Pulse wave velocity is decreased with obesity in an elderly Chinese population

Estimated pulse wave velocity as a forefront indicator of developing metabolic syndrome in Korean adults

BACKGROUND/AIMS

The predictive value of the estimated pulse wave velocity (ePWV) for the development of metabolic syndrome has not yet been extensively explored. This study aimed to fill this gap by evaluating ePWV as a potential predictor of metabolic syndrome development in middle-aged Korean adults.

METHODS

Using prospective data obtained from the Ansan-Ansung cohort database, participants without metabolic syndrome at baseline were studied. ePWV was calculated using specific equations based on age and blood pressure. The primary outcome was the incidence of metabolic syndrome during a median follow-up period of 187 months.

RESULTS

Among the 6,186 participants, 2,726 (44.1%) developed metabolic syndrome during the follow-up period. ePWV methvalues were categorized into tertiles to assess their predictive value for the development of metabolic syndrome. An ePWV cut-off of 7.407 m/s was identified as a predictor of metabolic syndrome development, with a sensitivity of 0.743 and a specificity of 0.464. Participants exceeding this cut-off, especially those in the third tertile (8.77-14.63 m/s), had a notably higher risk of developing metabolic syndrome. Specifically, the third tertile exhibited a 52.8% cumulative incidence compared with 30.8% in the first tertile. After adjustments, those in the third tertile faced a 1.530-fold increased risk of metabolic syndrome (95% confidence interval, 1.330-1.761).

CONCLUSION

ePWV is a significant predictor of the development of metabolic syndrome. This finding underscores the potential of ePWV as a cardiometabolic risk assessment tool and can thus provide useful information for primary prevention strategies.

Improving Nutritional Status Was Associated with Decreasing Disease Severity and Shortening of Negative Conversion Time of PCR Test in Non-ICU Patients with COVID-19

Background

Nutrition is an important prevention in old patients with COVID-19. However, in China, there are few studies on the correlation between nutrition and COVID-19.

Methods

A total of 148 hospitalized COVID-19 (65.7 ± 16.0 [range: from 21 to 101] years old) patients were enrolled in this study. The information of demographic, biochemical results, vaccination doses, types of COVID-19, PCR test negative conversion time, and scores of Mini Nutritional Assessment Short Form (MNA-SF) for evaluating nutritional status were recorded. We first explored the relationships between MNA-SF performance and the severities of COVID-19 in the groups with non-vaccinated, vaccinated, and all the patients using multivariable ordinal logistic regression. Further, we explored the relationships between performance of MNA-SF and the time of negative conversion of PCR in the groups with non-vaccinated, vaccinated, and all the patients using COX proportional hazards survival regression.

Results

Group of patients with malnutrition or at risk of malnutrition group was associated with older of the age, those who had not been vaccinated, in fewer people who were asymptomatic type and in more people who showed longer of the negative conversion time of PCR, lower of the BMI, and the lower of the hemoglobin level. Each additional increase of one point of MNA-SF was associated with a 17% decrease in the odds of a worse type of COVID-19 in all patients, and the significant result exists in non-vaccinated patients. One point increase of MNA-SF was associated with increased 11% of hazard ratios of turning negative of PCR and well-nourished group was associated with increased 46% of hazard ratio of turning negative of PCR.

Conclusion

Higher nutrition is associated with less severity of COVID-19, especially in the non-vaccinated group. Higher nutrition is also associated with shorter time of turning negative of PCR in non-ICU COVID-19 patients.

Interaction between body mass index and blood pressure on the risk of vascular stiffness : A community-based cross-sectional study and implications for nursing

Objective

This study aimed to analyze associations between body mass index (BMI) and vascular measurements (brachial ankle pulse wave velocity [baPWV] and ankle-brachial index [ABI]), whether blood pressure (BP) was involved in the relationship, and implications for nursing.

Methods

A cross-sectional study was conducted, including 1,894 middle-aged and older adults who underwent routine health screening at a community medical center in the Zhangjiang community in Shanghai, China. Participants were divided into three groups based on BMI: normal weight (n = 1,202), overweight (n = 480), and obese (n = 212). Multivariate linear regression models and smooth curve fittings were used to evaluate the associations between BMI and indices of vascular stiffness. Mediation analysis examined whether blood pressure mediate the association between BMI and vascular stiffness.

