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Hamaoka M, Leuenberger UA, Gao Z, Aziz F, Kim DJK, Luck JC, Blaha C, Cauffman AE, Sinoway LI, Cui J. Effects of acute hyperoxia on autonomic function and coronary tone in patients with peripheral artery disease. Am J Physiol Heart Circ Physiol 2024; 326:H1544-H1549. [PMID: 38700471 DOI: 10.1152/ajpheart.00225.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/05/2024]
Abstract
Numerous studies have shown that oxidative stress plays an important role in peripheral artery disease (PAD). Prior reports suggested autonomic dysfunction in PAD. We hypothesized that responses of the autonomic nervous system and coronary tone would be impaired in patients with PAD during exposure to acute hyperoxia, an oxidative stressor. In 20 patients with PAD and 16 healthy, sex- and age-matched controls, beat-by-beat heart rate (HR, from ECG) and blood pressure (BP, with Finometer) were recorded for 10 min during room air breathing and 5 min of hyperoxia. Cardiovagal baroreflex sensitivity and HR variability (HRV) were evaluated as measures of autonomic function. Transthoracic coronary echocardiography was used to assess peak coronary blood flow velocity (CBV) in the left anterior descending coronary artery. Cardiovagal baroreflex sensitivity at rest was lower in PAD than in healthy controls. Hyperoxia raised BP solely in the patients with PAD, with no change observed in healthy controls. Hyperoxia induced an increase in cardiac parasympathetic activity assessed by the high-frequency component of HRV in healthy controls but not in PAD. Indices of parasympathetic activity were lower in PAD than in healthy controls throughout the trial as well as during hyperoxia. Hyperoxia induced coronary vasoconstriction in both groups, while the coronary perfusion time fraction was lower in PAD than in healthy controls. These results suggest that the response in parasympathetic activity to hyperoxia (i.e., oxidative stress) is blunted and the coronary perfusion time is shorter in patients with PAD.NEW & NOTEWORTHY Patients with peripheral artery disease (PAD) showed consistently lower parasympathetic activity and blunted cardiovagal baroreflex sensitivity compared with healthy individuals. Notably, hyperoxia, which normally boosts parasympathetic activity in healthy individuals, failed to induce this response in patients with PAD. These data suggest altered autonomic responses during hyperoxia in PAD.
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Affiliation(s)
- Mami Hamaoka
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Urs A Leuenberger
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Zhaohui Gao
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Faisal Aziz
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Danielle Jin-Kwang Kim
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Jonathan Carter Luck
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Cheryl Blaha
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Aimee E Cauffman
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
| | - Jian Cui
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
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Song J, Choi JY, Lee BW, Eom D, Song CH. Visualizing a Cold Stress-Specific Pulse Wave in Traditional Pulse Diagnosis ('Tight Pulse') Correlated with Vascular Changes in the Radial Artery Induced by a Cold Pressor Trial. SENSORS (BASEL, SWITZERLAND) 2024; 24:2086. [PMID: 38610298 PMCID: PMC11014190 DOI: 10.3390/s24072086] [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: 02/16/2024] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024]
Abstract
Radial pulse diagnosis is the most common method to examine the human health state in Traditional East Asian Medicine (TEAM). A cold stress-related suboptimal health state (subhealth) is often undetectable during routine medical examinations, however, it can be detected through the palpation of specific pulse waves, particularly a 'tight pulse', in TEAM. Therefore, this study examined a correlation between 'tight pulse' and vascular changes in the radial artery (RA) induced by a cold pressor trial (CPT). Twenty healthy subjects underwent sequentially control trial and CPT with room-temperature and ice-cold water, respectively, on the right forearm. The radial pulse and vascular changes were then examined on the left arm. The radial pulse scores for frequencies of 'tight pulse' with strong arterial tension increased after the CPT compared with the control trial. The pulse scores were reversely correlated with the RA thickness and volumes in ultrasonography, but not with changes in the systolic/diastolic blood pressure. The RA thickness-based vascular surface and three-dimensional images visualized a 'tight pulse' showing the vasoconstriction and bumpy-/rope-shaped vascular changes in the radial pulse diagnostic region after the CPT. These findings provide valuable insights into the potential integration of clinical radial pulse diagnosis with ultrasonography for cold-related subhealth.
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Affiliation(s)
- Jichung Song
- Department of Medical History, College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Republic of Korea;
| | - Jae Young Choi
- Department of Urology, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Byung-Wook Lee
- Department of Medical Classics & History, College of Korean Medicine, Dongguk University, Gyeongju 38066, Republic of Korea;
| | - Dongmyung Eom
- Department of Medical Classics, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea;
| | - Chang-Hyun Song
- Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Republic of Korea
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Zhang J, You S, Yu L, Zhang Y, Li Z, Zhao N, Zhang B, Kang L, Sun S. The hysteresis damage of cold exposure on tissue and transcript levels in mice. J Therm Biol 2024; 120:103823. [PMID: 38442663 DOI: 10.1016/j.jtherbio.2024.103823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Although cold stress-induced damage to the heart and thyroid has been reported, specific organ associations between the heart and thyroid with delayed injury mechanisms have not been investigated. In this study, we determined the damage time and transcript levels of a large number of genes in the heart and thyroid after cold exposure. Meanwhile, we analysed the relationship between heart and thyroid injury in human medical records to determine the association of delayed injury from cold exposure. METHODS Mice were exposed to cold stress and hysteresis injury. Gene changes at the transcriptional level were detected using high throughput sequencing technology. The most variable genes were verified at the protein level using Western Blotting and medical records were collected and analysed. RESULTS The damage was the most severe when the animals were allowed to recover to room temperature for 4 h after exposure to cold stress. During this process, STAT1 and ATF3 genes were acutely up-regulated. Analysis of human medical records showed the highest correlation between AST and T4 under cold stress (p = 0.0011). CONCLUSIONS Exposure to cold increases blood level of free thyroid hormone and biomarkers of myocardial injury, as well as related mRNA levels. These changes were more pronounced after return to room temperature.
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Affiliation(s)
- Jing Zhang
- Shihezi University College of Chemistry and Chemical Engineering, College of Pharmacy / Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, Xinjiang, China; Xinjiang University of Science&Technology, School of Medicine, Korla, 841000, China
| | - Shiwan You
- Shihezi University College of Chemistry and Chemical Engineering, College of Pharmacy / Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, Xinjiang, China
| | - Lan Yu
- Shanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest Agriculture and Forestry University, Yangling, Shaanxi, 712100, China
| | - Yuling Zhang
- Shihezi University College of Chemistry and Chemical Engineering, College of Pharmacy / Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, Xinjiang, China
| | - Zuoping Li
- Shihezi University College of Chemistry and Chemical Engineering, College of Pharmacy / Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, Xinjiang, China
| | - Na Zhao
- Shihezi University College of Chemistry and Chemical Engineering, College of Pharmacy / Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, Xinjiang, China
| | - Bo Zhang
- Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Sichuan Industrial Institute of Antibiotics, School of Pharmacy, Chengdu University, Chengdu, 610106, China.
| | - Lihua Kang
- Shihezi University College of Chemistry and Chemical Engineering, College of Pharmacy / Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, Xinjiang, China.
| | - Shiguo Sun
- Shihezi University College of Chemistry and Chemical Engineering, College of Pharmacy / Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, Xinjiang, China; Shanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest Agriculture and Forestry University, Yangling, Shaanxi, 712100, China.
