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Cândido J, Camelo LDV, Brant L, Cunha RS, Mill JG, Barreto SM. Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study. Arq Bras Cardiol 2024; 120:e20230409. [PMID: 38451613 PMCID: PMC11021122 DOI: 10.36660/abc.20230409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/04/2023] [Accepted: 10/04/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Central Illustration : Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study. BACKGROUND Arterial stiffening can directly affect the kidneys, which are passively perfused by a high flow. However, whether the relation between arterial stiffness and renal function depends on diabetes and hypertension conditions, is a matter of debate. OBJECTIVE To investigate the relationship between arterial stiffening by carotid-to-femoral pulse wave velocity (cfPWV) and chronic kidney disease (CKD) incidence in individuals and verify whether this association is present in individuals without hypertension and diabetes. METHODS A longitudinal study of 11,647 participants of the ELSA-Brasil followed up for four years (2008/10-2012/14). Baseline cfPWV was grouped per quartile, according to sex-specific cut-offs. Presence of CKD was ascertained by glomerular filtration rate (eGFR-CKD-EPI) < 60 ml/min/1.73 m2 and/or albumin-to-creatinine ratio ≥ 30 mg/g. Logistic regression models were run for the whole cohort and a subsample free from hypertension and diabetes at baseline, after adjustment for age, sex, race, schooling, smoking, cholesterol/HDL ratio, body mass index, diabetes, use of antihypertensive, systolic blood pressure, heart rate, and cardiovascular disease. Statistical significance was set at 5%. RESULTS The chance of CKD was 42% (CI 95%: 1.05;1.92) greater among individuals in the upper quartile of cfPWV. Among normotensive, non-diabetic participants, individuals in the 2nd, 3rd, and 4th quartiles of cfPWV presented greater chances of developing CKD, as compared to those in the lower quartile, and the magnitude of this association was the greatest for those in the upper quartile (OR: 1.81 CI 95%: 1.14;2.86). CONCLUSION Higher cfPWV increased the chances of CKD and suggests that this effect is even greater in individuals without diabetes and hypertension.
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Affiliation(s)
- Júlia Cândido
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Lidyane do Valle Camelo
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Luisa Brant
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Roberto Sá Cunha
- Universidade Federal do Espirito SantoVitoriaESBrasilUniversidade Federal do Espirito Santo, Vitoria, ES – Brasil
| | - José Geraldo Mill
- Universidade Federal do Espirito SantoVitoriaESBrasilUniversidade Federal do Espirito Santo, Vitoria, ES – Brasil
| | - Sandhi Maria Barreto
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
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Hidalgo Santiago JC, Perelló Martínez J, Vargas Romero J, Luis Pallares J, Michan Doña A, Gómez-Fernández P. Association of aortic stiffness with abdominal vascular and coronary calcifications in patients with stage 3 and 4 chronic kidney disease. Nefrologia 2024; 44:256-267. [PMID: 38555207 DOI: 10.1016/j.nefroe.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/03/2023] [Indexed: 04/02/2024] Open
Abstract
RATIONALE AND OBJECTIVES Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC). The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries(CAC). MATERIALS AND METHODS We included 87 pacientes with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pvc-f) and Pvc-f adjusted for age, blood pressure, sex and heart rate (Pvc-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respecti-vely. For the study of the association between Pvc-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pvc-f index for prediction of VC using receiver-operating characteristic (ROC). RESULTS Pvc-f and Pvc-f index were 11.3 ± 2.6 and 10.6 m/s, respectively. The Pvc-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively. Albuminuria (β = 0.13, p = 0.005) and Kauppila score (β = 0.36, p = 0.001) were independently associated with Pvc-f index. In turn, Pvc-f index (β = 0.39, p = 0.001), DM (β = 0.46, p = 0.01), and smoking (β = 0.53; p = 0.006) were associated with Kauppila score, but only Pvc-f index predicted AAC [OR: 3.33 (95% CI: 1.6-6.9; p = 0.001)]. The Kauppila score was independently associated with the Agatston score (β = 1.53, p = 0.001). The presence of AAC identified patients with CAC with a sensitivity of 73%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 38%. The Vpc-f index predicted the presence of CAC [OR: 3.35 (95% CI: 1.04-10.2, p = 0.04)]. In the ROC curves, using the Vpc-f index, the AUC for AAC and CAC was 0.82 (95%CI: 0.71-0.93, p = 0.001) and 0.81 (95% CI: 0.67-0.96, p = 0.02), respectively. CONCLUSIONS When stage 3-4 CKD coexists with DM there is an increase in aortic stiffness determined by the Vpc-f index. In stage 3-4 CKD, AAC and CAC are very prevalent and both often coexist. The Vpc-f index is independently associated with AAC and CAC and may be useful in identifying patients with VC in these territories.
