Arterial Stiffness and Long-Term Risk of Health Outcomes: The Framingham Heart Study

Associations between potassium, arterial stiffness, and risk of cardiovascular disease in the Jackson Heart Study: Potassium, arterial stiffness, and CVD risk

Background

Potassium (K) measures are associated with cardiovascular disease (CVD) risk factors, particularly blood pressure (BP). Arterial stiffness is a pre-clinical marker of CVD risk. We sought to study associations of K measures with arterial stiffness and CVD risk in a population at high-risk of CVD.

Methods

We studied participants from the Jackson Heart Study (JHS), a longitudinal cohort of adults racially minoritized as Black, who were without CVD at Visit 1 (2000-2004). We compared characteristics between participants with low-normal (lowK) (≤4.0 mmol/L) vs. high-normal (highK) (>4.0 mmol/L) serum K. We used multivariable regression to examine associations of serum and dietary K at Visit 1 with arterial stiffness [brachial artery pulse pressure (PP) and carotid-femoral pulse wave velocity (CFPWV)], measured between 2012 and 2017, incident CVD overall over up to 15 years of follow-up, and individual CVD outcomes.

Results

We included 4035 JHS participants in our analyses; mean age was 54 years, 64 % were female. Participants with highK as compared to lowK had lower mean baseline BP and had reduced arterial stiffness. In adjusted models, higher serum K (per standard deviation increase) was associated with lower CFPWV [estimate (95 % CI) -1.66 (-2.88, -0.44)]. There was a significant difference in cumulative incidence of CVD, with the highK group having lower risk (P = 0.047); however, we did not observe statistically significant associations between serum K and any CVD outcomes after multivariable adjustment. We found no significant associations between dietary K and arterial stiffness or incident CVD.

Conclusions

In this cohort of Black adults, higher serum K was significantly associated with lower arterial stiffness. Further study is needed to assess the relationship between K's association with arterial stiffness and future CVD risk.

Longitudinal dynamics of pulse wave velocity in the days after acute ischaemic stroke: prospective cohort study

OBJECTIVES

Arterial stiffness as assessed by pulse wave velocity (PWV) improves the prediction of first-ever and recurring stroke and of stroke outcomes when measured in the days after stroke. Here, we investigated the longitudinal dynamics of PWV in the days after acute ischaemic stroke.

DESIGN

Monocentric, prospective cohort study nested within a clinical trial registry with repeated measurement assessment of PWV.

SETTING

Comprehensive middle European stroke centre.

PARTICIPANTS

20 men and women that suffered stroke from November 2022 through August 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

Change in carotid-femoral PWV was investigated by recording PWV four times between 1.2 and 9.9 days after stroke using a Vicorder device. Haemodynamic and patient-, stroke- and care-related variables were investigated as potential modifiers of PWV trajectories.

RESULTS

Twenty patients aged 61.3±16.9 years (14 males) were included. There was a daily decline in PWV of -0.19 m/s (95% CI: -0.29 to -0.09; p<0.001) until approximately 8 days after stroke, corresponding to a total relative decline of -15.5% (95% CI: -22.3 to -8.1; p<0.001). Whereas higher anxiety predicted 0.11 m/s (95% CI: 0.01 to 0.20; p=0.044) slower daily decline, decline was not significantly related to baseline PWV, blood pressures, stroke severity or location, or functional status (all p>0.05). Rank-order correlation between the earliest and latest PWV measurements was 0.87 (95% CI: 0.69 to 0.95; p<0.001).

CONCLUSIONS

A marked decline in PWV during the first week after acute ischaemic stroke should be accounted for when interpreting PWV after recent stroke.

TRIAL REGISTRATION NUMBER

The STROKE-CARD Registry was registered at ClinicalTrials.gov (NCT04582825).

