1
|
Delacoste FBC, Goulart CDL, Guidoti AB, Türck P, Eibel B, Irigoyen MC, de Araujo CLP, Dal Lago P. Evaluating the impact of short-term nitrate-rich dietary supplementation on endothelial function in COPD: A randomized crossover study. Respir Med 2024; 232:107745. [PMID: 39053520 DOI: 10.1016/j.rmed.2024.107745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/24/2024] [Accepted: 07/23/2024] [Indexed: 07/27/2024]
Abstract
AIM This study aimed to investigate the acute effects of dietary nitrate ingestion through l-arginine supplementation or dehydrated beet consumption on endothelial function in chronic obstructive pulmonary disease (COPD) patients. The secondary outcome was to analyze arterial stiffness, plasma nitrate, and nitrate/protein concentration. METHODS In this randomized crossover study, subjects with COPD underwent three series of supplementation: (1) l-arginine, (2) dehydrated beetroot, and (3) a placebo that appeared like the other supplements. Each intervention lasted 14 days, with a 7-day washout period between series. Participants underwent endothelial function assessment using flow-mediated dilatation (FMD), and plasma nitrate levels were measured at the end of each supplementation series. RESULTS Seventeen subjects (twelve male) completed the study protocol. Only five subjects presented endothelial dysfunction (RHI ≤0.51) at baseline. The mean baseline characteristics included age 66.5 ± 9.4 years, BMI 27.5 ± 4.5 kg/m2, FEV1, 0.79 (0.67-1.06) L. There were no differences (p > 0.05) between the groups or from pre-to post-interventions for RHI and arterial stiffness index (AIx) values, as well as parameters of endothelium-dependent vasodilation, such as blood flow velocity (BFV), shear stress, shear rate, FMD (mm), and FMD%. There was also no differences (p > 0.05) between the groups or from pre-to post-interventions plasma nitrate levels. CONCLUSIONS Acute dietary supplementation with nitrates, at the doses provided, did not show a significant improvement in endothelial function assessed by FMD, EndoPAT, or plasma nitrate levels in COPD. These findings suggest that a higher dose or prolonged supplementation might be required to achieve a therapeutic effect.
Collapse
Affiliation(s)
- Fernanda Beatriz Costa Delacoste
- Graduation Program in Rehabilitation Sciences, Experimental Laboratory of Physiology Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Cassia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Universidade Federal de Sao Carlos (UFSCar), São Carlos, SP, Brazil
| | - Augusto Baumhardt Guidoti
- Graduation Program in Rehabilitation Sciences, Experimental Laboratory of Physiology Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Patrick Türck
- Laboratory of Cardiovascular Physiology and Reactive Oxygen Species from the Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | - Bruna Eibel
- Clinical Investigation Laboratory (LIC), Instituto de Cardiologia do Rio Grande do Sul (IC-FUC), Porto Alegre, Brazil
| | - Maria Claudia Irigoyen
- Experimental Laboratory of Hypertension, Heart Institute (InCor), University of São Paulo (USP), São Paulo, Brazil
| | - Cintia Laura Pereira de Araujo
- Graduation Program in Rehabilitation Sciences, Experimental Laboratory of Physiology Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Pedro Dal Lago
- Graduation Program in Rehabilitation Sciences, Experimental Laboratory of Physiology Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Graduation Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| |
Collapse
|
2
|
Wang Y, Wang X, Luo J, Qiu B, Huang R, Xiao Y. Urinary Epinephrine Sulfate Can Predict Cardiovascular Risk in Moderate-to-Severe OSA: A Metabolomics-Based Study. Nat Sci Sleep 2024; 16:1153-1168. [PMID: 39131167 PMCID: PMC11314438 DOI: 10.2147/nss.s470154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/27/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose There are currently no ideal indicators for predicting the cardiovascular risk of obstructive sleep apnea (OSA). This study aimed to employ urinary metabolomics to detect early cardiovascular risk in patients with moderate-to-severe OSA. Patients and Methods Male participants who underwent polysomnography from November 2020 to May 2021 were screened. Clinical data, polysomnography data and urine samples were collected. Untargeted metabolomics analyses of urine were performed. Multivariate analyses and receiver operating characteristic (ROC) curve analyses were subsequently performed to identify potential biomarkers. Associations between metabolites and clinical indicators and cardiovascular risk were examined through linear regression analyses with interaction and mediation analyses. Results Thirty-six male participants were included in the study, comprising 22 males with moderate-to-severe OSA and 14 age-matched controls, with an average age of 39.6 ± 9.2 years. We identified 65 metabolites in the study, involving pathways including pyrimidine, androgen, estrogen, vitamin B6 and sulfate/sulfite metabolism. Among them, epinephrine sulfate was the most significantly altered metabolite. ROC analyses highlighted that epinephrine sulfate had the highest area under the curve (AUC=0.883) for detecting moderate-to-severe OSA. Epinephrine sulfate was statistically correlated with OSA severity, hypoxia-related indicators (apnea-hypopnea index: r=0.685; oxygen desaturation index: r=0.743, p<0.0001), arterial stiffness (arterial augmentation index: r=0.361, p=0.031) and long-term cardiovascular risk (Framingham cardiovascular risk: r=0.375, p=0.024). Linear regression analysis revealed that epinephrine sulfate was significantly associated with an increased in the Framingham risk (β = 0.004, 95% CI = 0.000-0.009, p = 0.049), with the effect partly mediated by systolic blood pressure (27.6%) and not moderated by other factors. Additionally, it also significantly associated with the increased in the arterial augmentation index (β = 0.019, 95% CI = 0.000-0.037, p = 0.046), with the effect fully mediated by blood pressure and not moderated by other indices statistically. Conclusion There are significant metabolic pathway alterations in moderate-to-severe OSA patients. Urinary epinephrine sulfate markedly predicts early cardiovascular risk in OSA patients.
Collapse
Affiliation(s)
- Yuxin Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaona Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jinmei Luo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Bintao Qiu
- Department of Central Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Rong Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| |
Collapse
|
3
|
Ramraj O, Badhwar S, Pereira TJ, Edgell H. Pilot Assessment of Piezoelectric Transducers as a Cost-Effective Alternative to EndoPAT. J Vasc Res 2024:1-8. [PMID: 39074454 DOI: 10.1159/000540200] [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: 11/30/2023] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Current microvascular assessments may not be practical or accessible requiring experienced personnel and/or ongoing equipment costs. Piezoelectric transducers can reliably obtain finger blood pressure waves, similar to peripheral arterial tonometry devices; thus, they could be used to estimate microvascular function. We aimed to validate piezoelectric transducers as an alternative measure of microvascular function compared to EndoPAT. METHODS Twenty-five adults (aged 20-64 years) completed reactive hyperemia (5 min forearm circulatory occlusion and 3 min recovery) with piezoelectric transducers on the middle fingers and EndoPAT probes on the index fingers. Average area under the curve (AUC) of the pulse wave signal for the occluded and control arms was determined at baseline, every 30 s post-occlusion, and 10 s around the peak response. Microvascular function index (MFI) was calculated as the ratio of AUC post-occlusion to AUC baseline in the test arm, then normalized to the same ratio in the control arm. MFI at each time point was correlated with the reactive hyperemia index (RHI) from the EndoPAT. RESULTS The greatest significance was found between RHI and MFI at 10 s around the peak response (Spearman's r = 0.67, p = 0.0002; Pearson's r = 0.76, p = 0.00001). CONCLUSION MFI is a reusable and user-friendly microvascular function assessment that could provide better access to vascular health screening.
Collapse
Affiliation(s)
- Olivia Ramraj
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Smriti Badhwar
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Tania J Pereira
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Heather Edgell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Bagherimohamadipour M, Hammad M, Visotcky A, Sparapani R, Kulinski J. Effects of Singing on Vascular Health in Older Adults with Coronary Artery Disease: A Randomized Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.25.24311033. [PMID: 39108506 PMCID: PMC11302710 DOI: 10.1101/2024.07.25.24311033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Background The impact of singing on cardiovascular health has not been extensively studied. The aim of this study is to investigate the effect of singing on cardiovascular biomarkers in an aging population with coronary artery disease. Methods Participants had three study visits separated by 2-7 days, according to a randomized, single-blind, cross-over, controlled design: (1) a 30-minute period of coached singing from an in-person music therapist, (2) a 30-minute period of singing along to an instructional video and (3) a 30-minute rest (control). Primary outcomes included macrovascular endothelial function assessed by brachial artery flow-mediated dilation and microvascular function assessed by peripheral arterial tonometry (Framingham reactive hyperemia index; fRHI). Heart rate variability was a secondary outcome. Results Sixty-five subjects (mean age 67.7± 0.8, 40% women) completed the study. Compared to control, there was an increase in fRHI for the singing video intervention (estimate 0.54, SE 0.25, p=0.005) but not for the coaching intervention (estimate 0.11, SE 0.18, p=0.570). There was no change in macrovascular function with either intervention. The low frequency/high frequency (LF/HF) ratio increased by 2.80 (SE 1.03, p=0.008), and the LnHF power decreased by -0.90 ms2 (SE 0.29, p=0.003) with the video (during to pre-change). When assessing post- to pre- change, the coaching intervention showed a significant change of -0.62 ms2 (SE 0.29, p=0.036) in LnHF power. Conclusions Singing along to an instructional video for 30 minutes improved microvascular, but not macrovascular, endothelial function, in older patients with CAD. HRV changes with singing are similar to that of exercise. Clinical trial registration ClinicalTrials.gov, identifier: NCT04121741.
Collapse
Affiliation(s)
| | - Muhammad Hammad
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Alexis Visotcky
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Rodney Sparapani
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Jacquelyn Kulinski
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
5
|
Rolek B, Błażejowska E, Procyk G, Zimodro JM, Gąsecka A. Dedicated devices for non-invasive cardiovascular risk assessment - the future of cardiovascular prevention. Cardiol J 2024; 31:496-498. [PMID: 38767064 PMCID: PMC11229805 DOI: 10.5603/cj.96477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/27/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Bartosz Rolek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ewelina Błażejowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Procyk
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Michał Zimodro
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| |
Collapse
|
6
|
Alasmari AM, Alsulayyim AS, Alghamdi SM, Philip KEJ, Buttery SC, Banya WAS, Polkey MI, Armstrong PC, Rickman MJ, Warner TD, Mitchell JA, Hopkinson NS. Oral nitrate supplementation improves cardiovascular risk markers in COPD: ON-BC, a randomised controlled trial. Eur Respir J 2024; 63:2202353. [PMID: 38123239 PMCID: PMC10831142 DOI: 10.1183/13993003.02353-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Short-term studies suggest that dietary nitrate (NO3 -) supplementation may improve the cardiovascular risk profile, lowering blood pressure (BP) and enhancing endothelial function. It is not clear if these beneficial effects are sustained and whether they apply in people with COPD, who have a worse cardiovascular profile than those without COPD. Nitrate-rich beetroot juice (NR-BRJ) is a convenient dietary source of nitrate. METHODS The ON-BC trial was a randomised, double-blind, placebo-controlled parallel group study in stable COPD patients with home systolic BP (SBP) measurement ≥130 mmHg. Participants were randomly allocated (1:1) using computer-generated, block randomisation to either 70 mL NR-BRJ (400 mg NO3 -) (n=40) or an otherwise identical nitrate-depleted placebo juice (0 mg NO3 -) (n=41), once daily for 12 weeks. The primary end-point was between-group change in home SBP measurement. Secondary outcomes included change in 6-min walk distance (6MWD) and measures of endothelial function (reactive hyperaemia index (RHI) and augmentation index normalised to a heart rate of 75 beats·min-1 (AIx75)) using an EndoPAT device. Plasma nitrate and platelet function were also measured. RESULTS Compared with placebo, active treatment lowered SBP (Hodges-Lehmann treatment effect -4.5 (95% CI -5.9- -3.0) mmHg), and improved 6MWD (30.0 (95% CI 15.7-44.2) m; p<0.001), RHI (0.34 (95% CI 0.03-0.63); p=0.03) and AIx75 (-7.61% (95% CI -14.3- -0.95%); p=0.026). CONCLUSIONS In people with COPD, prolonged dietary nitrate supplementation in the form of beetroot juice produces a sustained reduction in BP, associated with an improvement in endothelial function and exercise capacity.
Collapse
Affiliation(s)
- Ali M Alasmari
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | - Abdullah S Alsulayyim
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Saeed M Alghamdi
- Clinical Technology Department, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Keir E J Philip
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Sara C Buttery
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Winston A S Banya
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Paul C Armstrong
- Centre for Immunobiology, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew J Rickman
- National Heart and Lung Institute, Cardiothoracic Pharmacology, Vascular Biology, Imperial College London, London, UK
| | - Timothy D Warner
- Centre for Immunobiology, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jane A Mitchell
- National Heart and Lung Institute, Cardiothoracic Pharmacology, Vascular Biology, Imperial College London, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| |
Collapse
|
7
|
Al-Hassany L, Linstra KM, Meun C, van den Berg J, Boersma E, Danser AHJ, Fauser BCJM, Laven JSE, Wermer MJH, Terwindt GM, Maassen Van Den Brink A. Decreased role of neuropeptides in the microvascular function in migraine patients with polycystic ovary syndrome. Atherosclerosis 2023; 384:117172. [PMID: 37400308 DOI: 10.1016/j.atherosclerosis.2023.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND AND AIMS To understand pathophysiological mechanisms underlying migraine as a cardiovascular risk factor, we studied neuropeptide action and endothelial function as measures of peripheral microvascular function in middle-aged women with or without migraine. METHODS We included women with the endocrine disorder polycystic ovary syndrome (PCOS), a population with supposed elevated cardiovascular risk, with and without comorbid migraine. In 26 women without and 23 women with migraine in the interictal phase (mean age 50.8 ± 2.9 years) local thermal hyperemia (LTH) of the skin of the volar forearm was measured cross-sectionally under control conditions, after inhibition of neuropeptide release by 5% lidocaine/prilocaine (EMLA) cream application, and after inhibition of nitric oxide formation by iontophoresis of NG-monomethyl-l-arginine (L-NMMA). Hereafter, changes in the natural logarithm of the reactive hyperemia index (lnRHI) and augmentation index (AI) during reperfusion after occlusion-derived ischemia were measured. RESULTS While mean values under control conditions and L-NMMA conditions were similar, migraine patients had a significantly higher mean area of the curve (AUC) of the total LTH response after EMLA application than those without (86.7 ± 26.5% versus 67.9 ± 24.2%; p = 0.014). This was also reflected by a higher median AUC of the plateau phase under similar conditions in women with migraine compared to those without (83.2% (IQR[73.2-109.5]) versus 73.2% (IQR[54.3-92.0]); p = 0.039). Mean changes in lnRHI and AI scores were similar in both groups. CONCLUSIONS In PCOS patients with migraine, neuropeptide action was lower compared with those without migraine. While larger studies are warranted, these findings provide a potential mechanism supporting previous findings that migraine may be independent from traditional risk factors, including atherosclerosis.
