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Dorogovtsev VN, Yankevich DS, Gaydashev AE, Martyushev-Poklad AV, Podolskaya JA, Borisov IV, Grechko AV. Preclinical Orthostatic Abnormalities May Predict Early Increase in Vascular Stiffness in Different Age Groups: A Pilot Study. Diagnostics (Basel) 2023; 13:3243. [PMID: 37892064 PMCID: PMC10606479 DOI: 10.3390/diagnostics13203243] [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: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Clinical orthostatic hypotension (OH) and hypertension (OHT) are risk factors for arterial hypertension (AH) and cardiovascular diseases (CVD) and are associated with increased vascular stiffness. Preclinical OH and OHT are poorly understood. The main objective was to investigate preclinical orthostatic abnormalities and their association with increased vascular stiffness in different age groups of adults. A specially designed head-up tilt test standardized for hydrostatic column height was used to detect them. Three age groups of clinically healthy subjects were examined. In the group of young adults up to 30 years old, a significant predominance of orthostatic normotension (ONT) and an insignificant number of subjects with preclinical OH and OHT were found. In the age group over 45 years, compared to the group under 30 years, there was a twofold decrease in the proportion of individuals with ONT and a significant increase with preclinical OH and OHT. In all age groups, there was a significant orthostatic increase in vascular stiffness (as measured by the brachial-ankle pulse wave velocity (baPWV), which was recovered to the baseline level when returning to the supine position. Overall, subjects with preclinical OH and OHT had significantly higher baPWV values compared to those with ONT (p = 0.001 and p = 0.002, respectively), with all subjects having vascular stiffness values within normal age-related values.
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Affiliation(s)
- Victor N. Dorogovtsev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Dmitry S. Yankevich
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Andrey E. Gaydashev
- Problem Scientific Research Laboratory, Smolensk State Medical University, 214019 Smolensk, Russia;
| | - Andrey V. Martyushev-Poklad
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Julia A. Podolskaya
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Ilya V. Borisov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
| | - Andrey V. Grechko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (D.S.Y.); (A.V.M.-P.); (J.A.P.); (A.V.G.)
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Magid-Bernstein J, Girard R, Polster S, Srinath A, Romanos S, Awad IA, Sansing LH. Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circ Res 2022; 130:1204-1229. [PMID: 35420918 PMCID: PMC10032582 DOI: 10.1161/circresaha.121.319949] [Citation(s) in RCA: 135] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Intracerebral hemorrhage (ICH) is a devastating form of stroke with high morbidity and mortality. This review article focuses on the epidemiology, cause, mechanisms of injury, current treatment strategies, and future research directions of ICH. Incidence of hemorrhagic stroke has increased worldwide over the past 40 years, with shifts in the cause over time as hypertension management has improved and anticoagulant use has increased. Preclinical and clinical trials have elucidated the underlying ICH cause and mechanisms of injury from ICH including the complex interaction between edema, inflammation, iron-induced injury, and oxidative stress. Several trials have investigated optimal medical and surgical management of ICH without clear improvement in survival and functional outcomes. Ongoing research into novel approaches for ICH management provide hope for reducing the devastating effect of this disease in the future. Areas of promise in ICH therapy include prognostic biomarkers and primary prevention based on disease pathobiology, ultra-early hemostatic therapy, minimally invasive surgery, and perihematomal protection against inflammatory brain injury.
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Affiliation(s)
| | - Romuald Girard
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Sean Polster
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Abhinav Srinath
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Sharbel Romanos
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Issam A. Awad
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Lauren H. Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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3
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Boateng SY, Olfert IM, Chantler PD. Role of Perivascular Adipose Tissue and Exercise on Arterial Function with Obesity. Exerc Sport Sci Rev 2021; 49:188-196. [PMID: 33831902 PMCID: PMC8195847 DOI: 10.1249/jes.0000000000000251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adipose tissue and arterial dysfunction are common in the obese state. Perivascular adipose tissue (PVAT) plays an important role in mediating arterial health, and with obesity, the PVAT dysfunction negatively affects arterial health. Exercise training exerts direct and beneficial effects on PVAT, providing an additional and novel pathway by which exercise can improve arterial health in diseased populations.
