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Velcheva I, Antonova N, Kmetski T, Tsonevska G, Stambolieva K, Alexandrova A, Bechev B. Local carotid stiffness, hemodynamic forces and blood viscosity in patients with cerebral lacunar infarctions. Clin Hemorheol Microcirc 2024:CH242333. [PMID: 39031347 DOI: 10.3233/ch-242333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
OBJECTIVE The carotid stiffness is an important factor in the pathogenesis of cerebrovascular small vessel disease. Our study aimed to evaluate the relation of the local arterial stiffness of the common carotid artery (CCA) to the hemodynamic forces and blood viscosity in patients with cerebral lacunar infarctions (LI). METHODS Twenty-two patients with chronic LI and 15 age-matched controls were examined. An ultrasound examination of the CCA intima-media thickness (IMT), the parameters of local CCA stiffness: distensibility (DC) and compliance coefficients (CC), α and β stiffness indices and pulse wave velocity (PWV) was performed. The local hemodynamic forces were calculated: circumferential wall tension (CWT) and wall shear stress (WSS). Whole blood viscosity (WBV) and shear stresses at shear rates of 0.277 s - 1 to 94.5 s - 1 were measured in patients and controls. RESULTS Higher values of IMT, a significant decrease of DC and CC and an increase of α and β stiffness indices and PWV in the LI patients compared to the controls were obtained. A parallel significant increase in CWT and a decrease in WSS was found. An increase in WBV and a significant increase in shear stresses were detected. In the LI patients, the increased stiffness indices were associated with an increase in age, cholesterol and WBV at higher shear rates in the left CCA. In the controls, the IMT and stiffness indices correlated significantly with the hemodynamic factors and WBV in both CCAs, while the stiffness indices correlated with the hemodynamic forces in the left CCA. CONCLUSION The results of the present study demonstrate different associations of the local carotid stiffness indices with the hemodynamic forces and WBV in patients with LI and controls.
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Affiliation(s)
- Irena Velcheva
- Clinic of Neurology, Uni Hospital, Panagyurishte, Bulgaria
| | - Nadia Antonova
- Department of Biomechanics, Institute of Mechanics, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Tsocho Kmetski
- Clinic of Neurology, Uni Hospital, Panagyurishte, Bulgaria
| | | | | | - Anika Alexandrova
- Department of Biomechanics, Institute of Mechanics, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Blagovest Bechev
- Department of Medical Physics and Biophysics, Medical University, Sofia, Bulgaria
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Acampa M, Lazzerini PE, Cartocci A, Iadanza E, Cevenini G, Domenichelli C, Accioli R, Salvini V, Guideri F, Tassi R, Martini G. The Impact of Sex and Arterial Stiffness Interactions on the Outcome after an Acute Ischemic Stroke: A Retrospective Cohort Study. J Clin Med 2024; 13:4095. [PMID: 39064135 PMCID: PMC11278401 DOI: 10.3390/jcm13144095] [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: 05/30/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Arterial stiffness (AS) is an independent predictor of cardiovascular events and is associated with a poor prognosis. While AS may represent a novel therapeutic target, recent evidence shows that it is sexually dimorphic. The aim of this study was to evaluate relative sex differences in arterial stiffness and their possible impact on the outcome of acute ischemic stroke. Methods: We retrospectively evaluated a cohort of adult patients with the following inclusion criteria: acute ischemic stroke, which occurred within 24 h from the onset of symptoms, confirmed through neuroimaging examinations, additional evaluations including extracranial and transcranial arterial ultrasound examinations, transthoracic echocardiography, a 12-lead resting ECG, and continuous 24 h in-hospital blood pressure monitoring. Based on the 24 h blood pressure monitoring, the following parameters were evaluated: systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and arterial stiffness index (ASI). The modified Rankin scale (mRS) was assessed at 90 days to evaluate the 3-month clinical outcome, defining an unfavorable outcome as an mRS score ≥ 3. To assess the factors associated with unfavorable outcomes, a stepwise logistic regression model was performed on the total sample size, and the analyses were replicated after stratifying by sex. Results: A total of 334 patients (176 males, 158 females) were included in the analysis. There was a significant sex-dependent impact of ASI on the 90-day unfavorable Rankin score (mRS score ≥ 3) as only men had a reduced likelihood of favorable outcomes with increasing arterial stiffness (OR:1.54, 95% CI: 1.06-2.23; P-interaction = 0.023). Conclusions: The influence of ASI on the 3-month functional outcome after acute ischemic stroke is at least in part sex-related, suggesting that, in males, higher ASI values are associated with a worse outcome.
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Affiliation(s)
- Maurizio Acampa
- Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (F.G.); (G.M.)
| | - Pietro Enea Lazzerini
- Electroimmunology Unit, Division of Internal Medicine and Geriatrics, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (P.E.L.); (R.A.); (V.S.)
| | - Alessandra Cartocci
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (E.I.); (G.C.)
| | - Ernesto Iadanza
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (E.I.); (G.C.)
| | - Gabriele Cevenini
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (A.C.); (E.I.); (G.C.)
| | - Carlo Domenichelli
- Stroke Unit, Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, 53100 Siena, Italy; (C.D.); (R.T.)
| | - Riccardo Accioli
- Electroimmunology Unit, Division of Internal Medicine and Geriatrics, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (P.E.L.); (R.A.); (V.S.)
| | - Viola Salvini
- Electroimmunology Unit, Division of Internal Medicine and Geriatrics, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (P.E.L.); (R.A.); (V.S.)
| | - Francesca Guideri
- Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (F.G.); (G.M.)
| | - Rossana Tassi
- Stroke Unit, Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, 53100 Siena, Italy; (C.D.); (R.T.)
| | - Giuseppe Martini
- Stroke Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (F.G.); (G.M.)
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Chen H, Colasurdo M, Schrier C, Marino J, Phipps MS, Wozniak MA, Cronin CA, Mehndiratta P, Cole JW, Miller TR, Cherian J, Gandhi D, Chaturvedi S, Jindal G. Optimal Angiographic Goal and Number of Passes for Octogenarians Undergoing Endovascular Stroke Thrombectomy. World Neurosurg 2024; 186:e283-e289. [PMID: 38552786 DOI: 10.1016/j.wneu.2024.03.123] [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: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The optimal recanalization goal and number of endovascular thrombectomy (EVT) passes for elderly patients with large vessel occlusion strokes is unclear. METHODS Consecutive patients 80 years or older undergoing EVT were identified from 2016 to 2022 at a single center. Clinical information, procedural details, and modified treatment in cerebral ischemia (mTICI) scores were collected. Primary outcome was modified Rankin scale (mRS) at 90 days. Bivariate and multivariable analyses were conducted to assess associations between mTICI scores, EVT passes, and 90-day outcomes. RESULTS One hundred twenty-six patients were identified. At 90 days, mTICI 2b recanalization resulted in high rates of poor outcomes (8.7% functional independence and 60.9% mortality) not significantly different from mTICI 0, 1 or 2a (median mRS 6 vs. 6, P = 0.61). Complete recanalization (mTICI 2c or 3) led to significantly better mRS outcomes at 90 days compared to mTICI 2b (median mRS 4 vs. 6, adjusted P = 0.038), with 26.8% functional independence and 37.8% mortality. In multivariable analysis, complete recanalization was significantly associated with better 90-day outcomes than mTICI 2b or lower recanalization (odds ratio 4.24 [95% Confidence interval 1.46-12.3]; P = 0.002), while the number of passes was not independently associated with worse outcomes (P = 0.98). CONCLUSIONS For octogenarians, mTICI 2b recanalization yields limited clinical benefit and results in poor 90-day outcomes. In contrast, complete recanalization is independently associated with significantly better outcomes. Thus, once the decision is made to pursue EVT in the elderly, mTICI 2c or better recanalization should be the angiographic goal. Providers should not withhold thrombectomy passes based on age alone.
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Affiliation(s)
- Huanwen Chen
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA; Department of Neurology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Marco Colasurdo
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA; Department of Interventional Radiology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Chad Schrier
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jose Marino
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Michael S Phipps
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Marcella A Wozniak
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Carolyn A Cronin
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Prachi Mehndiratta
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - John W Cole
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Timothy R Miller
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Dheeraj Gandhi
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA; Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA; Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
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Shi Y, Yu C, Zhou W, Wang T, Zhu L, Bao H, Li P, Cheng X. Estimated pulse wave velocity as a predictor of all-cause and cardiovascular mortality in patients with hypertension in China: a prospective cohort study. Front Cardiovasc Med 2024; 11:1365344. [PMID: 38742177 PMCID: PMC11089216 DOI: 10.3389/fcvm.2024.1365344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Background Whether the estimated pulse wave velocity (ePWV) in Chinese patients with hypertension can serve as an independent predictor of cardiovascular and all-cause mortality remains unknown. Therefore, this study investigated the associations between ePWV and cardiovascular and all-cause mortalities and explored potential effect modifiers influencing these relationships. Finally, we compared the ePWV with the brachial-ankle pulse wave velocity (baPWV) to determine which parameter better predicts mortality. Methods The population of this longitudinal cohort study was selected from the China H-type Hypertension Registry Study. The exposure and outcome variables were ePWV and all-cause and cardiovascular mortalities, respectively. The Cox proportional hazard regression model was applied to assess the associations between ePWV and all-cause and cardiovascular mortalities. The performances of ePWV and baPWV in predicting death were compared using the receiver operating characteristic (ROC) curve area, net reclassification improvement index (NRI), and integrated discrimination improvement index (IDI). Results This prospective study enrolled 14,232 patients with hypertension. Following an average follow-up of 48 months, 806 individuals succumbed to all-cause mortality, with 397 cases specifically attributed to cardiovascular diseases. The Cox proportional regression analysis revealed a significant association between a 1 m/s increase in ePWV and a 37% higher risk of all-cause mortality (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.31-1.43) as well as a 52% higher risk of cardiovascular mortality (HR: 1.52, 95% CI: 1.43-1.62) in the fully adjusted model. The findings for ePWV according to quartile demonstrated hazard ratios for all-cause mortality for Q2 (10.25 < ePWV < 11.32), Q3 (11.32 < ePWV < 12.40), and Q4 (ePWV ≥ 12.40) of 1.50 (HR: 1.50, 95% CI: 1.07-2.10), 2.34 (HR: 2.34, 95% CI: 1.73-3.18), and 4.09 (HR: 4.09, 95% CI: 3.05-5.49), respectively, compared with Q1 (ePWV < 10.25). The risk of cardiovascular death also increased in proportion to the rise in ePWV. The results of the area under the ROC curve, NRI, and IDI all indicated that ePWV outperformed baPWV in predicting mortality. The results of the subgroup analysis demonstrated that body mass index (BMI) and hypoglycemic drug use modified the association between ePWV and mortality. Conclusions The performance of ePWV in predicting all-cause and cardiovascular mortalities was superior to that of baPWV alone. Patients who were overweight or obese with higher ePWV values exhibited a significantly increased risk of all-cause death. The correlation between elevated ePWV and the risk of cardiovascular death was more pronounced in patients who had not received hypoglycemic drugs.