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Gondim ML, Rocha HNM, Mira PAC, Nobrega ACL, Prodel E. Effects of alpha-adrenergic receptor blockade on coronary circulation in postmenopausal women. Eur J Appl Physiol 2023; 123:2779-2790. [PMID: 37368136 DOI: 10.1007/s00421-023-05267-4] [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: 01/31/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
We sought to investigate the effect of the α1-adrenergic receptor blockade during handgrip exercise (Grip), isolated metaboreflex activation (Metabo), and cold pressor test (CPT) on coronary circulation in young (YW) and postmenopausal women (PMW). Ten YW and 9 PMW underwent two protocols: (1) 3 min of baseline followed by 3 min of CPT and (2) 3 min of rest, 3 min of Grip followed by 3 min of Metabo. Protocols were carried out under control conditions and α1-adrenergic receptor blockade (oral prazosin 0.03 mg·kg-1). Coronary blood velocity (CBV) and vascular conductance (CCI) were lower in PMW. Grip increased CBV only in YW (YW: Δ18.0 ± 21.1% vs. PMW: Δ4.2 ± 10.1%; p < 0.05), and the blockade did not change the CBV response to Grip in YW and PMW. During the Metabo, CBV returned to resting levels in YW and was unchanged from rest in PMW, before (YW:Δ1.7 ± 8.7% vs. PMW: Δ- 1.5 ± 8.6) and under the blockade (YW: Δ4.5 ± 14.8% vs. PMW: Δ9.1 ± 29.5%). CPT did not change CBV in both groups (YW: Δ3.9 ± 8.0 vs. PMW: Δ- 4.1 ± 6.2%), following the α1-blockade, CPT increased CBV only in YW (YW: Δ11.2 ± 12.8% vs. PMW: Δ2.2 ± 7.1%; p < 0.05 for group and condition). CCI decreased during Grip, Metabo, and CPT in YW and PMW, while the blockade prevented that decrease only in YW. The α1-adrenergic receptor plays a role in the control of coronary circulation in young women, evoking stronger vasoconstriction during CPT than Grip and Metabo in YW. PMW have impaired vasomotor control in the coronary circulation, which seems not to be caused by the α1-adrenergic receptor.
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Affiliation(s)
- Maitê L Gondim
- Laboratory of Exercise Science, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Helena N M Rocha
- Laboratory of Exercise Science, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
- Laboratory of Integrative Cardiometabology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Pedro A C Mira
- Laboratory of Exercise Science, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Antonio C L Nobrega
- Laboratory of Exercise Science, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Eliza Prodel
- Laboratory of Exercise Science, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil.
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Portes AMO, Paula ABR, Miranda DCD, Resende LT, Coelho BIC, Teles MC, Jardim IABA, Natali AJ, Castrucci AMDL, Isoldi MC. A systematic review of the effects of cold exposure on pathological cardiac remodeling in mice. J Therm Biol 2023; 114:103598. [PMID: 37321023 DOI: 10.1016/j.jtherbio.2023.103598] [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: 01/26/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
Exposure to cold promotes cardiac remodeling, characterized by deleterious effects on structure and function, contributing to increased mortality from cardiovascular diseases. The mechanisms associated with these changes are poorly understood. This review gathers the literature data on the main alterations and mechanisms associated with the adverse cardiac structural and functional remodeling induced by cold exposure in mice. Original studies were identified by searching PubMed, Scopus, and Embase databases from January 1990 to June 2022. This systematic review was conducted in accordance with the criteria established by PRISMA and registered in PROSPERO (CRD42022350637). The risk of bias was evaluated by the SYRCLE. Eligible studies included original papers published in English that evaluated cardiac outcomes in mice submitted to short- or long-time cold exposure and had a control group at room temperature. Seventeen original articles were included in this review. Cold exposure induces pathological cardiac remodeling, characterized by detrimental structural and functional parameters, changes in metabolism and autophagy process, and increases in oxidative stress, inflammation, and apoptosis. In addition, Nppa, AT1A, Fbp3, BECN, ETA, and MT, appear to play fundamental roles in regulating cardiac remodeling. We suggest that strategies that seek to minimize the CVD risk and adverse effects of cold exposure should target these agents.
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Affiliation(s)
- Alexandre Martins Oliveira Portes
- Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Department of Physical Education, Federal University of Viçosa, Viçosa, Brazil.
| | | | - Denise Coutinho de Miranda
- Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Department of Nutrition, Governador Ozanam Coelho University Center, Uba, Brazil
| | | | | | - Maria Cecília Teles
- Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | | | - Antônio José Natali
- Department of Physical Education, Federal University of Viçosa, Viçosa, Brazil
| | - Ana Maria de Lauro Castrucci
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil; Department of Biology, University of Virginia, Charlottesville, United States
| | - Mauro César Isoldi
- Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
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Seasonal dynamics of myocardial infarctions in regions with different types of a climate: a meta-analysis. Egypt Heart J 2022; 74:84. [PMID: 36547747 PMCID: PMC9774076 DOI: 10.1186/s43044-022-00322-5] [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: 03/23/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is known that cardiovascular events (CVE) occur more often in winter than in summer. However, dependence of myocardial infarction (MI) risk of on various meteorological factors is still not fully understood. Also, the dependence of the seasonal dynamics of MI on gender and age has not yet been studied. The purpose of our meta-analysis is to reveal dependence of the circannual dynamics of MI hospitalizations on gender, age, and characteristics of a region's climate. MAIN BODY Using Review Manager 5.3, we performed a meta-analysis of 26 publications on the seasonal dynamics of MI. In our meta-analysis, the relative MI risk was higher in colder compared to warmer seasons. Old age insignificantly increased the seasonal MI risk; gender did not affect the seasonal dynamics of MI, but MI was more common in men than in women. The severity of the seasonal dynamics of MI risk depended on the climate of the region. In a climate with a small amplitude of circannual fluctuations in air temperature, atmospheric pressure, and partial oxygen density in the air, as well as in regions where air humidity is higher in winter than in summer, an increase in MI risk in winter compared to summer was significant. It was not significant in regions with opposite climatic tendencies. CONCLUSIONS Based on the results of our studies, it can be concluded that a decrease in air temperature increases in MI risk; in addition, hypoxia in the hot season can provoke CVE associated with ischemia.
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Albeladi F, Wahby Salem I, Zahrani M, Alarbedi L, Abukhudair A, Alnafei H, Alraiqi A, Alyoubi N. Incidence of Coronary Artery Disease in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2019–2020: A Retrospective Cohort Study. Cureus 2022; 14:e28770. [PMID: 36225503 PMCID: PMC9531715 DOI: 10.7759/cureus.28770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background Coronary artery disease (CAD) remains a significant cause of death and morbidity in people globally despite advances in treatment. Prevention of CAD risk factors is crucial to reducing its prevalence. We conducted this study to determine the incidence of CAD from 2019 to 2020 in King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA), and its major risk factors among this population. Method This retrospective study involved all patients diagnosed with CAD at KAUH in 2019 and 2020. We analyzed validated hospital data to determine the incidence of CAD and identify the risk factors among participants. The incidence of CAD was calculated based on the total number of patients admitted to KAUH by gender, age group, and nationality (Saudi/non-Saudi). Result The study included 1,364 patients with a mean age of 49 years. Most patients were men (n=1,050; 77%), with fewer women (n=314; 23%), and 71.2% were non-Saudi. The incidence of CAD in 2019 was 220.98 per 10,000, and the incidence in 2020 was 3,030.52 per 10,000. However, the incidence for 2020 was confounded by the coronavirus disease 2019 pandemic-related restrictions affecting hospital admissions. The most common diagnosis was acute transmural myocardial infarction, and patients aged <60 years had a significantly high incidence of hypertension, high total cholesterol levels, low low-density lipoprotein levels, and high triglyceride levels. Patients ≥60 years had a significantly high incidence of chronic kidney disease, low hemoglobin levels, history of ischemic heart disease, and intensive care unit or critical care unit admission. Conclusion The study demonstrated a significant rise in CAD incidence associated with advanced age and male sex. Further prevention and control of these risk factors would be essential to decrease the incidence of CAD. A national community-based prevention effort should be implemented to avoid the expected CAD epidemic in KSA.