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Affiliation(s)
- Samuel Y Boateng
- Biological Sciences, School of Biological Sciences, University of Reading, UK
| | - I. Mark Olfert
- Department of Human Performance, Division of Exercise Physiology, School of Medicine, West Virginia University, USA
- West Virginia Clinical and Translational Science Institute (WVCTSI), Morgantown, WV
| | - Paul D Chantler
- Department of Human Performance, Division of Exercise Physiology, School of Medicine, West Virginia University, USA
- West Virginia Clinical and Translational Science Institute (WVCTSI), Morgantown, WV
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4
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Wang W, Norby FL, George KM, Alonso A, Mosley TH, Gottesman RF, Meyer ML, Lutsey PL. Association of Carotid Intima-Media Thickness and Other Carotid Ultrasound Features With Incident Dementia in the ARIC-NCS. J Am Heart Assoc 2021; 10:e020489. [PMID: 33870735 PMCID: PMC8200760 DOI: 10.1161/jaha.120.020489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Increased carotid intima‐media thickness, interadventitial diameter, presence of carotid plaque, and lower distensibility are predictors for cardiovascular disease. These indices likely relate to cerebrovascular disease, and thus may constitute a form of vascular contributions to dementia and Alzheimer disease–related dementia. Therefore, we assessed the relationship of carotid measurements and arterial stiffness with incident dementia in the ARIC (Atherosclerosis Risk in Communities) study. Methods and Results A total of 12 459 ARIC participants with carotid arterial ultrasounds in 1990 to 1992 were followed through 2017 for dementia. Dementia cases were identified using in‐person and phone cognitive status assessments, hospitalization discharge codes, and death certificate codes. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident dementia. Participants were aged 57±6 at baseline, 57% were women, and 23% were Black individuals. Over a median follow‐up time of 24 years, 2224 dementia events were ascertained. After multivariable adjustments, the highest quintile of carotid intima‐media thickness and interadventitial diameter in midlife was associated with increased risk of dementia (HR [95% CIs], 1.25 [1.08–1.45]; and 1.22 [1.04–1.43], respectively) compared with its respective lowest quintile. Presence of carotid plaque did not have a significant association with dementia (HR [95% CI], 1.06 [0.97–1.15]). Higher distensibility was associated with lower risk of dementia (HR [95% CI] highest versus lowest quintile, 0.76 [0.63–0.91]). Conclusions Greater carotid intima‐media thickness, interadventitial diameter, and lower carotid distensibility are associated with an increased risk of incident dementia. These findings suggest that both atherosclerosis and carotid stiffness may be implicated in dementia risk.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Faye L Norby
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN.,Department of Cardiology Center for Cardiac Arrest Prevention Cedars-Sinai Smidt Heart Institute Los Angeles CA
| | - Kristen M George
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN.,Division of Public Health Sciences University of California Davis Davis CA
| | - Alvaro Alonso
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Thomas H Mosley
- The MIND Center University of Mississippi Medical Center Jackson MS
| | | | - Michelle L Meyer
- Department of Emergency Medicine University of North Carolina at Chapel Hill NC
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
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5
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Ayo-Martin O, García-García J, Hernández-Fernández F, Gómez-Hontanilla M, Gómez-Fernández I, Andrés-Fernández C, Lamas C, Alfaro-Martínez JJ, Botella F, Segura T. Cerebral hemodynamics in obesity: relationship with sex, age, and adipokines in a cohort-based study. GeroScience 2021; 43:1465-1479. [PMID: 33449308 DOI: 10.1007/s11357-020-00313-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/07/2020] [Indexed: 11/28/2022] Open
Abstract
Overweight and obesity are well-known independent risk factors for stroke in the general population although uncertain in the case of the elderly, according to the obesity paradox. Little is known about underlying mechanisms. Our study aims to assess whether there is a relationship between excess body weight (measured as waist circumference) and poor cerebral hemodynamics (measured by transcranial Doppler parameters: basal, mean flow velocity (MFV), and dynamic, cerebrovascular reserve (CvR) in the right middle cerebral artery (RMCA)). A possible underlying molecular mechanism was analyzed via plasma leptin, adiponectin, TNF-α, IL-6, VCAM, and CRP levels. One hundred sixty-five subjects were included. Bivariate and multivariate regression showed a linear correlation between waist circumference and hemodynamics in RMCA, with clear gender effects: MFV (global NS, men β - 0.26 p < 0.01; women NS), CvR (global: β - 0.15 p < 0.01; men: β - 0.29 p < 0.01, women: β - 0.19 p < 0.09). For subjects above 65 years, there is no significant relationship between AbP and cerebral hemodynamics. In multivariate regression models, only leptin correlated independently with MFV in RMCA (β 7.24, p < 0.01) and CvR (β - 0.30, p < 0.01). In both cases, waist circumference remains significantly related to both parameters. There is an inverse linear correlation between excess body weight and cerebral hemodynamics, independent of other vascular risk factors and clearly influenced by gender. This relation disappears in the elderly population. Leptin might play a role in this relationship. Nevertheless, there must be another associated mechanism, not identified in this study.
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Affiliation(s)
- Oscar Ayo-Martin
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, C/ Hermanos Falcó, 37, 02008, Albacete, Spain.