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Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
| | - Chao Yu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Tao Wang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Lingjuan Zhu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Ping Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-Center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
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Moncion K, Rodrigues L, Wiley E, Noguchi KS, Negm A, Richardson J, MacDonald MJ, Roig M, Tang A. Aerobic exercise interventions for promoting cardiovascular health and mobility after stroke: a systematic review with Bayesian network meta-analysis. Br J Sports Med 2024; 58:392-400. [PMID: 38413134 DOI: 10.1136/bjsports-2023-107956] [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] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To determine the superiority of aerobic exercise (AE) interventions on key outcomes of stroke recovery, including cardiorespiratory fitness (V̇O2peak, primary outcome), systolic blood pressure (SBP) and mobility (6 min Walk Test (6MWT) distance and 10 m Usual Gait Speed) after stroke. DATA SOURCES MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO and AMED Allied and Complementary Medicine were searched from inception to February 2023. ELIGIBILITY CRITERIA Randomised controlled trials were included that compared the effects of any AE interventions (low-intensity, moderate-intensity, high-intensity continuous training (HICT), high-intensity interval training (HIIT)) to no exercise, usual care or other AE interventions in individuals poststroke. ANALYSES Systematic review with Bayesian network meta-analysis (NMA) methodology was employed. Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. The Grading of Recommendations, Assessment, Development and Evaluation minimally contextualised framework for NMA was followed. RESULTS There were 28 studies (n=1298) included in the NMA for V̇O2peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT and 18 (n=775) for the 10 m Usual Gait Speed. The greatest effect on V̇O2peak, 6MWT and 10 m Usual Gait Speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all outcomes of interest. HIIT was the most effective intervention for improving V̇O2peak (2.9 mL/kg/min (95% credible interval 0.8 to 5.0) moderate certainty) compared with usual care. CONCLUSION This NMA suggests that higher-intensity AE is superior to traditional low-intensity to moderate-intensity AE for improving outcomes after stroke.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lynden Rodrigues
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ahmed Negm
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Maureen Jane MacDonald
- Department of Kinesiology, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Mena L, Mengual JJ, García-Sánchez SM, Avellaneda-Gómez C, Font MÀ, Montull C, Castrillo L, Blanch P, Castellanos P, Lleixa M, Martín-Baranera M, Armario P, Gómez-Choco M. Relationship of arterial stiffness and baseline vascular burden with new lacunes and microbleeds: A longitudinal cohort study. Eur Stroke J 2024; 9:251-258. [PMID: 37873938 PMCID: PMC10916807 DOI: 10.1177/23969873231207764] [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: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Arterial stiffness may have a significant impact on the development of cerebral small vessel disease (cSVD). PATIENTS AND METHODS We obtained pulse wave velocity (24-h PWV) by means of ambulatory blood pressure monitoring (ABPM) in patients with a recent small subcortical infarct (RSSI). Patients with known cardiac or arterial embolic sources were excluded. Lacunes, microbleeds, white matter hyperintensities and enlarged perivascular spaces at baseline were assessed in a brain MRI and included in a cSVD score. A follow-up MRI was obtained 2 years later and assessed for the appearance of new lacunes or microbleeds. We constructed both unadjusted and adjusted models, and subsequently selected the optimal models based on the area under the curve (AUC) of the predicted probabilities. RESULTS Ninety-two patients (mean age 67.04 years, 69.6% men) were evaluated and 25 had new lacunes or microbleeds during follow-up. There was a strong correlation between 24-h PWV and age (r = 0.942, p < 0.001). cSVD was associated with new lacunes or microbleeds when adjusted by age, 24-h PWV, NT-proBNP and hypercholesterolemia (OR 2.453, CI95% 1.381-4.358). The models exhibiting the highest discrimination, as indicated by their area under the curve (AUC) values, were as follows: 1 (AUC 0.854) - Age, cSVD score, 24-h PWV, Hypercholesterolemia; 2 (AUC 0.852) - cSVD score, 24-h PWV, Hypercholesterolemia; and 3 (AUC 0.843) - Age, cSVD score, Hypercholesterolemia. CONCLUSIONS cSVD score is a stronger predictor for cSVD progression than age or hemodynamic parameters in patients with a RSSI.
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Affiliation(s)
- Luis Mena
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Juan José Mengual
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Sonia María García-Sánchez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Carla Avellaneda-Gómez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Maria Àngels Font
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Caterina Montull
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Laura Castrillo
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pedro Blanch
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Cardiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pere Castellanos
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Mercè Lleixa
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Montserrat Martín-Baranera
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Epidemiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Armario
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Manuel Gómez-Choco
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
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Cheng W, Kong F, Pan H, Luan S, Yang S, Chen S. Superior predictive value of estimated pulse wave velocity for all-cause and cardiovascular disease mortality risk in U.S. general adults. BMC Public Health 2024; 24:600. [PMID: 38402165 PMCID: PMC10893621 DOI: 10.1186/s12889-024-18071-2] [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: 05/14/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Estimated pulse wave velocity (ePWV) has been proposed as a potential approach to estimate carotid-femoral pulse wave velocity. However, the potential of ePWV in predicting all-cause mortality (ACM) and cardiovascular disease mortality (CVM) in the general population is unclear. METHODS We conducted a prospective cohort study using the data of 33,930 adults (age ≥ 20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 until the end of December 2019. The study outcomes included ACM and CVM. Survey-weighted Cox proportional hazards models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the association between ePWV and ACM and CVM. To further investigate whether ePWV was superior to traditional risk factors in predicting ACM and CVM, comparisons between ePWV and the Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) models were performed. Integrated Discriminant Improvement (IDI) and Net Reclassification Improvement (NRI) were employed to analyze differences in predictive ability between models. RESULTS The weighted mean age of the 33,930 adults included was 45.2 years, and 50.28% of all participants were men. In the fully adjusted Cox regression model, each 1 m/s increase in ePWV was associated with 50% and 49% increases in the risk of ACM (HR 1.50; 95% CI, 1.45-1.54) and CVM (HR 1.49; 95% CI, 1.41-1.57), respectively. After adjusting for FRS, each 1 m/s increase in ePWV was still associated with 29% (HR 1.29; 95% CI, 1.24-1.34) and 34% (HR 1.34; 95% CI, 1.23-1.45) increases in the risk of ACM and CVM, respectively. The area under the curve (AUC) predicted by ePWV for 10-year ACM and CVM were 0.822 and 0.835, respectively. Compared with the FRS model, the ePWV model improved the predictive value of ACM and CVM by 5.1% and 3.8%, respectively, with no further improvement in event classification. In comparison with the PCE model, the ePWV model's ability to predict 10-year ACM and CVM was improved by 5.1% and 3.5%, and event classification improvement was improved by 34.5% and 37.4%. CONCLUSIONS In the U.S. adults, ePWV is an independent risk factor for ACM and CVM and is independent of traditional risk factors. In the general population aged 20 to 85 years, ePWV has a robust predictive value for the risk of ACM and CVM, superior to the FRS and PCE models. The predictive power of ePWV likely originates from the traditional risk factors incorporated into its calculation, rather than from an indirect association with measured pulse wave velocity.
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Affiliation(s)
- Wenke Cheng
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Fanliang Kong
- University Medical Center of Göttingen, Georg-August University, Göttingen, Germany
| | - Huachun Pan
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Sisi Luan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shumin Yang
- State Key Laboratory of Agriculture Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Siwei Chen
- Department of Cardiovascular Medicine, Nanchang People's Hospital (The Third Hospital of Nanchang), No.1268, Jiuzhou Street, Chaoyang New District, Jiangxi, Nanchang, China.
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Xu M, Wang W, Chen R, Zhou L, Hu H, Qiao G, Wang L, Liu X, Wang Q, Ai Y, Ren H, Hu P. Individual and combined associations of estimated pulse wave velocity and systemic inflammation response index with risk of stroke in middle-aged and older Chinese adults: a prospective cohort study. Front Cardiovasc Med 2023; 10:1158098. [PMID: 38028467 PMCID: PMC10655141 DOI: 10.3389/fcvm.2023.1158098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background and aims Estimated pulse wave velocity (ePWV) and systemic inflammatory response index (SIRI) have been recently investigated as a marker of arterial stiffness and a novel systemic inflammatory indicator. This study aims to examine the independent and combined association of ePWV and SIRI with incident stroke and its subtypes. Methods Data of the Dongfeng-Tongji cohort study was analyzed for 9,154 middle-aged and older adults, who were free of cardiovascular disease and cancer and were followed up to document incident stroke. But their association with incident stroke events and its subtypes have not been well studied. Multivariable adjusted Cox regression models were used to determine the independent and combined association of ePWV and SIRI with incident stroke events. Results Over a 7.22-year follow-up, the cohort documented 491 stroke cases (387 ischemic stroke and 104 hemorrhagic stroke). The multivariate adjusted model showed that with each one-unit increase in the level of ePWV, the corresponding hazard ratios (HRs) (95% CI) for total stroke, ischemic stroke, and hemorrhagic stroke were 1.53 (95% CI, 1.23-1.90), 1.42 (95% CI, 1.11-1.83), and 1.92 (95% CI, 1.21-3.03), respectively. Similarly, with each one-unit increase in log-transformed levels of SIRI, the corresponding HRs (95% CI) for total stroke, ischemic stroke, and hemorrhagic stroke were 1.23 (95% CI,1.04-1.47), 1.16 (95% CI, 0.96-1.41), and 1.52 (95% CI, 1.05-2.20), respectively. There appeared to be a combined effect of ePWV and SIRI on stroke; Participants with high levels of both ePWV and SIRI had a higher risk of total stroke and hemorrhagic stroke, with multiple adjusted HR of 2.43 (95% CI, 1.09-5.42). Additionally, the incorporation of ePWV in addition to traditional cardiovascular risk factors significantly improved the predictive accuracy for total stroke with C statistic increased from 0.684 (95% CI, 0.661-0.707) to 0.687 (95% CI, 0.664-0.710; x2 = 6.65; p for difference = 0.010), and (suggestively) for ischemic stroke with C statistic increased from 0.684 (95% CI, 0.659-0.71) to 0.691(95% CI, 0.666-0.717; x2 = 3.13, p for difference = 0.077), respectively. Conclusions The presence of both high ePWV and SIRI individually, as well as together, was found to be associated with an increased incidence of stroke. The combined stroke risk assessment using these two indicators could potentially improve non-invasive assessment and treatment strategies for high-risk patients, as these indicators are easily accessible in clinical practice.