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Raiko JRH, Saari T, Orava J, Savisto N, Parkkola R, Haaparanta-Solin M, Nuutila P, Virtanen KA. Changes in electrocardiogram parameters during acute nonshivering cold exposure and associations with brown adipose tissue activity, plasma catecholamine levels, and brachial blood pressure in healthy adults. Physiol Rep 2021; 9:e14718. [PMID: 33580902 PMCID: PMC7881801 DOI: 10.14814/phy2.14718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/12/2020] [Accepted: 12/19/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sympathetic activity causes changes in electrocardiogram (ECG) during cold exposure and the changes have been studied mostly during hypothermia and less during mild acute nonshivering cold exposure. Cold-induced sympathetic activity also activates brown adipose tissue (BAT) and increases arterial blood pressure (BP) and plasma catecholamine levels. We examined changes in ECG parameters during acute nonshivering cold exposure and their associations with markers of sympathetic activity during cold exposure: brachial blood pressure (BP), plasma catecholamine levels, and BAT activity measured by positron emission tomography (PET). METHODS AND RESULTS Healthy subjects (M/F = 13/24, aged 20-55 years) were imaged with [15 O]H2 O (perfusion, N = 37) and [18 F]FTHA to measure plasma nonesterified fatty acid uptake (NEFA uptake, N = 37) during 2-h nonshivering cold exposure. 12-lead ECG (N = 37), plasma catecholamine levels (N = 17), and brachial BP (N = 31) were measured at rest in room temperature (RT) and re-measured after a 2-h nonshivering cold exposure. There were significant differences between RT and cold exposure in P axis (35.6 ± 26.4 vs. 50.8 ± 22.7 degrees, p = 0.005), PR interval (177.7 ± 24.6 ms vs.163.0 ± 28.7 ms, p = 0.001), QRS axis (42.1 ± 31.3 vs. 56.9 ± 24.1, p = 0.003), and QT (411.7 ± 25.5 ms vs. 434.5 ± 39.3 ms, p = 0.001). There was no significant change in HR, QRS duration, QTc, JTc, and T axis during cold exposure. Systolic BP (127.2 ± 15.7 vs. 131.8 ± 17.9 mmHg, p = 0.008), diastolic BP (81.7 ± 12.0 vs. 85.4 ± 13.0 mmHg, p = 0.02), and plasma noradrenaline level increased during cold exposure (1.97 ± 0.61 vs. 5.07 ± 1.32 µmol/L, p = 0.001). Cold-induced changes in ECG parameters did not correlate with changes in BAT activity, brachial BP, plasma catecholamines, or skin temperature. CONCLUSIONS During short-term nonshivering cold exposure, there were increases in P axis, PR interval, QRS axis, and QT compared to RT in healthy adults. Cold-induced changes in ECG parameters did not correlate with BAT activity, brachial BP, or plasma catecholamine levels which were used as markers of cold-induced sympathetic activity.
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Affiliation(s)
- Juho R H Raiko
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Teemu Saari
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Janne Orava
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Nina Savisto
- Turku PET Centre, University of Turku, Turku, Finland
| | - Riitta Parkkola
- Turku PET Centre, Turku University Hospital, Turku, Finland.,Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Pirjo Nuutila
- Turku PET Centre, Turku University Hospital, Turku, Finland.,Department of Endocrinology, Turku University Hospital, Turku, Finland
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Min JY, Choi YS, Lee HS, Lee S, Min KB. Increased cold injuries and the effect of body mass index in patients with peripheral vascular disease. BMC Public Health 2021; 21:294. [PMID: 33579232 PMCID: PMC7881551 DOI: 10.1186/s12889-020-09789-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background Exposure to extremely or moderate low temperatures is associated with increased morbidity and mortality risk. Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. Given that cold temperature causes constriction of the small arteries and veins in the skin, patients who suffer from peripheral circulation problems, like PVD, may be vulnerable to cold injuries. This study aimed to investigate the association between PVD and cold-induced injuries in the winter among Korean adults. We further analyzed the association stratified by body mass index (BMI) classification. Methods We used the 2002–2015 National Health Insurance Service-National Sample Cohort data and included a total of 535,186 adults as the study population. Patients with underlying PVD were identified by ICD-10 code I73. Cold-related illnesses were defined by ICD-10 codes (T690, T691, T698, T699, T330 ~ T339, T340 ~ T349, and T350 ~ T357). Body mass index (BMI) was categorized into underweight, normal weight, overweight, and obese. Results A total of 23.21% (n = 124,224) were PVD patients, and 0.59% (n = 3154) had cold-induced injuries. PVD patients were more likely to be diagnosed with cold injuries, but it was valid only in the underweight or normal weight groups. After adjusting for age, sex, income, cigarette smoking, alcohol consumption, regular exercise, high blood pressure, and hyperglycemia, PVD patients had a significantly increased odds ratio (OR) for cold injuries [adjusted OR = 1.11; 95% confidence intervals (95% CI): 1.01–1.21]. Increased OR for cold injuries in PVD patients was also observed in adults (adjusted OR = 1.14; 95% CI: 1.03–1.25 in Model 2), but not in the elderly. When we classified study subjects into the four BMI groups, the adjusted OR of cold injuries in PVD patients was significant in the underweight group (OR = 1.83; 95% CI, 1.26–2.66) and normal weight group (OR = 1.15; 95% CI, 1.03–1.27), not in those with overweight and obese. In adults, a consistent result was found in adults in the underweight group (OR = 1.63; 95% CI, 1.08–2.47 in Model 2) and normal weight group (OR = 1.19; 95% CI, 1.07–1.33 in Model 2). In the elderly, the adjusted OR for cold injuries was only significant in the underweight group (OR = 3.37; 95% CI, 1.08–10.53 in Model 2). Conclusions We found a significant association between PVD and cold-induced injuries in the general population. BMI modified the association. Thus, the association observed appears to be clinically applicable to PVD patients being low to normal BMI.
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Affiliation(s)
- Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Yeon-Soo Choi
- Department of Statistics and Data Science, College of Commerce and Economics, Yonsei University, Seoul, Republic of Korea
| | - Hyeong-Seong Lee
- Department of Statistics and Data Science, College of Commerce and Economics, Yonsei University, Seoul, Republic of Korea
| | - Sohyae Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Seoul, 110-799, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Seoul, 110-799, Republic of Korea.
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Wang Z, Ni X, Gao D, Sun L, Zhu X, Jiao J, Zhou Q, Chen C, Zhang N, Wu Z, Yang Z, Yuan H. Investigation of the Reference Interval Values of Fasting Plasma Glucose, Blood Pressure, and Blood Lipids in the Longevity People Aged 90 Years Old and Above. Diabetes Metab Syndr Obes 2021; 14:3711-3718. [PMID: 34456578 PMCID: PMC8387246 DOI: 10.2147/dmso.s327823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To our knowledge, the normal fasting plasma glucose (FPG), blood pressure (BP), and blood lipids (BL) interval values have not been well-established in the longevity population. This study aims to provide a reference for the establishment of normal BP, FPG, and BL interval values in the longevity people in China. PATIENTS AND METHODS A total of 7417 people were selected from the natural longevity cohort in Guangxi, with an age range of 20-110 years old, including 7093 classified as the non-longevity (20-89 years old) (94.02%) and 324 classified as the longevity (≥90 years old) (5.98%); there were 4309 men (58.1%) and 3108 women (41.9%). FPG, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and low-density lipoprotein (LDL-C) levels were defined as desirable levels when they were below the 75th percentile (P75), borderline levels from the 75th to 90th percentile (P75-P90), and high levels above P90; triglyceride (TG) levels above P90 were defined as high; and high-density lipoprotein cholesterol (HDL-C) levels below the 5th percentile (P5) were defined as low levels. RESULTS The reference interval values of FPG in the longevity were as follows: desirable levels <6.15 mmol/L, borderline levels 6.15-7.45 mmol/L, high levels ≥7.45 mmol/L. Reference interval values of systolic blood pressure (SBP) were as follows: desirable levels <160.00 mmHg, borderline levels 160.00-174.50 mmHg, high levels ≥175.00 mmHg. DBP reference interval values were as follows: desirable levels <88.00 mmHg, borderline levels 88.00-90.00 mmHg, high levels ≥90.00 mmHg. TC reference interval values were as follows: desirable levels <5.59 mmol/L, borderline levels 5.59-6.45 mmol/L, high levels ≥6.45 mmol/L. LDL-C reference interval values were as follows: desirable levels <3.30 mmol/L, borderline levels 3.30-3.85 mmol/L, high levels ≥3.85 mmol/L. TG reference interval values were as follows: desirable levels <2.82 mmol/L, high levels ≥2.82 mmol/L. HDL-C reference interval values were as follows: low levels <0.80 mmol/L, desirable levels ≥0.80 mmol/L. CONCLUSION The reference interval values of BP, FPG, and BL are different between the longevity population and the non-longevity population, and the interval values change with increasing age.