Collapse
Affiliation(s)
- Linda Al-Hassany
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands
| | - Katie M Linstra
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands; Leiden University Medical Center, Department of Neurology, Leiden, the Netherlands
| | - Cindy Meun
- Erasmus MC University Medical Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Rotterdam, the Netherlands
| | - Jeffrey van den Berg
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands
| | - Eric Boersma
- Erasmus MC University Medical Center Rotterdam, Department of Cardiology, the Netherlands
| | - A H Jan Danser
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands
| | - Bart C J M Fauser
- University Medical Center Utrecht, Department of Reproductive Medicine & Gynaecology, Utrecht, the Netherlands
| | - Joop S E Laven
- Erasmus MC University Medical Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Rotterdam, the Netherlands
| | - Marieke J H Wermer
- Leiden University Medical Center, Department of Neurology, Leiden, the Netherlands
| | - Gisela M Terwindt
- Leiden University Medical Center, Department of Neurology, Leiden, the Netherlands
| | - Antoinette Maassen Van Den Brink
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands.
| |
Collapse
|
8
|
Tahsin CT, Michopoulos V, Powers A, Park J, Ahmed Z, Cullen K, Jenkins NDM, Keller-Ross M, Fonkoue IT. Sleep efficiency and PTSD symptom severity predict microvascular endothelial function and arterial stiffness in young, trauma-exposed women. Am J Physiol Heart Circ Physiol 2023; 325:H739-H750. [PMID: 37505472 PMCID: PMC10642999 DOI: 10.1152/ajpheart.00169.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 07/29/2023]
Abstract
Posttraumatic stress disorder (PTSD) is linked to sleep disturbances and significantly higher risk of developing cardiovascular disease (CVD). Furthermore, vascular dysfunction and sleep are independently associated with CVD. Uncovering the link between PTSD symptom severity, sleep disturbances, and vascular function could shine a light on mechanisms of CVD risk in trauma-exposed young women. The purpose of the present study was to investigate the individual and combined effects of sleep efficiency and PTSD symptom severity on vascular function. We recruited 60 otherwise healthy women [age, 26 ± 7 yr and body mass index (BMI), 27.7 ± 6.5 kg/m2] who had been exposed to trauma. We objectively quantified sleep efficiency (SE) using actigraphy, microvascular endothelial function via Framingham reactive hyperemia index (fRHI), and arterial stiffness via pulse-wave velocity (PWV). PTSD symptom severity was assessed using the PTSD checklist for fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (PCL5). PWV was correlated with age (r = 0.490, P < 0.001) and BMI (r = 0.484, P < 0.001). In addition, fRHI was positively correlated with SE (r = 0.409, P = 0.001) and negatively correlated with PTSD symptoms (r = -0.382, P = 0.002). To explore the predictive value of SE and PTSD symptoms on PWV and fRHI, we conducted two multivariate linear regression models. The model predicting PWV was significant (R2 = 0.584, P < 0.001) with age, BMI, blood pressure, and SE emerging as predictors. Likewise, the model predicting fRHI was significant (R2 = 0.360, P < 0.001) with both PTSD symptoms and SE as significant predictors. Our results suggest that although PTSD symptoms mainly impact microvascular endothelial function, sleep efficiency is additionally associated with arterial stiffness in young trauma-exposed women, after controlling for age and BMI.NEW & NOTEWORTHY This is the first study to investigate the individual and combined impacts of objective sleep and PTSD symptoms severity on arterial stiffness and microvascular endothelial function in young premenopausal women. We report that in young trauma-exposed women, although low sleep efficiency is associated with overall vascular function (i.e., microvascular endothelial function and arterial stiffness), the severity of PTSD symptoms is specifically associated with microvascular endothelial function, after accounting for age and body mass index.
Collapse
Affiliation(s)
- Chowdhury Tasnova Tahsin
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs, Research Service Line, Atlanta Veterans Affairs Healthcare Systems, Decatur, Georgia, United States
| | - Zynab Ahmed
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Kathryn Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Nathaniel D M Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa, United States
| | - Manda Keller-Ross
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Ida T Fonkoue
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| |
Collapse
|
9
|
Oberhoffer FS, Langer M, Li P, Vilsmaier T, Sciuk F, Kramer M, Kolbinger B, Jakob A, Rogenhofer N, Dalla-Pozza R, Thaler C, Haas NA. Vascular function in a cohort of children, adolescents and young adults conceived through assisted reproductive technologies-results from the Munich heARTerY-study. Transl Pediatr 2023; 12:1619-1633. [PMID: 37814707 PMCID: PMC10560362 DOI: 10.21037/tp-23-67] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/12/2023] [Indexed: 10/11/2023] Open
Abstract
Background Over 8 million individuals worldwide have been conceived through assisted reproductive technologies (ART). There is conflicting evidence on the cardiovascular health of ART offspring. This study aimed to investigate vascular function in a cohort of children, adolescents and young adults conceived through ART compared to spontaneously conceived peers. Methods Anthropometric variables, diet quality, level of physical activity and sedentary behavior were assessed. An extensive evaluation of vascular function was conducted. Blood pressure as well as endothelial function were evaluated. Carotid intima-media thickness was recorded sonographically. Blood draws were taken to determine blood lipids as well as HbA1c. Results In total, 66 ART subjects conceived through in vitro fertilization (IVF) or intracytoplasmic sperm injection and 86 spontaneously conceived peers were included in this observational cohort study. Both groups were similar in age [11.31 (8.10-18.00) vs. 11.85 (8.72-18.27) years, P=0.373]. ART subjects displayed a significantly higher body fat percentage [19.30% (15.80-26.02%) vs. 15.91% (13.21-21.00%), P=0.007]. Both groups did not differ significantly in diet quality, physical activity, sedentary behavior, and vascular function. Blood lipids and HbA1c were comparable between both groups. ART subjects showed significantly lower levels of triglycerides compared to spontaneously conceived peers. The prevalence of lipoprotein (a) [Lp(a)] ≥50 mg/dL tended to be higher within the ART cohort. Vascular function did not deteriorate more profoundly with age in ART subjects than in spontaneously conceived peers. Conclusions The results of the current study do not indicate a significantly lower vascular function in a cohort of children, adolescents and young adults conceived through ART compared to spontaneously conceived peers. Future studies should address the prevalence of elevated Lp(a) levels in infertile individuals who sought ART treatment. In addition, more studies evaluating body fat percentage as well as cardiovascular morbidity in adult ART subjects are required. For a more precise cardiovascular risk stratification, multi-center studies with larger ART sample sizes, preferably at adult age, are required in the future.
Collapse
Affiliation(s)
| | - Magdalena Langer
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Pengzhu Li
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Theresa Vilsmaier
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, University Hospital, LMU Munich, Germany
| | - Franziska Sciuk
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Marie Kramer
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Brenda Kolbinger
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, University Hospital, LMU Munich, Germany
| | - André Jakob
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Nina Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, University Hospital, LMU Munich, Germany
| | - Robert Dalla-Pozza
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| | - Christian Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, University Hospital, LMU Munich, Germany
| | - Nikolaus Alexander Haas
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
10
|
Reitz KM, Althouse AD, Forman DE, Zuckerbraun BS, Vodovotz Y, Zamora R, Raffai RL, Hall DE, Tzeng E. MetfOrmin BenefIts Lower Extremities with Intermittent Claudication (MOBILE IC): randomized clinical trial protocol. BMC Cardiovasc Disord 2023; 23:38. [PMID: 36681798 PMCID: PMC9862509 DOI: 10.1186/s12872-023-03047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) affects over 230 million people worldwide and is due to systemic atherosclerosis with etiology linked to chronic inflammation, hypertension, and smoking status. PAD is associated with walking impairment and mobility loss as well as a high prevalence of coronary and cerebrovascular disease. Intermittent claudication (IC) is the classic presenting symptom for PAD, although many patients are asymptomatic or have atypical presentations. Few effective medical therapies are available, while surgical and exercise therapies lack durability. Metformin, the most frequently prescribed oral medication for Type 2 diabetes, has salient anti-inflammatory and promitochondrial properties. We hypothesize that metformin will improve function, retard the progression of PAD, and improve systemic inflammation and mitochondrial function in non-diabetic patients with IC. METHODS 200 non-diabetic Veterans with IC will be randomized 1:1 to 180-day treatment with metformin extended release (1000 mg/day) or placebo to evaluate the effect of metformin on functional status, PAD progression, cardiovascular disease events, and systemic inflammation. The primary outcome is 180-day maximum walking distance on the 6-min walk test (6MWT). Secondary outcomes include additional assessments of functional status (cardiopulmonary exercise testing, grip strength, Walking Impairment Questionnaires), health related quality of life (SF-36, VascuQoL), macro- and micro-vascular assessment of lower extremity blood flow (ankle brachial indices, pulse volume recording, EndoPAT), cardiovascular events (amputations, interventions, major adverse cardiac events, all-cause mortality), and measures of systemic inflammation. All outcomes will be assessed at baseline, 90 and 180 days of study drug exposure, and 180 days following cessation of study drug. We will evaluate the primary outcome with linear mixed-effects model analysis with covariate adjustment for baseline 6MWT, age, baseline ankle brachial indices, and smoking status following an intention to treat protocol. DISCUSSION MOBILE IC is uniquely suited to evaluate the use of metformin to improve both systematic inflammatory responses, cellular energetics, and functional outcomes in patients with PAD and IC. TRIAL REGISTRATION The prospective MOBILE IC trial was publicly registered (NCT05132439) November 24, 2021.
Collapse
Affiliation(s)
- Katherine M Reitz
- Department of Surgery, University of Pittsburgh, South Tower, Rm 351.6, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Daniel E Forman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Geriatrics Research, Education, and Clinical Care, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Brian S Zuckerbraun
- Department of Surgery, University of Pittsburgh, South Tower, Rm 351.6, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, South Tower, Rm 351.6, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
- Center for Systems Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, South Tower, Rm 351.6, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | | | - Daniel E Hall
- Department of Surgery, University of Pittsburgh, South Tower, Rm 351.6, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Geriatrics Research, Education, and Clinical Care, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Wolff Center, UPMC, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Edith Tzeng
- Department of Surgery, University of Pittsburgh, South Tower, Rm 351.6, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
11
|
Del Bo’ C, Tucci M, Martini D, Marino M, Bertoli S, Battezzati A, Porrini M, Riso P. Acute effect of blueberry intake on vascular function in older subjects: Study protocol for a randomized, controlled, crossover trial. PLoS One 2022; 17:e0275132. [PMID: 36454906 PMCID: PMC9714894 DOI: 10.1371/journal.pone.0275132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Aging is associated with an increased risk of developing cardiovascular disease which is often accompanied by a decline in vascular health and function. Current evidence suggests that berries may have a potential role in the modulation of vascular function, but dietary interventions are still needed to confirm findings, especially in older subjects. In the context of the MIND FoodS HUB project, this study aims to investigate the effect of a single serving of blueberry (250 g of blueberry versus a control product) in a group of older subjects (≥ 60y) through a randomized, controlled, cross-over dietary intervention trial. Specifically, the study evaluates the absorption kinetics of bioactives following the blueberries intake and the effects on markers related to oxidative stress, inflammation, and vascular function analyzed at different time points. By considering a drop-out rate estimate of 25%, at least 20 subjects will be recruited in the study. The study will provide evidence to support the potential beneficial effects of blueberry and its bioactive compounds on vascular function in a group of population more susceptible to vascular dysfunction and to the development of cardiovascular diseases. Moreover, the study will contribute the analysis of several metabolic and functional markers that can support the biological plausibility of the results obtained. Finally, the trial will provide data on the absorption and metabolism of blueberry bioactives which will be used to study their association with the different markers under study. Trail registration: The trial is registered at ISRCTN (http://isrctn.com/ISRCTN18262533); May 7, 2021.
Collapse
Affiliation(s)
- Cristian Del Bo’
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
| | - Massimiliano Tucci
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
| | - Daniela Martini
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
| | - Mirko Marino
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
| | - Simona Bertoli
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
| | - Alberto Battezzati
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
| | - Marisa Porrini
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
| | - Patrizia Riso
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milano, Italy
- * E-mail:
| |
Collapse
|
12
|
Somayaji K, Frenkel M, Tabaza L, Visotcky A, Ruck TK, Ofori EK, Widlansky ME, Kulinski J. Acute effects of singing on cardiovascular biomarkers. Front Cardiovasc Med 2022; 9:869104. [PMID: 35924212 PMCID: PMC9339901 DOI: 10.3389/fcvm.2022.869104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSinging is a physical activity involving components of the vagal nerves manifested as changes in cardiac autonomic regulation.AimsThe aim of this pilot study is to investigate the acute effects of singing on biomarkers of cardiovascular health.MethodsAdult subjects were recruited from cardiology clinics to participate in a single 90-min study visit. Vascular function was measured at the fingertips with peripheral arterial tonometry (PAT) before and after singing to a 14-min video led by a voice expert. Heart rate variability (HRV) was measured with a chest strap sensor at baseline, during, and after singing. PAT measurements were expressed as reactive hyperemia index (RHI) and Framingham reactive hyperemia index (fRHI). Measures of HRV included root mean square of successive RR interval differences (RMSSD) and standard deviation of NN (or RR) intervals (SDNN).ResultsSixty subjects completed the study (68% female, mean age 61 ±13 years, mean BMI 32 ± 8). There was a significant increase in fRHI (1.88 ± 0.14 to 2.10 ± 0.14, p = 0.02) after singing with no significant change in the RHI (1.99 ± 0.10 to 2.12 ± 0.09, p = 0.22). There was a reduction in HRV during singing (compared to baseline) (RMSSD: 42.0 ± 5 to 32.6 ± 4, p = 0.004 and SDNN: 54 ± 4 to 33.5 ± 3, p = 0.009). HRV measures trended back toward baseline after singing.ConclusionsA short duration of singing improved vascular function acutely. Improvements were more substantial in subjects with abnormal baseline endothelial function. HRV patterns were similar to that of light-intensity exercise. Future studies should confirm favorable vascular adaptation to more sustained singing interventions.Clinical trial registrationClinicalTrials.gov, identifer: NCT03805529.