| | - Jorge García-García
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, C/ Hermanos Falcó, 37, 02008, Albacete, Spain
| | - Francisco Hernández-Fernández
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, C/ Hermanos Falcó, 37, 02008, Albacete, Spain
| | | | | | | | - Cristina Lamas
- Endocrinology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - José Joaquín Alfaro-Martínez
- Endocrinology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Francisco Botella
- Endocrinology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Tomás Segura
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, C/ Hermanos Falcó, 37, 02008, Albacete, Spain
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6
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Frigerio B, Werba JP, Amato M, Ravani A, Sansaro D, Coggi D, Vigo L, Tremoli E, Baldassarre D. Traditional Risk Factors are Causally Related to Carotid Intima-Media Thickness Progression: Inferences from Observational Cohort Studies and Interventional Trials. Curr Pharm Des 2020; 26:11-24. [PMID: 31838990 DOI: 10.2174/1381612825666191213120339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 12/24/2022]
Abstract
In the present review, associations between traditional vascular risk factors (VRFs) and carotid intimamedial thickness progression (C-IMTp) as well as the effects of therapies for VRFs control on C-IMTp were appraised to infer causality between each VRF and C-IMTp. Cohort studies indicate that smoking, binge drinking, fatness, diabetes, hypertension and hypercholesterolemia are associated with accelerated C-IMTp. An exception is physical activity, with mixed data. Interventions for the control of obesity, diabetes, hypertension and hypercholesterolemia decelerate C-IMTp. Conversely, scarce information is available regarding the effect of smoking cessation, stop of excessive alcohol intake and management of the metabolic syndrome. Altogether, these data support a causative role of several traditional VRFs on C-IMTp. Shortcomings in study design and/or ultrasonographic protocols may account for most negative studies, which underlines the importance of careful consideration of methodological aspects in investigations using C-IMTp as the outcome.
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Affiliation(s)
| | - José P Werba
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Mauro Amato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Daniela Coggi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Universita di Milano, Milan, Italy
| | - Lorenzo Vigo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Dipartimento di Scienze Farmacologiche e Biomolecolari, Universita di Milano, Milan, Italy
| | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Università di Milano, Milan, Italy
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7
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Abstract
: Hypertension is a worldwide known cause of morbidity and mortality in the elderly and is a major risk factor for cardiovascular complications such as stroke, myocardial infarction, renal complications and heart failure. Although the mechanisms of hypertension remain largely unknown, a recent new concept is that aortic stiffening is a cause of hypertension in middle-aged and older individuals, which highlighted the importance of aortic stiffening in the development of age-related hypertension. Understanding the pathogenesis of aortic stiffness therefore became one of the important approaches to preventing and controlling hypertension. This review discusses the recent progress of the potential causes of aortic stiffening and its implication on the pathogenesis of hypertension, in terms of aging, inflammation, metabolic syndromes, neuroendocrine and the interaction among these causes.
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Affiliation(s)
- John O. ONUH
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, USA, 30303
| | - Hongyu QIU
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, USA, 30303
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8
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Kruszyńska E, Łoboz-Rudnicka M, Palombo C, Vriz O, Kozakova M, Ołpińska B, Morizzo C, Łoboz-Grudzień K, Jaroch J. Carotid Artery Stiffness in Metabolic Syndrome: Sex Differences. Diabetes Metab Syndr Obes 2020; 13:3359-3369. [PMID: 33061497 PMCID: PMC7524178 DOI: 10.2147/dmso.s262192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/17/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The effect of metabolic syndrome (MS) on carotid stiffness (CS) in the context of gender is under research. OBJECTIVE We examined the relationship between the MS and CS in men (M) and women (W) and investigated if the impact of cardiovascular risk factors on CS is modulated by gender. PATIENTS AND METHODS The study included 419 subjects (mean age 54.3 years): 215 (51%) with MS (109 W and 106 M) and 204 (49%) without MS (98 W and 106 M). Carotid intima-media thickness (IMT) and CS parameters (beta stiffness index (beta), Peterson's elastic modulus (Ep), arterial compliance (AC) and one-point pulse wave velocity (PWV-beta)) were measured with the echo-tracking (eT) system. RESULTS ANCOVA demonstrated that MS was associated with elevated CS indices (p = 0.003 for beta and 0.025 for PWV-beta), although further sex-specific analysis revealed that this relationship was significant only in W (p = 0.021 for beta). Age was associated with CS in both M and W, pulse pressure (PP) and body mass index turned out to be determinants of CS solely in W, while the effect of mean arterial pressure (MAP) and heart rate was more pronounced in M. MANOVA performed in subjects with MS revealed that age and diabetes mellitus type 2 were determinants of CS in both sexes, diastolic blood pressure and MAP - solely in M and systolic blood pressure, PP and waist circumference - solely in W (the relationship between the waist circumference and AC was paradoxical). CONCLUSION The relationship between MS and CS is stronger in W than in M. In subjects with MS, various components of arterial pressure exert different sex-specific effects on CS - with the impact of the pulsative component of arterial pressure (PP) observed in W and the impact of the steady component (MAP) observed in M.