Effect of 12-wk dietary nitrate supplementation on carotid arterial stiffness in postmenopausal females

Menopause is associated with reduced nitric oxide (NO) bioavailability, a key contributor to increased arterial stiffness and, consequently, greater risk of cardiovascular disease-related mortality in postmenopausal females. Even though dietary nitrate has been shown to increase NO bioavailability in postmenopausal females acutely, previous studies showed no impact of dietary nitrate supplementation on arterial stiffness in postmenopausal females. Their findings were likely limited by the acute and/or short-term design. Thus, this study aimed to determine whether 12 wk of dietary nitrate supplementation via beetroot extract improves carotid artery stiffness in postmenopausal females. A randomized, double-blind, placebo-controlled, and parallel-design trial was conducted with 20 postmenopausal females (60-85 yr). Participants received nitrate-rich (NR-BEETx, 8.8 mmol/day) or nitrate-depleted (ND-BEETx) beetroot extract. Carotid stiffness parameters-pulse wave velocity (PWVβ), β stiffness, pressure-strain elastic modulus, augmentation index (AIx), and arterial compliance-were measured at baseline and weeks 4, 8, and 12. Serum nitrate and nitrite concentrations and blood pressure were also assessed. Compared with ND-BEETx, NR-BEETx supplementation significantly reduced PWVβ, β stiffness, elastic modulus, and AIx at weeks 4, 8, and 12, whereas arterial compliance increased by week 12. Serum nitrate and nitrite concentrations were elevated five- to sixfold and 1.5- to 2-fold, respectively, in the NR-BEETx group, with peak concentrations occurring at week 8 and showing a plateau or slight decrease at week 12. Blood pressure remained unchanged in both groups. Twelve weeks of nitrate-rich beetroot extract supplementation improved carotid artery stiffness and increased NO bioavailability without altering blood pressure. These findings suggest that beetroot extract supplementation can be recommended as an alternative nutritional strategy to mitigate carotid artery stiffening in postmenopausal females.NEW & NOTEWORTHY Postmenopausal females experience reduced nitric oxide (NO) bioavailability and elevated carotid artery stiffness, a well-established independent risk factor for end-organ damage and all-cause mortality. In this study, we demonstrate that 12 wk of dietary nitrate supplementation through beetroot extract significantly increased NO bioavailability and improved carotid artery stiffness in postmenopausal females.

Estimated Pulse Wave Velocity and Stroke Among Middle-Aged and Older Population: Insights From 3 Prospective Cohorts

BACKGROUND

Arterial stiffness is recognized as a new risk factor for stroke. However, the association between estimated pulse wave velocity (ePWV), a well-established indirect measure of arterial stiffness and stroke among older adults, remains incompletely investigated.

METHODS

This study utilized data from 3 prospective, nationally representative cohorts: the Health and Retirement Study in the United States, the English Longitudinal Study of Aging in the United Kingdom, and the China Health and Retirement Longitudinal Study in China. ePWV was calculated based on age and mean arterial pressure. Cox proportional hazard models were used to compute hazard ratios and 95% CIs.

RESULTS

The final analysis included 6458 participants from the Health and Retirement Study (mean age: 66.99 years; 40.4% men), 6458 from the English Longitudinal Study of Aging (mean age: 66.32; 44.4% men), and 12 415 from the China Health and Retirement Longitudinal Study (mean age: 58.60; 46.2% men). Over follow-up periods of 10.28 years in the Health and Retirement Study, 9.95 years in the English Longitudinal Study of Aging, and 6.30 years in the China Health and Retirement Longitudinal Study, 624 (9.7%), 374 (5.8%), and 656 (5.3%) participants developed stroke, respectively. Fully adjusted Cox regression analysis revealed a significant association between ePWV and incident stroke across all cohorts (Health and Retirement Study: hazard ratio, 1.29 [95% CI, 1.24-1.35]; English Longitudinal Study of Aging: hazard ratio, 1.37 [95% CI, 1.28-1.46]; China Health and Retirement Longitudinal Study: hazard ratio, 1.20 [95% CI, 1.15-1.25]).

CONCLUSIONS

This study demonstrated that higher levels of ePWV were associated with increased risks of incident stroke among middle-aged and older populations. Arterial stiffness assessment through ePWV could potentially improve primary prevention and treatment strategies for stroke.