Collapse
Affiliation(s)
- Kamila Somayaji
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mogen Frenkel
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Luai Tabaza
- Division of Cardiovascular Diseases, Einstein Medical Center, Philadelphia, PA, United States
| | - Alexis Visotcky
- Division of Biostatistics, Medical College of Wisconsin, Institute for Health and Equity, Milwaukee, WI, United States
| | - Tanya Kruse Ruck
- Department of Music, Peck School of the Arts, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Ernest Kwesi Ofori
- Department of Physical Therapy, Whitworth University, Spokane, WA, United States
| | - Michael E. Widlansky
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jacquelyn Kulinski
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Jacquelyn Kulinski
| |
Collapse
|
13
|
Pancaldi E, Tedino C, Riccardi M, Alghisi F, Cimino G, Pascariello G, Calvi E, Sciatti E, Vizzardi E, Metra M. Endothelial function evaluation in idiopathic vs. ischemic dilated cardiomyopathy. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:136-142. [PMID: 35873186 PMCID: PMC9301029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
AIMS In the latest years an emerging interest has risen towards the role of endothelial dysfunction (ED) in the pathogenesis of heart failure (HF) since the very first steps of the disease. Since the prevalent etiology of HF is ischemic cardiomyopathy (ICM), it is still not clear whether the connection with ED is linked to HF itself or to atherosclerosis. The aim is to determine the presence of ED in subjects with idiopathic dilated cardiomyopathy (IDCM) compared to ICM. METHODS In this observational study 107 patients were enrolled, 65 of them suffering from IDCM and 42 from ICM. ED was assessed as peripheral arterial tonometry by means of EndoPAT device. The Reactive Hyperaemia Index (RHI) was calculated, ED being established with RHI values ≤1.67 and normal endothelial function >2.00 (grey area between 1.67 and 2.00). RESULTS ED, expressed both as RHI ≤1.67 and RHI ≤2.00, showed a similar prevalence in the two groups. However, they differed as regards sex, dyslipidemia and statin use. CONCLUSION Endothelial function, evaluated through peripheral artery tonometry, seems equally compromised in patients with IDCM and ICM.
Collapse
Affiliation(s)
- Edoardo Pancaldi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Chiara Tedino
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Mauro Riccardi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Fabio Alghisi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Giuliana Cimino
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Greta Pascariello
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Emiliano Calvi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia Brescia, Italy
| |
Collapse
|
14
|
Lal A, Dave N, Barry MA, Sood A, Mitchell P, Thiagalingam A. A stronger association of diabetes mellitus with impaired hyperaemia using a novel ECG-gated device compared with peripheral arterial tonometry. Int Ophthalmol 2022; 42:2855-2869. [PMID: 35672599 PMCID: PMC9420096 DOI: 10.1007/s10792-022-02276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Impaired digital reactive hyperaemia and flicker-stimulated retinal vascular response are commonly reported risk markers of cardiovascular disease. This is the first study to determine the correlation of these risk markers with diabetes mellitus by comparing our novel flicker-modulated ECG-gated fundoscope with the EndoPAT2000 system. METHODS In total, 119 controls and 120 participants with diabetes mellitus partook in this cross-sectional study. The EndoPAT2000 system assessed digital reactive hyperaemia under fasting conditions. A mydriatic ECG-gated fundoscope with a novel flicker module acquired digital retinal images of the left eye before, during and after flicker stimulation. An inhouse semi-automated software measured retinal vessel diameters using a validated protocol with two observers repeating measurements in a subset of 10 controls and 10 participants with diabetes mellitus. Intra- and inter-observer reliability analyses occurred by the interclass correlation coefficient. A receiver operating characteristic curve established associations of variables with diabetes mellitus. RESULTS Diabetes mellitus was more strongly associated with flicker-stimulated retinal arteriolar calibre change from baseline (AUC 0.81, 95% CI 0.75-0.87, p < 0.0001) than reactive hyperaemia index. Median flicker-stimulated arteriolar calibre change from baseline (controls: 2.74%, IQR 1.07 vs diabetes mellitus: 1.64%, IQR 1.25, p < 0.0001) and reactive hyperaemia index (controls: 1.87, IQR 0.81 vs diabetes mellitus: 1.60, IQR 0.81, p = 0.003) were lower in diabetes mellitus than controls. Intra- and inter-observer reliability coefficients were high from 0.87 to 0.93. CONCLUSIONS Impaired flicker-stimulated retinal arteriolar calibre change from baseline is more highly correlated with diabetes mellitus in this study than a reduced reactive hyperaemia index.
Collapse
Affiliation(s)
- Anchal Lal
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia, 2145. .,Sydney Medical School (Westmead Clinical School), The University of Sydney, Sydney, NSW, Australia, 2145. .,Centre for Vision Research, Westmead Institute for Medical Research, Sydney, NSW, Australia, 2145. .,Department of Cardiology, Room 2082, Level 2, Clinical Sciences Corridor, Westmead Hospital, Cnr Darcy and Hawkesbury Roads, Westmead, Sydney, NSW, Australia, 2145.
| | - Neha Dave
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia, 2308
| | | | - Annika Sood
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia, 2145
| | - Paul Mitchell
- Sydney Medical School (Westmead Clinical School), The University of Sydney, Sydney, NSW, Australia, 2145.,Centre for Vision Research, Westmead Institute for Medical Research, Sydney, NSW, Australia, 2145
| | - Aravinda Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia, 2145.,Sydney Medical School (Westmead Clinical School), The University of Sydney, Sydney, NSW, Australia, 2145
| |
Collapse
|
15
|
Lal A, Dave N, Kazi S, Mitchell P, Thiagalingam A. Comparison of experiences and preferences following non-invasive cardiovascular risk procedures: a cross-sectional survey in participants with and without diabetes mellitus. J Diabetes Metab Disord 2022; 21:463-474. [PMID: 35673505 PMCID: PMC9167168 DOI: 10.1007/s40200-022-00996-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
Aims Endothelial dysfunction is an early risk marker of cardiovascular disease in diabetes mellitus. Timely screening is important in reducing cardiovascular disease-associated morbidity and mortality. This cross-sectional study investigates the acceptability and preferability of non-invasive cardiovascular risk procedures (EndoPAT2000 system and the ECG-gated fundoscope) in participants with diabetes mellitus compared to controls. Methods A self-administered Likert scale-based questionnaire was completed by 106 controls and 117 participants with diabetes mellitus, identified through stratified random sampling, upon conclusion of an Australian Heart Eye sub-study conducted at Westmead Hospital, NSW, Australia from 2012 to 2014. Pearson’s χ2 test, independent-samples t-test and regression analysis were performed. Results Study participants who responded to the questionnaire had no preference for procedures (controls: 2.4 ± 1.1 vs diabetes mellitus: 2.5 ± 0.9, p = 0.38) but had an overall more negative experience with most aspects of the ECG-gated fundoscope than the EndoPAT2000 system. Of those with diabetes mellitus, participants who provided poorer self-rated health expressed discomfort with the mydriatic drops (ß 0.27, 95%CI 0.001 - 0.54, p = 0.049) and the fundoscope’s green light filter (ß 0.27, 95%CI 0.07 - 0.47, p = 0.009), as well as maintaining still (ß 0.40, 95%CI 0.08 - 0.72, p = 0.02) and not blinking (ß 0.38, 95%CI 0.07 - 0.70, p = 0.02) during photo acquisition. These participants were also less willing to repeat the ECG-gated fundoscope procedure (ß 0.29, 95%CI 0.07 - 0.52, p = 0.01). Conclusions Participants with diabetes mellitus, especially with poorer self-rated health, had a more negative experience with the ECG-gated fundoscope than the EndoPAT2000 system. Difficulties experienced under examination by the ECG-gated fundoscope appear related to the procedural design, which requires amendments improving patient comfort and compliance.
Collapse
Affiliation(s)
- Anchal Lal
- Department of Cardiology, Room 2082, Level 2, Clinical Sciences Corridor, Westmead Hospital, Cnr Darcy and Hawkesbury Roads, Westmead, Sydney, NSW 2145 Australia
- Sydney Medical School (Westmead Clinical School), The University of Sydney, Sydney, NSW 2145 Australia
- Centre for Vision Research, Westmead Institute for Medical Research, Sydney, NSW Australia 2145
| | - Neha Dave
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Samia Kazi
- Department of Cardiology, Room 2082, Level 2, Clinical Sciences Corridor, Westmead Hospital, Cnr Darcy and Hawkesbury Roads, Westmead, Sydney, NSW 2145 Australia
- Sydney Medical School (Westmead Clinical School), The University of Sydney, Sydney, NSW 2145 Australia
| | - Paul Mitchell
- Sydney Medical School (Westmead Clinical School), The University of Sydney, Sydney, NSW 2145 Australia
- Centre for Vision Research, Westmead Institute for Medical Research, Sydney, NSW Australia 2145
| | - Aravinda Thiagalingam
- Department of Cardiology, Room 2082, Level 2, Clinical Sciences Corridor, Westmead Hospital, Cnr Darcy and Hawkesbury Roads, Westmead, Sydney, NSW 2145 Australia
- Sydney Medical School (Westmead Clinical School), The University of Sydney, Sydney, NSW 2145 Australia
| |
Collapse
|
16
|
Biophysical Markers of Suspected Preeclampsia, Fetal Growth Restriction and the Two Combined—How Accurate They Are? REPRODUCTIVE MEDICINE 2022. [DOI: 10.3390/reprodmed3020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives—To conduct a secondary analysis of prediction accuracy of biophysical markers for suspected Preeclampsia (PE), Fetal Growth Restriction (FGR) and the two combined near delivery in a Slovenian cohort. Methods—This was a secondary analysis of a database of a total 125 Slovenian pregnant women attending a high-risk pregnancy clinic due to suspected PE (n = 31), FGR (n = 16) and PE + FGR (n = 42) from 28–39 weeks gestation and their corresponding term (n = 21) and preterm (PTD, n = 15) controls. Data for Mean Arterial blood Pressure (MAP) and Uterine artery pulsatility index (UtA PI) estimated by Doppler sonography were extracted from the database of patients who were tested at admission to the high-risk clinic with the suspected complications. The reactive hyperemia index (RHI), and the Augmentation Index (AIX%) were extracted from the patient database using measured values obtained with the assistance of the Endo PAT, a device set to measure the signal of the peripheral arterial tone (PAT) from the blood vessels endothelium. Linear regression coefficients, Box and Whisker plots, Area under the Curve (AUC) of receiver Operation Characteristic (ROC) curves, and multiple regression were used to assess the marker accuracy using detection rate (DR) and false-positive rate (FPR) and previously reported cut-offs for estimating the positive and negative predictive value (NPV and PPV). The SPSS non-parametric statistics (Kruskal Wallis and Mann–Whitney) and Spearman’s regression coefficient were used to assess marker accuracy; p < 0.05 was considered significant. Results—MAP values reached diagnostic accuracy (AUC = 1.00, DR = 100%) for early PE cases delivered < 34, whereas UtA Doppler PI values yielded such results for early FGR < 34 weeks and the two combined reached such accuracy for PE + FGR. To reach diagnostic accuracy for all cases of the complications, the Endo PAT markers with values for MAP and UtA Doppler PI were required for cases near delivery. Multiple regression analyses showed added value for advanced maternal age and gestational week in risk assessment for all cases of PE, FGR, and PE + FGR. Spearman’s regression coefficient yielded r > 0.6 for UtA Doppler PI over GA for PE and FGR, whereas for RHI over BMI, the regression coefficient was r > 0.5 (p < 0.001 for each). Very high correlations were also found between UtA Doppler PI and sFlt-1/PlGF or PlGF (r = −0.495, p < 0.001), especially in cases of FGR. Conclusion—The classical biophysical markers MAP and UtA Doppler PI provided diagnostic accuracy for PE and FGR < 34 wks gestation. A multiple biophysical marker analysis was required to reach diagnostic accuracy for all cases of these complications. The UtA Doppler PI and maternal serum sFlt-1/PlGF or PlGF were equally accurate for early cases to enable the choice of the markers for the clinical use according to the more accessible method.
Collapse
|
17
|
Benthien J, Meusel M, Cayo Talavera S, Eitel I, Drömann D, Franzen KF. JUUL™ing and Heating Lead to a Worsening of Arterial Stiffness. MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9040028. [PMID: 35447876 PMCID: PMC9025913 DOI: 10.3390/medicines9040028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
Background: The widespread use of the JUUL™ device ignited a discussion about the effects these products have on harm reduction. Therefore, we conducted a study directly comparing the JUUL™ device with a cigarette, a heated tobacco product, and a nicotine-free e-cigarette to examine the acute effects on arterial stiffness. Methods: This crossover-designed study examines 20 occasional smokers (age 25.2 ± 2.5 years). Study participants used each of the four smoking devices for a duration of 5 min following a protocol. Peripheral blood pressure and parameters of arterial stiffness and endothelial vasodilator function such as the reactive hyperemia index and the augmentation index were measured using the EndoPAT™2000 before and after. Results: In addition to significant peripheral hemodynamic changes after 5 and 10 min (p < 0.05), the reactive hyperemia index showed a significant decrease for all devices 15 min after consumption and remained significantly decreased after 60 min (p < 0.01). The augmentation index adjusted for a heart rate of 75 bpm increased significantly for all devices 15 and 60 min after consumption (p < 0.01). Conclusions: In conclusion, the increases in blood pressure and arterial stiffness are similar after smoking, JUUL™ing, heating, and vaping. These changes may be associated with an increase in cardiovascular risks; however, an evaluation of the long-term effects of JUUL™ing, vaping and heating is needed.
Collapse
Affiliation(s)
- Julia Benthien
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Moritz Meusel
- Medical Clinic II, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (M.M.); (I.E.)
| | - Silja Cayo Talavera
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Ingo Eitel
- Medical Clinic II, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (M.M.); (I.E.)
| | - Daniel Drömann
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Klaas F. Franzen
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
- Correspondence: ; Tel.: +49-(451)-500-45003
| |
Collapse
|
18
|
Janić M, Rizzo M, Cosentino F, Pantea Stoian A, Lunder M, Šabović M, Janež A. Effect of Oral Semaglutide on Cardiovascular Parameters and Their Mechanisms in Patients with Type 2 Diabetes: Rationale and Design of the Semaglutide Anti-Atherosclerotic Mechanisms of Action Study (SAMAS). Diabetes Ther 2022; 13:795-810. [PMID: 35258841 PMCID: PMC8989913 DOI: 10.1007/s13300-022-01226-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) management has reached a point where not only optimal glycaemic control is necessary, but also additional interventions with proven cardiovascular risk reduction benefit. Subcutaneous semaglutide has been shown to provide cardiovascular protection, but its use may be limited by its injection formulation. To overcome this limitation, an oral semaglutide tablet has been developed, which could potentially be of the same value as its injection counterpart, but in a much wider group of patients with T2D, thereby allowing for broader cardiovascular risk reduction in this vulnerable patient population. METHODS A total of 100 consecutive patients with T2D and a disease duration of up to 10 years, without manifest cardiovascular disease, who are treated with metformin (± sulphonylurea) and optimal cardioprotective therapy, will be recruited in a single-blinded, randomized trial named "Semaglutide Anti-atherosclerotic Mechanisms of Action Study (SAMAS)." After 1:1 randomization, patients will receive either oral semaglutide 14 mg daily or placebo for 1 year. The primary outcome comprises changes in atherosclerosis-related structural and functional characteristics of the arterial wall, namely: reduction of the carotid intima-media thickness, improvement of endothelial function and decrease in arterial stiffness. Secondary outcomes are changes in atherogenic small dense low-density lipoproteins, glucose control (HbA1c) and inflammatory markers (hsCRP). Possible correlations between primary endpoints and changes in lipids, HbA1c and high-sensitivity C-reactive protein will be sought. DISCUSSION This is the first study to investigate the direct and indirect anti-atherosclerotic mechanisms of oral semaglutide. The results are expected to confirm the position of oral semaglutide in the multifactorial management of T2D with an emphasis on cardiovascular disease prevention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05147896.