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Affiliation(s)
- Man Xu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenqiang Wang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Li Zhou
- Academy of Nutrition and Health, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Hui Hu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Guiyuan Qiao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Ling Wang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | | | - Qiuhong Wang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yating Ai
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Hairong Ren
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Ping Hu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Hu Y, Huan J, Wang X, Lin L, Li Y, Zhang L, Li Y. Association of estimated carotid-femoral pulse wave velocity with frailty in middle-aged and older adults with cardiometabolic disease. Aging Clin Exp Res 2023; 35:2425-2436. [PMID: 37698768 DOI: 10.1007/s40520-023-02556-y] [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: 02/21/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE The prevalence of frailty in individuals with cardiometabolic disease (CMD) has become a growing concern in public health. The purpose of this study was to investigate the association between estimated pulse wave velocity (ePWV) and frailty in middle-aged and older adults with CMD. METHODS We analyzed data from 23,313 non-institutionalized adults with CMD from the National Health and Nutrition Examination Survey 2003-2018. Frailty status was determined using the frailty index, and logistic regression models were used to assess the association of ePWV with frailty risk. Multivariable logistic regression and propensity-score matching (PSM) were used to adjust for potential confounders. The restricted cubic spline regression model was used to evaluate the non-linear association between ePWV and frailty risk. RESULTS After adjusting for potential confounding factors, we found that each one m/s increase in ePWV was associated with a 15% higher risk of frailty (odds ratio [OR] = 1.15, 95% confidence interval [CI] 1.12 to 1.18, P < 0.001). After PSM, the association remained significant (OR = 1.05, 95% CI 1.03 to 1.08, P < 0.001). The logistic models with restricted cubic splines showed a non-linear dose-response association, with the risk of frailty increasing more rapidly when ePWV exceeded 9.5 m/s. CONCLUSIONS The findings of this study suggest that a higher level of ePWV is associated with an increased risk of frailty in middle-aged and older adults with CMD, and may serve as a viable alternative to directly measured cfPWV.
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Affiliation(s)
- Yuanlong Hu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China
| | - Jiaming Huan
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China
| | - Xiaojie Wang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China
| | - Lin Lin
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuan Li
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Key Laboratory of Traditional Chinese Medicine Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Provincial Key Laboratory of Traditional Chinese Medicine for Basic Research, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lei Zhang
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yunlun Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China.
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China.
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Lixia District, Jinan, Shandong, China.
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Mukaddim RA, Liu Y, Graham M, Eickhoff JC, Weichmann AM, Tattersall MC, Korcarz CE, Stein JH, Varghese T, Eliceiri KW, Mitchell C. In Vivo Adaptive Bayesian Regularized Lagrangian Carotid Strain Imaging for Murine Carotid Arteries and Its Associations With Histological Findings. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2103-2112. [PMID: 37400303 PMCID: PMC10527160 DOI: 10.1016/j.ultrasmedbio.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES Non-invasive methods for monitoring arterial health and identifying early injury to optimize treatment for patients are desirable. The objective of this study was to demonstrate the use of an adaptive Bayesian regularized Lagrangian carotid strain imaging (ABR-LCSI) algorithm for monitoring of atherogenesis in a murine model and examine associations between the ultrasound strain measures and histology. METHODS Ultrasound radiofrequency (RF) data were acquired from both the right and left common carotid artery (CCA) of 10 (5 male and 5 female) ApoE tm1Unc/J mice at 6, 16 and 24 wk. Lagrangian accumulated axial, lateral and shear strain images and three strain indices-maximum accumulated strain index (MASI), peak mean strain of full region of interest (ROI) index (PMSRI) and strain at peak axial displacement index (SPADI)-were estimated using the ABR-LCSI algorithm. Mice were euthanized (n = 2 at 6 and 16 wk, n = 6 at 24 wk) for histology examination. RESULTS Sex-specific differences in strain indices of mice at 6, 16 and 24 wk were observed. For male mice, axial PMSRI and SPADI changed significantly from 6 to 24 wk (mean axial PMSRI at 6 wk = 14.10 ± 5.33% and that at 24 wk = -3.03 ± 5.61%, p < 0.001). For female mice, lateral MASI increased significantly from 6 to 24 wk (mean lateral MASI at 6 wk = 10.26 ± 3.13% and that at 24 wk = 16.42 ± 7.15%, p = 0.048). Both cohorts exhibited strong associations with ex vivo histological findings (male mice: correlation between number of elastin fibers and axial PMSRI: rs = 0.83, p = 0.01; female mice: correlation between shear MASI and plaque score: rs = 0.77, p = 0.009). CONCLUSION The results indicate that ABR-LCSI can be used to measure arterial wall strain in a murine model and that changes in strain are associated with changes in arterial wall structure and plaque formation.
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Affiliation(s)
- Rashid Al Mukaddim
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuming Liu
- Laboratory for Optical and Computational Instrumentation, Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA
| | - Melissa Graham
- Research Animal Resources and Compliance, Comparative Pathology Laboratory, University of Wisconsin-Madison, Madison, WI, USA
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Ashley M Weichmann
- Small Animal Imaging and Radiotherapy Facility, Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Claudia E Korcarz
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - James H Stein
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin W Eliceiri
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Laboratory for Optical and Computational Instrumentation, Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA; Small Animal Imaging and Radiotherapy Facility, Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Morgridge Institute for Research, Madison, WI, USA
| | - Carol Mitchell
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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11
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Wang Y, Liu H, Wang J, Hu X, Wang A, Chen K, Wang A, Zang L, Cheng Y, Gu W, Dou J, Mu Y, Du J, Lyu Z. The association between brachial-ankle pulse-wave velocity and adverse cardiovascular events in 5719 community participants a prospective cohort study. J Hypertens 2023; 41:1411-1419. [PMID: 37334543 DOI: 10.1097/hjh.0000000000003481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND The brachial-ankle pulse-wave velocity (baPWV) is regarded as the gold standard in the evaluation of arterial stiffness. Its prognostic significance for major adverse cardiovascular events (MACE) has been demonstrated. However, the factors influencing the association between baPWV and MACE risk have not been determined. In this study, we investigated the association of baPWV and MACE risk and whether it is affected by the risk factors for different cardiovascular diseases (CVDs). METHODS This was a prospective cohort study that initially enrolled 6850 participants from 12 communities in Beijing. The participants were divided into three subgroups according to their baPWV values. The primary outcome was the first occurrence of MACE, defined as hospitalization from cardiovascular diseases, first occurrence of a nonfatal myocardial infarction, or nonfatal stroke. Cox proportional hazards regression and restricted cubic spline analyses were used to examine the association between baPWV and MACE. The effect of CVD risk factors on the relationship between baPWV and MACE was explored in subgroup analyses. RESULTS The final study population consisted of 5719 participants. During a median follow-up of 34.73 months, MACE occurred in 169 participants. The restricted cubic spline analysis indicated a positive linear relationship between baPWV and MACE risk. After adjustment for cardiovascular risk factors, the hazard ratio (HR) for MACE risk per SD increase in baPWV was 1.272 [95% confidence interval (CI): 1.149-1.407, P < 0.001], and the HR for MACE in the high-baPWV vs. the low-baPWV group was 1.965 (95% CI: 1.296-2.979, P = 0.001). Adding baPWV to the conventional cardiovascular risk factors significantly improved the model's prediction performance and the net reclassification (NRI) [NRI: 0.379 (95% CI: 0.072-0.710), P = 0.025] in MACE discrimination. However, in the subgroup analysis, two CVD risk factors, stable coronary heart disease and hypertension, showed significant interaction effects ( Pinteraction both < 0.05). This result indicated that the effect of CVD risk factors must be taken into account when assessing the relationship between baPWV and MACE. CONCLUSION baPWV is a potential marker to improve the identification of MACE risk in the general population. A positive linear correlation was firstly determined between baPWV and MACE risk, but it may not be valid in participants with stable coronary heart disease and hypertension.
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Affiliation(s)
- Yuhan Wang
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Xicheng District
| | - Hongzhou Liu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
- Department of Endocrinology, Aerospace Center Hospital, Haidian District, Beijing, China
| | - Jincheng Wang
- Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Xiaodong Hu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Anping Wang
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Kang Chen
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Anning Wang
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Li Zang
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Yu Cheng
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Weijun Gu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Jingtao Dou
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Yiming Mu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Jin Du
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
| | - Zhaohui Lyu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Haidian District
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Liu F, Ling Q, Xie S, Xu Y, Liu M, Hu Q, Ma J, Yan Z, Gao Y, Zhao Y, Zhu W, Yu P, Luo J, Liu X. Association between triglyceride glucose index and arterial stiffness and coronary artery calcification: a systematic review and exposure-effect meta-analysis. Cardiovasc Diabetol 2023; 22:111. [PMID: 37179288 PMCID: PMC10183133 DOI: 10.1186/s12933-023-01819-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/30/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The triglyceride and glucose (TyG) index has been linked to various cardiovascular diseases. However, it's still unclear whether the TyG index is associated with arterial stiffness and coronary artery calcification (CAC). METHODS We conducted a systematic review and meta-analysis of relevant studies until September 2022 in the PubMed, Cochrane Library, and Embase databases. We used a random-effects model to calculate the pooled effect estimate and the robust error meta-regression method to summarize the exposure-effect relationship. RESULTS Twenty-six observational studies involving 87,307 participants were included. In the category analysis, the TyG index was associated with the risk of arterial stiffness (odds ratio [OR]: 1.83; 95% CI 1.55-2.17, I2 = 68%) and CAC (OR: 1.66; 95% CI 1.51-1.82, I2 = 0). The per 1-unit increment in the TyG index was also associated with an increased risk of arterial stiffness (OR: 1.51, 95% CI 1.35-1.69, I2 = 82%) and CAC (OR: 1.73, 95% CI 1.36-2.20, I2 = 51%). Moreover, a higher TyG index was shown to be a risk factor for the progression of CAC (OR = 1.66, 95% CI 1.21-2.27, I2 = 0, in category analysis, OR = 1.47, 95% CI 1.29-1.68, I2 = 41% in continuity analysis). There was a positive nonlinear association between the TyG index and the risk of arterial stiffness (Pnonlinearity < 0.001). CONCLUSION An elevated TyG index is associated with an increased risk of arterial stiffness and CAC. Prospective studies are needed to assess causality.
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Affiliation(s)
- Fuwei Liu
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Qin Ling
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Shaofeng Xie
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Yi Xu
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Menglu Liu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Qingwen Hu
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Zhiwei Yan
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China
- Provincial University Key Laboratory of Sport and Health Science, School of Physical Education and Sport Sciences, Fujian Normal University, Fuzhou, Fujian, China
| | - Yan Gao
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China
| | - Yujie Zhao
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Yu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Luo
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China.
| | - Xiao Liu
- Department of Cardiology, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Castelli R, Gidaro A, Casu G, Merella P, Profili NI, Donadoni M, Maioli M, Delitala AP. Aging of the Arterial System. Int J Mol Sci 2023; 24:6910. [PMID: 37108072 PMCID: PMC10139087 DOI: 10.3390/ijms24086910] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Aging of the vascular system is associated with deep changes of the structural proprieties of the arterial wall. Arterial hypertension, diabetes mellitus, and chronic kidney disease are the major determinants for the loss of elasticity and reduced compliance of vascular wall. Arterial stiffness is a key parameter for assessing the elasticity of the arterial wall and can be easily evaluated with non-invasive methods, such as pulse wave velocity. Early assessment of vessel stiffness is critical because its alteration can precede clinical manifestation of cardiovascular disease. Although there is no specific pharmacological target for arterial stiffness, the treatment of its risk factors helps to improve the elasticity of the arterial wall.