Results

Multiple linear regression analysis showed that BMI to be significantly and negatively associated with baPWV (β = -0.06 [-0.10, -0.03]) and ABI (β = -0.004 [-0.005, -0.003]), respectively. The interaction test results of systolic blood pressure (SBP) in the relationship between BMI and baPWV were significant (P for interaction = 0.01). After adjusting for age and sex, mediation analyses showed that BMI and baPWV were correlated (β = 0.090, P < 0.001) and mediated by SBP (β = 0.533, P < 0.001) and diastolic blood pressure (DBP) (β = 0.338, P < 0.001). A negative association was found between BMI and ABI (β = -0.135, P < 0.001), which appeared to be partially mediated by SBP (β = 0.124, P < 0.001) and DBP (β = 0.053, P < 0.001). Additional subgroup analysis based on blood pressure levels did not revealed statistically significant mediating effects.

Conclusions

Our findings showed conflicting associations between BMI and non-invasive vascular measurements of arterial stiffness. BP may have a biological interaction in the relationship between BMI and baPWV. Managing blood pressure and weight through comprehensive clinical care is crucial for preventing stiffness or blockage of vessels in middle-aged and older adults.

Interaction Between Obesity and Hypertension on Arteriosclerosis in Chinese Urban Adults: A Population-Based Cross-Sectional Study

This study recruited 9,830 participants to identify whether the interaction between obesity and hypertension affects the occurrence of arteriosclerosis in Chinese adults. Brachial-ankle pulse wave velocity (baPWV) was measured to diagnose arteriosclerosis. Unconditional logistic regression was used for multiplicative interaction. The additive interaction was represented by relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy (S). Hypertension was an independent risk factor for baPWV (p < .01), but obesity was not (p = .08). The interaction between obesity and hypertension on arteriosclerosis was not multiplicative (adjusted odds ratio = 0.89 (0.79-1.01), p = .07), but a negative additive interaction (RERI = -4.33, AP = -2.91, S = 0.10; p < .01) exists. Therefore, obesity may reduce the risk of arteriosclerosis caused by hypertension when hypertension and obesity coexist, especially in women and middle-aged people, which supports the obesity paradox.

Cross-sectional association between body fat percentage and arteriosclerosis assessed by Cardio-Ankle Vascular Index in a Chinese population: a retrospective observational study

OBJECTIVE

To evaluate arteriosclerosis using Cardio-Ankle Vascular Index (CAVI) and to explore the relation between the body fat percentage (BFP) and CAVI.

DESIGN

A retrospective observational study.

SETTING AND PARTICIPANTS

A total of 1152 patients admitted to a geriatric unit and general practice at a mega hospital in Wuhan, China, from November 2018 to November 2019 were included in this study.

PRIMARY OUTCOME

Association between BFP and CAVI.

RESULTS

Multiple linear regression analysis showed that BFP was positively correlated with CAVI after correction for potential confounding variables (β=0.03; 95% CI: 0.01 to 0.05); this association persisted after BFP was treated by quartile categorical variables and the trend test was statistically significant (p for trend=0.002). Meanwhile, the generalised additive model showed a non-linear association between BFP and CAVI. When BFP<20.6%, BFP is not associated with CAVI for (β=-0.02; 95% CI: -0.06 to 0.03), but when BFP≥20.6%, there is a linear positive association between BFP and CAVI (β=0.05; 95% CI: 0.02 to 0.07). Subgroup analysis showed that there was an interaction between BFP and CAVI in the age stratification (p interaction=0.038).

CONCLUSION

BFP was non-linearly correlated with CAVI, with a 0.05 increase in CAVI for every 1% increase in BFP when BFP≥20.6% and a 0.03 increase in CAVI in those >65 years of age.

Does body mass index or waist-hip ratio correlate with arterial stiffness based on brachial-ankle pulse wave velocity in Chinese rural adults with hypertension?

Background

The relationship between obesity indices and arterial stiffness (AS) has not been fully discovered nor has it been studied in depth in large hypertensive patient populations. The aim of this study was to explore the association between body mass index (BMI) and waist-hip ratio (WHR) levels and AS based on brachial-ankle pulse wave velocity (baPWV) in Chinese rural adults with hypertension.

Methods

This cross-sectional study analyzed 5049 Chinese rural adults with essential hypertension. BMI was calculated as the body weight in kilograms divided by the square of the height in meters (kg/m²). Central obesity was defined as WHR ≥ 0.9 for males and ≥ 0.85 for females. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV).