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Affiliation(s)
- Ewa Kruszyńska
- Cardiology Department, T. Marciniak Hospital, Emergency Medicine Center, Wrocław, Poland
| | - Maria Łoboz-Rudnicka
- Cardiology Department, T. Marciniak Hospital, Emergency Medicine Center, Wrocław, Poland
- Correspondence: Maria Łoboz-Rudnicka Email
| | - Carlo Palombo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Olga Vriz
- Department of Cardiology and Emergency, San Antonio Hospital, Udine, Italy
| | - Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Bogusława Ołpińska
- Cardiology Department, T. Marciniak Hospital, Emergency Medicine Center, Wrocław, Poland
| | - Carmela Morizzo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Krystyna Łoboz-Grudzień
- Cardiology Department, T. Marciniak Hospital, Emergency Medicine Center, Wrocław, Poland
- Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Joanna Jaroch
- Cardiology Department, T. Marciniak Hospital, Emergency Medicine Center, Wrocław, Poland
- Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
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Carotid circumferential wall stress is not associated with cognitive performance among individuals in late middle age: The Maastricht Study. Atherosclerosis 2018; 276:15-22. [PMID: 30006323 DOI: 10.1016/j.atherosclerosis.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/06/2018] [Accepted: 07/03/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Arterial remodelling aims at normalising circumferential wall stress (CWS). Greater CWS in the carotid artery has previously been associated with the prevalence and severity of cerebral small vessel disease, a major cause of ageing-related cognitive decline. Here we test the hypothesis that greater carotid CWS is associated with poorer cognitive performance. METHODS We studied 722 individuals (60 ± 8 years, 55% men, 42.5% highly educated, blood pressure 137 ± 19/77 ± 11 mmHg, n = 197 with type 2 diabetes) who completed a neuropsychological assessment and underwent vascular ultrasound to measure the intima-media thickness (IMT) and interadventitial diameter (IAD) of the left common carotid artery at a plaque-free site. From IMT and IAD, lumen diameter (LD) was calculated. These structural measures were then combined with local carotid pulse pressure and brachial mean arterial pressure to obtain a measure of pulsatile (CWSpulsatile) and average (CWSmean) mechanical load on the vessel wall. Cognitive domains assessed were memory, executive function and attention, and processing speed. RESULTS After adjustment for age, sex, and education, regression analyses showed that neither CWSpulsatile nor CWSmean were associated with measures of cognitive performance (p-values ≥0.31). This null association did not differ by age or educational level, and was observed in both individuals with and without carotid plaque, diabetes and/or hypertension. In addition, none of the individual measures of carotid structure (i.e. IMT, IAD, and LD) was related to cognitive performance. CONCLUSIONS The present cross-sectional study shows that carotid CWS is not associated with cognitive performance, at least not among relatively highly educated individuals in late middle age with adequately controlled cardiovascular risk factors.
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Abdelhafiz AH, Marshall R, Kavanagh J, El-Nahas M. Management of hypertension in older people. Expert Rev Endocrinol Metab 2018; 13:181-191. [PMID: 30063423 DOI: 10.1080/17446651.2018.1500893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION As the population ages, the prevalence of hypertension is increasing. Treatment of hypertension is associated with a reduction in cardiovascular risk. However, the optimal blood pressure targets in older people are not clearly defined due to paucity of randomised clinical trials specific to this age group. AREAS COVERED We performed a Medline and Embase search from 1998 to present for articles on the management of hypertension in older people published in English language. EXPERT COMMENTARY The recent guidelines have suggested a lower blood pressure target of less than 130/80 mmHg. Due to the heterogeneity of older people, this universal low target may not be applicable to all of them. Targets based on functional level rather than chronological age are more appropriate. Special considerations in older people such as increased prevalence of frailty, falls, dementia, polypharmacy and the predominance of isolated systolic hypertension should also be taken into account. Tighter control, if well tolerated, is suitable for the fit person but relaxed targets are more reasonable in individuals with physical or cognitive decline. Therefore, in older people, targets should be individualised putting quality, rather than quantity, of life at the heart of their care plans.