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Affiliation(s)
- Zhaoping Wang
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Xiaolin Ni
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
- Graduate School of Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Danni Gao
- Graduate School of Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, People’s Republic of China
- Peking University Fifth School of Clinical Medicine (Beijing Hospital), Beijing, 100730, People’s Republic of China
| | - Liang Sun
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Xiaoquan Zhu
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Juan Jiao
- Clinical Laboratory Department, The Seventh Medical Center, PLA General Hospital, Beijing, 100730, People’s Republic of China
| | - Qi Zhou
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Chen Chen
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Nan Zhang
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Zhu Wu
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Ze Yang
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
| | - Huiping Yuan
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, National Center for Gerontology, Beijing, 100730, People’s Republic of China
- Correspondence: Huiping Yuan The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Dongdan DaHua Road 1#, Beijing, 100730, People’s Republic of ChinaTel +86-10-58115043Fax +86-10-65237929 Email
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11
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Alba BK, Castellani JW, Charkoudian N. Cold‐induced cutaneous vasoconstriction in humans: Function, dysfunction and the distinctly counterproductive. Exp Physiol 2019; 104:1202-1214. [DOI: 10.1113/ep087718] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/30/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Billie K. Alba
- Thermal & Mountain Medicine Division US Army Research Institute of Environmental Medicine Natick MA USA
- Oak Ridge Institute of Science and Education Belcamp MD USA
| | - John W. Castellani
- Thermal & Mountain Medicine Division US Army Research Institute of Environmental Medicine Natick MA USA
| | - Nisha Charkoudian
- Thermal & Mountain Medicine Division US Army Research Institute of Environmental Medicine Natick MA USA
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12
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Miller AJ, Luck JC, Kim DJK, Leuenberger UA, Aziz F, Radtka JF, Sinoway LI, Muller MD. Peripheral revascularization attenuates the exercise pressor reflex and increases coronary exercise hyperemia in peripheral arterial disease. J Appl Physiol (1985) 2018; 125:58-63. [PMID: 29648515 DOI: 10.1152/japplphysiol.01046.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Peripheral arterial disease (PAD) is associated with augmented blood pressure (BP) and impaired coronary blood flow responses to exercise, which may increase cardiovascular risk. We investigated the effects of leg revascularization on the BP and coronary blood flow responses to exercise in PAD. Seventeen PAD patients (11 men, 66 ± 2 yr) performed single-leg plantar flexion exercise 24 h before and 1 mo following leg revascularization. BP and heart rate (HR) were measured continuously, and rate pressure product (systolic BP × HR) was calculated as an index of myocardial oxygen demand. Coronary blood velocity was obtained by transthoracic Doppler echocardiography in 8/17 subjects. The mean BP response to plantar flexion exercise was attenuated by leg revascularization (pre-revascularization: 15 ± 4 vs. post-revascularization: 7 ± 3 mmHg, P = 0.025). The HR response to plantar flexion was also attenuated following leg revascularization (pre-revascularization: 9 ± 1 vs. post-revascularization: 6 ± 1 beats/min, P = 0.006). The change in coronary blood velocity with exercise was greater at the post-revascularization visit: 4 ± 1 vs. pre-revascularization: -1 ± 2 cm/s ( P = 0.038), even though the change in rate pressure product was not greater following revascularization in these subjects (pre-revascularization: 2,796 ± 871 vs. post-revascularization: 1,766 ± 378 mmHg·beats/min, P = 0.082). These data suggest that leg revascularization alters reflex control of BP, HR, and coronary blood flow in response to exercise in patients with PAD. NEW & NOTEWORTHY We found that peripheral revascularization procedures lowered exercise blood pressure and improved coronary blood flow in patients with peripheral arterial disease.
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Affiliation(s)
- Amanda J Miller
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
| | - J Carter Luck
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Danielle Jin-Kwang Kim
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Urs A Leuenberger
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Faisal Aziz
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
| | - John F Radtka
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Matthew D Muller
- Penn State Heart and Vascular Institute, Penn State University College of Medicine , Hershey, Pennsylvania
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13
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van Mil ACCM, Tymko MM, Kerstens TP, Stembridge M, Green DJ, Ainslie PN, Thijssen DHJ. Similarity between carotid and coronary artery responses to sympathetic stimulation and the role of α 1-receptors in humans. J Appl Physiol (1985) 2018; 125:409-418. [PMID: 29565771 DOI: 10.1152/japplphysiol.00386.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Carotid artery (CCA) dilation occurs in healthy subjects during cold pressor test (CPT), while the magnitude of dilation relates to cardiovascular risk. To further explore this phenomenon and mechanism, we examined carotid artery responses to different sympathetic tests, with and without α1-receptor blockade and assessed similarity to these responses between carotid and coronary arteries. In randomized order, 10 healthy participants (25 ± 3 yr) underwent sympathetic stimulation using the CPT (3-min left-hand immersion in ice-slush) and lower-body negative pressure (LBNP). Before and during sympathetic tests, CCA diameter and velocity (Doppler ultrasound) and left anterior descending (LAD) coronary artery velocity (echocardiography) were recorded across 3 min. Measures were repeated 90 min following selective α1-receptor blockade via oral prazosin (0.05 mg/kg body wt). CPT significantly increased CCA diameter, LAD maximal velocity, and velocity-time integral area-under-the-curve (all P < 0.05). In contrast, LBNP resulted in a decrease in CCA diameter, LAD maximal velocity, and velocity time integral (VTI; all P < 0.05). Following α1-receptor blockade, CCA and LAD velocity responses to CPT were diminished. In contrast, during LBNP (-30 mmHg), α1-receptor blockade did not alter CCA or LAD responses. Finally, changes in CCA diameter and LAD VTI responses to sympathetic stimulation were positively correlated ( r = 0.66, P < 0.01). We found distinct carotid artery responses to different tests of sympathetic stimulation, where α1 receptors partly contribute to CPT-induced responses. Finally, we found agreement between carotid and coronary artery responses. These data indicate similarity between carotid and coronary responses to sympathetic tests and the role of α1 receptors that is dependent on the nature of the sympathetic challenge. NEW & NOTEWORTHY We showed distinct carotid artery responses to cold pressor test (CPT; i.e., dilation) and lower-body negative pressure (LBNP; i.e., constriction). Blockade of α1-receptors significantly attenuated dilator responses in carotid and coronary arteries during CPT, while no changes were found during LBNP. Our findings indicate strong similarity between carotid and coronary artery responses to distinct sympathetic stimuli, and for the role of α-receptors.