Results

The prevalence of overweight, general obesity, central obesity and increased AS were 26.88%, 3.39%, 63.85% and 44.01%, respectively. Multivariate logistic regression analysis indicated that BMI levels were negatively associated with the prevalence of increased AS (adjusted-OR per SD increase: 0.74, 95% CI 0.67–0.81, P < 0.001). When BMI was instead treated as a categorical variable divided into tertiles, the same relationship was observed (P for trend < 0.001). Inversely, WHR levels were positively associated with the prevalence of increased AS (adjusted-OR per SD increase: 1.25, 95% CI 1.14–1.36, P < 0.001). Compared to subjects without central obesity, those with central obesity had a higher prevalence of increased AS (adjusted-OR: 1.52, 95% CI 1.28–1.81, P < 0.001). Linear regression models indicated similar results in the correlation between BMI or WHR levels and baPWV levels (adjusted-β per SD increase: − 0.57, 95% CI − 0.68 to − 0.46, P < 0.001; adjusted-β per SD increase: 4.46, 95% CI 3.04–5.88, P < 0.001). There were no interactions in terms of age and blood pressure on the relationship between BMI or WHR levels and the prevalence of increased AS or baPWV levels.

Conclusion

There was an inverse relationship between BMI levels and increased AS or baPWV levels, whereas WHR levels and central obesity were positively associated with increased AS or baPWV levels in Chinese rural adults with hypertension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02390-y.

Development and Validation of a Prediction Model for Elevated Arterial Stiffness in Chinese Patients With Diabetes Using Machine Learning

Background

Arterial stiffness assessed by pulse wave velocity is a major risk factor for cardiovascular diseases. The incidence of cardiovascular events remains high in diabetics. However, a clinical prediction model for elevated arterial stiffness using machine learning to identify subjects consequently at higher risk remains to be developed.

Methods

Least absolute shrinkage and selection operator and support vector machine-recursive feature elimination were used for feature selection. Four machine learning algorithms were used to construct a prediction model, and their performance was compared based on the area under the receiver operating characteristic curve metric in a discovery dataset (n = 760). The model with the best performance was selected and validated in an independent dataset (n = 912) from the Dryad Digital Repository (https://doi.org/10.5061/dryad.m484p). To apply our model to clinical practice, we built a free and user-friendly web online tool.

Results

The predictive model includes the predictors: age, systolic blood pressure, diastolic blood pressure, and body mass index. In the discovery cohort, the gradient boosting-based model outperformed other methods in the elevated arterial stiffness prediction. In the validation cohort, the gradient boosting model showed a good discrimination capacity. A cutoff value of 0.46 for the elevated arterial stiffness risk score in the gradient boosting model resulted in a good specificity (0.813 in the discovery data and 0.761 in the validation data) and sensitivity (0.875 and 0.738, respectively) trade-off points.

Conclusion

The gradient boosting-based prediction system presents a good classification in elevated arterial stiffness prediction. The web online tool makes our gradient boosting-based model easily accessible for further clinical studies and utilization.

Development and Validation of a Prediction Model for Elevated Arterial Stiffness in Chinese Patients With Diabetes Using Machine Learning

Background

Arterial stiffness assessed by pulse wave velocity is a major risk factor for cardiovascular diseases. The incidence of cardiovascular events remains high in diabetics. However, a clinical prediction model for elevated arterial stiffness using machine learning to identify subjects consequently at higher risk remains to be developed.

Methods

Least absolute shrinkage and selection operator and support vector machine-recursive feature elimination were used for feature selection. Four machine learning algorithms were used to construct a prediction model, and their performance was compared based on the area under the receiver operating characteristic curve metric in a discovery dataset (n = 760). The model with the best performance was selected and validated in an independent dataset (n = 912) from the Dryad Digital Repository (https://doi.org/10.5061/dryad.m484p). To apply our model to clinical practice, we built a free and user-friendly web online tool.

Results

The predictive model includes the predictors: age, systolic blood pressure, diastolic blood pressure, and body mass index. In the discovery cohort, the gradient boosting-based model outperformed other methods in the elevated arterial stiffness prediction. In the validation cohort, the gradient boosting model showed a good discrimination capacity. A cutoff value of 0.46 for the elevated arterial stiffness risk score in the gradient boosting model resulted in a good specificity (0.813 in the discovery data and 0.761 in the validation data) and sensitivity (0.875 and 0.738, respectively) trade-off points.

Conclusion

The gradient boosting-based prediction system presents a good classification in elevated arterial stiffness prediction. The web online tool makes our gradient boosting-based model easily accessible for further clinical studies and utilization.