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Affiliation(s)
- Ahmed H Abdelhafiz
- a Department of Geriatric Medicine , Rotherham General Hospital , Rotherham , UK
| | - Rachel Marshall
- a Department of Geriatric Medicine , Rotherham General Hospital , Rotherham , UK
| | - Joseph Kavanagh
- a Department of Geriatric Medicine , Rotherham General Hospital , Rotherham , UK
| | - Meguid El-Nahas
- b Department of Geriatric Medicine , Rotherham General Hospital, Global kidney academy , Sheffield, Rotherham , UK
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11
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Janzarik WG, Gerber AK, Markfeld-Erol F, Sommerlade L, Allignol A, Reinhard M. No long-term impairment of cerebral autoregulation after preeclampsia. Pregnancy Hypertens 2018; 13:171-173. [DOI: 10.1016/j.preghy.2018.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 04/19/2018] [Accepted: 06/10/2018] [Indexed: 10/14/2022]
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12
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Sedaghat S, van Sloten TT, Laurent S, London GM, Pannier B, Kavousi M, Mattace-Raso F, Franco OH, Boutouyrie P, Ikram MA, Stehouwer CDA. Common Carotid Artery Diameter and Risk of Cardiovascular Events and Mortality: Pooled Analyses of Four Cohort Studies. Hypertension 2018; 72:85-92. [PMID: 29785959 DOI: 10.1161/hypertensionaha.118.11253] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/04/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022]
Abstract
Carotid arterial diameter enlargement is a manifestation of arterial remodeling and may be a risk factor for cardiovascular disease (CVD). We evaluated the association between carotid artery diameter and risk of stroke, coronary heart disease, CVD, and all-cause mortality and explored whether the associations could be explained by processes involved in arterial remodeling, that is, blood pressure-related media thickening, arterial stiffness, arterial wall stress, and atherosclerosis. We included 4887 participants (mean age 67±9 years; 54% women) from 4 cohort studies: Rotterdam Study, NEPHROTEST, Hoorn Study, and a study by Blacher et al. Common carotid artery properties were measured using echotracking. Incident cases were recorded based on medical records. We used Cox proportional hazard models adjusting for cardiovascular risk factors and estimates of processes underlying arterial remodeling. During follow-up (mean, 11 years), 379 (8%) individuals had a stroke, 516 had a (11%) coronary heart disease, 807 had a (17%) CVD, and 1486 (30%) had died. After adjustment for cardiovascular risk factors, individuals in the highest tertile of carotid diameter (diameter >8 mm) compared with those in the lowest tertile (diameter <7 mm) had a higher incidence of stroke (hazard ratio, 1.5; 95% confidence interval, 1.1-2.0). From all estimates of processes underlying arterial remodeling, adjustment for carotid intima-media thickness attenuated this association (hazard ratio after adjustment for intima-media thickness, 1.2; 95% confidence interval, 0.9-1.6). Larger carotid diameter was associated with risk of CVD and mortality but not clearly with coronary heart disease risk. We showed that a larger carotid diameter is associated with incident stroke, CVD, and mortality. Carotid intima-media thickness, a measure of blood pressure-related media thickening, partially explained the association with stroke incidence.
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Affiliation(s)
- Sanaz Sedaghat
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.)
| | - Thomas T van Sloten
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.).,Inserm U970, HEGP, AP-HP, Université Paris-Descartes, France (T.T.v.S., S.L., P.B.)
| | - Stéphane Laurent
- Inserm U970, HEGP, AP-HP, Université Paris-Descartes, France (T.T.v.S., S.L., P.B.).,Department of Pharmacology, Georges Pompidou European Hospital, Paris, France (S.L., P.B.)
| | - Gérard M London
- Department of Nephrology, Hôpital Manhès, Paris, France (G.M.L.)
| | - Bruno Pannier
- Centre d'Investigations Préventives et Cliniques (IPC Center), Paris, France (B.P.)
| | - Maryam Kavousi
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.)
| | | | - Oscar H Franco
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.)
| | - Pierre Boutouyrie
- Inserm U970, HEGP, AP-HP, Université Paris-Descartes, France (T.T.v.S., S.L., P.B.).,Department of Pharmacology, Georges Pompidou European Hospital, Paris, France (S.L., P.B.)
| | - M Arfan Ikram
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.).,Neurology (M.A.I.).,Radiology (M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
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13
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Cuspidi C, Sala C, Tadic M, Gherbesi E, Grassi G, Mancia G. Association of metabolic syndrome with carotid thickening and plaque in the general population: A meta-analysis. J Clin Hypertens (Greenwich) 2018; 20:4-10. [PMID: 29194933 PMCID: PMC8031311 DOI: 10.1111/jch.13138] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/30/2017] [Accepted: 09/03/2017] [Indexed: 12/01/2022]
Abstract
We performed a meta-analysis of population studies reporting data on carotid intima-media thickness and plaque in patients with and without metabolic syndrome (MetS) to provide a new piece of information on the relationship of MetS with both phenotypes of vascular damage. The Ovid MEDLINE, PubMed, and Cochrane CENTRAL databases were searched without time restriction up to December 31, 2016. Overall, 19 696 patients (22.2% with MetS) were included in eight studies. Common carotid intima-media thickness was greater in patients with MetS compared with those without it (788 ± 47 μm vs 727 ± 44 μm), with a standard means difference of 0.28 ± 0.06 (P = .00003). Increased intima-media thickness in patients with MetS was paralleled by a higher prevalence of plaques. The present meta-analysis shows that MetS is associated with both ultrasonographic phenotypes of carotid damage. This finding is consistent with the view of MetS as a cluster of hemodynamic and nonhemodynamic factors promoting vascular hypertrophy and plaque.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Istituto Auxologico ItalianoMilanoItaly
| | - Carla Sala
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore Policlinico di MilanoMilanoItaly
| | - Marijana Tadic
- Department of CardiologyCharité‐University‐Medicine Campus Virchow KlinikumBerlinGermany
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore Policlinico di MilanoMilanoItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Istituto di Ricerche a Carattere Scientifico MultimedicaMilanItaly
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14