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Affiliation(s)
- Anke C C M van Mil
- Department of Physiology, Radboudumc, Nijmegen , The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Liverpool , United Kingdom
| | - Michael M Tymko
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada
| | - Thijs P Kerstens
- Department of Physiology, Radboudumc, Nijmegen , The Netherlands
| | - Mike Stembridge
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada.,Cardiff School of Sport, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Daniel J Green
- School of Sports Science, Exercise and Health, the University of Western Australia , Nedlands , Australia
| | - Philip N Ainslie
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada
| | - Dick H J Thijssen
- Department of Physiology, Radboudumc, Nijmegen , The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Liverpool , United Kingdom
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Borner A, Murray K, Trotter C, Pearson J. Baseline aortic pulse wave velocity is associated with central and peripheral pressor responses during the cold pressor test in healthy subjects. Physiol Rep 2017; 5:5/14/e13357. [PMID: 28733312 PMCID: PMC5532490 DOI: 10.14814/phy2.13357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 11/24/2022] Open
Abstract
Cold environmental temperatures increase sympathetic nerve activity and blood pressure, and increase the risk of acute cardiovascular events in aged individuals. The acute risk of cardiovascular events increases with aortic pulse wave velocity as well as elevated central and peripheral pulse pressures. The aim of this study was to examine the independent influence of aortic pulse wave velocity upon central and peripheral pressor responses to sympathetic activation via the cold pressor test (CPT). Twenty‐two healthy subjects (age: 18–73 years) completed a CPT with the left hand immersed in 2–4°C water for 3 min. During the CPT, central (from: 36 ± 7 to: 51 ± 12 mmHg) and peripheral pulse pressure increased (from: 54 ± 7 to: 66 ± 11; both P < 0.05). In all subjects the increase in central pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r2 = 0.221, P = 0.027) but not age (P > 0.05). In a subset of subjects with higher arterial stiffness, the increase in peripheral pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r2 = 0.415, P = 0.032) but not age (P > 0.05). These data indicate that central and peripheral pulse pressure responses during sympathetic activation are positively and independently associated with aortic pulse wave velocity through a wide age range. Decreasing aortic pulse wave velocity in aged individuals with elevated arterial stiffness may help reduce the incidence of acute cardiovascular events upon exposure to cold environmental temperatures.
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Affiliation(s)
- Anastasiya Borner
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - Kyle Murray
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - Claire Trotter
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - James Pearson
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
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15
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Ross AJ, Gao Z, Luck JC, Blaha CA, Cauffman AE, Aziz F, Radtka JF, Proctor DN, Leuenberger UA, Sinoway LI, Muller MD. Coronary Exercise Hyperemia Is Impaired in Patients with Peripheral Arterial Disease. Ann Vasc Surg 2016; 38:260-267. [PMID: 27575303 DOI: 10.1016/j.avsg.2016.05.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is an atherosclerotic vascular disease that affects over 200 million people worldwide. The hallmark of PAD is ischemic leg pain and this condition is also associated with an augmented blood pressure response to exercise, impaired vascular function, and high risk of myocardial infarction and cardiovascular mortality. In this study, we tested the hypothesis that coronary exercise hyperemia is impaired in PAD. METHODS Twelve patients with PAD and no overt coronary disease (65 ± 2 years, 7 men) and 15 healthy control subjects (64 ± 2 years, 9 men) performed supine plantar flexion exercise (30 contractions/min, increasing workload). A subset of subjects (n = 7 PAD, n = 8 healthy) also performed isometric handgrip exercise (40% of maximum voluntary contraction to fatigue). Coronary blood velocity in the left anterior descending artery was measured by transthoracic Doppler echocardiography; blood pressure and heart rate were monitored continuously. RESULTS Coronary blood velocity responses to 4 min of plantar flexion exercise (PAD: Δ2.4 ± 1.2, healthy: Δ6.0 ± 1.6 cm/sec, P = 0.039) and isometric handgrip exercise (PAD: Δ8.3 ± 4.2, healthy: Δ16.9 ± 3.6, P = 0.033) were attenuated in PAD patients. CONCLUSION These data indicate that coronary exercise hyperemia is impaired in PAD, which may predispose these patients to myocardial ischemia.
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Affiliation(s)
- Amanda J Ross
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - Zhaohui Gao
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - Jonathan Carter Luck
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - Cheryl A Blaha
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - Aimee E Cauffman
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - Faisal Aziz
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - John F Radtka
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - David N Proctor
- Department of Kinesiology, Noll Laboratory, The Pennsylvania State University, State College, PA
| | - Urs A Leuenberger
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA
| | - Matthew D Muller
- Penn State Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA.
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Medical Evaluation for Exposure Extremes: Cold. Wilderness Environ Med 2015; 26:S63-8. [DOI: 10.1016/j.wem.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/16/2015] [Indexed: 01/16/2023]
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Abstract
Risk of injury in cold environments is related to a combination of athlete preparedness, preexisting medical conditions, and the body's physiologic response to environmental factors, including ambient temperature, windchill, and wetness. The goal of this section is to decrease the risk of hypothermia, frostbite, and nonfreezing cold injuries as well as to prevent worsening of preexisting conditions in cold environments using a preparticipation screening history, examination, and counseling. Cold weather exercise can be done safely with education, proper preparation, and appropriate response to changing weather conditions.
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Rivera-Lara L, Kowalski RG, Schneider EB, Tamargo RJ, Nyquist P. Elevated relative risk of aneurysmal subarachnoid hemorrhage with colder weather in the mid-Atlantic region. J Clin Neurosci 2015; 22:1582-7. [PMID: 26149403 DOI: 10.1016/j.jocn.2015.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
We have previously reported an increase of 0.6% in the relative risk of aneurysmal subarachnoid hemorrhage (aSAH) in response to every 1°F decrease in the maximum daily temperature (Tmax) in colder seasons from patients presenting to our regional tertiary care center. We hypothesized that this relationship would also be observed in the warmer summer months with ambient temperatures greater than 70°F. From prospectively collected incidence data for aSAH patients, we investigated absolute Tmax, average daily temperatures, intraday temperature ranges, and the variation of daily Tmax relative to 70°F to assess associations with aSAH incidence for patients admitted to our institution between 1991 and 2009 during the hottest months and days on which Tmax>70°F. For all days treated as a group, the mean Tmax (± standard deviation) was lower when aSAH occurred than when it did not (64.4±18.2°F versus 65.8±18.3°F; p=0.016). During summer months, the odds ratio (OR) of aSAH incidence increased with lower mean Tmax (OR 1.019; 95% confidence interval 1.001-1.037; p=0.043). The proportion of days with aSAH admissions was lower on hotter days than the proportion of days with no aSAH (96% versus 98%; p=0.006). aSAH were more likely to occur during the summer and on days with a temperature fluctuation less than 10°F (8% versus 4%; p=0.002). During the hottest months of the year in the mid-Atlantic region, colder maximum daily temperatures, a smaller heat burden above 70°F, and smaller intraday temperature fluctuations are associated with increased aSAH admissions in a similar manner to colder months. These findings support the hypothesis that aSAH incidence is more likely with drops in temperature, even in the warmer months.