Collapse
Affiliation(s)
- Miodrag Janić
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia.
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, 90100, Palermo, Italy
| | - Francesco Cosentino
- Unit of Cardiology, Karolinska Institute and Karolinska University Hospital, University of Stockholm, Stockholm, Sweden
| | - Anca Pantea Stoian
- Faculty of Medicine, Diabetes, Nutrition and Metabolic Diseases, Carol Davila University, Bucharest, Romania
| | - Mojca Lunder
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Mišo Šabović
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia
- Clinical Department of Vascular Diseases, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Andrej Janež
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia
| |
Collapse
|
19
|
Weerts J, Mourmans SGJ, Barandiarán Aizpurua A, Schroen BLM, Knackstedt C, Eringa E, Houben AJHM, van Empel VPM. The Role of Systemic Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction. Biomolecules 2022; 12:biom12020278. [PMID: 35204779 PMCID: PMC8961612 DOI: 10.3390/biom12020278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 02/06/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing incidence, leading to a health care problem of epidemic proportions for which no curative treatments exist. Consequently, an urge exists to better understand the pathophysiology of HFpEF. Accumulating evidence suggests a key pathophysiological role for coronary microvascular dysfunction (MVD), with an underlying mechanism of low-grade pro-inflammatory state caused by systemic comorbidities. The systemic entity of comorbidities and inflammation in HFpEF imply that patients develop HFpEF due to systemic mechanisms causing coronary MVD, or systemic MVD. The absence or presence of peripheral MVD in HFpEF would reflect HFpEF being predominantly a cardiac or a systemic disease. Here, we will review the current state of the art of cardiac and systemic microvascular dysfunction in HFpEF (Graphical Abstract), resulting in future perspectives on new diagnostic modalities and therapeutic strategies.
Collapse
Affiliation(s)
- Jerremy Weerts
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
- Correspondence: ; Tel.: +31-43-387-7097
| | - Sanne G. J. Mourmans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Arantxa Barandiarán Aizpurua
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Blanche L. M. Schroen
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Christian Knackstedt
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| | - Etto Eringa
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, 6211 LK Maastricht, The Netherlands;
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Alfons J. H. M. Houben
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands;
| | - Vanessa P. M. van Empel
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands; (S.G.J.M.); (A.B.A.); (B.L.M.S.); (C.K.); (V.P.M.v.E.)
| |
Collapse
|
20
|
Malheiro LF, Gaio R, Vaz da Silva M, Martins S, Sarmento A, Santos L. Peripheral arterial tonometry as a method of measuring reactive hyperaemia correlates with organ dysfunction and prognosis in the critically ill patient: a prospective observational study. J Clin Monit Comput 2021; 35:1169-1181. [PMID: 32889643 PMCID: PMC7474512 DOI: 10.1007/s10877-020-00586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/24/2020] [Indexed: 11/05/2022]
Abstract
Predictions of mortality may help in the selection of patients who benefit from intensive care. Endothelial dysfunction is partially responsible for many of the organic dysfunctions in critical illness. Reactive hyperaemia is a vascular response of the endothelium that can be measured by peripheral arterial tonometry (RH-PAT). We aimed to assess if reactive hyperaemia is affected by critical illness and if it correlates with outcomes. Prospective study with a cohort of consecutive patients admitted to an Intensive Care Unit. RH-PAT was accessed on admission and on the 7th day after admission. Early and late survivors were compared to non-survivors. The effect of RH-PAT variation on late mortality was studied by a logistic regression model. The association between RH-PAT and severity scores and biomarkers of organic dysfunction was investigated by multivariate analysis. 86 patients were enrolled. Mean ln(RHI) on admission was 0.580 and was significantly lower in patients with higher severity scores (p < 0.01) and early non-survivors (0.388; p = 0.027). The model for prediction of early-mortality estimated that each 0.1 decrease in ln(RHI) increased the odds for mortality by 13%. In 39 patients, a 2nd RH-PAT measurement was performed on the 7th day. The variation of ln(RHI) was significantly different between non-survivors and survivors (- 24.2% vs. 63.9%, p = 0.026). Ln(RHI) was significantly lower in patients with renal and cardiovascular dysfunction (p < 0.01). RH-PAT is correlated with disease severity and seems to be an independent marker of early mortality, cardiovascular and renal dysfunctions. RH-PAT variation predicts late mortality. There appears to be an RH-PAT impairment in the acute phase of severe diseases that may be reversible and associated with better outcomes.
Collapse
Affiliation(s)
- Luis Filipe Malheiro
- Intensive Care Unit, Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal.
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal.
- Department of Medicine Faculty of Medicine, University of Porto, Porto, Portugal.
- Serviço de Doenças Infeciosas, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Rita Gaio
- Department of Mathematics, Faculty of Science Sciences and CMUP, Centre of Mathematics of the University of Porto; University of Porto, Porto, Portugal
| | - Manuel Vaz da Silva
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Martins
- Clinical Pathology Department, Centro Hospitalar de São João and EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - António Sarmento
- Intensive Care Unit, Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
- Department of Medicine Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Intensive Care Unit, Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
- Department of Medicine Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
21
|
Baier JM, Funck KL, Vernstrøm L, Laugesen E, Poulsen PL. Low physical activity is associated with impaired endothelial function in patients with type 2 diabetes and controls after 5 years of follow-up. BMC Endocr Disord 2021; 21:189. [PMID: 34535107 PMCID: PMC8449475 DOI: 10.1186/s12902-021-00857-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The long-term association between physical activity and endothelial function has not previously been investigated in patients with type 2 diabetes. Therefore, we aimed to evaluate the relationship between physical activity and endothelial function, assessed by peripheral arterial tonometry, in patients with type 2 diabetes and non-diabetic controls after 5 years of follow-up. METHODS We included 51 patients with newly diagnosed type 2 diabetes and 53 sex- and age matched controls. Participants underwent baseline clinical characterization including objective measurement of physical activity level using accelerometery. After 5 years of follow-up, participants were re-examined, and endothelial function was assessed as natural logarithm of reactive hyperemia index (lnRHI). RESULTS Physical activity at baseline was associated with lnRHI after 5 years of follow-up in both patients with type 2 diabetes and controls. An increase of 1 standard deviation (SD) in daytime physical activity corresponded to a 6.7 % increase in RHI (95 % confidence interval: 1.1;12.5 %, p = 0.02). We found no difference in lnRHI between patients with diabetes and controls (0.67 ± 0.29 vs. 0.73 ± 0.31, p = 0.28). CONCLUSIONS Daytime physical activity is associated with endothelial function after 5 years of follow-up in patients with type 2 diabetes and controls.
Collapse
Affiliation(s)
- Jonathan Mathias Baier
- Department of Internal Medicine and Endocrinology and Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Kristian Løkke Funck
- Department of Internal Medicine and Endocrinology and Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Liv Vernstrøm
- Department of Internal Medicine and Endocrinology and Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Esben Laugesen
- Department of Internal Medicine and Endocrinology and Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Per Løgstrup Poulsen
- Department of Internal Medicine and Endocrinology and Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| |
Collapse
|
22
|
Koshiba H, Maeshima E. Acute effects of moderate-intensity cycling exercise on endothelial function in young healthy men: An investigation using the reactive hyperemia index. Technol Health Care 2021; 29:317-322. [PMID: 32568139 DOI: 10.3233/thc-202281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endothelial cells play an important role in the prevention of cardiovascular disease. OBJECTIVE In this study, we examined the effects of transient aerobic exercise on peripheral endothelial function. METHODS Twenty-seven healthy male college students were selected as subjects and randomly divided into two groups: 13 in the control group and 14 in the exercise group. The subjects in the exercise group had a 15-minute supine rest, followed by 30 minutes of cycling exercise at moderate intensity, while measuring the reactive hyperemia index (RHI), an indicator of endothelial function, before and after exercise. The subjects in the control group had a 40-minute rest, during which RHI was measured with the same timing as in the exercise group. RESULTS Two-factor analysis of variance revealed a statistically significant interaction effect. In the exercise group, RHI increased significantly after exercise. However, no significant change was observed in the control group. When RHI before exercise was compared between the two groups, no significant difference was found. However, RHI after exercise was significantly higher in the exercise group. CONCLUSIONS The results of this study suggest that 30 minutes of moderate-intensity exercise may have a favorable impact on peripheral endothelial function.
Collapse
Affiliation(s)
- Hiroya Koshiba
- Faculty of Health and Well-being, Kansai University, Osaka, Japan
| | - Etsuko Maeshima
- Graduate School of Sport and Exercise Sciences, Osaka University of Health and Sport Sciences, Osaka, Japan
| |
Collapse
|
23
|
Troy AM, Cheng HM. Human microvascular reactivity: a review of vasomodulating stimuli and non-invasive imaging assessment. Physiol Meas 2021; 42. [PMID: 34325417 DOI: 10.1088/1361-6579/ac18fd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/29/2021] [Indexed: 11/11/2022]
Abstract
The microvasculature serves an imperative function in regulating perfusion and nutrient exchange throughout the body, adaptively altering blood flow to preserve hemodynamic and metabolic homeostasis. Its normal functioning is vital to tissue health, whereas its dysfunction is present in many chronic conditions, including diabetes, heart disease, and cognitive decline. As microvascular dysfunction often appears early in disease progression, its detection can offer early diagnostic information. To detect microvascular dysfunction, one uses imaging to probe the microvasculature's ability to react to a stimulus, also known as microvascular reactivity (MVR). An assessment of MVR requires an integrated understanding of vascular physiology, techniques for stimulating reactivity, and available imaging methods to capture the dynamic response. Practical considerations, including compatibility between the selected stimulus and imaging approach, likewise require attention. In this review, we provide a comprehensive foundation necessary for informed imaging of MVR, with a particular focus on the challenging endeavor of assessing microvascular function in deep tissues.
Collapse
Affiliation(s)
- Aaron M Troy
- Institute of Biomedical Engineering, University of Toronto, Toronto, CANADA
| | | |
Collapse
|
24
|
Ripa RS, Zobel EH, von Scholten BJ, Jensen JK, Binderup T, Diaz LJ, Curovic VR, Hansen TW, Rossing P, Kjaer A. Effect of Liraglutide on Arterial Inflammation Assessed as [ 18F]FDG Uptake in Patients With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial. Circ Cardiovasc Imaging 2021; 14:e012174. [PMID: 34187185 PMCID: PMC8300846 DOI: 10.1161/circimaging.120.012174] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The mechanism behind the cardiovascular protection observed with human GLP-1 RA (glucagon-like peptide-1 receptor agonists) in type 2 diabetes is unknown. We hypothesized that treatment with the GLP-1 RA liraglutide had a positive effect on vascular inflammation. METHODS LIRAFLAME (Effect of liraglutide on vascular inflammation in type-2 diabetes: A randomized, placebocontrolled, double-blind, parallel clinical PET/CT trial) was a double-blind, randomized controlled trial performed at a single university hospital clinic in Denmark. Patients with type 2 diabetes were via computer-generated randomization list assigned (1:1) liraglutide up to 1.8 mg or placebo once daily for 26 weeks. The primary end point was change in vascular inflammation over 26 weeks assessed by [18F]-fluorodeoxyglucose positron emission tomography/computed tomography. Analyses were based on intention-to-treat. Key secondary outcomes included change in other indices of atherosclerosis. RESULTS Between October 26, 2017, and August 16, 2019, 147 patients were screened and 102 were randomly assigned to liraglutide (n=51) or placebo (n=51) and 99 (97%) completed the trial. Change in the [18F]-fluorodeoxyglucose positron emission tomography measure of vascular inflammation (active-segment target-to-background ratio) did not differ between treatment groups: change from baseline to 26 weeks was -0.04 (95% CI, -0.17 to 0.08) in the liraglutide group compared with -0.09 (-0.19 to 0.01) in the placebo group (mean difference, 0.05 [95% CI, -0.11 to 0.21], P=0.53). Secondary analyses restricted to [18F]-fluorodeoxyglucose positron emission tomography of the carotid arteries as well as other indices of atherosclerosis confirmed the primary result. We performed an explorative analysis of interaction between treatment group and history of cardiovascular disease (P=0.052). CONCLUSIONS In this low to moderate risk population with type 2 diabetes, liraglutide did not change vascular inflammation assessed as [18F]-fluorodeoxyglucose uptake compared with placebo. An explorative analysis indicated a possible effect in persons with history of cardiovascular disease, in line with current guidelines where liraglutide is recommended to patients with history of cardiovascular disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03449654.
Collapse
Affiliation(s)
- Rasmus S Ripa
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark (R.S.R., J.K.J., T.B., A.K.)
| | - Emilie H Zobel
- Steno Diabetes Center Copenhagen, Denmark (E.H.Z., B.J.v.S., L.J.D., V.R.C., T.W.H., P.R.)
| | - Bernt J von Scholten
- Steno Diabetes Center Copenhagen, Denmark (E.H.Z., B.J.v.S., L.J.D., V.R.C., T.W.H., P.R.).,Novo Nordisk A/S, Søborg, Denmark (B.J.v.S.)
| | - Jacob K Jensen
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark (R.S.R., J.K.J., T.B., A.K.)
| | - Tina Binderup
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark (R.S.R., J.K.J., T.B., A.K.)
| | - Lars J Diaz
- Steno Diabetes Center Copenhagen, Denmark (E.H.Z., B.J.v.S., L.J.D., V.R.C., T.W.H., P.R.)
| | - Viktor R Curovic
- Steno Diabetes Center Copenhagen, Denmark (E.H.Z., B.J.v.S., L.J.D., V.R.C., T.W.H., P.R.)
| | - Tine W Hansen
- Steno Diabetes Center Copenhagen, Denmark (E.H.Z., B.J.v.S., L.J.D., V.R.C., T.W.H., P.R.)
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Denmark (E.H.Z., B.J.v.S., L.J.D., V.R.C., T.W.H., P.R.).,University of Copenhagen, Denmark (P.R.)