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Affiliation(s)
| | | | - Javier Vargas Romero
- Unidad de Radiodiagnóstico, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | - José Luis Pallares
- Unidad de Radiodiagnóstico, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | - Alfredo Michan Doña
- Unidad de medicina Interna, Hospital Universitario de Jerez, Biomedical Research and Innovation Institute of Cadiz (INiBICA), Jerez de la Frontera, Spain
| | - Pablo Gómez-Fernández
- Unidad de Factores de Riesgo Vascular, Hospital Universitario de Jerez, Jerez de la Frontera, Spain.
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3
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Barzilay JI, Farag YMK, Durthaler J. Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease. J Am Heart Assoc 2024; 13:e030131. [PMID: 38214258 PMCID: PMC10926810 DOI: 10.1161/jaha.123.030131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Albuminuria, an established biomarker of the progression of chronic kidney disease, is also recognized as a biomarker for the risk of cardiovascular disease. Elevated urinary albumin excretion indicates kidney damage and systemic vascular disease, including myocardial capillary disease and arterial stiffness. Albuminuria is associated with an increased risk of coronary artery disease, stroke, heart failure, arrhythmias, and microvascular disease. There are now several therapeutic agents that can lead to albuminuria lowering and a reduction in cardiovascular risk. However, screening for albuminuria is still low. Considering the importance of multidisciplinary management of patients with cardiovascular disease, it is crucial that health care professionals managing such patients are aware of the benefits of albuminuria surveillance and management.
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Du M, Wang Y, Hu G, Wang D, Man Z, Chu C, Liao Y, Chen C, Ma Q, Yan Y, Jia H, Sun Y, Zhang X, Luo W, Chang M, Mu J. Association of high-normal albuminuria and vascular aging: Hanzhong adolescent hypertension study. J Clin Hypertens (Greenwich) 2023; 25:1096-1104. [PMID: 37966821 PMCID: PMC10710548 DOI: 10.1111/jch.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
Normoalbuminuria has recently been associated with increased cardiovascular risk, and vascular aging is proposed as the early manifestation of cardiovascular disease. Here, the authors aimed to examine the association of high-normal albuminuria and vascular aging in a Chinese cohort. From our previously established cohort, 1942 participants with estimated glomerular filtration rate ≥60 mL/min/1.73 m2 or urinary albumin-creatinine ratio (UACR) <30 mg/g were enrolled. Brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s and/or carotid intima-media thickness (CIMT) ≥0.9 mm were used as indicators of vascular aging. Multivariate regression and receiving operating characteristic curve analysis were performed to examine the relationship between continuous and categorical UACR with vascular aging. We found an average UACR value of 8.08 (5.45-12.52) mg/g in this study. BaPWV and CIMT demonstrated positive correlations with lg-UACR (p < .05). High-normal albuminuria (10-29 mg/g) was significantly associated with the presence of vascular aging after adjusting for multiple cardiovascular confounders (OR = 1.540, 95% CI = 1.203-1.972, p = .001). In addition, a lg-UACR cutoff point of 0.918 lg(mg/g) (equal to UACR of 8.285 mg/g) was significantly associated with the presence of vascular aging and its components for all participants and those without hypertension or diabetes and without medication (p < .05). Briefly, high-normal albuminuria was significantly associated with vascular aging in this sample of Chinese adults. These findings implied the warning of elevated UACR even within normal range in clinical practice and the importance of UACR screening in normoalbuminuria for early detection and prevention of cardiovascular disease in otherwise healthy participants.