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Affiliation(s)
- Roberto Castelli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy
| | - Gavino Casu
- Cardiology Unit, Azienda Ospedaliero, Universitaria di Sassari, 07100 Sassari, Italy
| | - Pierluigi Merella
- Cardiology Unit, Azienda Ospedaliero, Universitaria di Sassari, 07100 Sassari, Italy
| | - Nicia I. Profili
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mattia Donadoni
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy
| | - Margherita Maioli
- Department of Biochemical Science, University of Sassari, 07100 Sassari, Italy
| | - Alessandro P. Delitala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Aortic Stiffness: A Major Risk Factor for Multimorbidity in the Elderly. J Clin Med 2023; 12:jcm12062321. [PMID: 36983321 PMCID: PMC10058400 DOI: 10.3390/jcm12062321] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Multimorbidity, the coexistence of multiple health conditions in an individual, has emerged as one of the greatest challenges facing health services, and this crisis is partly driven by the aging population. Aging is associated with increased aortic stiffness (AoStiff), which in turn is linked with several morbidities frequently affecting and having disastrous consequences for the elderly. These include hypertension, ischemic heart disease, heart failure, atrial fibrillation, chronic kidney disease, anemia, ischemic stroke, and dementia. Two or more of these disorders (multimorbidity) often coexist in the same elderly patient and the specific multimorbidity pattern depends on several factors including sex, ethnicity, common morbidity routes, morbidity interactions, and genomics. Regular exercise, salt restriction, statins in patients at high atherosclerotic risk, and stringent blood pressure control are interventions that delay progression of AoStiff and most likely decrease multimorbidity in the elderly.
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Mixed circuit training acutely reduces arterial stiffness in patients with chronic stroke: a crossover randomized controlled trial. Eur J Appl Physiol 2023; 123:121-134. [PMID: 36205814 DOI: 10.1007/s00421-022-05061-8] [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: 03/21/2022] [Accepted: 09/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Investigate whether a single bout of mixed circuit training (MCT) can elicit changes in arterial stiffness in patients with chronic stroke. Second, to assess the between-day reproducibility of post-MCT arterial stiffness measurements. METHODS Seven participants (58 ± 12 years) performed a non-exercise control session (CTL) and two bouts of MCT on separate days in a randomized counterbalanced order. The MCT involved 3 sets of 15 repetition maximum for 10 exercises, with each set separated by 45-s of walking. Brachial-radial pulse wave velocity (br-PWV), radial artery compliance (AC) and reflection index (RI1,2) were assessed 10 min before and 60 min after CTL and MCT. Ambulatory arterial stiffness index (AASI) was calculated from 24-h recovery ambulatory blood pressure monitoring. RESULTS Compared to CTL, after 60 min of recovery from the 1st and 2nd bouts of MCT, lower values were observed for br-PWV (mean diff = - 3.9 and - 3.7 m/s, respectively, P < 0.01; ICC2,1 = 0.75) and RI1,2 (mean diff = - 16.1 and - 16.0%, respectively, P < 0.05; ICC2,1 = 0.83) concomitant with higher AC (mean diff = 1.2 and 1.0 × 10-6 cm5/dyna, respectively, P < 0.01; ICC2,1 = 0.40). The 24-h AASI was reduced after bouts of MCT vs. CTL (1st and 2nd bouts of MCT vs. CTL: mean diff = - 0.32 and - 0.29 units, respectively, P < 0.001; ICC2,1 = 0.64). CONCLUSION A single bout of MCT reduces arterial stiffness during laboratory (60 min) and ambulatory (24 h) recovery phases in patients with chronic stroke with moderate-to-high reproducibility. TRIAL REGISTRATION Ensaiosclinicos.gov.br identifier RBR-5dn5zd.
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16
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Chhabra JS, Juneja A, Etkin Y, Landis G, Gardener H, Garuthara M, Hoffstaetter T, Oropallo A. The effect of nutrition on stroke risk: A systematic review. Nutr Health 2022; 29:255-267. [PMID: 36040714 DOI: 10.1177/02601060221122218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: An estimated 33% reduction in cardiovascular events can be achieved when incorporating whole grains, fruits, vegetables, poultry, nuts, and vegetable oils in the diet along with reduced consumption of refined carbohydrates, processed meats, and sugar sweetened beverages. We performed a systematic review to analyze the impact of nutritional intervention on stroke risk, as there is no current consensus concerning dietary recommendation for primary and secondary stroke prevention. Methods: A literature search of the PubMed database from January 2010 to June 2020 was performed using combinations of the following search terms: carotid disease, carotid artery disease, carotid stenosis, carotid intima-media thickness (CIMT), diet, nutrition, micronutrition, embolic stroke, and stroke. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. Results: 28 studies met our inclusion criteria. Multiple studies showed an inverse relationship between consumption of vegetables and fruits and stroke risk. Vitamin B12 or a combination of B Vitamins was the most common supplement studied in stroke prevention. Only one RCT showed the use of B12 (500 micrograms/day) correlated with lower CIMT at follow up in healthy vegetarians. Discussion: The key findings from this systematic review indicate that adopting a diet rich in fruits and vegetables earlier in life may lower stroke risk compared with meats and fat intake. B vitamins also appear to confer some protection against stroke. However, not enough data exists to support the use of multivitamins, calcium, soy products and other supplements for primary or secondary stroke prevention.
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Affiliation(s)
| | | | - Yana Etkin
- Northwell Health, New Hyde Park, NY, USA
| | | | - Hannah Gardener
- University of Miami Miller School of Medicine, Miami, FL, USA
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17
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Huang Z, Ding X, Yue Q, Wang X, Chen Z, Cai Z, Li W, Cai Z, Chen G, Lan Y, Wu W, Wu S, Chen Y. Triglyceride-glucose index trajectory and stroke incidence in patients with hypertension: a prospective cohort study. Cardiovasc Diabetol 2022; 21:141. [PMID: 35897017 PMCID: PMC9331781 DOI: 10.1186/s12933-022-01577-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023] Open
Abstract
Background It has been suggested that the baseline triglyceride-glucose (TyG) index, a simple surrogate measure for insulin resistance, is significantly associated with the occurrence of stroke. Nevertheless, the impact of longitudinal patterns of TyG on the stroke risk in hypertensive patients is still unknown. Hence, this study aimed to investigate the association between TyG index trajectory and stroke risk among hypertensive patients. Methods This prospective study included 19,924 hypertensive patients from the Kailuan Study who underwent three waves survey and were free of myocardial infarction, cancer and stroke before or during 2010. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2], and latent mixed modelling was used to identify the trajectory of TyG during the exposure period (2006–2010). Furthermore, the Cox proportional hazard models were applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) for incident stroke of different trajectory groups. Results Five distinct TyG trajectory were identified during 2006–2010: low-stable (n = 2483; range, 8.03–8.06), moderate low-stable (n = 9666; range, 8.58–8.57), moderate high-stable (n = 5759; range, 9.16–9.09), elevated-stable (n = 1741; range, 9.79–9.75), and elevated-increasing (n = 275; range, 10.38–10.81). During the median follow-up of 9.97 years, 1,519 cases of incident stroke were identified, including 1,351 with ischemic stroke and 215 with hemorrhage stroke. After adjusting for confounding variables, the HR and 95% CI of stroke were 2.21 (1.49,3.28) for the elevated-increasing group, 1.43 (1.13,1.83) for the elevated-stable group, 1.35 (1.10,1.64) for the moderate high-stable group, 1.26 (1.06,1.52) for the moderate low-stable group, respectively, when compare with the low-stable group. Similar results were observed in ischemic stroke, but a significant association was not found between TyG trajectory and risk of hemorrhage stroke. Conclusion A long-term elevated TyG index in hypertensive patients is associated with an increased risk of stroke, especially ischemic stroke. This finding implies that regular monitoring of TyG index may assist in identifying individuals at a higher risk of stroke among patients with hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01577-7.
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Affiliation(s)
- Zegui Huang
- Shantou University Medical College, Shantou, China, Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
| | - Xiong Ding
- School of Public Health, Wuhan University, Wuhan, China
| | - Qing Yue
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xianxuan Wang
- Shantou University Medical College, Shantou, China.,Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
| | - Zekai Chen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Zefeng Cai
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
| | - Weijian Li
- Shantou University Medical College, Shantou, China.,Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
| | - Zhiwei Cai
- Shantou University Medical College, Shantou, China.,Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
| | | | - Yulong Lan
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
| | - Weiqiang Wu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Road, Tangshan, 063000, China
| | - Youren Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia North Road, Shantou, 515000, China
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18
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Impact of estimated pulse wave velocity and socioeconomic status on the risk of stroke in men: a prospective cohort study. J Hypertens 2022; 40:1165-1169. [PMID: 35239548 DOI: 10.1097/hjh.0000000000003118] [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 High pulse wave velocity (PWV) and low socioeconomic status (SES) are each associated with increased risk of stroke, but clarification of the interplay between PWV, SES and the risk of stroke appears to be warranted to identify vulnerable populations at high risk of stroke. We conducted a prospective study that examined the independent and joint associations of PWV and SES with the risk of stroke in the general population. METHODS The current study included 2666 men aged 42-61 years, who were enrolled in the Kuopio Ischaemic Heart Disease Study cohort. Estimated PWV (ePWV), a proxy of carotid-femoral PWV, was calculated from an equation based on age and mean blood pressure. SES was assessed using self-reported questionnaires and classified as tertiles, whereas ePWV was categorized as high (≥10 m/s) and low (<10 m/s). RESULTS Individuals with high ePWV had a 48% higher risk of stroke after adjusting for confounding factors, whereas individuals with low SES had a similar 35% increased risk of stroke, compared with those high SES. Results of the joint associations of ePWV and SES with stroke showed high ePWV-high SES and high ePWV-low SES to be each associated with an increased risk of stroke: hazard ratios 1.53, 95% confidence intervals (CIs) (1.12-2.08) and hazard ratio 1.63, 95% CI (1.21-2.20), respectively, but low ePWV-low SES was not associated with a heightened risk of stroke (hazard ratio 1.12, 95% CI 0.87-1.44) compared with the low ePWV-high SES group. CONCLUSION ePWV and SES are each independently associated with stroke risk. The association between elevated ePWV and the heightened risk of stroke is regardless of low or high SES.