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark (R.S.R., J.K.J., T.B., A.K.)
| |
Collapse
|
25
|
Shahriar MH, Chowdhury MAH, Ahmed S, Eunus M, Kader SB, Begum BA, Islam T, Sarwar G, Al Shams R, Raqib R, Alam DS, Parvez F, Ahsan H, Yunus M. Exposure to household air pollutants and endothelial dysfunction in rural Bangladesh: A cross-sectional study. Environ Epidemiol 2021; 5:e132. [PMID: 33870008 PMCID: PMC8043736 DOI: 10.1097/ee9.0000000000000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
More than one third of world's population use biomass fuel for cooking that has been linked to an array of adverse health hazards including cardiovascular mortality and morbidity. As part of Bangladesh Global Environmental and Occupational Health (GEO Health) project, we assessed whether household air pollution (HAP) was associated with dysfunction in microvascular circulation (measured by reactive hyperemia index [RHI]). METHODS We measured exposure to HAP (particulate matter [PM2.5], carbon monoxide [CO], and black carbon [BC]) for 48 hours of 200 healthy nonsmoker adult females who used biomass fuel for cooking. Exposure to PM2.5 and BC were measured using personal monitor, RTI MicroPEM (RTI International, NC) with an internal filter that had been both pre- and post-weighed to capture the deposited pollutants concentration. Lascar CO logger was used to measure CO. Endothelial function was measured by forearm blood flow dilatation response to brachial artery occlusion using RHI based on peripheral artery tonometry. A low RHI score (<1.67) indicates impaired endothelial function. RESULTS Average 48 hours personal exposure to PM2.5 and BC were 144.15 μg/m3 (SD 61.26) and 6.35 μg/m3 (SD 2.18), respectively. Interquartile range for CO was 0.73 ppm (0.62-1.35 ppm). Mean logarithm of RHI (LnRHI) was 0.57 in current data. No statistically significant association was observed for LnRHI with PM2.5 (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.92, 1.01; P = 0.16), BC (OR = 0.85; 95% CI = 0.72, 1.01; P = 0.07), and CO (OR = 0.89; 95% CI = 0.64, 1.25; P = 0.53) after adjusting for potential covariates. CONCLUSIONS In conclusion, HAP was not associated with endothelial dysfunction among nonsmoking females in rural Bangladesh who used biomass fuel for cooking for years.
Collapse
Affiliation(s)
- Mohammad Hasan Shahriar
- Department of Public Health Sciences, Biological Science Division, The University of Chicago, Chicago, Illinois
- UChicago Research Bangladesh, Dhaka, Bangladesh
| | - Muhammad Ashique Haider Chowdhury
- Department of Public Health Sciences, Biological Science Division, The University of Chicago, Chicago, Illinois
- icddr,b, Dhaka, Bangladesh
| | - Shyfuddin Ahmed
- icddr,b, Dhaka, Bangladesh
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | | | | | | | | | | | | | | | - Dewan S. Alam
- School of Kinesiology and Health Sciences, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Faruque Parvez
- Mailman School of Public Health, Columbia University, New York, New York
| | - Habibul Ahsan
- Department of Public Health Sciences, Biological Science Division, The University of Chicago, Chicago, Illinois
- UChicago Research Bangladesh, Dhaka, Bangladesh
- Mailman School of Public Health, Columbia University, New York, New York
- Institute for Population and Precision Health, The University of Chicago, Chicago, Illinois
| | | |
Collapse
|
26
|
High-sodium diet does not worsen endothelial function in female patients with postural tachycardia syndrome. Clin Auton Res 2021; 31:563-571. [PMID: 33689063 DOI: 10.1007/s10286-021-00772-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Postural tachycardia syndrome (POTS), a syndrome characterized by orthostatic symptoms and a heart rate increase of at least 30 beats per minute in the absence of hypotension upon standing, is often accompanied by increased sympathetic activity and low blood volume. A common non-pharmacologic recommendation for patients with POTS is a high-sodium (HS) diet with the goal of bolstering circulating blood volume. The objective of this study is to assess the effects of 6 days of a HS diet on endothelial function in POTS. METHODS A total of 14 patients with POTS and 13 age-matched healthy controls, all females, were studied following 6 days on a low-sodium (LS) diet (10 mEq/day) and 6 days on a HS diet (300 mEq/day) in a crossover design. We measured endothelial function following reactive hyperemia in the brachial artery using flow-mediated dilation (FMD), leg blood flow (LBF) using strain gauge plethysmography in the calf, and reactive hyperemic index (RHI) in the microcirculation of the hand using pulsatile arterial tonometry. RESULTS On the LS diet, FMD% did not differ between patients with POTS and the healthy controls although peak brachial artery diameter was lower for the patient group. RHI was higher for the patient group than for the controls, but there were no differences in post-ischemic LBF increase. On the HS diet, there were no between-group differences in FMD%, LBF increase, or RHI. CONCLUSION In summary, a HS diet for 6 days did not induce endothelial dysfunction. This non-pharmacologic treatment used for patients with POTS does not negatively affect endothelial function when used for a sub-acute duration. TRIAL REGISTRATION ClinicalTrials.gov NCT01550315; March 9, 2012.
Collapse
|
27
|
de Paula MP, Moraes AB, de Souza MDGC, Cavalari EMR, Campbell RC, Fernandes GDS, Farias MLF, Mendonça LMC, Madeira M, Bouskela E, Kraemer-Aguiar LG, Vieira Neto L. Cortisol level after dexamethasone suppression test in patients with non-functioning adrenal incidentaloma is positively associated with the duration of reactive hyperemia response on microvascular bed. J Endocrinol Invest 2021; 44:609-619. [PMID: 32686043 DOI: 10.1007/s40618-020-01360-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Data on endothelial derangements in patients with non-functioning adrenal incidentaloma (NFAI) are scarce. METHODS We investigated if NFAI patients present clinical, biochemical and endothelial alterations compared to individuals without an adrenal lesion and also the associations among these variables. Forty-two NFAI and 40 controls were evaluated. NFAI diagnosis and controls were defined according to the current guidelines and based on a normal adrenal imaging exam, respectively. Body composition was evaluated by dual emission X-ray absorptiometry. Endothelial reactivity was assessed by two methods: tonometry (Endo-PAT®) and laser speckle contrast imaging (LSCI). RESULTS There were no differences between groups regarding age, gender, ethnicity, smoking status, and statin use. The frequency of metabolic syndrome according to the International Diabetes Federation criteria was 69% and 57.9%, respectively in NFAI and controls (p = 0.36), whereas the atherosclerotic cardiovascular disease (ASCVD) risk was 63.4% and 66.7% (p = 0.81). The clinical, laboratory, and anthropometric characteristics, as well as body composition, were similar between the groups. Additionally, any differences between groups were observed on endothelial reactivity tests. Nevertheless, we noted an association between cortisol levels after 1 mg-dexamethosone suppression test (1 mg-DST) and the duration of post-occlusive reactive hyperemia tested on microcirculation (r = 0.30; p = 0.03). NFAI patients require more antihypertensive drugs to achieve blood pressure control (p = 0.04). The number of antihypertensive drugs used to control blood pressure correlated with cortisol levels after 1 mg-DST (r = 0.29; p = 0.03). CONCLUSIONS Since both groups herein investigated had a high frequency of metabolic syndrome and ASCVD risk, it might explain similarities observed on endothelial reactivity. Nevertheless, prolonged reactive hyperemia response on microcirculation was correlated with cortisol levels under suppression.
Collapse
Affiliation(s)
- M P de Paula
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - A B Moraes
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - M das Graças Coelho de Souza
- Laboratory for Clinical and Experimental Research on Vascular Biology, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - E M R Cavalari
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - R C Campbell
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - G da Silva Fernandes
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - M L F Farias
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - L M C Mendonça
- Department of Internal Medicine and Rheumatology Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil
| | - M Madeira
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil
| | - E Bouskela
- Laboratory for Clinical and Experimental Research on Vascular Biology, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - L G Kraemer-Aguiar
- Laboratory for Clinical and Experimental Research on Vascular Biology, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - L Vieira Neto
- Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Professor Rodolpho Paulo Rocco Street, 255, 9th Floor, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
28
|
Dutra-Clarke M, Tapia D, Curtin E, Rünger D, Lee GK, Lakatos A, Alandy-Dy Z, Freedkin L, Hall K, Ercelen N, Alandy-Dy J, Knight M, Pahl M, Lombardo D, Kimonis V. Variable clinical features of patients with Fabry disease and outcome of enzyme replacement therapy. Mol Genet Metab Rep 2021; 26:100700. [PMID: 33437642 PMCID: PMC7788237 DOI: 10.1016/j.ymgmr.2020.100700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/29/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency in the enzyme α-galactosidase A due to mutations in the GLA gene. This leads to an accumulation of globotriaosylceramide (GL-3) in many tissues, which results in progressive damage to the kidneys, heart, and nervous system. We present the molecular and clinical characteristics and long-term outcomes of FD patients from a multidisciplinary clinic at the University of California, Irvine treated with agalsidase beta enzyme replacement therapy (ERT) for 2-20 years. This cohort comprised 24 adults (11 males, 13 females) and two male children (median age 45; range 10-68 years). Of the 26 patients in this cohort, 20 were on ERT (12 males, 8 females). We describe one novel variant not previously reported in the literature in a patient with features of 'classic' FD. The vast majority of patients in this cohort presented with symptoms of 'classic' FD including peripheral neuropathic pain, some form of cardiac involvement, angiokeratomas, corneal verticillata, hypohidrosis, tinnitus, and gastrointestinal symptoms, primarily abdominal pain. The majority of males had clinically evident renal involvement. An annual eGFR reduction of -1.88 mL/min/1.73 m2/yr during the course of ERT was seen in this cohort. The most common renal presentation was proteinuria, and one individual required a renal transplant. Other common findings were pulmonary involvement, lymphedema, hearing loss, and significantly, three patients had strokes. Notably, there was a high prevalence of endocrine dysfunction and low bone mineral density, including several with osteoporosis. While enzyme replacement therapy (ERT) cleared plasma GL-3 in this cohort, there was limited improvement in renal function or health-related quality of life based on the patient-reported SF-36 Health Survey. Physical functioning significantly declined over the course of ERT treatment, which may be, in part, due to the late initiation of ERT in several patients. Further delineation of the phenotypic and genotypic spectrum in patients with FD and the long-term outcome of ERT will help improve management and treatment options for this disease.
Collapse
Affiliation(s)
- Marina Dutra-Clarke
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
- Division of Genetics, Department of Pediatrics, University of California, Los Angeles, CA, USA
| | - Daisy Tapia
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Emily Curtin
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Dennis Rünger
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Grace K. Lee
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Anita Lakatos
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
- Sue and Bill Gross Stem Cell Research Center, University of California, Irvine, CA, USA
| | - Zyza Alandy-Dy
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Linda Freedkin
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Kathy Hall
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Nesrin Ercelen
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
- Department of Genetics, Amerikan Hospital, Istanbul, Turkey
| | - Jousef Alandy-Dy
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Margaret Knight
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Madeleine Pahl
- Division of Nephrology, Department of Medicine, University of California, Irvine, CA, USA
| | - Dawn Lombardo
- Division of Cardiology, Department of Medicine, University of California, Irvine, CA, USA
| | - Virginia Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
- Department of Pathology, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
- Environmental and Occupational Health, University of California, Irvine, CA, USA
| |
Collapse
|
29
|
Cerqueira A, Quelhas-Santos J, Sampaio S, Ferreira I, Relvas M, Marques N, Dias CC, Pestana M. Endothelial Dysfunction Is Associated with Cerebrovascular Events in Pre-Dialysis CKD Patients: A Prospective Study. Life (Basel) 2021; 11:life11020128. [PMID: 33562195 PMCID: PMC7915587 DOI: 10.3390/life11020128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with chronic kidney disease (CKD) have markedly increased rates of end stage renal disease, major adverse cardiovascular/cerebrovascular events (MACCEs), and mortality. Endothelial dysfunction (ED) is an early marker of atherosclerosis that is emerging as an increasingly important non-traditional cardiovascular risk factor in CKD. There is a lack of clinical studies examining the association between ED and both cardiovascular and renal endpoints in patients with CKD. Aims: We examined the association between reactive hyperemia index (RHI), a validated measure of endothelial function measured by peripheral arterial tonometry (PAT), with traditional cardiovascular risk factors in pre-dialysis CKD patients and prospectively evaluated the role of RHI as predictor of renal and cardiovascular outcomes in this population. Methods: One hundred and twenty pre-dialysis patients with CKD stages 1 to 5 (CKD group) and 18 healthy kidney donor candidates (control group) were recruited and had a successful RHI measurement by PAT. General demographic and clinical information including traditional cardiovascular risk factors were registered from all participants. Thereafter, patients were prospectively followed-up for a median time of 47 (IQR 19–66) months to determine associations of RHI with renal outcomes, MACCEs, hospitalizations or mortality. Results: In the CKD patient population, the mean age was 57.7 ± 15.5 years, the mean eGFR was 54.9 ± 36.7 mL/min/1.73 m2 (CKD-EPI) and 57 were males (47.5%). At baseline, in univariate analysis, RHI in the CKD group correlated positively with eGFR (r = 0.332, p < 0.0001) and correlated negatively with age (r = −0.469, p < 0.0001), Charlson index (r = −0.399, p < 0.0001), systolic blood pressure (r = −0.256, p = 0.005), and proteinuria (r = 0.211, p = 0.027). Reactive hyperemia index in the control group did not significantly differ from RHI observed in patients with CKD stages 1 to 5 (2.09 ± 0.40 vs. 2.01 ± 0.06, p = 0.493). In adjusted analysis, only age (β = −0.014, p = 0.003) remained independently associated with RHI at baseline. During follow-up, 8 patients suffered a MACCEs, 33 patients experienced renal function deterioration, 17 patients were hospitalized for medical reasons and 6 patients died. RHI at baseline was not significantly associated with CKD progression (1.94 vs. 2.02, p = 0.584), hospitalizations (1.90 vs. 2.04, p = 0.334), and all-cause mortality (1.65 vs. 2.01, p = 0.208) or MACCEs (1.77 vs. 2.01, p = 0.356), but was significantly associated with cerebrovascular events (1.27 vs. 2.02, p = 0.004) and with a composite cardiovascular outcome (MACCEs, hospital admissions and death; 1.73 vs. 2.07, p = 0.035). Conclusion: Our results suggest that RHI may be a predictor for the development of cerebrovascular events in pre-dialysis CKD patients who may benefit from more aggressive preventive measures.
