nitroprusside, respectively, coupled to laser-Doppler flowmetry. At 0900, 1200, 1500, and 1800, heart rate (HR) and instantaneous blood pressure (BP) were recorded in the supine position. At D1, D3, and the day after one night of sleep recovery (D4), markers of vascular endothelial cell activation, including soluble intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, and interleukin-6 were measured from blood samples at 0800. Compared with D1, plasma levels of E-selectin were raised at D3, whereas intercellular adhesion molecule-1 and interleukin-6 were raised at D4 ( P < 0.05). The endothelium-dependent and -independent CVC were significantly decreased after 29 h of TSD ( P < 0.05). By contrast, HR, systolic BP, and the normalized low-frequency component of HR variability (0.04–0.15 Hz), a marker of the sympathetic activity, increased significantly within 32 h of TSD ( P < 0.05). In conclusion, acute exposure to 40 h of TSD appears to cause vascular dysfunction before the increase in sympathetic activity and systolic BP.
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Affiliation(s)
- Fabien Sauvet
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
| | - Georges Leftheriotis
- Université d'Angers, Unité Mixte Centre National de la Recherche Scientifique 6214-Institut National de la Santé et de la Recherche Médicale 771, Angers, France
| | - Danièlle Gomez-Merino
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
| | - Christophe Langrume
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
| | - Catherine Drogou
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
| | - Pascal Van Beers
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
| | - Cyprien Bourrilhon
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
| | - Geneviève Florence
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
| | - Mounir Chennaoui
- Institut de Recherche Biomédicale des Armées, Département des Environnements Opérationnels, Brétigny sur Orge; and
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Agarwal SC, Allen J, Murray A, Purcell IF. Comparative reproducibility of dermal microvascular blood flow changes in response to acetylcholine iontophoresis, hyperthermia and reactive hyperaemia. Physiol Meas 2009; 31:1-11. [DOI: 10.1088/0967-3334/31/1/001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lenasi H. The role of nitric oxide- and prostacyclin-independent vasodilatation in the human cutaneous microcirculation: effect of cytochrome P450 2C9 inhibition. Clin Physiol Funct Imaging 2009; 29:263-70. [DOI: 10.1111/j.1475-097x.2009.00862.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hettema ME, Zhang D, Stienstra Y, Smit AJ, Bootsma H, Kallenberg CGM. No effects of bosentan on microvasculature in patients with limited cutaneous systemic sclerosis. Clin Rheumatol 2009; 28:825-33. [PMID: 19350343 PMCID: PMC2686804 DOI: 10.1007/s10067-009-1157-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 12/11/2008] [Accepted: 03/05/2009] [Indexed: 11/26/2022]
Abstract
The endothelium-derived vasoconstrictor molecule endothelin-1 (ET-1) has been suggested to play a role in the pathogenesis of Raynaud’s phenomenon (RP) and systemic sclerosis (SSc). We studied the effect of bosentan on microvascular structure and function in patients with RP secondary to limited cutaneous SSc in a mechanistic pilot study. In this single center, open study, 15 patients with limited cutaneous SSc were treated with bosentan for 16 weeks with a follow-up period of 4 weeks. Changes in microvascular structure and function were studied with assessment of vasodilatory microvascular responses using laser Doppler fluxmetry combined with iontophoresis, capillary permeability using fluorescence videomicroscopy, nailfold capillary microscopy, and serological markers of endothelial activation. No significant changes were seen in vasodilator responses to acetylcholine and sodium nitroprusside following bosentan treatment. No effect was noted on capillary permeability during treatment. The number of nailfold capillaries remained unchanged. The endothelial activation marker vascular cell adhesion molecule did not change during treatment, but levels of thrombomodulin significantly decreased after 12 weeks of treatment. Bosentan did not induce significant changes in vasodilator responses, capillary permeability, and capillary density during treatment, so no evidence was obtained for structural improvement of microvascular structure and function in this short-time mechanistic pilot study in patients with lcSSc.