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Affiliation(s)
- Ming‐Fei Du
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yang Wang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Gui‐Lin Hu
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Dan Wang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Zi‐Yue Man
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Chao Chu
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yue‐Yuan Liao
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Chen Chen
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Qiong Ma
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yu Yan
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Hao Jia
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yue Sun
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Xi Zhang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Wen‐Jing Luo
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ming‐Ke Chang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Jian‐Jun Mu
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)Ministry of EducationXi'anChina
- International Joint Research Center for Cardiovascular Precision Medicine of Shaanxi ProvinceXi'anChina
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Kao TW, Liao CW, Tsai CH, Chang YY, Pan CT, Chang CC, Lee BC, Huang WC, Huang KH, Lu CC, Lai TS, Chan CK, Chueh JS, Wu VC, Hung CS, Chen ZW, Lin YH. Synergistic effect of albuminuria on atherosclerosis in patients with primary aldosteronism. Ther Adv Chronic Dis 2023; 14:20406223231210114. [PMID: 38362007 PMCID: PMC10867404 DOI: 10.1177/20406223231210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/10/2023] [Indexed: 02/17/2024] Open
Abstract
Background Primary aldosteronism (PA) has been associated with atherosclerosis beyond the extent of essential hypertension, but the impact of albuminuria remains unknown. Objective To investigate the effect of concomitant albuminuria on arterial stiffness in PA. Design Prospective cohort study. Methods A prospective cohort study was conducted to evaluate the association of albuminuria (>30 mg/g in morning spot urine) with arterial stiffness, as measured non-invasively by pulse wave velocity (PWV) in patients with PA. Propensity score matching (PSM) with age, sex, diabetes, systolic and diastolic blood pressure, creatinine, potassium, number of antihypertensive medications, and hypertension history was used to balance baseline characteristics. The effects of albuminuria on PWV before and 1 year after treatment were analyzed. Results A total of 840 patients with PA were enrolled, of whom 243 had concomitant albuminuria. After PSM, there were no significant differences in baseline demographic parameters except alpha-blocker and spironolactone use. PWV was greater in the presence of albuminuria (p = 0.012) and positively correlated with urine albumin-creatinine ratio. Multivariable regression analysis identified albuminuria, age, body weight, systolic blood pressure, and calcium channel blocker use as independent predictors of PWV. As for treatment response, only PA patients with albuminuria showed significant improvements in PWV after PSM (p = 0.001). The magnitude of improvement in PWV increased with urine albumin-creatinine ratio and reached plateau when it exceeded 100 mg/g according to restricted cubic spline analysis. Conclusion Concomitant albuminuria in PA was associated with greater arterial stiffness and more substantial improvement after targeted treatment. Both the baseline and the improved extent of PWV increased in correlation with rising urine albumin-creatinine ratio levels, reaching a plateau when the urine albumin-creatinine ratio surpassed 100 mg/g.