Collapse
Affiliation(s)
- Ana Cerqueira
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
- Correspondence: ; Tel.: +351-22-5512100; Fax: +351-22-5512228
| | | | - Susana Sampaio
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
| | - Inês Ferreira
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
| | - Miguel Relvas
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
| | - Nídia Marques
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
| | - Cláudia Camila Dias
- Department of Community Medicine Health Information and Decision, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal;
- CINTESIS–Center for Health Technology and Services Research, 4200-250 Porto, Portugal
| | - Manuel Pestana
- Nephrology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (S.S.); (I.F.); (M.R.); (N.M.); (M.P.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, 4200-250 Porto, Portugal
| |
Collapse
|
30
|
Chopoorian AH, Wahba A, Celedonio J, Nwazue V, Smith EC, Garland EM, Paranjape S, Okamoto LE, Black BK, Biaggioni I, Raj SR, Gamboa A. Impaired Endothelial Function in Patients With Postural Tachycardia Syndrome. Hypertension 2021; 77:1001-1009. [PMID: 33486983 DOI: 10.1161/hypertensionaha.120.16238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to evaluate endothelial function in postural tachycardia syndrome (PoTS), a poorly understood chronic condition characterized by a state of consistent orthostatic tachycardia (delta heart rate ≥30 beats per minute) upon standing without orthostatic hypotension. Nineteen patients with PoTS and 9 healthy controls were studied after 3 days of a fixed, caffeine-free, normal sodium (150 milliequivalents/day) diet. All participants underwent autonomic function testing, including sinus arrhythmia, valsalva maneuver, hyperventilation, cold pressor, handgrip, and a standing test with catecholamine measurements, followed by endothelial function testing. We analyzed 3 measures of endothelial function: percent brachial flow-mediated dilation, digital pulsatile arterial tonometry, and postischemic percent leg blood flow. Flow-mediated dilation was significantly lower in patients with PoTS (6.23±3.54% for PoTS) than in healthy controls (10.6±4.37% for controls versus, P=0.014). PoTS and controls had similar digital pulsatile arterial tonometry (1.93±0.40 arbitrary units for controls versus 2.13±0.63 arbitrary units for PoTS). PoTS had similar but suggestive percent leg blood flow to controls (313±158% for PoTS versus 468±236% for controls, P=0.098). Patients with PoTS have significantly reduced flow-mediated dilation compared with healthy controls, suggesting that PoTS is characterized by endothelial dysfunction in conduit arteries. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01308099.
Collapse
Affiliation(s)
- Abby H Chopoorian
- From the Vanderbilt University School of Medicine (A.H.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Amr Wahba
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Jorge Celedonio
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Victor Nwazue
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Emily C Smith
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Emily M Garland
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Sachin Paranjape
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Luis E Okamoto
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Bonnie K Black
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Italo Biaggioni
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology, Vanderbilt University, Nashville, TN (I.B.)
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (S.R.R.)
| | - Alfredo Gamboa
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
31
|
Taj T, Gliga AR, Hedmer M, Wahlberg K, Assarsson E, Lundh T, Tinnerberg H, Albin M, Broberg K. Effect of welding fumes on the cardiovascular system: a six-year longitudinal study. Scand J Work Environ Health 2021; 47:52-61. [PMID: 32725248 PMCID: PMC7801138 DOI: 10.5271/sjweh.3908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This study investigated whether low-to-moderate exposure to welding fumes is associated with adverse effects on the cardiovascular system. Methods To test this, we performed a longitudinal analysis of 78 mild steel welders and 96 controls; these subjects were examined twice, six years apart (ie, timepoints 1 and 2). All subjects (male and non-smoking at recruitment) completed questionnaires describing their health, work history, and lifestyle. We measured their blood pressure, endothelial function (by EndoPAT), and risk markers for cardiovascular disease [low-density lioprotein (LDL), homocysteine, C-reactive protein]. Exposure to welding fumes was assessed from the responses to questionnaires and measurements of respirable dust in their breathing zones adjusted for use of respiratory protection equipment. Linear mixed-effect regression models were used for the longitudinal analysis. Results Median respirable dust concentrations, adjusted for respirable protection, of the welders were 0.7 (5-95 percentile range 0.2-4.2) and 0.5 (0.1-1.9) mg/m 3at timepoints 1 and 2, respectively. Over the six-year period, welders showed a statistically significant increase in systolic [5.11 mm Hg, 95% confidence interval (CI) 1.92-8.31] and diastolic (3.12 mm Hg, 95% CI 0.74-5.5) blood pressure compared with controls (multi-variable adjusted mixed effect models). Diastolic blood pressure increased non-significantly by 0.22 mm Hg (95% CI -0.02-0.45) with every additional year of welding work. No consistent significant associations were found between exposure and endothelial function, LDL, homocysteine, or C-reactive protein. Conclusion Exposure to welding fumes at low-to-moderate levels is associated with increased blood pressure, suggesting that reducing the occupational exposure limit (2.5 mg/m 3for inorganic respirable dust in Sweden) is needed to protect cardiovascular health of workers.
Collapse
Affiliation(s)
- Tahir Taj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Babcock MC, DuBose LE, Witten TL, Brubaker A, Stauffer BL, Hildreth KL, Moreau KL. Assessment of macrovascular and microvascular function in aging males. J Appl Physiol (1985) 2020; 130:96-103. [PMID: 33151774 DOI: 10.1152/japplphysiol.00616.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aging is associated with reductions in endothelial function, observations primarily reported using brachial artery ultrasound. There is growing interest in the use of peripheral artery tonometry (PAT) of microvessels in the fingertip to assess endothelial function because it is less technically demanding and has a high sensitivity and specificity for assessing coronary endothelial function. Moreover, similar to brachial artery flow-mediated dilation (FMD), PAT predicts cardiovascular disease outcomes. However, the relationship between PAT and FMD have yet to be examined in the context of aging. To address this question, reactive hyperemic index (RHI) using EndoPAT and FMD using brachial artery ultrasound were assessed after 5 min of forearm ischemia in 20 younger (18-40 yr old; 29 ± 4 yr) and 20 older (60-75 yr old; 65 ± 4 yr) healthy adult men. Higher values of both FMD and RHI indicate better endothelial function. Endothelial function assessed via brachial artery FMD was lower in older (4.8 ± 2.1%), compared with younger (7.5 ± 1.6%) men (P < 0.001). In contrast, the RHI assessed via PAT was greater in older (2.2 ± 0.6), compared with younger (1.8 ± 0.5) men (P = 0.014). FMD and RHI were not correlated (r = -0.15; P = 0.35). We conclude that PAT may not be an appropriate measure to evaluate age-associated changes in endothelial function.NEW & NOTEWORTHY Microvessel endothelial function assessed via finger plethysmography may not reflect age-associated reductions in large artery endothelial function assessed via brachial artery flow-mediated dilation.
Collapse
Affiliation(s)
- Matthew C Babcock
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lyndsey E DuBose
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Teresa L Witten
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ashley Brubaker
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brian L Stauffer
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Division of Cardiology, Denver Health Medical Center, Denver, Colorado
| | - Kerry L Hildreth
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kerrie L Moreau
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Veterns Affairs Eastern Colorado Geriatric Research, Educational and Clinical Center, Denver, Colorado
| |
Collapse
|
33
|
Martini D, Marino M, Angelino D, Del Bo' C, Del Rio D, Riso P, Porrini M. Role of berries in vascular function: a systematic review of human intervention studies. Nutr Rev 2020; 78:189-206. [PMID: 31365093 DOI: 10.1093/nutrit/nuz053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Berries are a source of polyphenols with recognized health-promoting activities. Several studies suggest that consumption of berries may improve vascular function. OBJECTIVE The aim of this systematic review is to provide evidence of short- and long-term benefits of berries on outcomes of vascular function. DATA SOURCES Human intervention studies were collected from PubMed and Scopus databases. STUDY SELECTION Studies were eligible if they investigated the effects of acute or chronic berry consumption on one or more markers of vascular function in humans and provided a characterization of the berry polyphenolic content. Only randomized controlled trials were included, and studies were excluded if berries were combined with other foods. DATA EXTRACTION After selection, 22 randomized controlled trials were included and analyzed, most of which were performed in healthy individuals or patients with cardiovascular risk factors. RESULTS The overall results seem to suggest a protective role of berries in vascular function, likely dependent on the time of exposure, the type and dose of berry, and the biomarkers analyzed. Flow-mediated dilation and reactive hyperemia index (markers of vascular reactivity) improved following short-term interventions, while pulse wave velocity and augmentation index (markers of arterial stiffness) improved only after medium- to long-term intervention. CONCLUSIONS Current evidence suggests that berries, at physiological relevant doses, may have a role in the modulation of vascular function and stiffness. High-quality human intervention trials are encouraged in order to strengthen these findings and to better elucidate the mechanisms involved in such modulation.
Collapse
Affiliation(s)
- Daniela Martini
- D. Martini, D. Angelino, and D. Del Rio are with the Laboratory of Phytochemicals in Physiology, Department of Veterinary Sciences, University of Parma, Parma, Italy
| | - Mirko Marino
- M. Marino, C. Del Bo', P. Riso, and M. Porrini are with the Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, Milan, Italy
| | - Donato Angelino
- D. Martini, D. Angelino, and D. Del Rio are with the Laboratory of Phytochemicals in Physiology, Department of Veterinary Sciences, University of Parma, Parma, Italy
| | - Cristian Del Bo'
- M. Marino, C. Del Bo', P. Riso, and M. Porrini are with the Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, Milan, Italy
| | - Daniele Del Rio
- D. Martini, D. Angelino, and D. Del Rio are with the Laboratory of Phytochemicals in Physiology, Department of Veterinary Sciences, University of Parma, Parma, Italy
| | - Patrizia Riso
- M. Marino, C. Del Bo', P. Riso, and M. Porrini are with the Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, Milan, Italy
| | - Marisa Porrini
- M. Marino, C. Del Bo', P. Riso, and M. Porrini are with the Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, Milan, Italy
| |
Collapse
|
34
|
Hermans MP, Lempereur P, Salembier JP, Maes N, Albert A, Jansen O, Pincemail J. Supplementation Effect of a Combination of Olive ( Olea europea L.) Leaf and Fruit Extracts in the Clinical Management of Hypertension and Metabolic Syndrome. Antioxidants (Basel) 2020; 9:antiox9090872. [PMID: 32942738 PMCID: PMC7554871 DOI: 10.3390/antiox9090872] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The role of herbal products in the prevention of cardiovascular disease requires supporting evidence. This open pilot study assessed the effect of 2-month supplementation of a combination of olive leaf and fruit extracts (Tensiofytol®, Tilman SA, Baillonville, Belgium) in the clinical management of hypertension and metabolic syndrome (MetS). METHODS A total of 663 (pre)-hypertensive patients were enrolled by general practitioners and supplemented for two months with Tensiofytol®, two capsules per day (100 mg/d of oleuropein and 20 mg/d of hydroxytyrosol). Systolic and diastolic blood pressures (SBP/DBP) were measured before and after treatment. Markers of MetS, high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting blood glucose (FG) and waist circumference (WC), were also examined. RESULTS Significant reductions (p < 0.0001) in SBP/DBP (13 ± 10/7.1 ± 6.6 mmHg) were observed and similarly in pre-diabetic and diabetic patients. Improvements in SBP/DPB were independent of age and gender but greater for elevated baseline SBP/DBP. Tensiofytol® supplementation also significantly improved markers of MetS, with a decrease of TG (11%), WC (1.4%) and FG (4.8%) and an increase of HDL-C (5.3%). Minor side effects were reported in 3.2% patients. CONCLUSIONS This real-life, observational, non-controlled, non-randomized pilot study shows that supplementation of a combination of olive leaf and fruit extracts may be used efficiently and safely in reducing hypertension and MetS markers.
Collapse
Affiliation(s)
- Michel P. Hermans
- Service d’Endocrinologie et de Nutrition and Pôle Endocrinologie, Diabète et Nutrition (EDIN), Institut de Recherche expérimentale et clinique, UCLouvain, 1200 Brussels, Belgium;
| | - Philippe Lempereur
- Service de Cardiologie, Centre Hospitalier Bois de l’Abbaye, 4100 Seraing, Belgium;
| | - Jean-Paul Salembier
- Service de Cardiologie, CHU UCL Namur - site Sainte-Elisabeth, 5000 Namur, Belgium;
| | - Nathalie Maes
- Biostatistics and Medico-economic Information Department, University Hospital of Liège, 4000 Liège, Belgium; (N.M.); (A.A.)
| | - Adelin Albert
- Biostatistics and Medico-economic Information Department, University Hospital of Liège, 4000 Liège, Belgium; (N.M.); (A.A.)
| | - Olivia Jansen
- Laboratoire de Pharmacognosie, Centre Interdisciplinaire de Recherche sur le Médicament (CIRM), Université de Liège, 4000 Liège, Belgium;
| | - Joël Pincemail
- Department of Cardiovascular Surgery, CREDEC and Platform Nutrition Antioxydante et Santé, CHU and University of Liège, Sart Tilman, 4000 Liège, Belgium
- Correspondence:
| |
Collapse
|
35
|
Cardiac Rehabilitation and Endothelial Function. J Clin Med 2020; 9:jcm9082487. [PMID: 32756306 PMCID: PMC7463659 DOI: 10.3390/jcm9082487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022] Open
Abstract
Endothelial dysfunction is an early abnormality in the process of atherosclerosis and cardiovascular disease and has been associated with worse clinical outcome. Cardiac rehabilitation (CR) has been reported to be helpful to reduce cardiovascular events in various types of cardiac disease, but the mechanisms of its beneficial effects remain only partially known. In this article, we review the studies that assessed the effect of CR on endothelial function in patients with various cardiac conditions. Available data show that CR significantly improves impaired endothelial function in these patients, which may contribute to the beneficial effects of CR on clinical outcome.
Collapse
|
36
|
Takeda Y, Matoba K, Sekiguchi K, Nagai Y, Yokota T, Utsunomiya K, Nishimura R. Endothelial Dysfunction in Diabetes. Biomedicines 2020; 8:E182. [PMID: 32610588 PMCID: PMC7400447 DOI: 10.3390/biomedicines8070182] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
Diabetes is a worldwide health issue closely associated with cardiovascular events. Given the pandemic of obesity, the identification of the basic underpinnings of vascular disease is strongly needed. Emerging evidence has suggested that endothelial dysfunction is a critical step in the progression of atherosclerosis. However, how diabetes affects the endothelium is poorly understood. Experimental and clinical studies have illuminated the tight link between insulin resistance and endothelial dysfunction. In addition, macrophage polarization from M2 towards M1 contributes to the process of endothelial damage. The possibility that novel classes of anti-hyperglycemic agents exert beneficial effects on the endothelial function and macrophage polarization has been raised. In this review, we discuss the current status of knowledge regarding the pathological significance of insulin signaling in endothelium. Finally, we summarize recent therapeutic strategies against endothelial dysfunction with an emphasis on macrophage polarity.