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Affiliation(s)
- Lucia Rivera-Lara
- Department of Neurology, Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA.
| | - Robert G Kowalski
- Department of Neurology, Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA
| | - Eric B Schneider
- Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul Nyquist
- Department of Neurology, Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA
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Mynard JP, Smolich JJ. One-Dimensional Haemodynamic Modeling and Wave Dynamics in the Entire Adult Circulation. Ann Biomed Eng 2015; 43:1443-60. [DOI: 10.1007/s10439-015-1313-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/24/2015] [Indexed: 01/09/2023]
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Ross AJ, Gao Z, Pollock JP, Leuenberger UA, Sinoway LI, Muller MD. β-Adrenergic receptor blockade impairs coronary exercise hyperemia in young men but not older men. Am J Physiol Heart Circ Physiol 2014; 307:H1497-503. [PMID: 25239806 DOI: 10.1152/ajpheart.00584.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Patients with coronary artery disease have attenuated coronary vasodilator responses to physiological stress, which is partially attributed to a β-adrenergic receptor (β-AR)-mediated mechanisms. Whether β-ARs contribute to impaired coronary vasodilation seen with healthy aging is unknown. The purpose of this study was to investigate the role of β-ARs in coronary exercise hyperemia in healthy humans. Six young men (26 ± 1 yr) and seven older men (67 ± 4 yr) performed isometric handgrip exercise at 30% maximal voluntary contraction for 2 min after receiving intravenous propranolol, a β-AR antagonist, and no treatment. Isoproterenol, a β-AR agonist, was infused to confirm the β-AR blockade. Blood pressure and heart rate were monitored continuously, and coronary blood flow velocity (CBV, left anterior descending artery) was measured by transthoracic Doppler echocardiography. Older men had an attenuated ΔCBV to isometric exercise (3.8 ± 1.3 vs. 9.7 ± 2.1 cm/s, P = 0.02) compared with young men. Propranolol decreased the ΔCBV at peak handgrip exercise in young men (9.7 ± 2.1 vs. 2.7 ± 0.9 cm/s, P = 0.008). However, propranolol had no effect on ΔCBV in older men (3.8 ± 1.3 vs. 4.2 ± 1.9 cm/s, P = 0.9). Older men also had attenuated coronary hyperemia to low-dose isoproterenol. These data indicate that β-AR control of coronary blood flow is impaired in healthy older men.
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Affiliation(s)
- Amanda J Ross
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Zhaohui Gao
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Jonathan P Pollock
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Urs A Leuenberger
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Matthew D Muller
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
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Wilson TE, Klabunde RE, Monahan KD. Using thermal stress to model aspects of disease states. J Therm Biol 2014; 43:24-32. [DOI: 10.1016/j.jtherbio.2014.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/14/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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Figueroa A, Wong A, Kalfon R. Effects of watermelon supplementation on aortic hemodynamic responses to the cold pressor test in obese hypertensive adults. Am J Hypertens 2014; 27:899-906. [PMID: 24572702 DOI: 10.1093/ajh/hpt295] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cold-induced increases in aortic blood pressure (BP) may cause adverse cardiac events in hypertensives by increasing ventricular afterload. L-citrulline supplementation reduces BP at baseline and during the cold pressor test (CPT), but the effect on wave reflection (augmentation pressure (AP) and index (AIx)) is controversial. Our aim was to assess the effect of L-citrulline-rich watermelon supplementation on aortic hemodynamic responses to CPT in hypertensive adults. METHODS Brachial systolic BP (bSBP) and aortic systolic BP (aSBP), AP, AIx, AIx adjusted to 75 beats/min (AIx75), reflection time (Tr), first (P1) and second systolic peak (P2; wave reflection magnitude), heart rate (HR), and systolic time index (STI; myocardial oxygen demand) at baseline and during CPT and magnitude of the response from baseline to CPT were evaluated in 13 individuals (10 women; 57±1 year; bSBP 151±5 mm Hg). Participants were randomized to a 6-week watermelon or placebo supplementation in a crossover design. RESULTS Watermelon reduced (P < 0.05) bSBP, aSBP, P1, and P2 at baseline and CPT compared with placebo; thus, increases from baseline to CPT were unaffected. Watermelon did not affect AP, AIx, AIx75, and STI at baseline but decreased (P < 0.05) AP and STI during CPT and the increases in AP (~5mm Hg) and AIx75 (~7.3%) from baseline to CPT. CONCLUSIONS Watermelon supplementation reduced aortic BP and myocardial oxygen demand during CPT and the magnitude of the cold-induced increase in wave reflection in obese adults with hypertension. Watermelon may provide cardioprotection by attenuating cold-induced aortic hemodynamic responses. CLINICAL TRIALS REGISTRATION Clinicaltrial.gov register, NCT01185041.
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Affiliation(s)
- Arturo Figueroa
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, Florida.
| | - Alexei Wong
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, Florida
| | - Roy Kalfon
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, Florida
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Muller MD, Gao Z, McQuillan PM, Leuenberger UA, Sinoway LI. Coronary responses to cold air inhalation following afferent and efferent blockade. Am J Physiol Heart Circ Physiol 2014; 307:H228-35. [PMID: 24816257 DOI: 10.1152/ajpheart.00174.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cardiac ischemia and angina pectoris are commonly experienced during exertion in a cold environment. In the current study we tested the hypotheses that oropharyngeal afferent blockade (i.e., local anesthesia of the upper airway with lidocaine) as well as systemic β-adrenergic receptor blockade (i.e., intravenous propranolol) would improve the balance between myocardial oxygen supply and demand in response to the combined stimulus of cold air inhalation (-15 to -30°C) and isometric handgrip exercise (Cold + Grip). Young healthy subjects underwent Cold + Grip following lidocaine, propranolol, and control (no drug). Heart rate, blood pressure, and coronary blood flow velocity (CBV, from Doppler echocardiography) were continuously measured. Rate-pressure product (RPP) was calculated, and changes from baseline were compared between treatments. The change in RPP at the end of Cold + Grip was not different between lidocaine (2,441 ± 376) and control conditions (3,159 ± 626); CBV responses were also not different between treatments. With propranolol, heart rate (8 ± 1 vs. 14 ± 3 beats/min) and RPP responses to Cold + Grip were significantly attenuated. However, at peak exercise propranolol also resulted in a smaller ΔCBV (1.4 ± 0.8 vs. 5.3 ± 1.4 cm/s, P = 0.035), such that the relationship between coronary flow and cardiac metabolism was impaired under propranolol (0.43 ± 0.37 vs. 2.1 ± 0.63 arbitrary units). These data suggest that cold air breathing and isometric exercise significantly influence efferent control of coronary blood flow. Additionally, β-adrenergic vasodilation may play a significant role in coronary regulation during exercise.
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Affiliation(s)
- Matthew D Muller
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Zhaohui Gao
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Patrick M McQuillan
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Urs A Leuenberger
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
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Hintsala H, Kandelberg A, Herzig KH, Rintamäki H, Mäntysaari M, Rantala A, Antikainen R, Keinänen-Kiukaanniemi S, Jaakkola JJK, Ikäheimo TM. Central aortic blood pressure of hypertensive men during short-term cold exposure. Am J Hypertens 2014; 27:656-64. [PMID: 23964061 DOI: 10.1093/ajh/hpt136] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Short- and long-term exposures to cold increase blood pressure and may explain the higher wintertime cardiovascular morbidity and mortality. Hypertensive subjects may be more susceptible to adverse cold-related cardiovascular health effects. The aim of our study was to assess the effect of short-term cold exposure on central aortic blood pressure among untreated hypertensive men. METHODS We conducted a population-based recruitment of 41 hypertensive men and a control group of 20 men without hypertension (aged 55-65 years) who underwent whole-body cold exposure (15-minute exposure to temperature -10 °C, wind 3 m/s, winter clothes). Central aortic blood pressure, augmentation index, and subendocardial viability ratio were measured by radial artery applanation tonometry. RESULTS Short-term cold exposure increased the central aortic blood pressure similarly both in both hypertensive men, from 130/93 to 162/107 mm Hg (P < 0.001) and men in the control group, from 114/81 to 142/91 mmHg (P < 0.001). Augmentation index increased by 12% (from 10% to 22%, P < 0.001; and from 16% to 28%, P < 0.001, respectively), whereas subendocardial viability ratio decreased 10% (from 188% to 177%, P = 0.001; and from 203% to 193%, P = 0.01, respectively) during cold exposure in both hypertensive men and control subjects. CONCLUSIONS Short-term cold exposure increases central aortic blood pressure and cardiac workload, and myocardial oxygen demand slightly increases in relation to blood supply in untreated hypertensive middle-aged men. Because of the higher baseline blood pressure among hypertensive subjects, the cold-induced rise in central aortic blood pressure may increase the risk of adverse cardiovascular health effects.