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Affiliation(s)
- Martha E Hettema
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
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Dietary saturated and unsaturated fats as determinants of blood pressure and vascular function. Nutr Res Rev 2009; 22:18-38. [DOI: 10.1017/s095442240925846x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The amount and type of dietary fat have long been associated with the risk of CVD. Arterial stiffness and endothelial dysfunction are important risk factors in the aetiology of CHD. A range of methods exists to assess vascular function that may be used in nutritional science, including clinic and ambulatory blood pressure monitoring, pulse wave analysis, pulse wave velocity, flow-mediated dilatation and venous occlusion plethysmography. The present review focuses on the quantity and type of dietary fat and effects on blood pressure, arterial compliance and endothelial function. Concerning fat quantity, the amount of dietary fat consumed habitually appears to have little influence on vascular function independent of fatty acid composition, although single high-fat meals postprandially impair endothelial function compared with low-fat meals. The mechanism is related to increased circulating lipoproteins and NEFA which may induce pro-inflammatory pathways and increase oxidative stress. Regarding the type of fat, cross-sectional data suggest that saturated fat adversely affects vascular function whereas polyunsaturated fat (mainly linoleic acid (18 : 2n-6) and n-3 PUFA) are beneficial. EPA (20 : 5n-3) and DHA (22 : 6n-3) can reduce blood pressure, improve arterial compliance in type 2 diabetics and dyslipidaemics, and augment endothelium-dependent vasodilation. The mechanisms for this vascular protection, and the nature of the separate physiological effects induced by EPA and DHA, are priorities for future research. Since good-quality observational or interventional data on dietary fatty acid composition and vascular function are scarce, no further recommendations can be suggested in addition to current guidelines at the present time.
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Yamamoto-Suganuma R, Aso Y. Relationship between post-occlusive forearm skin reactive hyperaemia and vascular disease in patients with Type 2 diabetes--a novel index for detecting micro- and macrovascular dysfunction using laser Doppler flowmetry. Diabet Med 2009; 26:83-8. [PMID: 19125766 DOI: 10.1111/j.1464-5491.2008.02609.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS To investigate the relationship between the novel post-occlusive forearm skin reactive hyperaemia (PORH) index and macro- and microangiopathy by comparing it with traditional indices and a morphological analysis of skin blood flow after ischaemia. METHODS We studied 20 control subjects and 104 patients with Type 2 diabetes. Cutaneous blood flow (flux) in response to 5-min arterial occlusion in the forearm was measured using laser Doppler flowmetry. We defined the PORH index as the ratio of the area under the curve (AUC) 1 min after the release of the cuff relative to the AUC of a 1-min period before cuff inflation. The flux in response to arterial occlusion was divided morphologically into three patterns. Brachial-ankle pulse wave velocity (baPWV) was measured. RESULTS The PORH index was markedly lower in patients with diabetes than in control subjects. The PORH index correlated negatively with urinary albumin, peroneal motor nerve conduction velocity, and baPWV in the patients with diabetes. The PORH index, but not the morphological analysis, was an independent determinant of cardiovascular disease in patients with diabetes. CONCLUSIONS The PORH index may be the most sensitive indicator of micro- and macrovascular disease of the various measures of PORH in patients with Type 2 diabetes.
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Affiliation(s)
- R Yamamoto-Suganuma
- Department of Internal Medicine, Koshigaya Hospital, Dokkyo, Medical University, Saitama, Japan
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Al-Qaisi M, Kharbanda RK, Mittal TK, Donald AE. Measurement of endothelial function and its clinical utility for cardiovascular risk. Vasc Health Risk Manag 2008; 4:647-52. [PMID: 18827914 PMCID: PMC2515424 DOI: 10.2147/vhrm.s2769] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Over the past two decades, the central role of the endothelium in the initiation, progression, and clinical sequelae of atherosclerosis has been increasingly recognized. Assessment of the pathobiology of the endothelium and its ability to act as a potential therapeutic target remains an area of active research interest. Whilst endothelial function has been shown to be a marker for risk of cardiovascular events in high-risk groups, there remains considerable debate about the most appropriate way to assess this. We discuss the different clinical methods to assess endothelial function, focusing on flow-mediated dilatation (FMD) of the brachial artery, highlighting the importance of using a standardized methodology, as well as discussing the clinical limitations of using FMD in individuals.