Vascular ageing manifestations and hypertension in the community

Objective

To investigate the association between joint manifestations of vascular ageing (VA) and hypertension.

Methods

We used baseline (2008-2012) and follow-up data (up to 2024) from the Paris Prospective Study III, a French cohort of 10,157 participants. Prevalent and incident hypertension were determined at baseline (blood pressure ≥140/90 mmHg or on medication) and at 2, 4, 6, 8 and 10 years of follow-up (self-reported antihypertensive treatment). VA manifestations were assessed at baseline via echo-tracking in the right common carotid artery. Clustering analysis identified patterns of VA and their association with hypertension was assessed with logistic regression.

Results

The cross-sectional analysis included 9,096 participants (mean age: 59±6 years, 39 % female). Hypertension prevalence was 36 % (n = 3,276). Three clusters of VA manifestations were identified. Cluster 1 (n = 4,326;47.6 %) was characterized by healthy vascular ageing (HVA), Cluster 2 by increased arteriosclerosis (ART) (n = 2,274;25.0 %) and Cluster 3 by greater atherosclerosis prevalence (ATH) (n = 2,496;27.4 %). Compared to the HVA cluster, ART (aOR 3.94; 95 % CI 3.50;4.45) and ATH clusters (aOR 2.69; 95 % CI 2.38;3.04) were associated with prevalent hypertension. The prospective analysis included 5,310 normotensives with 754 (14.1 %) cases of incident hypertension (median follow-up of 10.05 years [range: 10.00;10.15]). Both ART (aOR 1.34; 95 % CI 1.08;1.65) and ATH (aOR 1.70; 95 % CI 1.40;2.07) clusters were associated with incident hypertension.

Conclusion

Vascular ageing manifestations reflecting increased carotid arteriosclerosis and atherosclerosis are related to prevalent and incident hypertension.

The incremental predictive value of arterial stiffness over SCORE2 in the setting of primary cardiovascular prevention: a 6-year follow-up study

AIM

Arterial stiffness hallmarks age-related cardiovascular diseases, precedes their onset and strongly links to accelerated disease progression. However, whether carotid-to-femoral pulse wave velocity (PWV), a proxy of arterial stiffness, predicts cardiovascular risk over and above SCORE2, a newly introduced risk score remains to be investigated.

METHODS

We measured PWV among 747 individuals without established atheromatosis. Study participants were followed up over a 6-year period for the incidence of cardiovascular events [[MACE)-cardiovascular mortality, stroke and myocardial infarction].

RESULTS

PWV emerged as an independent and additive predictor of first cardiovascular events when added in a model encompassing SCORE2 (hazard ratio = 1.10; 95% confidence interval (95% CI) = 1.07-1.14; P  < 0.001, Brier score changed from 0.073 (0.060-0.086) to 0.067 (0.055-0.081); P  < 0.001, c-statistic increased from 0.71 to 0.75; P  = 0.017; likelihood ratio: 20.22; P  < 0.001; the overall net reclassification improvement (NRI): 0.577; P  < 0.001, AICc changed from 697.81 to 679.60; BIC changed from 702.42 to 688.82]. An increase in PWV predicted a greater risk of future MACEs additively to conventional risk factors ( P  < 0.05). We performed Kaplan-Meier survival analysis for the tertiles of PWV [first tertile < 8.04 m/s; the second tertile: (8.04-10 m/s); the third tertile: (10-17.10 m/s); ( P  < 0.05 for all comparisons between the tertiles). PWV tertiles also predicted MACE when added to SCORE2 [for the second tertile: hazard ratio: 5.87 (95% CI: 1.73-19.92); P  = 0.004 and for the third tertile: hazard ratio: 9.69 (95% CI: 2.97-31.55); P  < 0.001 with the respective change of c-statistic from 0.739 to 0.772; P  = 0.012 and continuous NRI = 0.598].

CONCLUSION

PWV confers additive prognostic value to the newly introduced SCORE2 for adverse outcome in primary prevention.