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Boss HM, van der Graaf Y, Visseren FLJ, Van den Berg-Vos RM, Bots ML, de Borst GJ, Cramer MJ, Kappelle LJ, Geerlings MI. Physical Activity and Characteristics of the Carotid Artery Wall in High-Risk Patients-The SMART (Second Manifestations of Arterial Disease) Study. J Am Heart Assoc 2017; 6:JAHA.116.005143. [PMID: 28736388 PMCID: PMC5586269 DOI: 10.1161/jaha.116.005143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Physical activity reduces the risk of vascular disease. This benefit is not entirely explained through an effect on vascular risk factors. We examined the relationship of physical activity and characteristics of the carotid artery wall in patients with vascular disease or risk factors. Methods and Results Cross‐sectional analyses were performed in 9578 patients from the SMART (Second Manifestations of Arterial Disease) study, a prospective cohort study among patients with vascular disease or risk factors. Physical activity was assessed using questionnaires. Carotid intima‐media thickness and carotid artery stenosis of both common carotid arteries was measured. In a subset of 3165 participants carotid diastolic diameter and distension were assessed. Carotid stiffness was expressed as the distensibility coefficient and Young's elastic modulus. Regression analyses adjusted for vascular risk factors showed that physical activity was inversely associated with diastolic diameter (fifth versus first quintile B=−0.13 mm; 95% CI, −0.21 to −0.05) and decreased risk of carotid artery stenosis (relative risk, 0.58; 95% CI, 0.48–0.69). A light level of physical activity was associated with less carotid stiffness (second versus first quintile; Young's elastic modulus B=−0.11 kPa−1×10−3; 95% CI, −0.16 to −0.06; distensibility coefficient B=0.93 kPa×103; 95% CI, 0.34–1.51), but there was no additional benefit with increasing levels of physical activity. In patients with vascular disease, physical activity was inversely associated with common carotid intima‐media thickness, but not in patients with vascular risk factors. Conclusions In patients with vascular disease or risk factors, increased physical activity was associated with smaller carotid diastolic diameter, decreased risk of carotid artery stenosis, and less carotid stiffness, but it only showed benefits on carotid intima‐media thickness in patients with vascular disease.
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Affiliation(s)
- H Myrthe Boss
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology, OLVG West, Amsterdam, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Bruno RM, Reesink KD, Ghiadoni L. Advances in the non-invasive assessment of vascular dysfunction in metabolic syndrome and diabetes: Focus on endothelium, carotid mechanics and renal vessels. Nutr Metab Cardiovasc Dis 2017; 27:121-128. [PMID: 27773467 DOI: 10.1016/j.numecd.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/28/2016] [Accepted: 09/04/2016] [Indexed: 12/29/2022]
Abstract
AIM The present paper is a selective review on the methodology and clinical significance of techniques to assess specifically endothelial function, carotid mechanics and renal vascular function, particularly in the light of vascular dysfunction in metabolic syndrome and type 2 diabetes. DATA SYNTHESIS Endothelial dysfunction appears to be earlier detectable in the microcirculation of patients with altered glucose metabolism, while it attains significance in the macrocirculation at more advanced disease stages. Smooth muscle cell dysfunction is now increasingly recognized to play a role both in the development of endothelial dysfunction and abnormal arterial distensibility. Furthermore, impaired glucose metabolism affects carotid mechanics through medial calcification, structural changes in extracellular matrix due to advanced glycation and modification of the collagen/elastin material stiffness. The assessment of renal vascular function by dynamic ultrasound or magnetic resonance imaging has recently emerged as an appealing target for identifying subtle vascular alterations responsible for the development of diabetic nephropathy. CONCLUSIONS Vascular dysfunction represents a major mechanism for the development of cardiovascular disease in patients with abnormal glucose metabolism. Hence, the currently available non-invasive techniques to assess early structural and vascular abnormalities merit recommendation in this population, although their predictive value and sensitivity to monitor treatment-induced changes have not yet been established and are still under investigation.
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Affiliation(s)
- R M Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - K D Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Netherlands; Department of Biomedical Engineering, Cardiovascular Center, Maastricht University Medical Center, Netherlands
| | - L Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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16
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Carillon J, Jover B, Cristol JP, Rouanet JM, Richard S, Virsolvy A. Dietary supplementation with a specific melon concentrate reverses vascular dysfunction induced by cafeteria diet. Food Nutr Res 2016; 60:32729. [PMID: 27834185 PMCID: PMC5102128 DOI: 10.3402/fnr.v60.32729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 01/01/2023] Open
Abstract
Background Obesity-related metabolic syndrome is associated with high incidence of cardiovascular diseases partially consecutive to vascular dysfunction. Therapeutic strategies consisting of multidisciplinary interventions include nutritional approaches. Benefits of supplementation with a specific melon concentrate, enriched in superoxide dismutase (SOD), have previously been shown on the development of insulin resistance and inflammation in a nutritional hamster model of obesity. Objective We further investigated arterial function in this animal model of metabolic syndrome and studied the effect of melon concentrate supplementation on arterial contractile activity. Design and results The study was performed on a hamster model of diet-induced obesity. After a 15-week period of cafeteria diet, animals were supplemented during 4 weeks with a specific melon concentrate (Cucumis melo L.) Contractile responses of isolated aorta to various agonists and antagonists were studied ex vivo. Cafeteria diet induced vascular contractile dysfunction associated with morphological remodeling. Melon concentrate supplementation partially corrected these dysfunctions; reduced morphological alterations; and improved contractile function, especially by increasing nitric oxide bioavailability and expression of endogenous SOD. Conclusions Supplementation with the specific melon concentrate improves vascular dysfunction associated with obesity. This beneficial effect may be accounted for by induction of endogenous antioxidant defense. Such an approach in line with nutritional interventions could be a useful strategy to manage metabolic syndrome–induced cardiovascular trouble.