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Moncion K, Rodrigues L, MacKay-Lyons M, Eng JJ, Billinger SA, Ploughman M, Bailey DM, Trivino M, Bayley M, Thiel A, Roig M, Tang A. Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic. Neurorehabil Neural Repair 2022; 36:3-16. [PMID: 34711094 PMCID: PMC8721549 DOI: 10.1177/15459683211054175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lynden Rodrigues
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columba and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, BC, Canada
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer’s Disease Center, Fairway, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Ploughman
- Recovery and Performance Laboratory, BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Damian M. Bailey
- Neurovascular Research Laboratory, University of South Wales Faculty of Life Sciences and Education, Pontypridd, UK
| | - Michael Trivino
- Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Alexander Thiel
- Jewish General Hospital Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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20
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Rey-García J, Townsend RR. Large Artery Stiffness: A Companion to the 2015 AHA Science Statement on Arterial Stiffness. Pulse (Basel) 2021; 9:1-10. [PMID: 34722350 DOI: 10.1159/000518613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022] Open
Abstract
Large artery stiffness (LAS) has proven to be an independent risk factor for cardiovascular disease and mortality. Nevertheless, the position of current hypertension guidelines regarding the usefulness of assessing LAS differs across different continents. In general, European Guidelines recognize pulse wave velocity (PWV) as a marker of target organ damage but do not recommend its systematic use in general population. Asian guidelines consider PWV as a recommended test at diagnosis of hypertension, in contrast to North American guidelines that do not state any position about its usefulness. However, PWV predicts cardiovascular events, and several studies have shown that it improves risk classification adjusting for established risk factors especially for intermediate-risk patients. Finally, some advances have been made related to treatments affecting LAS. Dietary interventions such as sodium restriction and exercise-based interventions have a modest effect in reducing LAS. Pharmacological interventions, such as statins, or more recent advances with mineralocorticoid blocker seem to have a beneficial effect. Last, controversial effects of renal denervation on LAS have been found. Our goal here is to update the reader on LAS on these areas since the 2015 American Heart Association Scientific Statement.
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Affiliation(s)
- Jimena Rey-García
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.,Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Tjan A, Widiana IGR, Martadiani ED, Ayusta IMD, Asih MW, Sitanggang FP. Carotid artery stiffness measured by strain elastography ultrasound is a stroke risk factor. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Li J, Fang Y, Wu D. Mechanical forces and metabolic changes cooperate to drive cellular memory and endothelial phenotypes. CURRENT TOPICS IN MEMBRANES 2021; 87:199-253. [PMID: 34696886 PMCID: PMC8639155 DOI: 10.1016/bs.ctm.2021.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endothelial cells line the innermost layer of arterial, venous, and lymphatic vascular tree and accordingly are subject to hemodynamic, stretch, and stiffness mechanical forces. Normally quiescent, endothelial cells have a hemodynamic set point and become "activated" in response to disturbed hemodynamics, which may signal impending nutrient or gas depletion. Endothelial cells in the majority of tissue beds are normally inactivated and maintain vessel barrier functions, are anti-inflammatory, anti-coagulant, and anti-thrombotic. However, under aberrant mechanical forces, endothelial signaling transforms in response, resulting cellular changes that herald pathological diseases. Endothelial cell metabolism is now recognized as the primary intermediate pathway that undergirds cellular transformation. In this review, we discuss the various mechanical forces endothelial cells sense in the large vessels, microvasculature, and lymphatics, and how changes in environmental mechanical forces result in changes in metabolism, which ultimately influence cell physiology, cellular memory, and ultimately disease initiation and progression.
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Affiliation(s)
- Jin Li
- Committee on Molecular Metabolism and Nutrition, Biological Sciences Division, University of Chicago, Chicago, IL, United States; Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, United States
| | - Yun Fang
- Committee on Molecular Metabolism and Nutrition, Biological Sciences Division, University of Chicago, Chicago, IL, United States; Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, United States
| | - David Wu
- Committee on Molecular Metabolism and Nutrition, Biological Sciences Division, University of Chicago, Chicago, IL, United States; Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, United States.
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23
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Peçanha T, Bannell DJ, Sieczkowska SM, Goodson N, Roschel H, Sprung VS, Low DA. Effects of physical activity on vascular function in autoimmune rheumatic diseases: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 60:3107-3120. [PMID: 33521818 DOI: 10.1093/rheumatology/keab094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To summarize existing evidence and quantify the effects of physical activity on vascular function and structure in autoimmune rheumatic diseases (ARDs). METHODS Databases were searched (through March 2020) for clinical trials evaluating the effects of physical activity interventions on markers of micro- and macrovascular function and macrovascular structure in ARDs. Studies were combined using random effects meta-analysis, which was conducted using Hedges' g. Meta-analyses were performed on each of the following outcomes: microvascular function [i.e. skin blood flow or vascular conductance responses to acetylcholine (ACh) or sodium nitropusside (SNP) administration]; macrovascular function [i.e. brachial flow-mediated dilation (FMD%) or brachial responses to glyceryl trinitrate (GTN%); and macrovascular structure [i.e. aortic pulse wave velocity (PWV)]. RESULTS Ten studies (11 trials) with a total of 355 participants were included in this review. Physical activity promoted significant improvements in microvascular [skin blood flow responses to ACh, g = 0.92 (95% CI 0.42, 1.42)] and macrovascular function [FMD%, g = 0.94 (95% CI 0.56, 1.02); GTN%, g = 0.53 (95% CI 0.09, 0.98)]. Conversely, there was no evidence for beneficial effects of physical activity on macrovascular structure [PWV, g = -0.41 (95% CI -1.13, 0.32)]. CONCLUSIONS Overall, the available clinical trials demonstrated a beneficial effect of physical activity on markers of micro- and macrovascular function but not on macrovascular structure in patients with ARDs. The broad beneficial impact of physical activity across the vasculature identified in this review support its role as an effective non-pharmacological management strategy for patients with ARDs.
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Affiliation(s)
- Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology, Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel J Bannell
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University
| | - Sofia Mendes Sieczkowska
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology, Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nicola Goodson
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology, Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Victoria S Sprung
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University
| | - David A Low
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University
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Way KL, Lee AS, Twigg SM, Johnson NA. The effect of acute aerobic exercise on central arterial stiffness, wave reflections, and hemodynamics in adults with diabetes: A randomized cross-over design. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:499-506. [PMID: 32444343 PMCID: PMC8343005 DOI: 10.1016/j.jshs.2020.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/21/2019] [Accepted: 01/22/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Individuals with diabetes have greater central arterial stiffness, wave reflections, and hemodynamics, all of which promote the accelerated cardiovascular pathology seen in this population. Acute aerobic exercise has been shown to be an effective strategy for reducing central arterial stiffness, wave reflections, and hemodynamics in healthy individuals; however, the effects of acute aerobic exercise in reducing these outcomes is not well established in people with diabetes. Recently, implementation of high-intensity interval exercise (HIIE) has shown superior improvements in cardiovascular health outcomes when compared to traditional aerobic exercise. Yet, the effect of HIIE on the aforementioned outcomes in people with diabetes is not known. The purpose of this study was to (i) describe the central arterial stiffness, wave reflections, and hemodynamic responses to a bout of HIIE and moderate-intensity continuous exercise (MICE) in adults with diabetes; and (ii) compare the effects of HIIE and MICE on the aforementioned outcomes. METHODS A total of 24 adult men and women (aged 29-59 years old) with type 1 (n = 12) and type 2 (n = 12) diabetes participated in a randomized cross-over study. All participants completed the following protocols: (i) HIIE: cycling for 4 × 4 min at 85%-95% of heart rate peak (HRpeak), interspersed with 3 min of active recovery at 60%-70%HRpeak; (ii) MICE: 33 min of continuous cycling at 60%-70%HRpeak; and (iii) control (CON): lying quietly in a supine position for 30 min. RESULTS A significant group × time effect was found for changes in central systolic blood pressure (F = 3.20, p = 0.01) with a transient reduction for the HIIE group but not for the MICE or CON groups. There was a significant group × time effect for changes in augmentation index at a heart rate of 75 beats/min (F = 2.32, p = 0.04) with a decrease following for HIIE and MICE but not for CON. For all other measures of central arterial stiffness and hemodynamics, no significant changes were observed (p > 0.05). CONCLUSION A bout of HIIE appears to lead to a greater transient reduction in central systolic blood pressure than the reduction observed following MICE; however, both HIIE and MICE improved augmentation index at a heart rate of 75 beats/min in people with diabetes. There was no significant difference in response to HIIE and MICE in all outcomes. This provides preliminary evidence on the role of HIIE on such outcomes in people with diabetes.
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Affiliation(s)
- Kimberley L Way
- Faculty of Medicine and Health, Discipline of Exercise and Sports Science, University of Sydney, Lidcombe, NSW 2141, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia; Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Angela S Lee
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia; Faculty of Medicine and Health, Central Clinical School, University of Sydney, Camperdown, NSW 2006, Australia; Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Stephen M Twigg
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia; Faculty of Medicine and Health, Central Clinical School, University of Sydney, Camperdown, NSW 2006, Australia; Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Nathan A Johnson
- Faculty of Medicine and Health, Discipline of Exercise and Sports Science, University of Sydney, Lidcombe, NSW 2141, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia; Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, NSW 2006, Australia
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25
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Schofield CL, Rodrigo-Navarro A, Dalby MJ, Van Agtmael T, Salmeron-Sanchez M. Biochemical‐ and Biophysical‐Induced Barriergenesis in the Blood–Brain Barrier: A Review of Barriergenic Factors for Use in In Vitro Models. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202000068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Matthew J. Dalby
- Centre for the Cellular Microenvironment University of Glasgow Glasgow UK
| | - Tom Van Agtmael
- Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow UK
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Pereira MM, Torrado J, Sosa C, Zócalo Y, Bia D. Role of arterial impairment in preeclampsia: should the paradigm shift? Am J Physiol Heart Circ Physiol 2021; 320:H2011-H2030. [PMID: 33797272 DOI: 10.1152/ajpheart.01005.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Preeclampsia is a worldwide pregnancy complication with serious short- and long-term maternal and neonatal consequences. Our understanding of preeclampsia pathophysiology has significantly evolved over the last decades with the recognition that impaired arterial function and structure may occur early in the course of pregnancy, preceding the clinic-humoral syndrome and driving long-term cardiovascular disease risk in the future of these patients. Although an early abnormal placentation may be the inciting event for a large proportion of cases, there is growing evidence that challenges the placental hypothesis in all affected women, since placental histopathology lesions thought to be characteristic are neither sensitive nor specific markers for the disorder. Recent hemodynamic investigations and studies on left ventricular function and structure in women with preeclampsia further challenge this universal paradigm and propose that placental dysfunction could be secondary to a maternal cardiovascular maladaptation to pregnancy in certain patients. Supporting this hypothesis, certain vascular features, which are characteristically enhanced in normal pregnancy allowing a healthy vascular adaptation, are absent in preeclampsia and comparable to the nonpregnant population. However, arterial biomechanics in preeclampsia may only not cope with hemodynamic demands of pregnancy but also impose additional detrimental loads to the maternal heart ("impaired left-ventricle-aorta coupling") and transmit pressure and flow disturbances into the fetoplacental circulation ("impaired large arteries-microcirculation coupling"). In this review, we analyze the major role of the arterial dysfunction in the cardiovascular maladaptation hypothesis of preeclampsia, shed light on its potential etiopathogenic link, and discuss the complementary nature of the placental and cardiovascular theories.