Collapse
Affiliation(s)
- Yusuke Takeda
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.T.); (K.S.); (Y.N.); (T.Y.); (R.N.)
| | - Keiichiro Matoba
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.T.); (K.S.); (Y.N.); (T.Y.); (R.N.)
| | - Kensuke Sekiguchi
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.T.); (K.S.); (Y.N.); (T.Y.); (R.N.)
| | - Yosuke Nagai
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.T.); (K.S.); (Y.N.); (T.Y.); (R.N.)
| | - Tamotsu Yokota
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.T.); (K.S.); (Y.N.); (T.Y.); (R.N.)
| | - Kazunori Utsunomiya
- Center for Preventive Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
| | - Rimei Nishimura
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (Y.T.); (K.S.); (Y.N.); (T.Y.); (R.N.)
| |
Collapse
|
37
|
Profiling the endothelial function using both peripheral artery tonometry (EndoPAT) and Laser Doppler Flowmetry (LD) - Complementary studies or waste of time? Microvasc Res 2020; 130:104008. [PMID: 32330479 DOI: 10.1016/j.mvr.2020.104008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction (ED) plays a key role in developing of cardiovascular diseases and is an important predictor of future cardiovascular events. Nevertheless, there is no established method assessing endothelial function in general population. The most popular protocol includes the ultrasound-flow-mediated-dilation, but its repeatability is operator-dependent. We intended to compare the two other operator-independent methods assessing endothelial function - the EndoPAT and Laser Doppler flowmetry (LD), and we endeavored to place them on current individual profile of biochemical cardiovascular risk and endothelial function. A total of 61 clinically healthy subjects (aged 29 ± 1y) were investigated. The blood was collected for conventional cardiovascular risk markers, the NO-pathway metabolites (ADMA, L-arginine, SDMA), oxidative-stress-markers (MDA, thiol-index) as well as endothelial and platelet activation markers (sICAM1, sVCAM1, PAI-1, sE-selectin, sP-selectin, VEGF). Subsequently, all participants underwent examination by both EndoPAT and LD. There was a poor correlation between EndoPAT and LD results. No significant differences between participants with preserved and impaired endothelial function regarding endothelial activation nor cardiovascular risk markers were observed. Both methods assess endothelial function independently from the profile of endothelial pro/anti-inflammatory status and conventional risk factors, therefore further prospective studies are needed in order to verify their additional value in the cardiovascular risk stratification.
Collapse
|
38
|
Pereira de Araujo CL, Pereira Reinaldo G, Foscarini BG, Ferreira Schneider B, Moraes Menezes VJ, Dal Lago P. The effects of pulmonary rehabilitation on endothelial function and arterial stiffness in patients with chronic obstructive pulmonary disease. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1820. [DOI: 10.1002/pri.1820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/04/2019] [Accepted: 11/01/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Cintia Laura Pereira de Araujo
- Programa de Pós‐Graduação em Ciências da SaúdeUniversidade Federal de Ciências de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC)Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Gustavo Pereira Reinaldo
- Programa de Pós‐Graduação em Ciências da SaúdeUniversidade Federal de Ciências de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC)Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Betina Gabriele Foscarini
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC)Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Bárbara Ferreira Schneider
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC)Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Vlademir Junior Moraes Menezes
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC)Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Pedro Dal Lago
- Programa de Pós‐Graduação em Ciências da SaúdeUniversidade Federal de Ciências de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC)Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| |
Collapse
|
39
|
Camacho OM, Hedge A, Lowe F, Newland N, Gale N, McEwan M, Proctor C. Statistical analysis plan for "A randomised, controlled study to evaluate the effects of switching from cigarette smoking to using a tobacco heating product on health effect indicators in healthy subjects". Contemp Clin Trials Commun 2020; 17:100535. [PMID: 32072070 PMCID: PMC7013164 DOI: 10.1016/j.conctc.2020.100535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 02/06/2023] Open
Abstract
Tobacco harm reduction strategies aim to substitute smoking with potentially reduced risk products (PRRPs) such as e-cigarettes and tobacco-heating products (THPs). The health benefits of switching from smoking to PRRPs is unknown. A randomised controlled trial is being conducted to increase understanding of the health effects of switching from smoking to a THP in a 12-month long ambulatory study (ISRCTN81075760). Here we describe the study endpoints and the statistical analysis plan. Endpoints are divided into biomarkers of exposure (BoE) to tobacco smoke constituents and health effect indicators related to risk of lung cancer, cardiovascular and obstructive lung disease. These have been selected on the basis of extensive literature evidence. Three primary endpoints, augmentation index (risk factor for cardiovascular disease), total NNAL (linked to lung cancer) and 8-Epi-PGF2α type III (indicator of oxidative stress linked to various diseases), and multiple secondary endpoints will be analysed at 90, 180, and 360 days. Changes from baseline will be compared between study arms by specific contrasts in mixed models. Study wise multiple comparisons adjustments will be performed to account for multiplicity of timepoints and comparisons within timepoints. Generalisability of outcomes will be tested by a sensitivity analysis adjusting for age and gender. Importantly, an ancillary analysis will be performed to assess product compliance during the study based on plasma levels of CEVal, a surrogate marker for acrylonitrile exposure. The rationale underlying the selection of BoEs and health effect indicators, coupled with the statistical analysis plan will be central to understanding the potential health effects of replacing smoking with THP use for one year.
Collapse
Affiliation(s)
- Oscar M. Camacho
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Andrew Hedge
- Covance Clinical Research Unit Ltd, Springfield House, Hyde Street, Leeds, Yorkshire, LS2 9LH, UK
| | - Frazer Lowe
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Nik Newland
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Nathan Gale
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Mike McEwan
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Christopher Proctor
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| |
Collapse
|
40
|
Sharabi-Nov A, Kumar K, Fabjan Vodušek V, Premru Sršen T, Tul N, Fabjan T, Meiri H, Nicolaides KH, Osredkar J. Establishing a Differential Marker Profile for Pregnancy Complications Near Delivery. Fetal Diagn Ther 2019; 47:471-484. [PMID: 31778996 DOI: 10.1159/000502177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to define a differential marker profile for pregnancy complications near delivery. METHODS We enrolled pregnant women who were referred to the outpatient pregnancy clinic of the University Medical Center, Ljubljana, Slovenia, due to symptoms of pregnancy complications and women with a history of pregnancy complications attending the high-risk hospital clinic for close surveillance. They were evaluated for prior risk and were tested for biophysical and biochemical markers at the time of enrolment. Biochemical markers included the pro- and anti-angiogenic markers, along with additional previously reported markers of potential value, all tested by various formats of immuno-diagnostics. Biophysical markers included blood pressure, sonographic markers, and EndoPAT. Statistical differences were determined with Kruskal-Wallis and Mann-Whitney tests for continuous parameters, and Pearson χ2 for categorical values. p < 0.05 was considered significant. RESULTS The cohort included 125 pregnant patients, 31 developed preeclampsia (PE) alone (13 were <34 weeks' gestation), 16 had intrauterine growth restriction (IUGR) alone (12 were <34 weeks), 42 had both IUGR and PE (22 were <34 weeks), and 15 had an iatrogenic preterm delivery (PTD; 6 were <34 weeks). Twenty-one were unaffected and delivered a healthy baby at term. Mean arterial blood pressure and proteinuria were significantly higher in PE and PE+IUGR but not in pure IUGR or PTD. In PE, IUGR, and PE+IUGR, the levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng) were significantly higher, while placental growth factor (PlGF) was very low compared to unaffected controls and PTD. PE, IUGR, and PE+IUGR also had a high anti-angiogenic ratio (sFlt-1/PlGF) and a low proangiogenic ratio of PlGF/(sFlt-1+Eng). Levels of inhibin A were significantly higher in pure PE across subgroups but had many extreme values, which made it a poor differentiator. Higher uterine artery Doppler pulsatility indexes were detected in PE, IUGR, and PE+IUGR, with similar resistance indexes and peaks of systolic velocity. A significantly different marker level between PE and IUGR was found using arterial stiffness that was 10 times higher in PE; concurrently with an increase of the reactive hyperemia index, both were accompanied by a slight increase in placental protein 13. Higher tumor necrosis factor alpha (TNFα) differentially identified iatrogenic very early PTD (<34 weeks). CONCLUSION Arterial stiffness can serve as a major marker to differentiate PE (with/without IUGR) from pure IUGR near delivery. TNFα can differentiate iatrogenic early PTD from other complications of pregnancy and term IUGR.
Collapse
Affiliation(s)
| | - Kristina Kumar
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Vesna Fabjan Vodušek
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tanja Premru Sršen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Tul
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Women's Hospital Postojna, Postojna, Slovenia
| | - Teja Fabjan
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | | | - Kypros H Nicolaides
- The Fetal Medicine Institute and Fetal Medicine Foundation, London, United Kingdom
| | - Joško Osredkar
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
41
|
Chen ZW, Tsai CH, Pan CT, Chou CH, Liao CW, Hung CS, Wu VC, Lin YH. Endothelial Dysfunction in Primary Aldosteronism. Int J Mol Sci 2019; 20:ijms20205214. [PMID: 31640178 PMCID: PMC6829211 DOI: 10.3390/ijms20205214] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023] Open
Abstract
Primary aldosteronism (PA) is characterized by excess production of aldosterone from the adrenal glands and is the most common and treatable cause of secondary hypertension. Aldosterone is a mineralocorticoid hormone that participates in the regulation of electrolyte balance, blood pressure, and tissue remodeling. The excess of aldosterone caused by PA results in an increase in cardiovascular and cerebrovascular complications, including coronary artery disease, myocardial infarction, stroke, transient ischemic attack, and even arrhythmia and heart failure. Endothelial dysfunction is a well-established fundamental cause of cardiovascular diseases and also a predictor of worse clinical outcomes. Accumulating evidence indicates that aldosterone plays an important role in the initiation and progression of endothelial dysfunction. Several mechanisms have been shown to contribute to aldosterone-induced endothelial dysfunction, including aldosterone-mediated vascular tone dysfunction, aldosterone- and endothelium-mediated vascular inflammation, aldosterone-related atherosclerosis, and vascular remodeling. These mechanisms are activated by aldosterone through genomic and nongenomic pathways in mineralocorticoid receptor-dependent and independent manners. In addition, other cells have also been shown to participate in these mechanisms. The complex interactions among endothelium, inflammatory cells, vascular smooth muscle cells and fibroblasts are crucial for aldosterone-mediated endothelial dysregulation. In this review, we discuss the association between aldosterone and endothelial function and the complex mechanisms from a molecular aspect. Furthermore, we also review current clinical research of endothelial dysfunction in patients with PA.
Collapse
Affiliation(s)
- Zheng-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
- Cardiovascular center, National Taiwan University Hospital, Taipei 10002, Taiwan.
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 64041, Taiwan.
| | - Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
- Cardiovascular center, National Taiwan University Hospital, Taipei 10002, Taiwan.
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City 20844, Taiwan.
| | - Chien-Ting Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
- Cardiovascular center, National Taiwan University Hospital, Taipei 10002, Taiwan.
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 64041, Taiwan.
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10041, Taiwan.
| | - Che-Wei Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan.
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
- Cardiovascular center, National Taiwan University Hospital, Taipei 10002, Taiwan.
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
- Cardiovascular center, National Taiwan University Hospital, Taipei 10002, Taiwan.
| |
Collapse
|
42
|
Abstract
Passive exercise/movement has a long history in both medicine and physiology. Early clinical applications of passive exercise/movement utilized pneumatic and direct limb compression to stimulate the vasculature and evoke changes in blood flow to avoid complications brought about by stasis and vascular disease. Over the last 50 years, passive exercise/movement has continued to progress and has provided physiologists with a reductionist approach to mechanistically examine the cardiorespiratory, hyperemic, and afferent responses to movement without the confounding influence of metabolism that accompanies active exercise. This review, in addition to providing an historical perspective, focuses on the recent advancements utilizing passive leg movement, and how the hyperemic response at the onset of this passive movement has evolved from a method to evaluate the central and peripheral regulation of blood flow during exercise to an innovative and promising tool to assess vascular function. As an assessment of vascular function, passive leg movement is relatively simple to perform and provides a nitric oxide-dependent evaluation of endothelial function across the lifespan that is sensitive to changes in activity/fitness and disease state (heart failure, peripheral artery disease, sepsis). The continual refinement and characterization of passive leg movement are aimed at improving our understanding of blood flow regulation and the development of a clinically ready approach to predict and monitor the progression of cardiovascular disease.
Collapse
Affiliation(s)
- Joel D Trinity
- George E Wahlen Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Bldg 2, RM 1D29A, 500 Foothill Dr., Salt Lake City, UT, 84148, USA.
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA.
| | - Russell S Richardson
- George E Wahlen Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Bldg 2, RM 1D29A, 500 Foothill Dr., Salt Lake City, UT, 84148, USA
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
43
|
Wang L, Huang X, He W, Liu W, Yang J. Digital microvascular reactivity does not decline with impaired renal function in chronic kidney disease. BMC Nephrol 2019; 20:288. [PMID: 31362711 PMCID: PMC6668185 DOI: 10.1186/s12882-019-1484-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background The reactive hyperemia index (RHI), measured by peripheral arterial tonometry (PAT), is a novel measurement of endothelial function and has been proven to be valuable in cardiovascular risk stratification in several populations. The current study aims to explore its relation to renal function and its association with traditional cardiovascular risk factors in patients with chronic kidney disease (CKD). Methods Subjects with non-dialysis dependent CKD were recruited and 252 of them had a successful PAT test. In addition to general demographic and medical information, carotid-femoral pulse wave velocity (cfPWV), carotid-radial pulse wave velocity (crPWV) and augmentation index (AIx) were recorded. Results The mean age of the study population was 57.7 (±14.7) years and 155 (61.5%) were males. The average RHI was 1.92 (±14.7) with no difference noted between males and females. There was no statistically significant correlation between RHI and eGFR (r = − 0.107, p = 0.089) or urine protein-to-creatinine ratio (r = 0.036, p = 0.570). With adjustment for age and sex, RHI was associated with systolic blood pressure (BP) (β = 0.006, p = 0.001), diastolic BP (β = 0.008, p = 0.010), heart rate (β = − 0.007, p = 0.015) crPWV (β = 0.037, p = 0.022) and AIx (β = 0.006, p = 0.001), but not with cfPWV or any other conventional risk factors analyzed. Systolic BP remained the only predictor for RHI in the stepwise regression analysis. Conclusions RHI did not decline with reduced renal function in CKD patients and had a modest association with traditional cardiovascular risk factors. Further studies are warranted to determine if RHI could predict cardiovascular outcome in CKD patients.
Collapse
Affiliation(s)
- Lulu Wang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China
| | - Xiaoqin Huang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China
| | - Weichun He
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China
| | - Wenjin Liu
- Department of Radiology, University of Washington, 850 Republican Street, Seattle, 98109, USA.