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Affiliation(s)
- Julie Carillon
- Nutrition & Metabolism, UMR 204 NutriPass, University of Montpellier, Montpellier, France.,Bionov Research, Montpellier, France
| | - Bernard Jover
- EA7288, University of Montpellier, Montpellier, France.,PhyMedExp, INSERM U1046, UMR CNRS 9214, University of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, INSERM U1046, UMR CNRS 9214, University of Montpellier, Montpellier, France
| | - Jean-Max Rouanet
- Nutrition & Metabolism, UMR 204 NutriPass, University of Montpellier, Montpellier, France
| | - Sylvain Richard
- PhyMedExp, INSERM U1046, UMR CNRS 9214, University of Montpellier, Montpellier, France
| | - Anne Virsolvy
- PhyMedExp, INSERM U1046, UMR CNRS 9214, University of Montpellier, Montpellier, France;
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17
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Affiliation(s)
- Zhongjie Sun
- From the Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.
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18
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Chantler PD, Frisbee JC. Arterial function in cardio-metabolic diseases: from the microcirculation to the large conduits. Prog Cardiovasc Dis 2014; 57:489-96. [PMID: 25220256 DOI: 10.1016/j.pcad.2014.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The metabolic syndrome (MetS) is characterized as a constellation of metabolic risk factors such as obesity, hypertension, dyslipidemia, and hyperglycemia that co-occur within a given individual. This consultation of risk factors exposes MetS to a 3-fold increased risk of cardiovascular disease and an even higher risk of developing type 2 diabetes compared to healthy individuals. The pathophysiological mechanisms underlying this increased cardiovascular risk are incompletely understood but likely include alterations to macro- and micro-vasculature. The vasculature plays an important role not only in delivery and adjusting the quantity of blood delivered to the tissues, but the dynamic changes in structure and compliance significantly alter the hemodynamic stress imposed on the heart and end-organs. This review will give an overview of the pathophysiological changes to the vasculature that accompany MetS in both human and animal models, as well as the possible mechanistic pathways.
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Affiliation(s)
- Paul D Chantler
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV, USA; Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jefferson C Frisbee
- Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, WV, USA; Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV, USA.
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19
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Moker EA, Bateman LA, Kraus WE, Pescatello LS. The relationship between the blood pressure responses to exercise following training and detraining periods. PLoS One 2014; 9:e105755. [PMID: 25208075 PMCID: PMC4160181 DOI: 10.1371/journal.pone.0105755] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 07/23/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Exercise training lowers blood pressure (BP), while BP increases and returns to pre-training values with detraining. Yet, there is considerable variability in these BP responses. We examined the relationship between the BP responses after 6 months of training followed by 2 weeks of detraining among the same people. METHODOLOGY/PRINCIPAL FINDINGS Subjects (n = 75) (X+SD, 50.2 ± 10.6 yr) were sedentary, obese, and had prehypertension. They completed an aerobic (n = 34); resistance (n = 28); or aerobic + resistance or concurrent (n = 13) exercise training program. We calculated a metabolic syndrome z score (MetSz). Subjects were classified as BP responders (BP decreased) or non-responders (BP increased) to training and detraining. Linear and multivariable regression tested the BP response. Chi Square tested the frequency of responders and non-responders. The systolic BP (SBP, r = -0.474) and diastolic (DBP, r = -0.540) response to training negatively correlated with detraining (p<0.01), independent of modality (p>0.05). Exercise responders reduced SBP 11.5 ± 7.8 (n = 29) and DBP 9.8 ± 6.2 mmHg (n = 31); non-responders increased SBP 7.9.± 10.9 (n = 46) and DBP 4.9 ± 7.1 mmHg (n = 44) (p<0.001). We found 65.5% of SBP training responders were SBP detraining non-responders; while 60.9% of SBP training non-responders were SBP detraining responders (p = 0.034). Similarly, 80.6% of DBP training responders were DBP detraining non-responders; while 59.1% of DBP training non-responders were DBP detraining responders (p<0.001). The SBP detraining response (r = -0.521), resting SBP (r = -0.444), and MetSz (r = 0.288) explained 44.8% of the SBP training response (p<0.001). The DBP detraining response (r = -0.553), resting DBP (r = -0.450), and MetSz (r = 0.463) explained 60.1% of the DBP training response (p<0.001). CONCLUSIONS/SIGNIFICANCE As expected most subjects that decreased BP after exercise training, increased BP after detraining. An unanticipated finding was most subjects that increased BP after exercise training, decreased BP after detraining. Reasons why the negative effects of exercise training on BP maybe reversed with detraining among some people should be explored further. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov 1R01HL57354; 2003-2008; NCT00275145.