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Affiliation(s)
- María M Pereira
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | - Juan Torrado
- Jacobi Medical Center, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Claudio Sosa
- Department of Obstetrics and Gynecology "C", Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
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Beneficial Effect of Statin Therapy on Arterial Stiffness. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5548310. [PMID: 33860033 PMCID: PMC8026295 DOI: 10.1155/2021/5548310] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022]
Abstract
Arterial stiffness describes the increased rigidity of the arterial wall that occurs as a consequence of biological aging and several diseases. Numerous studies have demonstrated that parameters to assess arterial stiffness, especially pulse-wave velocity, are predictive of those individuals that will suffer cardiovascular morbidity and mortality. Statin therapy may be a pharmacological strategy to improve arterial elasticity. It has been shown that the positive benefits of statin therapy on cardiovascular disease is attributable not only to their lipid-lowering capacity but also to various pleiotropic effects, such as their anti-inflammatory, antiproliferative, antioxidant, and antithrombotic properties. Additionally, statins reduce endothelial dysfunction, improve vascular and myocardial remodeling, and stabilize atherosclerotic plaque. The aim of the present review was to summarize the evidence from human studies showing the effects of statins on arterial stiffness.
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Madonna R. Exploring the mechanisms of action of gliflozines in heart failure and possible implications in pulmonary hypertension. Vascul Pharmacol 2021; 138:106839. [PMID: 33524548 DOI: 10.1016/j.vph.2021.106839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
Although results from two major trials trials have shown a clear benefit of gliflozines in the management of heart failure (HF) irrespective of diabetes status, the mechanism of cardiac benefits remains incompletely understood. Gliflozines have an osmotic diuretic effect that differs from that of other diuretic classes, resulting in greater electrolyte-free water clearance, and clinical studies have shown that intravascular volume depletion is rare and occurs at similar frequency in the gliflozines and placebo groups. As a consequence of the negligible effects on the blood volume and body's fluid balance compared to diuretics, gliflozines may limit the reflex neurohumoral stimulation and activation of renin-angiotensin-aldosterone system (RAAS). Since neurohormonal and RAAS activation in patients with HF reduced or ejection fraction (HFrEF and HFpEF) also leads to systemic and pulmonary arterial stiffening, pulmonary hypertension (PH) and PH-related right ventricular failure, gliflozines may lead to a mitigation of systemic and pulmonary arterial stiffening, which in turn can reduce the degree of PH associated with HFrEF or HFpEF, can improve the ventricular arterial coupling and can reduce the overload of the left and right ventricle, improving their function. The current review discusses the latest findings regarding the effects of SGLT2 inhibitors on heart failure with focus also on pulmonary hypertension, discussing the molecular mechanisms involved.
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Affiliation(s)
- Rosalinda Madonna
- Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States of America; Institute of Cardiology, University of Pisa, Pisa, Italy.
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Matjuda EN, Engwa GA, Sewani-Rusike CR, Nkeh-Chungag BN. An Overview of Vascular Dysfunction and Determinants: The Case of Children of African Ancestry. Front Pediatr 2021; 9:769589. [PMID: 34956981 PMCID: PMC8709476 DOI: 10.3389/fped.2021.769589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022] Open
Abstract
The balance between dilatory and constrictive factors is important as it keeps blood vessels in a homeostatic state. However, altered physiological processes as a result of obesity, hypertension, oxidative stress, and other cardiovascular risk factors may lead to vascular damage, causing an imbalance of vasoactive factors. Over time, the sustained imbalance of these vasoactive factors may lead to vascular dysfunction, which can be assessed by non-invasive methods, such as flow-mediated dilation, pulse wave velocity, flow-mediated slowing, retinal vessel analysis, peripheral vascular reactivity, and carotid intima-media thickness assessment. Although there is increasing prevalence of cardiovascular risk factors (obesity and hypertension) in children in sub-Saharan Africa, little is known about how this may affect vascular function. This review focuses on vasoactive factors implicated in vascular (dys)function, highlighting the determinants and consequences of vascular dysfunction. It further describes the non-invasive methods used for vascular (dys)function assessments and, last, describes the impact of cardiovascular risk factors on vascular dysfunction in children of African ancestry.
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Affiliation(s)
- Edna N Matjuda
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha, South Africa
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, South Africa
| | - Constance R Sewani-Rusike
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha, South Africa
| | - Benedicta N Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, South Africa
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Short-term outcome after ischemic stroke and 24-h blood pressure variability: association and predictors. Hypertens Res 2020; 44:188-196. [PMID: 32801313 DOI: 10.1038/s41440-020-00534-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 11/09/2022]
Abstract
To examine the association between blood pressure (BP) variability measured within 24 h after admission for acute ischemic stroke and functional outcome 30 days after stroke onset and to find outcome predictors. A total of 174 patients were included in this retrospective study. Supine BP was measured every 4 h during the first 24 h after admission. The functional outcome was assessed using the modified Rankin Scale. BP parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were examined. A set of six variability indices was calculated, including standard deviation (SD), successive variation (SV), difference between maximum and minimum value (DMM), and maximal successive change (MSC). Patients with high SBP or PP variability measures were significantly more likely to develop an unfavorable outcome. All PP variability indices displayed the highest correlations with the outcome. This association was confirmed in logistic regression analysis, both in univariable model and a model adjusted to the baseline National Institute of Health Stroke Scale score and mean BP (the OR for an unfavorable outcome following a 10-mmHg increase in SD, SV, MSC, and DMM parameters was in the interval 1.4-2.7, p < 0.05). Following receiver operating characteristic analysis, the PP parameters yielded area under the curve (AUC) values between 0.654 and 0.666, p < 0.005. Thus, in the acute phase of ischemic stroke, the SD and MSC indices of PP variability during the first 24 h after admission were robustly associated with patients' 30-day outcomes and served as predictors of unfavorable outcomes with thresholds of 14 and 26 mmHg, respectively.
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Kerch G. Role of Changes in State of Bound Water and Tissue Stiffness in Development of Age-Related Diseases. Polymers (Basel) 2020; 12:E1362. [PMID: 32560459 PMCID: PMC7361708 DOI: 10.3390/polym12061362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
An essential effect of environmental stiffness on biological processes in cells at present is generally accepted. An increase in arterial stiffness with advanced age has been reported in many publications. The aim of the present review is to summarize current information about possible chemical reactions and physical processes that lead to tissue stiffening and result in age-related diseases in order to find methods that can prevent or retard time-dependent tissue stiffening. The analysis of published data shows that bound water acts as a plasticizer of biological tissues, a decrease in bound water content results in an increase in biological tissue stiffness, and increased tissue stiffness leads to NF-kB activation and triggered actin polymerization-NF-kB activation is associated with age-related diseases. It can be suggested that changes in bound water content through changing tissue stiffness can affect cellular processes and the development of pathologies related to aging. Both age-related diseases and COVID-19 may be associated with tight-junction disruption and increased tissue stiffness and permeability.
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Affiliation(s)
- Garry Kerch
- Faculty of Materials Science and Applied Chemistry, Riga Technical University, 1048 Riga, Latvia
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Yugar-Toledo JC, Moreno Júnior H, Gus M, Rosito GBA, Scala LCN, Muxfeldt ES, Alessi A, Brandão AA, Moreira Filho O, Feitosa ADDM, Passarelli Júnior O, Souza DDSMD, Amodeo C, Barroso WKS, Gomes MAM, Paiva AMGD, Barbosa ECD, Miranda RD, Vilela-Martin JF, Nadruz Júnior W, Rodrigues CIS, Drager LF, Bortolotto LA, Consolim-Colombo FM, Sousa MGD, Borelli FADO, Kaiser SE, Salles GF, Azevedo MDFD, Magalhães LBNC, Póvoa RMDS, Malachias MVB, Nogueira ADR, Jardim PCBV, Jardim TDSV. Brazilian Position Statement on Resistant Hypertension - 2020. Arq Bras Cardiol 2020; 114:576-596. [PMID: 32267335 PMCID: PMC7792719 DOI: 10.36660/abc.20200198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Heitor Moreno Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Miguel Gus
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | | | - Elizabeth Silaid Muxfeldt
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Wilson Nadruz Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde Pontifícia Universidade Católica de são Paulo, São Paulo, SP - Brasil
| | - Luciano Ferreira Drager
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | | | | | | | | | - Gil Fernando Salles
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Gomes VC, Fernando da Silva L, Zyngier SP, Silvestre GC, Queiroz A, Marques MA, Simão da Silva E. Left Common Carotid Artery Biomechanical Properties in Individuals over 80 years: Women Have Stiffer Vessels. Ann Vasc Surg 2020; 67:461-467. [PMID: 32173475 DOI: 10.1016/j.avsg.2020.01.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Considering the longevity of the worldwide population, the cardiovascular diseases deserve particular attention, especially the carotid artery disease in the ≥80-year-old population. The stiffness of the common carotid artery, for example, has been showed in numerous clinical studies as a marker of increased risk of stroke, dementia, and depression. Besides, with the emergence of new surgical techniques such as the transcarotid artery revascularization that uses the common carotid artery as a workstation, the biomechanical and histological features of this vessel, more than ever, must be detailed. METHODS Left common carotid artery fragments from 9 cadaver donors (≥80 years old) were evaluated. Biomechanical (failure stress, tension, and strain) and histological (percentage of collagen and elastic fibers) features of these samples were analyzed with special focus on gender differences. RESULTS Statistically significant differences in biomechanical and histological features between the genders were observed. The percentage of collagen fiber in intima (P = 0.008) and media (P = 0.041) layers was significantly lower in men than in women. A higher elasticity (failure strain) of the specimens in male gender was also observed (P = 0.025). No significant difference was observed in the layers thickness between the genders regardless which part of the arterial wall was considered. CONCLUSIONS These biomechanical and histological findings could be the responsible for the higher left common carotid artery stiffness observed among ≥80-year-old women when compared with men in numerous clinical studies in literature.