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Affiliation(s)
- Mo Al-Qaisi
- Royal Brompton and Harefield NHS Trust, London, UK.
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Turner J, Belch JJF, Khan F. Current concepts in assessment of microvascular endothelial function using laser Doppler imaging and iontophoresis. Trends Cardiovasc Med 2008; 18:109-16. [PMID: 18555183 DOI: 10.1016/j.tcm.2008.02.001] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 01/25/2008] [Accepted: 02/01/2008] [Indexed: 01/01/2023]
Abstract
Effective evaluation of endothelial function is a powerful tool for determining patients at risk of development and progression of cardiovascular disease. As an alternative to invasive tests of endothelial function, several noninvasive methods have been developed, including the use of laser Doppler flowmetry/imaging to measure cutaneous perfusion accompanied by iontophoresis of acetylcholine and sodium nitroprusside. It is clear from previous studies that this technique provides an easy, validated, and reproducible method for investigators to assess and monitor endothelial function in patients with a variety of pathologic conditions, but it may also be used to examine disease progression over time and responsiveness to treatment, thereby facilitating clinical trials. However, a standardization of protocols would help reduce the apparent controversy seen in the literature. With its increasing use by other groups, it is anticipated that further published studies will help to provide a better understanding of the development and progression of cardiovascular disease.
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Affiliation(s)
- Jamie Turner
- University Division of Medicine and Therapeutics, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, University of Dundee, DD1 9SY Scotland, UK
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Galarraga B, Khan F, Kumar P, Pullar T, Belch JJF. C-reactive protein: the underlying cause of microvascular dysfunction in rheumatoid arthritis. Rheumatology (Oxford) 2008; 47:1780-4. [DOI: 10.1093/rheumatology/ken386] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Wright CI, Scholten HJ, Schilder JCM, Elsen BM, Hanselaar W, Kroner CI, Draijer R, Kastelein JJP, Stok W, Karemaker J, de Groot E. Arterial stiffness, endothelial function and microcirculatory reactivity in healthy young males. Clin Physiol Funct Imaging 2008; 28:299-306. [DOI: 10.1111/j.1475-097x.2008.00807.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
UNLABELLED Low birth weight (LBW) is a risk factor for hypertension, stroke and coronary heart disease in adults. Mechanisms underlying cardiovascular disease may therefore be initiated in early life. Studies to investigate the initiating events and emergence of vascular risk markers in infancy and childhood have been an area of particular interest in recent years. The aim of this review is to focus on the early development of the human vascular tree in relation to LBW. Specific characteristics, including endothelial function, intima-media thickness, microvascular density, arterial dimensions and elasticity, will be discussed. LBW due to different causes--poor foetal growth or preterm birth--results in different patterns of altered development of the vascular system, which can already be seen in infancy. Follow-up studies in children and young adults indicate that vascular compromise in many ways persists in those born either small for gestational age or prematurely. CONCLUSION LBW is associated with structural and functional changes in the vascular tree, which have implications for cardiovascular health in adult life.
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Affiliation(s)
- Mikael Norman
- Department for Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
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Pries AR, Habazettl H, Ambrosio G, Hansen PR, Kaski JC, Schächinger V, Tillmanns H, Vassalli G, Tritto I, Weis M, de Wit C, Bugiardini R. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings. Cardiovasc Res 2008; 80:165-74. [PMID: 18511433 DOI: 10.1093/cvr/cvn136] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Obstructive disease of the large coronary arteries is the prominent cause for angina pectoris. However, angina may also occur in the absence of significant coronary atherosclerosis or coronary artery spasm, especially in women. Myocardial ischaemia in these patients is often associated with abnormalities of the coronary microcirculation and may thus represent a manifestation of coronary microvascular disease (CMD). Elucidation of the role of the microvasculature in the genesis of myocardial ischaemia and cardiac damage-in the presence or absence of obstructive coronary atherosclerosis-will certainly result in more rational diagnostic and therapeutic interventions for patients with ischaemic heart disease. Specifically targeted research based on improved assessment modalities is needed to improve the diagnosis of CMD and to translate current molecular, cellular, and physiological knowledge into new therapeutic options.