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Affiliation(s)
- Heidi Hintsala
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
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26
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Luo B, Zhang S, Ma S, Zhou J, Wang B. Effects of different cold-air exposure intensities on the risk of cardiovascular disease in healthy and hypertensive rats. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:185-194. [PMID: 23435512 DOI: 10.1007/s00484-013-0641-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 01/17/2013] [Accepted: 01/31/2013] [Indexed: 06/01/2023]
Abstract
Ten-week-old male Wistar rats (systolic blood pressure, 106-116 mmHg; body weight, 300-320 g) and spontaneously hypertensive rats (systolic blood pressure, 160-176 mmHg; body weight, 210.9-244.9 g) were used as healthy and hypertensive subjects to determine the effects of varying degrees of cold-air exposure in a climate chamber box. The three cold-air ranks were cold air I [minimum temperature (TMIN) 6.4 °C, ↓∆T48 8.6 °C], cold air II (TMIN 3.8 °C, ↓∆T48 11.2 °C), and cold air III (TMIN -0.3 °C, ↓∆T48 15.3 °C), as established from the cold-air data of Zhangye City, China. Each cold-air rank consisted of a temperature drop and a temperature increase with the same initial and terminal temperatures (15 °C). After cold-air exposure, the risk factors for cardiovascular disease (CVD) such as systolic blood pressure, whole blood viscosity (10/s and 150/s), plasma fibrinogen, and blood lipids of the rats were determined. The results indicated that the CVD risk factors of the healthy and hypertensive rats increased significantly with cold-air exposure intensities. The increase in systolic blood pressure was greater during temperature drops, whereas the increases in whole blood viscosity and plasma fibrinogen were greater after cold-air exposure. The effects of cold-air exposure on the CVD risk factors of healthy rats, particularly the systolic blood pressure, whole blood viscosity (150/s), and LDL/HDL, were greater than those in hypertensive rats. In conclusion, CVD risk may increase with cold-air ranks. Blood pressure-induced CVD risk may be greater during cold-air temperature drop, whereas atherosclerosis-induced CVD risk may be greater after cold-air exposure. The effect of cold air on the CVD risk factors in healthy subjects may be more significant than those in hypertensive subjects.
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Affiliation(s)
- Bin Luo
- School of Applied Meteorology, Nanjing University of Information Science and Technology, 219 Ningliulu, Nanjing, China
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27
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Muller MD, Gao Z, Patel HM, Heffernan MJ, Leuenberger UA, Sinoway LI. β-Adrenergic blockade enhances coronary vasoconstrictor response to forehead cooling. Am J Physiol Heart Circ Physiol 2014; 306:H910-7. [PMID: 24441550 DOI: 10.1152/ajpheart.00787.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Forehead cooling activates the sympathetic nervous system and can trigger angina pectoris in susceptible individuals. However, the effect of forehead cooling on coronary blood flow velocity (CBV) is not well understood. In this human experiment, we tested the hypotheses that forehead cooling reduces CBV (i.e., coronary vasoconstriction) and that this vasoconstrictor effect would be enhanced under systemic β-adrenergic blockade. A total of 30 healthy subjects (age range, 23-79 years) underwent Doppler echocardiography evaluation of CBV in response to 60 s of forehead cooling (1°C ice bag on forehead). A subset of subjects (n = 10) also underwent the procedures after an intravenous infusion of propranolol. Rate pressure product (RPP) was used as an index of myocardial oxygen demand. Consistent with our first hypothesis, forehead cooling reduced CBV from 19.5 ± 0.7 to 17.5 ± 0.8 cm/s (P < 0.001), whereas mean arterial pressure increased by 11 ± 2 mmHg (P < 0.001). Consistent with our second hypothesis, forehead cooling reduced CBV under propranolol despite a significant rise in RPP. The current studies indicate that forehead cooling elicits a sympathetically mediated pressor response and a reduction in CBV, and this effect is augmented under β-blockade. The results are consistent with sympathetic activation of β-receptor coronary vasodilation in humans, as has been demonstrated in animals.
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Affiliation(s)
- Matthew D Muller
- Pennsylvania State University College of Medicine, Pennsylvania State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
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Lennon-Edwards S, Farquhar WB. 'Cold as ice', why do old coronary arteries pay the price? J Physiol 2013; 591:2775-6. [PMID: 23729794 DOI: 10.1113/jphysiol.2013.255620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shannon Lennon-Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
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Gao Z, Muller MD, Sinoway LI, Leuenberger UA. Intravenous phentolamine abolishes coronary vasoconstriction in response to mild central hypovolemia. J Appl Physiol (1985) 2013; 116:216-21. [PMID: 24311747 DOI: 10.1152/japplphysiol.01048.2013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Animal studies indicate alpha-adrenergic coronary vasoconstriction helps maintain left ventricular function during physiological stress. Whether this process occurs in humans is unknown. In the current study, we used transthoracic Doppler echocardiography to test the effect of lower body negative pressure (LBNP) on coronary blood flow velocity (CBV, left anterior descending coronary artery) and myocardial function in eight young healthy subjects before and after systemic infusion of phentolamine, a nonselective alpha blocker. Heart rate (HR) and blood pressure (BP) were monitored on a beat-by-beat basis. Peak diastolic CBV and myocardial systolic and diastolic tissue velocities (Sm and Em), were quantified at baseline, and at -5 mmHg, -10 mmHg, and -15 mmHg LBNP. Coronary vascular resistance index (CVRI) was calculated as the quotient of diastolic BP and CBV. Phentolamine reduced baseline diastolic BP and increased HR but did not affect the reflex adjustments to LBNP. The reduction in CBV due to LBNP was blunted by phentolamine at -10 mmHg and -15 mmHg. Importantly, the increase in CVRI (i.e., coronary vasoconstriction) was abolished by phentolamine at -5 mmHg (0.21 ± 0.06 vs. 0.83 ± 0.13), -10 mmHg (0.24 ± 0.03 vs. 1.68 ± 0.31), and -15 mmHg (0.27 ± 0.10 vs. 2.34 ± 0.43). These data indicate that alpha-adrenergic coronary vasoconstriction is present during low levels of LBNP. With alpha blockade, more coronary flow is needed to maintain cardiac function. Our data suggest that alpha-adrenergic tone enhances coronary flow efficiency, presumably by redistributing flow from the epicardium to the endocardium.
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Affiliation(s)
- Zhaohui Gao
- Penn State Hershey Heart and Vascular Institute, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania
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30
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Patel HM, Mast JL, Sinoway LI, Muller MD. Effect of healthy aging on renal vascular responses to local cooling and apnea. J Appl Physiol (1985) 2013; 115:90-6. [PMID: 23640587 DOI: 10.1152/japplphysiol.00089.2013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sympathetically mediated renal vasoconstriction may contribute to the pathogenesis of hypertension in older adults, but empirical data in support of this concept are lacking. In 10 young (26 ± 1 yr) and 11 older (67 ± 2 yr) subjects, we quantified acute hemodynamic responses to three sympathoexcitatory stimuli: local cooling of the forehead, cold pressor test (CPT), and voluntary apnea. We hypothesized that all stimuli would increase mean arterial blood pressure (MAP) and renal vascular resistance index (RVRI) and that aging would augment these effects. Beat-by-beat MAP, heart rate (HR), and renal blood flow velocity (from Doppler) were measured in the supine posture, and changes from baseline were compared between groups. In response to 1°C forehead cooling, aging was associated with an augmented MAP (20 ± 3 vs. 6 ± 2 mmHg) and RVRI (35 ± 6 vs. 16 ± 9%) but not HR. In older adults, there was a positive correlation between the cold-induced pressor response and forehead pain (R = 0.726), but this effect was not observed in young subjects. The CPT raised RVRI in both young (56 ± 13%) and older (45 ± 8%) subjects, but this was not different between groups. Relative to baseline, end-expiratory apnea increased RVRI to a similar extent in both young (46 ± 14%) and older (41 ± 9%) subjects. During sympathetic activation, renal vasoconstriction occurred in both groups. Forehead cooling caused an augmented pressor response in older adults that was related to pain perception.