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Affiliation(s)
- Vivian Carla Gomes
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Luiz Fernando da Silva
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Selene Perrotti Zyngier
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Gina Camillo Silvestre
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Alexandre Queiroz
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Michele Alberto Marques
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Erasmo Simão da Silva
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
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Trush E, Ivanova S, Savin A, Yushchuk E, Teltevskaya I, Melehina I, Dobrovolskaya L. Arterial stiffness in patients with acute cerebrovascular accident. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:16-21. [DOI: 10.17116/jnevro202012012216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hsu PC, Lee WH, Tsai WC, Chu CY, Chen YC, Lee MK, Lin TH, Lee CS, Voon WC, Lai WT, Sheu SH, Su HM. Impact of Simultaneous Consideration of Cardiac and Vascular Function on Long-Term All-Cause and Cardiovascular Mortality. J Clin Med 2019; 8:jcm8122145. [PMID: 31817192 PMCID: PMC6947191 DOI: 10.3390/jcm8122145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Left ventricular ejection fraction (LVEF) is a good indicator of cardiac function, and brachial-ankle pulse wave velocity (baPWV) is a good indicator of vascular function. Both of them can predict cardiovascular (CV) outcomes. Objectives: There is scarce literature discussing the impact of simultaneous consideration of cardiac and vascular function on overall and CV mortality. Methods: We included 958 patients and classified them into four groups. Groups 1 to 4 were patients with LVEF ≥ 50% and baPWV below the median, LVEF < 50% but baPWV below the median, LVEF ≥ 50% but baPWV above the median, and LVEF < 50% and baPWV above the median, respectively. Results: The median follow-up to mortality was 93 (25th–75th percentile: 69–101) months. There were 91 cases of CV mortality and 238 cases of all-cause mortality. After multivariable analysis, age, gender, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of all-cause mortality (P ≤ 0.038) and age, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of CV mortality (P ≤ 0.008). Conclusions: Patients with higher LVEF and lower baPWV had a similar overall and CV mortality as patients with higher LVEF and baPWV. Patients with lower LVEF and higher baPWV had the highest overall and CV mortality among the four study groups. In addition, patients with lower LVEF alone had a higher CV mortality than the patients with higher baPWV alone. Therefore, simultaneous consideration of cardiac and vascular function may be useful in predicting overall and CV mortality.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Wei-Chung Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ying-Chih Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Meng-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ho-Ming Su
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
- Correspondence: ; Tel.: 886-7-8036783-3441; Fax: 886-7-8063346
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Odai T, Terauchi M, Kato K, Hirose A, Miyasaka N. Effects of Grape Seed Proanthocyanidin Extract on Vascular Endothelial Function in Participants with Prehypertension: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients 2019; 11:E2844. [PMID: 31757033 PMCID: PMC6950399 DOI: 10.3390/nu11122844] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/08/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023] Open
Abstract
This study aimed to investigate the effects of grape seed proanthocyanidin extract (GSPE) on blood pressure and vascular endothelial function in middle-aged Japanese adults with prehypertension. We conducted a randomized, double-blind, placebo-controlled study on 6 men and 24 women aged 40-64 years old. The participants were randomized to receive tablets containing either low-dose (200 mg/day) or high-dose (400 mg/day) GSPE, or placebo, for 12 weeks. Systolic and diastolic blood pressures (SBP and DBP, respectively), brachial flow-mediated dilation (FMD), and other cardiovascular parameters were measured before and after 4, 8, and 12 weeks of treatment. The mean SBP in the high-dose group significantly decreased by 13 mmHg after 12 weeks (P = 0.028), although FMD did not change. In an ad hoc analysis of non-smoking participants (n = 21), the mean SBP, DBP, stiffness parameter β, distensibility, incremental elastic modulus (Einc), and pulse wave velocity (PWV) also significantly improved in the high-dose group after 12 weeks. Changes in Einc and PWV from baseline to 12 weeks were significantly greater in the high-dose group than in the placebo group (Einc, P = 0.023; PWV, P = 0.03). GSPE consumption could help maintain vascular elasticity and normal blood pressure in this population.
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Affiliation(s)
- Tamami Odai
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.O.); (A.H.); (N.M.)
| | - Masakazu Terauchi
- Department of Women’s Health, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;
| | - Kiyoko Kato
- Department of Women’s Health, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;
| | - Asuka Hirose
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.O.); (A.H.); (N.M.)
- Department of Women’s Health, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (T.O.); (A.H.); (N.M.)
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Pickup L, Radhakrishnan A, Townend JN, Ferro CJ. Arterial stiffness in chronic kidney disease. Curr Opin Nephrol Hypertens 2019; 28:527-536. [DOI: 10.1097/mnh.0000000000000535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology. DISEASE MARKERS 2019; 2019:9636197. [PMID: 31612072 PMCID: PMC6757252 DOI: 10.1155/2019/9636197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 12/31/2022]
Abstract
Purpose The study is aimed at identifying echocardiographic and circulating biomarkers as well as hemodynamic indices of embolic stroke of undetermined etiology (ESUS) in patients aged <65. Methods We prospectively investigated 520 patients with confirmed ischemic stroke and selected those 65 patients who were diagnosed with ESUS (age 54 (47-58) years, 42% male). An additional 36 without stroke but with a similar risk profile were included as a control group (age 53 (47-58) years, 61% male). All patients underwent echocardiography, noninvasive assessment of hemodynamic parameters using a SphygmoCor tonometer (AtCor Med., Australia), and measurements of selected biomarkers. Results ESUS patients and controls were well matched for baseline characteristics including blood pressure and left ventricular ejection fraction (LVEF). Compared to controls, patients with ESUS had lower mean early diastolic (E') and systolic (S') mitral annular velocities and a higher ratio of the peak velocity of early diastolic transmitral flow to the peak velocity of early diastolic mitral annular motion (all p < 0.01). The peak velocity flow in the late diastole (A wave) value and LV mass indexed to the body surface area (LVMI) (g/m2) were higher in the ESUS group than in the control group (both p < 0.01). The isovolumetric relaxation time (IVRT) was longer and the mean left atrial volume index (LAVI) was higher in ESUS patients compared to the control group. Parameters of arterial stiffness such as augmentation pressure, augmentation index, and augmentation index adjusted to a heart rate of 75 bpm (AIx75) were higher in ESUS patients compared to controls (p < 0.05). Patients in the ESUS group had higher levels of asymmetric dimethylarginine, interleukin 6, and N-terminal probrain natriuretic peptide (NT-proBNP, all p < 0.05) than those in the control group. In multivariate analysis, the following factors were significantly associated with the presence of ESUS: AIx75 (odds ratio (OR) 1.095, 95% confidence interval (CI) 1.004-1.194; p = 0.04), IVRT (OR 1.045, 95% CI: 1.009-1.082; p = 0.014), LAVI (OR 1.3, 95% CI: 1.099-1.537; p = 0.002), and NT-proBNP (OR 1.003, 95% CI: 1.001-1.005; p = 0.005). Conclusions Increased arterial stiffness and indices of diastolic dysfunction as well as a higher NT-proBNP level are significantly associated with ESUS. These parameters require further scrutiny over time to understand their impact on the development of symptomatic heart failure. The ClinicalTrials.gov identifier is NCT03377465.
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Yang Y, Wang A, Yuan X, Zhao Q, Liu X, Chen S, Wang X, Wang Y, Wu S, Wang Y. Association between healthy vascular aging and the risk of the first stroke in a community-based Chinese cohort. Aging (Albany NY) 2019; 11:5807-5816. [PMID: 31422381 PMCID: PMC6710043 DOI: 10.18632/aging.102170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
In this study we tested whether vascular aging is associated with the risk of first stroke in the Kailuan cohort, a community-based Chinese cohort. For participants aged ≥ 50 years, healthy vascular aging (HVA) was defined as an absence of hypertension and a brachial-ankle pulse wave velocity < the mean + 2 standard deviations, which was determined from a reference sample of healthy participants aged < 30 years. The primary outcome was first stroke (ischemic or hemorrhagic). In total, 11,474 participants were enrolled. The prevalence of HVA decreased from 36.0% in participants aged 50-59 years to 4.7% in those aged ≥ 70 years. During a median follow-up of 3.3 years, the incidence of first stroke was 0.5% in the HVA group but was 2.6% in the Non-HVA group. After adjusting for confounding variables, HVA was associated with a 0.32-fold lower risk of first stroke compared to the Non-HVA group (95% confidence interval, 0.18-0.56; p < 0.001). It thus appears that HVA reduced the risk of first stroke in a community-based Chinese population. This suggests that evaluation of vascular aging as part of public health screening may be useful for stroke risk assessment.
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Affiliation(s)
- Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiaodong Yuan
- Department of Neurology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Quanhui Zhao
- Graduate School, North China University of Science and Technology, Tangshan, China.,Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Xiaoxue Liu
- Department of Cardiology, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Xiuyan Wang
- Department of Geriatric disease, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Brothers RM, Fadel PJ, Keller DM. Racial disparities in cardiovascular disease risk: mechanisms of vascular dysfunction. Am J Physiol Heart Circ Physiol 2019; 317:H777-H789. [PMID: 31397168 DOI: 10.1152/ajpheart.00126.2019] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) accounts for a third of all deaths in the United States making it the leading cause of morbidity and mortality. Although CVD affects individuals of all races/ethnicities, the prevalence of CVD is highest in non-Hispanic black (BL) individuals relative to other populations. The mechanism(s) responsible for elevated CVD risk in the BL population remains incompletely understood. However, impaired vascular vasodilator capacity and exaggerated vascular vasoconstrictor responsiveness are likely contributing factors, both of which are present even in young, otherwise healthy BL individuals. Within this review, we highlight some historical and recent data, collected from our laboratories, of impaired vascular function, in terms of reduced vasodilator capacity and heightened vasoconstrictor responsiveness, in the peripheral and cerebral circulations in BL individuals. We provide data that such impairments may be related to elevated oxidative stress and subsequent reduction in nitric oxide bioavailability. In addition, divergent mechanisms of impaired vasodilatory capacity between BL men and women are discussed. Finally, we propose several directions where future research is needed to fill in knowledge gaps, which will allow for better understanding of the mechanisms contributing to impaired vascular function in this population. Ultimately, this information will allow for better lifestyle and therapeutic approaches to be implemented in an effort to minimize the increased CVD burden in the BL population.
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Affiliation(s)
- R Matthew Brothers
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - David M Keller
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
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41
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Wu D, Birukov K. Endothelial Cell Mechano-Metabolomic Coupling to Disease States in the Lung Microvasculature. Front Bioeng Biotechnol 2019; 7:172. [PMID: 31380363 PMCID: PMC6658821 DOI: 10.3389/fbioe.2019.00172] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022] Open
Abstract
Lungs are the most vascular part of humans, accepting the totality of cardiac output in a volume much smaller than the body itself. Due to this cardiac output, the lung microvasculature is subject to mechanical forces including shear stress and cyclic stretch that vary with the cardiac and breathing cycle. Vessels are surrounded by extracellular matrix which dictates the stiffness which endothelial cells also sense and respond to. Shear stress, stiffness, and cyclic stretch are known to influence endothelial cell state. At high shear stress, endothelial cells exhibit cell quiescence marked by low inflammatory markers and high nitric oxide synthesis, whereas at low shear stress, endothelial cells are thought to "activate" into a pro-inflammatory state and have low nitric oxide. Shear stress' profound effect on vascular phenotype is most apparent in the arterial vasculature and in the pathophysiology of vascular inflammation. To conduct the flow of blood from the right heart, the lung microvasculature must be rigid yet compliant. It turns out that excessive substrate rigidity or stiffness is important in the development of pulmonary hypertension and chronic fibrosing lung diseases via excessive cell proliferation or the endothelial-mesenchymal transition. Recently, a new body of literature has evolved that couples mechanical sensing to endothelial phenotypic changes through metabolic signaling in clinically relevant contexts such as pulmonary hypertension, lung injury syndromes, as well as fibrosis, which is the focus of this review. Stretch, like flow, has profound effect on endothelial phenotype; metabolism studies due to stretch are in their infancy.