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Affiliation(s)
- Ting-Wei Kao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National University Cancer Center, Taipei, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Yao Chang
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Chien-Ting Pan
- Department of Internal Medicine, National University Hospital and National University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National University Hospital and National University College of Medicine, Taipei, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National University Hospital, Taipei, Taiwan
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | | | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No. 579, Sec. 2, Yun-Lin Rd., Douliu City, Yun-Lin County 640203
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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6
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Luo Y, Wang Q, Li H, Lin W, Yao J, Zhang J, Duan S, Zhang W, Zheng Y, Cai G, Zhang L, Dong Z, Chen X. Serum Cystatin C is Associated with Peripheral Artery Stiffness in Patients with Type 2 Diabetes Mellitus Combined with Chronic Kidney Disease. Clin Biochem 2023:110593. [PMID: 37270044 DOI: 10.1016/j.clinbiochem.2023.110593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Cystatin C (CysC) is associated with arterial stiffness. However, its suitability for evaluating patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) remains unclear. We aimed to investigate the relationship between CysC levels and peripheral arterial stiffness (PAS) in patients with T2DM combined with CKD. METHODS Participants' arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV), and those with a baPWV ≥ 1800 cm/s were included in the PAS group. Additionally, patients were divided into young (18-44 years old), middle-aged (45-59 years old), and older (≥ 60 years old) groups. RESULTS Of 200 patients, 94 (47%) were diagnosed with PAS. Multivariate logistic regression revealed that age, pulse pressure, and CysC levels (odds ratio = 1.525, 95% confidence interval: 1.072-2.168, P = 0.019) were independently correlated with PAS in patients with T2DM combined with CKD. The levels of CysC in different age groups were positively correlated with baPWV, and the correlation was significantly higher in the young group (r = 0.739, P < 0.001) than in the middle-aged (r = 0.329, P < 0.001) and older (r = 0.496, P < 0.001) groups. The multifactor linear regression analysis revealed that CysC was significantly correlated with baPWV in the young group (β = 0.455, P = 0.002). CONCLUSION CysC was an independent predictor of PAS in patients with T2DM combined with CKD and was more significantly associated with baPWV in young patients than in middle-aged and older patients. CysC may may be an early predictor of peripheral arteriosclerosis in patients with T2DM combined with CKD.
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Affiliation(s)
- Yayong Luo
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Hangtian Li
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Wenwen Lin
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Jin Yao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Jie Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Shuwei Duan
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Weiguang Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Ying Zheng
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China.
| | - Zheyi Dong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China.
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China.
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7
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Gong J, Han Y, Gao G, Chen A, Fang Z, Lin D, Liu Y, Luo L, Xie L. Sex-specific difference in the relationship between body fat percentage and arterial stiffness: Results from Fuzhou study. J Clin Hypertens (Greenwich) 2023; 25:286-294. [PMID: 36815754 PMCID: PMC9994159 DOI: 10.1111/jch.14649] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
Obesity and overweight are closely related to cardiovascular mortality. Arterial stiffness is one of the important risks for cardiovascular diseases and is strongly related with the cardiovascular mortality. However, the relationship between obesity and arterial stiffness is still controversial. A cross-sectional study was performed to examine the relationship of body fat percentage (BFP), an indicator of obesity, with carotid-femoral pulse wave velocity (cfPWV) in 2603 subjects (aged 58.62 ± 11.27 years, male 71.07%, hypertension 64.89%). All participants were divided into four groups according to the gender and the presence of arterial stiffening based on a value ≥10 m/s of cfPWV(group1 : male with cfPWV <10 m/s, group2 : male with cfPWV ≥10 m/s, group3 : female with cfPWV <10 m/s, group4 : female with cfPWV ≥10 m/s). Body weight, height, waist circumference, blood pressure were measured and clinical biochemical tests were recorded. cfPWV was measured using a non-invasive automatic device (Complior Analysis, France). BFP were calculated by CUN-BAE equation. The level of cfPWV was significantly increased with the increasing trend of BFP in both males and females. Stepwise multiple regression analysis revealed that SBP, DBP, HR, Hcy, BFP, FPG were independent associated with cfPWV in females and SBP, eGFR, FPG, BFP, DBP were independent associated with cfPWV in males. In the subgroups stratified by age, BFP was correlated with cfPWV only in females over 60 years old, but not in female those aged under 60 years old and males. In addition to the age and blood pressure, BFP was one of important predictor of arterial stiffening special in females aged over 60 years old.