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Affiliation(s)
- Hardikkumar M Patel
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, PA 17033, USA
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31
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Monahan KD, Feehan RP, Sinoway LI, Gao Z. Contribution of sympathetic activation to coronary vasodilatation during the cold pressor test in healthy men: effect of ageing. J Physiol 2013; 591:2937-47. [PMID: 23478134 DOI: 10.1113/jphysiol.2013.251298] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The sympathetic nervous system is an important regulator of coronary blood flow. The cold pressor test (CPT) is a powerful sympathoexcitatory stressor. We tested the hypotheses that: (1) CPT-induced sympathetic activation elicits coronary vasodilatation in young adults that is impaired with advancing age and (2) combined α- and β-adrenergic blockade diminishes/abolishes these age-related differences. Vascular responses of the left anterior descending artery to the CPT were determined by transthoracic Doppler echocardiography before (pre-blockade) and during (post-blockade) systemic co-administration of α- and β-adrenergic antagonists in young (n = 9; 26 ± 1 years old, mean ± SEM) and older healthy men (n = 9; 66 ± 2 years old). Coronary vascular resistance (CVR; mean arterial pressure/coronary blood velocity) was used as an index of vascular tone. CPT decreased CVR (i.e. coronary vasodilatation occurred) in young ( -33 ± 6%), but not older men ( -3 ± 4%; P < 0.05 vs. young) pre-blockade. Adrenergic blockade abolished CPT-induced coronary vasodilatation in young men ( -33 ± 6% vs. 0 ± 6%, pre-blockade vs. post-blockade, respectively; P < 0.05) such that responses post-blockade mirrored those of older men ( -3 ± 4% vs. 8 ± 9%; both P > 0.05 compared to young pre-blockade). Impaired CPT-induced coronary vasodilatation could not be explained by a reduced stimulus for vasodilatation as group and condition effects persisted when CVR responses were expressed relative to myocardial oxygen demand (rate-pressure product). These data indicate that the normal coronary vascular response to sympathetic activation in young men is pronounced vasodilatation and this effect is lost with age as the result of an adrenergic mechanism. These findings may help explain how acute sympathoexcitation may precipitate angina and coronary ischaemic events, particularly in older adults.
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Affiliation(s)
- Kevin D Monahan
- Penn State Hershey Heart and Vascular Institute, The Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA 17033-2390, USA.
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Gao Z, Novick M, Muller MD, Williams RJ, Spilk S, Leuenberger UA, Sinoway LI. Exercise and diet-induced weight loss attenuates oxidative stress related-coronary vasoconstriction in obese adolescents. Eur J Appl Physiol 2013; 113:519-28. [PMID: 22814577 PMCID: PMC3613987 DOI: 10.1007/s00421-012-2459-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 07/05/2012] [Indexed: 01/20/2023]
Abstract
Obesity is a disease of oxidative stress (OS). Acute hyperoxia (breathing 100 % O(2)) can evoke coronary vasoconstriction by the oxidative quenching of nitric oxide (NO). To examine if weight loss would alter the hyperoxia-related coronary constriction seen in obese adolescents, we measured the coronary blood flow velocity (CBV) response to hyperoxia using transthoracic Doppler echocardiography before and after a 4-week diet and exercise regimen in 6 obese male adolescents (age 13-17 years, BMI 36.5 ± 2.3 kg/m(2)). Six controls of similar age and BMI were also studied. The intervention group lost 9 ± 1 % body weight, which was associated with a reduced resting heart rate (HR), reduced diastolic blood pressure (BP), and reduced RPP (all P < 0.05). Before weight loss, hyperoxia reduced CBV by 33 ± 3 %. After weight loss, CBV only fell by 15 ± 3 % (P < 0.05). In the control group, CBV responses to hyperoxia were unchanged during the two trials. Thus weight loss: (1) reduces HR, BP, and RPP; and (2) attenuates the OS-related coronary constrictor response seen in obese adolescents. We postulate that: (1) the high RPP before weight loss led to higher myocardial O(2) consumption, higher coronary flow and greater NO production, and in turn a large constrictor response to hyperoxia; and (2) weight loss decreased myocardial oxygen demand and NO levels. Under these circumstances, hyperoxia-induced vasoconstriction was attenuated.
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Affiliation(s)
- Zhaohui Gao
- Penn State Hershey Heart & Vascular Institute, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Marsha Novick
- Penn State Children’s Hospital, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Matthew D. Muller
- Penn State Hershey Heart & Vascular Institute, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Ronald J. Williams
- Penn State Children’s Hospital, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Samson Spilk
- Penn State Hershey Heart & Vascular Institute, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Urs A. Leuenberger
- Penn State Hershey Heart & Vascular Institute, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Lawrence I. Sinoway
- Penn State Hershey Heart & Vascular Institute, The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033
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King SG, Ahuja KDK, Wass J, Shing CM, Adams MJ, Davies JE, Sharman JE, Williams AD. Effect of whole-body mild-cold exposure on arterial stiffness and central haemodynamics: a randomised, cross-over trial in healthy men and women. Eur J Appl Physiol 2012; 113:1257-69. [DOI: 10.1007/s00421-012-2543-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/31/2012] [Indexed: 01/23/2023]
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Muller MD, Gao Z, Mast JL, Blaha CA, Drew RC, Leuenberger UA, Sinoway LI. Aging attenuates the coronary blood flow response to cold air breathing and isometric handgrip in healthy humans. Am J Physiol Heart Circ Physiol 2012; 302:H1737-46. [PMID: 22345567 DOI: 10.1152/ajpheart.01195.2011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this echocardiography study was to measure peak coronary blood flow velocity (CBV(peak)) and left ventricular function (via tissue Doppler imaging) during separate and combined bouts of cold air inhalation (-14 ± 3°C) and isometric handgrip (30% maximum voluntary contraction). Thirteen young adults and thirteen older adults volunteered to participate in this study and underwent echocardiographic examination in the left lateral position. Cold air inhalation was 5 min in duration, and isometric handgrip (grip protocol) was 2 min in duration; a combined stimulus (cold + grip protocol) and a cold pressor test (hand in 1°C water) were also performed. Heart rate, blood pressure, O(2) saturation, and inspired air temperature were monitored on a beat-by-beat basis. The rate-pressure product (RPP) was used as an index of myocardial O(2) demand, and CBV(peak) was used as an index of myocardial O(2) supply. The RPP response to the grip protocol was significantly blunted in older subjects (Δ1,964 ± 396 beats·min(-1)·mmHg) compared with young subjects (Δ3,898 ± 452 beats·min(-1)·mmHg), and the change in CBV(peak) was also blunted (Δ6.3 ± 1.2 vs. 11.2 ± 2.0 cm/s). Paired t-tests showed that older subjects had a greater change in the RPP during the cold + grip protocol [Δ2,697 ± 391 beats·min(-1)·mmHg compared with the grip protocol alone (Δ2,115 ± 375 beats·min(-1)·mmHg)]. An accentuated RPP response to the cold + grip protocol (compared with the grip protocol alone) without a concomitant increase in CBV(peak) may suggest a dissociation between the O(2) supply and demand in the coronary circulation. In conclusion, older adults have blunted coronary blood flow responses to isometric exercise.
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Affiliation(s)
- Matthew D Muller
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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