Role of Advanced Glycation End Products in Mediating Glycated Haemoglobin and Pulse Wave Velocity in Healthy Adults

Background/Objectives: Poor metabolic control is associated with increased levels of advanced glycation end products (AGEs), which in turn may lead to increased arterial stiffness. The aim of this study was to estimate the association between glycated haemoglobin A1c (HbA1c) and aortic pulse wave velocity (a-PWV) in healthy subjects and to analyse the mediating effect of AGEs measured by skin autofluorescence (SAF) on this association. Methods: HbA1c, a-PWV and SAF were analysed in 390 healthy Spanish subjects from the EVasCu study (42.02 ± 13.14 years, 63.08% females). A directed acyclic graph (DAG) was generated to define the covariates to be included, and the model was confirmed via multiple linear regression analysis. Descriptive and exploratory analyses were performed to investigate the associations between variables. Finally, adjusted and unadjusted mediation analyses were performed to verify the influence of SAF on the main association between HbA1c and a-PWV. Results: Multiple linear regression analyses for a-PWV supported the validity of the structure in the DAG. Descriptive and exploratory analyses revealed that when the models were adjusted to include all covariates, the statistical significance of the main association disappeared. Mediation analysis revealed that SAF mediated 35.77% of the effect of HbA1c on a-PWV in the unadjusted model and 42.18% after adjusting for covariates. Conclusions: Our study suggests that increases in HbA1c levels are associated with increases in a-PWV and that this relationship is mediated by the SAF score in healthy adults.

Relationship between fundus of the eye examination and arterial stiffness

This review addresses the correlation between arterial stiffness, measured by pulse wave velocity (PWV), and retinal microvascular changes, highlighting the retina as an important accessible window for inferences about cardiovascular health. Arterial stiffness, intrinsically linked to vascular aging and several comorbidities, results in damage to the microcirculation, including ocular vasculature, which can act as a predictor of cardiovascular and cerebrovascular outcomes. The review highlights the relationship between PWV assessment and funduscopic examination, with the aim of improving diagnostic accuracy and optimizing the clinical application of these tools in the management of cardiovascular and ophthalmological diseases, thus promoting more effective and early intervention.

Physical Activity and Arterial Stiffness: A Narrative Review

Arterial stiffness is a significant predictor of cardiovascular disease and mortality. Physical activity (PA) has been extensively studied for its potential to reduce arterial stiffness, but the relationship between different types, durations, and intensities of PA and arterial stiffness remains a topic of ongoing research. Therefore, in this narrative review, we evaluated the current evidence focusing on the effect of PA on arterial stiffness and vascular health and discussed the known underlying physiological mechanisms. PA, irrespective of its intensity or pattern, is consistently associated with lower arterial stiffness. Aerobic exercise, particularly at higher intensities, is the most effective strategy for reducing arterial stiffness. These benefits are especially significant in populations with higher cardiovascular risk, such as those with type 2 diabetes mellitus and hypertension. Therefore, maintaining an active lifestyle into older age is crucial for vascular health and may contribute to healthy aging.

Three-dimensional assessment of ascending aortic stiffness, motion, and growth in ascending thoracic aortic aneurysm

Aims

Aortic wall stiffening in ascending thoracic aortic aneurysm (aTAA) is common. However, the spatial and temporal relationships between stiffness, aortic size, and growth in aTAA remain unclear.

Methods and results

In this single-centre retrospective study, we utilized vascular deformation mapping to extract multi-directional aortic motion, aortic distensibility, and aortic growth in a multi-planar fashion from multi-phasic ECG-gated computed tomography angiograms. Aortic displacement and stiffness metrics were compared between patients with sporadic ascending aortic dilation (Dilated), individuals without thoracic aortic dilation, and patients with Marfan syndrome. A total of 96 patients were included. Total and axial aortic root motion was significantly decreased in the Dilated group (n = 49) compared with the Non-dilated group (n = 38) and Marfan group (n = 16). Aortic distensibility was significantly lower in the Dilated group compared with the Non-dilated group and exhibited a more diffuse pattern of stiffening compared with the Marfan group in which stiffening was localized to the root. In Dilated group, aortic distensibility was moderately and positively associated with aortic growth rate (R = 0.34, P = 0.02). The moderate-to-strong association between age and aortic stiffness in non-dilated segments was either significantly blunted or absent in dilated segments.