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Affiliation(s)
- Jin Gong
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian Province, Fuzhou, Fujian, People's Republic of China.,Department of Geriatrics, National Regional Medical Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Ying Han
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian Province, Fuzhou, Fujian, People's Republic of China.,Department of Geriatrics, National Regional Medical Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Gufeng Gao
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Ai Chen
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Zhoufei Fang
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian Province, Fuzhou, Fujian, People's Republic of China.,Department of Geriatrics, National Regional Medical Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Dongjie Lin
- Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Yulong Liu
- Department of General Practice, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Li Luo
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian Province, Fuzhou, Fujian, People's Republic of China
| | - Liangdi Xie
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Hypertension Research Institute, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian Province, Fuzhou, Fujian, People's Republic of China.,Department of Geriatrics, National Regional Medical Center, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of General Practice, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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Yu M, Pan M, Liang Y, Li X, Li J, Luo L. A nomogram for screening sarcopenia in Chinese type 2 diabetes mellitus patients. Exp Gerontol 2023; 172:112069. [PMID: 36535452 DOI: 10.1016/j.exger.2022.112069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Diabetes is an important risk factor for sarcopenia and contributes to poor prognosis; it is important for clinicians to identify sarcopenia early in the population with type 2 diabetes mellitus. Our aim was to establish a clinical screening model of sarcopenia in Chinese patients with type 2 diabetes mellitus. METHODS A cross-sectional study was conducted involving 1131 hospitalized patients (62.67 ± 11.25 years) with type 2 diabetes mellitus, including 560 men and 571 women. All muscle/fat parameters were measured by dual energy X-ray absorptiometry and the clinical correlation with sarcopenia was evaluated. The least absolute shrinkage and selection operator was used to select optimal variables and build a nomogram chart of the sarcopenic screening model for patients with type 2 diabetes mellitus, respectively. The area under the receiver operating characteristic curve (AUC), the calibration curve, the analysis of the decision curve, the clinical impact curve, and external validations were used to evaluate discriminative ability and clinical applicability. RESULTS The prevalence of sarcopenia in patients with type 2 diabetes mellitus was 30.06 % (340/1131). Compared to the non-sarcopenic group, the sarcopenic group was older, more likely to be men, and had a higher heart rate and lower body mass index (BMI), waist-hip ratio (WHR), upper limb muscle mass, lower limb muscle mass and fat paraments (all P < 0.05). Five independent variables (age, sex, BMI, WHR and heart rate) were selected to construct a nomogram prediction model. The AUC was 0.907 (95 % CI: 0.890-0.925). The calibration curve, decision curve analysis, and clinical impact curves showed a wide range of nomograms with good clinical applicability under threshold probability. Additionally, internal validation showed a good AUC of 0.908 (95 % CI: 0.886-0.928) in the training set and 0.904 (95 % CI: 0.868-0.941) in the testing set, as well as an accuracy of 93.2 % for the screening of sarcopenia in the external validation set. CONCLUSIONS Age, sex, BMI, WHR, and heart rate were used to detect sarcopenia in patients with type 2 diabetes mellitus. The novel screening model is an accurate, easy-to-implement and low-cost tool for early identification of sarcopenia in Chinese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Mingzhong Yu
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Min Pan
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yebei Liang
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiaoling Li
- Fujian Medical University, Fuzhou, People's Republic of China
| | - Jingyan Li
- Fujian Medical University, Fuzhou, People's Republic of China
| | - Li Luo
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China; Branch of National Clinical Research Center for Aging and Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China; Clinical Research Center for Geriatric Hypertension Disease of Fujian province, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.