Brachial-ankle pulse wave velocity and cardio-ankle vascular index are associated with future cardiovascular events in a general population: The Nagahama Study

Faster pulse wave velocity (PWV) is known to be associated with the incidence of cardiovascular diseases (CVD). The aim of this study was to clarify the hypothesis that PWV may be associated with future CVD events even when its time-dependent changes were adjusted. We also investigated a prognostic significance of cardio-ankle vascular index, another index of arterial stiffness. Study participants included 8850 community residents. The repeated measures of the clinical parameters at 5.0 years after the baseline were available for 7249 of the participants. PWV was calculated using the arterial waveforms measured at the brachia and ankles (baPWV). The cardio-ankle vascular index was calculated by estimated pulse transit time from aortic valve to tibial artery. During the 8.53 years follow-up period, we observed 215 cases of CVD. The incidence rate increased linearly with baPWV quartiles (per 10 000 person-years: Q1, 2.7; Q2, 12.6; Q3, 22.5; Q4, 76.2), and the highest quartile was identified as an independent determinant of incident CVD by conventional Cox proportional hazard analysis adjusted for known risk factors [hazard ratio (HR), 4.00; p = .007]. Per unit HR of baPWV (HR, 1.15; p < .001) remained significant in the time-dependent Cox regression analysis including baPWV and other clinical values measured at 5-year after the baseline as time-varying variables (HR, 1.14; p < .001). The cardio-ankle vascular index was also associated with CVD with similar manner though the associations were less clear than that of baPWV. baPWV is a good risk marker for the incidence of CVD.

Increase in arterial stiffness measures after bariatric surgery

BACKGROUND AND AIMS

The relationship between obesity and arterial stiffness is complex, with a potential interaction by age (inverse association at younger age and positive at older age) and conflicting reports on the effect of lifestyle-based weight loss on arterial stiffness. Little is understood about post-bariatric surgery changes in arterial stiffness. This study aimed to examine post-bariatric surgery changes in arterial stiffness and identify factors associated with greater changes in arterial stiffness.

METHODS

In 72 patients (mean age 44.5 years, 72.2% female), we evaluated two arterial stiffness measures, cardio-ankle vascular index (CAVI) and heart-ankle pulse wave velocity (haPWV), one month prior to and 6 months after bariatric surgery. Another follow-up visit was conducted 12 months after bariatric surgery in a subset of 58 participants.

RESULTS

Six months after bariatric surgery, an evident decrease was seen in body mass index, heart rate, and systolic blood pressure. In contrast, both CAVI and haPWV significantly increased at 6 months (+0.64 [0.42, 0.87] and +0.24 [0.04, 0.44] m/s, respectively). Among 58 patients with relevant data, CAVI and haPWV remained elevated 12 months after bariatric surgery (+0.80 [0.53, 1.07] and +0.40 [0.17, 0.62] m/s, respectively). Being non-diabetic and having larger decreases in post-surgery heart rate were independently associated with greater increases in post-surgical CAVI.

CONCLUSIONS

Arterial stiffness measures, CAVI and haPWV, were elevated after bariatric surgery despite other favorable cardiometabolic changes. Further studies are necessary to elucidate the underlying mechanism and prognostic implications of this elevation in arterial stiffness measures after bariatric surgery.

Determinants of Brachial-Ankle Pulse Wave Velocity and Vascular Aging in Healthy Older Subjects

BACKGROUND Vascular aging is characterized by increasing arterial stiffness as measured by pulse wave velocity. The present study evaluated the factors influencing vascular aging in Chinese healthy older subjects. MATERIAL AND METHODS Disease- and treatment-free aged (≥60 years) participants were recruited from 2014 to 2019. Cardiometabolic risk factors and brachial-ankle pulse wave velocity (baPWV) were assessed. We defined healthy vascular aging (HVA) as the lowest 10% and early vascular aging (EVA) as the highest 10% of the baPWV distribution, after adjustment for age and blood pressure (BP). We fitted linear and logistic regression models to assess the determinants. RESULTS In all, 794 subjects (mean age 66.5±6.8 years, 71.0% male) were recruited; the 10th and 90th percentiles of baPWV were 1278 cm/s and 1955 cm/s, respectively. Age, BP, heart rate, and triglycerides were all positively associated with baPWV, whereas male subjects and body mass index (BMI) were negatively associated with baPWV. The number of participants diagnosed with either HVA or EVA was 80. Logistic regression models showed that sex, BMI, heart rate, and triglycerides were associated with HVA and EVA after adjustment for age, BP, and other confounding factors. CONCLUSIONS Male, high BMI, low heart rate, and low triglycerides are protective factors for vascular aging in the healthy aged population. Management of BMI, heart rate, triglycerides in a reasonable range may help to alleviate the vascular aging process.