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Affiliation(s)
- Emily A. Moker
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
| | - Lori A. Bateman
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - William E. Kraus
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Linda S. Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
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20
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Carotid atherosclerosis progression: the importance of systolic blood pressure. Hypertens Res 2014; 37:890-1. [DOI: 10.1038/hr.2014.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the United States and in Japan. Am J Cardiol 2014; 113:84-9. [PMID: 24169008 DOI: 10.1016/j.amjcard.2013.08.042] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022]
Abstract
The United States has a higher prevalence of metabolic syndrome (MS) and cardiovascular disease (CVD) mortality than Japan, but it is unknown how much of the difference in MS accounts for the mortality difference. The aim of this study was to examine the impact of MS on the excess CVD mortality in the United States compared with that in Japan. Data from the United States Third National Health and Nutrition Examination Survey (NHANES III; n = 12,561) and the Japanese National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in Aged (NIPPON DATA; n = 7,453) were analyzed. MS was defined as ≥3 of 5 risk factors (obesity, high blood pressure, decreased high-density lipoprotein cholesterol, elevated glycosylated hemoglobin, and elevated triglycerides). The results show that after a median of 13.8 years of follow-up in the United States, 1,683 patients died from CVD (11.75 per 1,000 person-years), and after a median of 15 years of follow-up in Japan, 369 patients died from CVD (3.56 per 1,000 person-years). The age-adjusted prevalence of MS was 26.7% in the United States and 19.3% in Japan. Of 5 MS factors, obesity, high blood pressure, elevated triglycerides, and glycosylated hemoglobin in the United States, and high blood pressure and elevated glycosylated hemoglobin in Japan were significant risk factors for CVD mortality. Estimates of 13.3% and 44% of the excess CVD mortality for the United States could be explained by the higher prevalence of MS and MS plus baseline CVD history than in Japan. In conclusion, the present study is the first to quantitatively demonstrate that MS and MS plus baseline CVD history may significantly contribute to the explanation of excess CVD mortality in the United States compared with Japan.
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Gepner AD, Korcarz CE, Colangelo LA, Hom EK, Tattersall MC, Astor BC, Kaufman JD, Liu K, Stein JH. Longitudinal effects of a decade of aging on carotid artery stiffness: the multiethnic study of atherosclerosis. Stroke 2013; 45:48-53. [PMID: 24253542 DOI: 10.1161/strokeaha.113.002649] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Arterial stiffening is associated with hypertension, stroke, and cognitive decline; however, the effects of aging and cardiovascular disease risk factors on carotid artery stiffening have not been assessed prospectively in a large multiethnic longitudinal study. METHODS Distensibility coefficient and the Young's elastic modulus (YEM) of the right common carotid artery were calculated at baseline and after a mean of 9.4 (standard deviation [SD], 0.5) years in 2650 participants. Effects of age and cardiovascular disease risk factors were evaluated by multivariable mixed regression and ANCOVA models. RESULTS At baseline, participants were 59.9 (SD, 9.4) years old (53% women; 25% black, 22% Hispanic, 14% Chinese). YEM increased from 1581 (SD, 927) to 1749 (SD, 1306) mm Hg (P<0.0001), and distensibility coefficient decreased from 3.1 (SD, 1.3) to 2.7 (SD, 1.1)×10(-3) mm Hg(-1) (P<0.001), indicating progressive arterial stiffening. YEM increased more among participants who were aged>75 years old at baseline (P<0.0001). In multivariable analyses, older age and less education independently predicted worsening YEM and distensibility coefficient. Stopping antihypertensive medication during the study period predicted more severe worsening of YEM (β=360.2 mm Hg; P=0.008). Starting antihypertensive medication after examination 1 was predictive of improvements in distensibility coefficient (β=1.1×10(-4) mm Hg(-1); P=0.024). CONCLUSIONS Arterial stiffening accelerates with advanced age. Older individuals experience greater increases in YEM than do younger adults, even after considering the effects of traditional risk factors. Treating hypertension may slow the progressive decline in carotid artery distensibility observed with aging and improve cerebrovascular health.
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Affiliation(s)
- Adam D Gepner
- From the Department of Medicine, Cardiovascular Medicine Division (A.D.G., C.E.K., M.C.T., J.H.S.), and Department of Medicine, Nephrology Division (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.); and Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (E.K.H., J.D.K.)
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Owolabi M, Agunloye A. Risk factors for stroke among patients with hypertension: A case–control study. J Neurol Sci 2013; 325:51-6. [DOI: 10.1016/j.jns.2012.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/20/2012] [Accepted: 11/27/2012] [Indexed: 12/13/2022]
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Struijker-Boudier HA, Blacher J, Lévy BI, Safar ME. Introduction to the Eighth International Workshop on Structure and Function of the Vascular System. Hypertension 2012; 60:504-6. [PMID: 22733465 DOI: 10.1161/hypertensionaha.112.198150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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