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Ye C, Wang T, Gong J, Cai X, Lian G, Luo L, Wang H, Xie L. Development of a nomogram for screening the risk of left ventricular hypertrophy in Chinese hypertensive patients. J Clin Hypertens (Greenwich) 2021; 23:1176-1185. [PMID: 33769693 PMCID: PMC8678799 DOI: 10.1111/jch.14240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022]
Abstract
Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular morbidity and mortality in hypertensives. Therefore, early identification of at-risk patients is necessary. The objective of this study was to estimate the risk of LVH among Chinese hypertensives by designing a nomogram. 832 hypertensives were divided into two groups based on the presence of LVH. The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were successively applied for optimal variable selection and nomogram construction. Discrimination power, calibration, and clinical usefulness were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Internal validation was performed using the bootstrap method. The nomogram included five predictors, namely gender, duration of hypertension, age, body mass index (BMI), and systolic blood pressure. The area under the ROC curve (AUC) was 0.724 (95% CI: 0.687-0.761), indicating moderate discrimination. The calibration curve showed an excellent agreement between the predicted LVH and the actual LVH probability. The risk threshold between 5% and 72% according to the decision curve analysis, and the nomogram is clinically beneficial. Internal validation by bootstrapping with 1000 samples showed a good C-index of 0.715, which suggested that the predictive abilities for the training set and testing set were in consistency. Our study proposed a nomogram that can be utilized to assess the LVH risk rapidly for Chinese hypertensives. This tool could be useful in identifying patients at high risk for LVH. Further studies are required to ascertain the stability and applicability of this nomogram.
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Affiliation(s)
- Chaoyi Ye
- Department of GeriatricsThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Tingjun Wang
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of General MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Jin Gong
- Department of GeriatricsThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of General MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xiaoqi Cai
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of General MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Guili Lian
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Li Luo
- Department of GeriatricsThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of General MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Huajun Wang
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Liangdi Xie
- Department of GeriatricsThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Fujian Hypertension Research InstituteThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of General MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
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Hidalgo-Santiago JC, Oneto-Otero J, Michán-Doña A, Gomez-Fernández P. Role of increased central arterial stiffness in macro and microvascular damage in patients with coronary artery disease. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33:224-234. [PMID: 33814197 DOI: 10.1016/j.arteri.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with heart disease frequently have renal dysfunction manifested by a decrease in glomerular filtration rate (GFR) and / or increase of albuminuria. OBJECTIVES The objective was to study the possible role of increased aortic stiffness in the presence and extent of coronary artery disease (CAD) and kidney dysfunction in a group of patients with suspected CAD. PATIENTS AND METHODS We studied forty-eight patients undergoing coronariography for suspected coronary disease (CAD). Using applanation tonometry on the radial artery and applying a transfer function, central blood pressure values were calculated. The study of aortic stiffness was done by determining the carotid-femoral pulse velocity (Pvc-f). RESULTS Of the 48 patients, 11 had no significant coronary lesions, 24 showed significant lesions in 1 or 2 coronary arteries and 13 in ≥ 3 arteries. The group with a higher degree of CD had significantly higher cPP values than the group without CD. The Pvc-f increased progressively and significantly with the degree of CD. The logistic regression showed that Pvc-f independently predicted the presence of CD. The relative risk of CD increased 2.5 times for each meter of increase in Pvc-f. The GFR was negatively and significantly correlated with age and Pvc-f was associated with albuminuria. CONCLUSIONS In patients with stable CD, Pvc-f, expression of aortic stiffness, is independently associated with the existence of CD and its degree of extension. The increase in arterial stiffness also participates in the decrease in GFR and in the increase in albuminuria.
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Affiliation(s)
| | - Jesús Oneto-Otero
- Servicio de Cardiología, Hospital Universitario de Jerez, Jerez, España
| | - Alfredo Michán-Doña
- Departamento de Medicina, Hospital Universitario de Jerez, Jerez, España; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, España
| | - Pablo Gomez-Fernández
- Unidad de Factores de Riesgo Vascular, Hospital Universitario de Jerez, Jerez, España.
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