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# North Zhongshan Road, Nanjing, 210003, China.
| |
Collapse
|
44
|
Somani YB, Pawelczyk JA, De Souza MJ, Kris-Etherton PM, Proctor DN. Aging women and their endothelium: probing the relative role of estrogen on vasodilator function. Am J Physiol Heart Circ Physiol 2019; 317:H395-H404. [PMID: 31173499 DOI: 10.1152/ajpheart.00430.2018] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite significant decreases in cardiovascular disease (CVD) mortality in the past three decades, it still remains the leading cause of death in women. Following menopause and the accompanying loss of estrogen, women experience a unique, accelerated rise in CVD risk factors. Dysfunction of the endothelium represents an important antecedent to CVD development, with rapid declines in endothelial vasodilator function reportedly taking place across the menopause transition. Importantly, the decline in endothelial function is independent of chronological age and is associated with estrogen deficiency. Estrogen-mediated effects, including increasing nitric oxide bioavailability and attenuating oxidative stress and inflammation, contribute to preserving endothelial health. This review will discuss studies that have probed the role of estrogen on endothelial vasodilator function in women at discrete stages of the menopause transition and the effects of estradiol supplementation in postmenopausal women. Estrogen receptor signaling is also an important aspect of endothelial function in women, and studies suggest that expression is reduced with both acute and prolonged estrogen deficiency. Changes in regulatory mechanisms of estrogen receptor-α expression as well as sensitivity to estrogen may underlie the differential effects of estrogen therapy in early (≤5 yr past final menstrual period) and late postmenopausal women (>5 yr past final menstrual period). Lastly, this review presents potential therapeutic targets that include increasing l-arginine bioavailability and estrogen receptor activation to prevent endothelial dysfunction in postmenopausal women as a strategy for decreasing CVD mortality in this high-risk population.
Collapse
Affiliation(s)
- Yasina B Somani
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania
| | - James A Pawelczyk
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania
| | - Mary Jane De Souza
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - David N Proctor
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
45
|
Venuraju S, Jeevarethinam A, Mehta VS, Ruano S, Dumo A, Nair D, Rosenthal M, Darko D, Cohen M, Rakhit R, Lahiri A. Predicting Severity of Coronary Artery Disease in Patients With Diabetes Using Endothelial Function Measured With Peripheral Arterial Tonometry: PROCEED Study. Angiology 2019; 70:613-620. [PMID: 30813747 DOI: 10.1177/0003319719833265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Endothelial dysfunction is common in patients with type 2 diabetes mellitus (T2DM) and is associated with atherosclerotic disease. This study aimed to determine prognostic factors for endothelial dysfunction and identify relationships between reactive hyperemia index (RHI) score, clinically relevant coronary artery disease (>50% stenosis), and major adverse cardiovascular events (MACEs) in patients with T2DM. Endothelial function was assessed using peripheral arterial tonometry and correlated with patient characteristics and cardiovascular outcomes during a median follow-up of 22.8 months. Among 235 patients with a median duration of T2DM of 13 years, mean (standard deviation) RHI score was 2.00 (0.76). Serum low- and high-density lipoprotein cholesterol levels positively (P = .004) and negatively (P = .02) predicted RHI score, respectively. Median coronary artery calcium (CAC) score was 109 Agatston units, but no correlation between CAC and RHI scores was observed. The RHI score did not predict the number or severity of coronary plaques identified using computed tomography coronary angiography. Additionally, there was no association between RHI score and the risk of an MACE during follow-up. Overall, endothelial function was not predictive of CAC score, extent, and severity of coronary plaque or MACEs and did not demonstrate utility in cardiovascular risk stratifying patients with T2DM.
Collapse
Affiliation(s)
- Shreenidhi Venuraju
- 1 Bedford Hospital, Bedford, United Kingdom.,2 Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Anand Jeevarethinam
- 2 Institute of Cardiovascular Science, University College London, London, United Kingdom.,3 Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | | | - Alain Dumo
- 1 Bedford Hospital, Bedford, United Kingdom
| | - Devaki Nair
- 5 Department of Diabetes and Endocrinology, Royal Free Hospital, London, United Kingdom
| | - Miranda Rosenthal
- 5 Department of Diabetes and Endocrinology, Royal Free Hospital, London, United Kingdom
| | | | - Mark Cohen
- 4 Barnet Hospital, London, United Kingdom
| | - Roby Rakhit
- 2 Institute of Cardiovascular Science, University College London, London, United Kingdom.,5 Department of Diabetes and Endocrinology, Royal Free Hospital, London, United Kingdom
| | - Avijit Lahiri
- 6 Imperial College School of Medicine, London, United Kingdom.,7 Healthcare Science, Middlesex University, London, United Kingdom.,8 Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom
| |
Collapse
|
46
|
Haldar S, Pakkiri LS, Lim J, Chia SC, Ponnalagu S, Drum CL, Henry CJ. Reductions in Postprandial Plasma Allantoin Concentrations With Increasing Doses of Polyphenol Rich Curry Intake - A Randomized Crossover Trial. Front Physiol 2019; 9:1899. [PMID: 30687117 PMCID: PMC6333854 DOI: 10.3389/fphys.2018.01899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/18/2018] [Indexed: 12/15/2022] Open
Abstract
While dietary or supplementary antioxidants are thought to inhibit or delay oxidation of biological molecules, their utility in vivo has been marred by equivocal evidence. Consumption of polyphenol rich foods has been thought to alleviate postprandial oxidative stress and/or improve endothelial function. Although, previous studies suggested the utility of allantoin as a biomarker of oxidative stress, controlled dose response studies with dietary antioxidants to test this in humans have been limited. We therefore investigated the effects of 2 doses of polyphenol rich curry consumption on postprandial plasma concentrations of allantoin, allantoin to uric acid ratio, F2-isoprostanes using liquid chromatography-tandem mass spectrometry (LCMS-MS) and measured endothelial function using peripheral arterial tonometry (endoPAT). In a randomized controlled crossover trial in 17 non-smoking, healthy, Chinese men, aged 23.7 ± 2.4 years and BMI 23.1 ± 2.3 kg/m2, the volunteers consumed 3 test meals in a random order, consisting of either non-curry Dose 0 Control (D0C, 0 g spices), or Dose 1 Curry (D1C, 6 g spices) or Dose 2 Curry (D2C, 12 g spices), after overnight fast. There were significant reductions in postprandial allantoin concentrations (p < 0.001) and allantoin to uric acid ratio (p < 0.001) at 2 h and 3 h following test meal consumption, indicating improvements in postprandial redox balance with increasing curry doses, although there were no differences between treatments on F2-isoprostane concentrations or on RHI (measured at 2 h only). Allantoin may have a utility as a biomarker of redox balance, in an acute setting. The study was registered at www.clinicaltrials.gov (Identifier No. NCT02599272).
Collapse
Affiliation(s)
- Sumanto Haldar
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Leroy Sivappiragasam Pakkiri
- Cardiovascular Research Institute, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph Lim
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Siok Ching Chia
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shalini Ponnalagu
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Chester Lee Drum
- Cardiovascular Research Institute, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Biochemistry, National University of Singapore, Singapore, Singapore
| |
Collapse
|
47
|
Morgillo S, Hill AM, Coates AM. The Effects of Nut Consumption on Vascular Function. Nutrients 2019; 11:nu11010116. [PMID: 30626111 PMCID: PMC6356931 DOI: 10.3390/nu11010116] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 01/23/2023] Open
Abstract
Vascular stiffness can be measured using numerous techniques including assessments of central haemodynamics, aortic arterial stiffness, and indices of aortic wave reflection and endothelial dilatation. Impaired vascular function is associated with increased risk of cardiovascular disease (CVD). Epidemiological studies indicate that regular nut consumption reduces CVD risk, with one of the proposed mechanisms being via improvements in vascular function. This narrative review summarizes the evidence from a systematic search of the literature of the effects of tree nut and peanut consumption on measures of vascular function excluding flow mediated dilatation. A total of 16 studies were identified, with a mix of acute controlled studies (n = 3), an uncontrolled pre/post chronic study (n = 1), chronic crossover (n = 7) and parallel studies (n = 5). Nut types tested included almonds, peanuts, pine nuts, pistachios and walnuts, with dose and length of supplementation varying greatly across studies. Most studies (n = 13) included individuals at risk for CVD, according to various criteria. Findings were inconsistent, with ten studies reporting no significant changes in vascular function and six studies (one acute and five chronic studies) reporting improvements in at least one measure of vascular function. In summary, nuts have the potential to improve vascular function and future studies should consider the population, dose and length of nut supplementation as well as suitability of the different vascular function techniques.
Collapse
Affiliation(s)
- Samantha Morgillo
- School of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Alison M Hill
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Alison M Coates
- School of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| |
Collapse
|
48
|
Masopustová A, Jehlička P, Huml M, Votava T, Trefil L, Kreslová M, Sýkora J. Plethysmographic and biochemical markers in the diagnosis of endothelial dysfunction in pediatric acute lymphoblastic leukemia survivors - new applications. Physiol Res 2018; 67:903-909. [PMID: 30204466 DOI: 10.33549/physiolres.933754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) and its treatment are associated with endothelial dysfunction (ED) and increased cardiovascular risk in adulthood. There are no data on ED in children after successful treatment of ALL. We aimed to assess new ED in these children using the plethysmographic reactive hyperemia index (RHI) and biomarkers that are known to be related to ED. In all, 22 children (mean 15.6 years), after successful treatment of ALL, and 18 healthy subjects were included in this prospective study. RHI, plasma concentrations of asymmetric dimethyl arginine (ADMA), high-sensitive CRP (hsCRP) and E-selectin were measured in all children. RHI values were significantly lower in ALL patients when compared with healthy controls (p<0.05). hsCRP was significantly increased in ALL patients compared with the control group (p<0.001). E-selectin plasma levels were higher in ALL patients as compared to healthy controls (p=0.05). This is the first study that combines both plethysmographic and biochemical methods to assess ED in ALL survivors. Significantly decreased RHI with elevated plasma concentrations of biochemical markers imply a possible association with premature ED in ALL patients. The combined diagnostic approach seems to be a valuable tool for more accurate detection of ED and preventive cardiovascular management in these patients.
Collapse
Affiliation(s)
- A Masopustová
- Department of Pediatrics, Faculty of Medicine in Pilsen, Faculty Hospital, Charles University in Prague, Pilsen, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
49
|
Cunha N, Machado AP. Proton pump inhibitors and the risk of severe adverse events - A cardiovascular bombshell? Rev Port Cardiol 2018; 37:859-863. [PMID: 29804887 DOI: 10.1016/j.repc.2017.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/08/2017] [Indexed: 10/16/2022] Open
Abstract
Proton pump inhibitors are currently one of the most prescribed pharmacological classes in developed countries, given their effectiveness and safety profile, which has until now been considered favorable. However, in recent years, several papers have been published that associate prolonged use of these drugs with a wide range of adverse effects, posing doubts about their safety. Among the adverse effects described is an increased risk of cardiovascular events. This relationship was first described in subjects after acute coronary syndrome due to the interference of proton pump inhibitors in the cytochrome P450 2C19 and the conversion of clopidogrel to its active metabolite. More recent studies have also reported this relationship with the use of antiplatelet agents that do not depend on cytochrome P450 2C19 activation. The proposed mechanism is inhibition of dimethylarginine dimethylaminohydrolase, a physiological inhibitor of asymmetric dimethylarginine, which increases plasma concentrations of the latter enzyme, leading to lower levels of nitric oxide. By reviewing in this article the relationship between the use of proton pump inhibitors and increased risk of cardiovascular and cerebrovascular events, the authors aim to alert the medical community to the potentially harmful effects of these drugs, and recommend the setting of a moratorium on their prolonged use.
Collapse
Affiliation(s)
- Nelson Cunha
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHLN), Centro Académico de Medicina de Lisboa e CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | | |
Collapse
|
50
|
Mannaerts D, Faes E, Gielis J, Van Craenenbroeck E, Cos P, Spaanderman M, Gyselaers W, Cornette J, Jacquemyn Y. Oxidative stress and endothelial function in normal pregnancy versus pre-eclampsia, a combined longitudinal and case control study. BMC Pregnancy Childbirth 2018; 18:60. [PMID: 29482567 PMCID: PMC5827979 DOI: 10.1186/s12884-018-1685-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pre-eclampsia (PE) is related to an impaired endothelial function. Endothelial dysfunction accounts for altered vascular reactivity, activation of the coagulation cascade and loss of vascular integrity. Impaired endothelial function originates from production of inflammatory and cytotoxic factors by the ischemic placenta and results in systemic oxidative stress (OS) and an altered bioavailability of nitric oxide (•NO). The free radical •NO, is an endogenous endothelium-derived relaxing factor influencing endothelial function. In placental circulation, endothelial release of •NO dilates the fetal placental vascular bed, ensuring feto-maternal exchange. The Endopreg study was designed to evaluate in vivo endothelial function and to quantify in vitro OS in normal and pre-eclamptic pregnancies. Methods/design The study is divided into two arms, a prospective longitudinal study and a matched case control study. In the longitudinal study, pregnant patients ≥18 years old with a singleton pregnancy will be followed throughout pregnancy and until 6 months post-partum. In the case control study, cases with PE will be compared to matched normotensive pregnant women. Maternal blood concentration of superoxide (O2•) and placental concentration of •NO will be determined using EPR (electron paramagnetic resonance). Endothelial function and arterial stiffness will be evaluated using respectively Peripheral Arterial Tonometry (PAT), Flow-Mediated Dilatation (FMD) and applanation tonometry. Placental expression of eNOS (endothelial NOS) will be determined using immune-histochemical staining. Target recruitment will be 110 patients for the longitudinal study and 90 patients in the case-control study. Discussion The results of Endopreg will provide longitudinal information on in vivo endothelial function and in vitro OS during normal pregnancy and PE. Adoption of these vascular tests in clinical practice potentially predicts patients at risk to develop cardiovascular events later in life after PE pregnancies. •NO, O2•− and eNOS measurements provide further inside in the pathophysiology of PE. Trial registration This trial has been registered on clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT02603913. Registered October 2015.
Collapse
Affiliation(s)
- Dominique Mannaerts
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium.,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Ellen Faes
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium.,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Jan Gielis
- ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Emeline Van Craenenbroeck
- Laboratory for Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Research Group Cardiovascular Diseases, Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Marc Spaanderman
- Departement of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wilfried Gyselaers
- Departement of Obstetrics and Gynecology, Ziekenhuis-Oost-Limburg (ZOL), Genk, Belgium
| | - Jerome Cornette
- Departement of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yves Jacquemyn
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium. .,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium. .,Department of Obstetrics and Gynaecology, Antwerp Surgical Training and Anatomy Research Centre (ASTARC), Antwerp University/Antwerp University Hospital, Antwerp, Belgium.
| |
Collapse
|