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Affiliation(s)
- David Wu
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Konstantin Birukov
- Department of Anesthesia, University of Maryland, Baltimore, MD, United States
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42
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Oyenuga AO, Folsom AR, Cheng S, Tanaka H, Meyer ML. Greater Adherence to Life's Simple 7 Is Associated With Less Arterial Stiffness: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Hypertens 2019; 32:769-776. [PMID: 31090885 PMCID: PMC6636696 DOI: 10.1093/ajh/hpz057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Greater arterial stiffness is associated independently with increased cardiovascular disease risk. The American Heart Association (AHA) has recommended following "Life's Simple 7 (LS7)" to optimize cardiovascular health; we tested whether better LS7 in middle age is associated with less arterial stiffness in later life. METHODS We studied 4,232 black and white participants aged 45-64 years at the baseline (1987-89) visit of the Atherosclerosis Risk in Communities Study cohort who also had arterial stiffness measured in 2011-13 (mean ± SD interval: 23.6 ± 1.0 years). We calculated a 14-point summary score for baseline LS7 and classified participants as having "poor" (0-4), "average" (5-9), or "ideal" (10-14) cardiovascular health. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CI) for arterial stiffening: a high carotid-femoral pulse wave velocity (cfPWV, ≥13.23 m/s) or a high central pulse pressure (central PP, ≥ 82.35 mm Hg). RESULTS The age, race, sex, and heart rate-adjusted ORs (95% CI) for high cfPWV in the "ideal," "average," and "poor" LS7 summary categories were 1 (Reference), 1.30 (1.11, 1.53), and 1.68 (1.10,2.56), respectively (P-trend = 0.0003). Similarly, the adjusted ORs (95% CI) for high central PP across LS7 summary categories were 1 (Reference), 1.48 (1.27, 1.74), and 1.63 (1.04, 2.56), respectively (P-trend <0.0001). CONCLUSION Greater LS7 score in middle age is associated with less arterial stiffness 2-3 decades later. These findings further support the AHA recommendation to follow LS7 for cardiovascular disease prevention.
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Affiliation(s)
- Abayomi O Oyenuga
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Hirofumi Tanaka
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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43
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Verma AK, Aarotale PN, Dehkordi P, Lou JS, Tavakolian K. Relationship between Ischemic Stroke and Pulse Rate Variability as a Surrogate of Heart Rate Variability. Brain Sci 2019; 9:E162. [PMID: 31295816 PMCID: PMC6680838 DOI: 10.3390/brainsci9070162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 12/18/2022] Open
Abstract
Autonomic reflex ascertains cardiovascular homeostasis during standing. Impaired autonomic reflex could lead to dizziness and falls while standing; this is prevalent in stroke survivors. Pulse rate variability (PRV) has been utilized in the literature in lieu of heart rate variability (HRV) for ambulatory and portable monitoring of autonomic reflex predominantly in young, healthy individuals. Here, we compared the PRV with gold standard HRV for monitoring autonomic reflex in ischemic stroke survivors. Continuous blood pressure and electrocardiography were acquired from ischemic stroke survivors (64 ± 1 years) and age-matched controls (65 ± 2 years) during a 10-minute sit-to-stand test. Beat-by-beat heart period (represented by RR and peak-to-peak (PP) intervals), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse arrival time (PAT), an indicator of arterial stiffness, were derived. Time and frequency domain HRV (from RR intervals) and PRV (from PP intervals) metrics were extracted. PAT was lower (248 ± 7 ms vs. 270 ± 8 ms, p < 0.05) suggesting higher arterial stiffness in stroke survivors compared to controls during standing. Further, compared to controls, the agreement between HRV and PRV was impaired in stroke survivors while standing. The study outcomes suggest that caution should be exercised when considering PRV as a surrogate of HRV for monitoring autonomic cardiovascular control while standing in stroke survivors.
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Affiliation(s)
- Ajay K Verma
- School of Electrical Engineering and Computer Science, University of North Dakota, Grand Forks, ND 58202, USA
| | - Parshuram N Aarotale
- School of Electrical Engineering and Computer Science, University of North Dakota, Grand Forks, ND 58202, USA
| | - Parastoo Dehkordi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jau-Shin Lou
- Sanford Brain and Spine Center, Sanford Health, Fargo, ND 58103, USA
| | - Kouhyar Tavakolian
- School of Electrical Engineering and Computer Science, University of North Dakota, Grand Forks, ND 58202, USA.
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Iqbal A, Kain K, Hassan A. Investigation of large artery calcification in non-contrast computed tomography with small vessel disease, large artery atherosclerosis and stroke subtype in ischaemic stroke patients. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3s-s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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Iqbal A, Kain K, Hassan A. Investigation of large artery calcification in non-contrast computed tomography with small vessel disease, large artery atherosclerosis and stroke subtype in ischaemic stroke patients. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3-s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Abstract
PURPOSE OF REVIEW Increased arterial stiffness, an abnormal structural and functional change in the vascular wall, is a precursor for hypertension, coronary heart disease, stroke, and associated cardiovascular disease (CVD). The aim of this paper is to review the etiology of arterial stiffening and potential therapeutic approaches to modulate arterial fibrosis and stiffness. RECENT FINDINGS The Framingham Heart Study demonstrated that arterial stiffness is an independent predictor of CVD and related morbidity and mortality. Dysfunction of endothelial cells, vascular smooth muscle cells, extracellular matrix, and other functional elements of the vessel wall contribute to underlying pathophysiology of increased arterial stiffness. An activated renin-angiotensin-aldosterone system, oxidative stress, abnormal peri-vascular adipose tissue, inflammation, and increased sympathetic nervous system activity are associated with the development and progression of arterial fibrosis, stiffening, and associated CVD. In this review, we will discuss the structural and function changes and mechanisms of the vessel wall in arterial stiffness and provide potential therapeutic strategies.
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47
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Avolio A, Kim MO, Adji A, Gangoda S, Avadhanam B, Tan I, Butlin M. Cerebral Haemodynamics: Effects of Systemic Arterial Pulsatile Function and Hypertension. Curr Hypertens Rep 2018; 20:20. [PMID: 29556793 DOI: 10.1007/s11906-018-0822-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Concepts of pulsatile arterial haemodynamics, including relationships between oscillatory blood pressure and flow in systemic arteries, arterial stiffness and wave propagation phenomena have provided basic understanding of underlying haemodynamic mechanisms associated with elevated arterial blood pressure as a major factor of cardiovascular risk, particularly the deleterious effects of isolated systolic hypertension in the elderly. This topical review assesses the effects of pulsatility of blood pressure and flow in the systemic arteries on the brain. The review builds on the emerging notion of the "pulsating brain", taking into account the high throughput of blood flow in the cerebral circulation in the presence of mechanisms involved in ensuring efficient and regulated cerebral perfusion. RECENT FINDINGS Recent studies have provided evidence of the relevance of pulsatility and hypertension in the following areas: (i) pressure and flow pulsatility and regulation of cerebral blood flow, (ii) cerebral and systemic haemodynamics, hypertension and brain pathologies (cognitive impairment, dementia, Alzheimer's disease), (iii) stroke and cerebral small vessel disease, (iv) cerebral haemodynamics and noninvasive estimation of cerebral vascular impedance, (v) cerebral and systemic pulsatile haemodynamics and intracranial pressure, (iv) response of brain endothelial cells to cyclic mechanical stretch and increase in amyloid burden. Studies to date, producing increasing epidemiological, clinical and experimental evidence, suggest a potentially significant role of systemic haemodynamic pulsatility on structure and function of the brain.
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Affiliation(s)
- Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Mi Ok Kim
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Audrey Adji
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia.,St. Vincent's Clinic, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Sumudu Gangoda
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Bhargava Avadhanam
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
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48
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Ecobici M, Stoicescu C. Arterial Stiffness and Hypertension - Which Comes First? MAEDICA 2017; 12:184-190. [PMID: 29218066 PMCID: PMC5706758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Arterial hypertension is one of the traditional risk factors involved in the development of cardiovascular events, while arterial stiffness is an independent predictor of cardiovascular disease in patients with hypertension. It seems that the risk factors involved in the pathology of uncontrolled hypertension are similar to those that contribute to the development of arterial stiffness. After evidence showed that arterial stiffness is an independent prognostic factor for the occurrence of cardiovascular events in patients with arterial hypertension, the importance of assessing arterial stiffness was recognized in a document drafted by the European Society of Hypertension in 2007. Many factors, some still insufficiently studied, are involved in the development and worsening of arterial stiffness, especially in patients with certain comorbidities (diabetes, hypertension, chronic kidney disease). The evaluation of pulse wave velocity (PWV) remains the gold standard for non-invasive assessment of arterial stiffness. It seems that changes in terms of lifestyle and drug therapy have some positive effects on improving arterial stiffness, but further studies are needed to prove this concept. Our review aims to highlight the novelty of the mechanisms, the assessment methods, some of the clinical aspects, as well as the therapeutic implications of arterial stiffness, especially in patients with hypertension.
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Affiliation(s)
- Monica Ecobici
- Clinic of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Claudiu Stoicescu
- Clinic of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
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Mozos I, Malainer C, Horbańczuk J, Gug C, Stoian D, Luca CT, Atanasov AG. Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases. Front Immunol 2017; 8:1058. [PMID: 28912780 PMCID: PMC5583158 DOI: 10.3389/fimmu.2017.01058] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/15/2017] [Indexed: 01/13/2023] Open
Abstract
Arterial stiffness predicts an increased risk of cardiovascular events. Inflammation plays a major role in large arteries stiffening, related to atherosclerosis, arteriosclerosis, endothelial dysfunction, smooth muscle cell migration, vascular calcification, increased activity of metalloproteinases, extracellular matrix degradation, oxidative stress, elastolysis, and degradation of collagen. The present paper reviews main mechanisms explaining the crosstalk between inflammation and arterial stiffness and the most common inflammatory markers associated with increased arterial stiffness, considering the most recent clinical and experimental studies. Diverse studies revealed significant correlations between the severity of arterial stiffness and inflammatory markers, such as white blood cell count, neutrophil/lymphocyte ratio, adhesion molecules, fibrinogen, C-reactive protein, cytokines, microRNAs, and cyclooxygenase-2, in patients with a broad variety of diseases, such as metabolic syndrome, diabetes, coronary heart disease, peripheral arterial disease, malignant and rheumatic disorders, polycystic kidney disease, renal transplant, familial Mediterranean fever, and oral infections, and in women with preeclampsia or after menopause. There is strong evidence that inflammation plays an important and, at least, partly reversible role in the development of arterial stiffness, and inflammatory markers may be useful additional tools in the assessment of the cardiovascular risk in clinical practice. Combined assessment of arterial stiffness and inflammatory markers may improve non-invasive assessment of cardiovascular risk, enabling selection of high-risk patients for prophylactic treatment or more regular medical examination. Development of future destiffening therapies may target pro-inflammatory mechanisms.
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Affiliation(s)
- Ioana Mozos
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Jarosław Horbańczuk
- The Institute of Genetics and Animal Breeding, Polish Academy of Sciences, Jastrzębiec, Poland
| | - Cristina Gug
- Department of Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- 2nd Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Constantin Tudor Luca
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Atanas G Atanasov
- The Institute of Genetics and Animal Breeding, Polish Academy of Sciences, Jastrzębiec, Poland.,Department of Pharmacognosy, Faculty of Life Sciences, University of Vienna, Vienna, Austria.,Department of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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