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Affiliation(s)
- Axel R Pries
- Department of Physiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Arnimallee 22, D-14195 Berlin, Germany
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Gomes MB, Matheus ASM, Tibiriçá E. Evaluation of microvascular endothelial function in patients with type 1 diabetes using laser-Doppler perfusion monitoring: which method to choose? Microvasc Res 2008; 76:132-3. [PMID: 18533196 DOI: 10.1016/j.mvr.2008.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 03/20/2008] [Accepted: 04/17/2008] [Indexed: 12/27/2022]
Abstract
The evaluation of microvascular function is essential in the investigation of the pathophysiology of cardiometabolic diseases [Struijker-Boudier, H.A. et al., 2007. Evaluation of the microcirculation in hypertension and cardiovascular disease. Eur. Heart J. 28, 2834-2840]. In clinical research and practice, the study of microcirculation is of great value in the assessment of the effects of medical interventions and monitoring disease progression. It is well-known that patients with type 1 and 2 diabetes have microvascular dysfunction that results from numerous factors including hyperglycemia, oxidative stress and insulin resistance [Schalkwijk, C.G., Stehouwer, C.D., 2005. Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clin. Sci. (Lond). 109, 143-159]. Moreover, skin microvascular dysfunction in type 1 diabetes precedes symptoms of end-organ microvascular disease [Khan, F. et al., 2000. Impaired skin microvascular function in children, adolescents, and young adults with type 1 diabetes. Diabetes Care 23, 215-220]. In this study, we assessed skin microvascular function of patients with type 1 diabetes using laser-Doppler perfusion monitoring (LDPM) coupled with physiological and pharmacological local vasodilator stimuli.
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Franklin VL, Khan F, Kennedy G, Belch JJF, Greene SA. Intensive insulin therapy improves endothelial function and microvascular reactivity in young people with type 1 diabetes. Diabetologia 2008; 51:353-60. [PMID: 18040663 DOI: 10.1007/s00125-007-0870-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 07/19/2007] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS Macrovascular disease is an important cause of the increased morbidity and mortality rates associated with type 1 diabetes, and this vascular impairment begins in childhood. The aim of this study was to determine whether introducing intensive diabetes management [intensive insulin therapy (IIT) and 'Sweet Talk' text-messaging support] produces measurable improvements in endothelial function. METHODS One hundred and twenty-six patients fulfilled the eligibility criteria (type 1 diabetes for >1 year; on conventional insulin therapy (CIT); aged between 8 and 18 years), of whom 92 enrolled. Patients were randomised to group 1, CIT only (n=28); group 2, CIT and Sweet Talk (n=33); or group 3, IIT and Sweet Talk (n=31). Vascular assessments (including measures of endothelial damage, activation, dysfunction and oxidative stress) and HbA1c were performed at baseline and repeated after 12 months of the study. RESULTS Glycaemic control deteriorated in patients on CIT, but improved significantly in patients allocated to IIT (p=0.007). IIT was associated with significantly greater improvements in E-selectin (p<0.0001) than CIT (group 1, p=0.026 and group 2, p=0.053). Vascular responses to acetylcholine improved in patients on IIT (p=0.017), but not in patients receiving CIT. These changes were all independent of HbA1c level. CONCLUSIONS/INTERPRETATION IIT appears to be associated with improvements in vascular markers, independently of changes in HbA1c, suggesting that IIT may confer vascular protection in addition to improving glycaemic control.
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Affiliation(s)
- V L Franklin
- Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
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