Conclusion

Vascular deformation mapping provides multi-level stiffness assessments of the ascending aorta using multi-phasic computed tomography angiography. Ascending aortic stiffening is a spatially heterogeneous process with stiffening tending to increase with degree of regional dilation and age, whereas lower stiffness was associated with faster growth of the mid-ascending aorta in those with sporadic aTAA.

Associations of circulating T-cell subsets with carotid artery stiffness: the multiethnic study of atherosclerosis

Arterial stiffness measured by total pulse wave velocity (T-PWV) is associated with an increased risk of multiple age-related diseases. T-PWV can be described by structural (S-PWV) and load-dependent (LD-PWV) arterial stiffening. T-cells have been implicated in arterial remodeling, arterial stiffness, and hypertension in humans and animals; however, it is unknown whether T-cells are risk factors for T-PWV or its components. Therefore, we evaluated the cross-sectional associations of peripheral T-cell subpopulations with T-PWV, S-PWV, and LD-PWV. Peripheral blood T-cells were characterized using flow cytometry, and carotid artery stiffness was measured using B-mode ultrasound to calculate T-PWV at the baseline examination in a participant subset of the Multi-Ethnic Study of Atherosclerosis (MESA, n = 1,984). A participant-specific exponential model was used to calculate S-PWV and LD-PWV based on elastic modulus and blood pressure gradients. The associations between five primary (P-significance < 0.01) and 25 exploratory (P-significance < 0.05) immune cell subpopulations, per 1-SD increment, and arterial stiffness measures were assessed using adjusted linear regression models. For the primary analysis, higher CD4+CD28-CD57+, but not CD8+CD28-CD57+, T-cells were associated with higher LD-PWV (β = 0.04 m/s, P < 0.01) after adjusting for covariates. None of the remaining T-cell subpopulations in the primary analysis were associated with T-PWV or S-PWV. For the exploratory analysis, several memory and differentiated/senescence-associated CD4+ and CD8+ T-cell subpopulations were associated with greater T-PWV, S-PWV, and LD-PWV after adjusting for covariates. In conclusion, we highlight novel associations in humans between CD4+ and CD8+ memory and differentiated/senescence-associated T-cell subpopulations and measures of arterial stiffness in MESA. These results warrant longitudinal, prospective studies that examine changes in T-cell subpopulations and arterial stiffness in humans.NEW & NOTEWORTHY We investigated associations between T-cells and novel measures of structural and load-dependent arterial stiffness in a large multiethnic cohort. The primary analysis revealed that pro-inflammatory, senescence-associated CD4+CD28-CD57+ T-cells were associated with higher load-dependent arterial stiffness. An exploratory analysis revealed that multiple pro-inflammatory CD4+ and CD8+ T-cell subpopulations were associated with both higher structural and load-dependent arterial stiffness. These results suggest that pro-inflammatory T-cells may contribute to arterial stiffness through both arterial remodeling and elevated blood pressure.

Developing technologies to assess vascular ageing: a roadmap from VascAgeNet

Vascular ageing (vascular ageing) is the deterioration of arterial structure and function which occurs naturally with age, and which can be accelerated with disease. Measurements of vascular ageing are emerging as markers of cardiovascular risk, with potential applications in disease diagnosis and prognosis, and for guiding treatments. However, vascular ageing is not yet routinely assessed in clinical practice. A key step towards this is the development of technologies to assess vascular ageing. In this Roadmap, experts discuss several aspects of this process, including: measurement technologies; the development pipeline; clinical applications; and future research directions. The Roadmap summarises the state of the art, outlines the major challenges to overcome, and identifies potential future research directions to address these challenges.

Clinical research progress in pulse wave velocity in the assessment of vascular aging

Vascular aging refers to the degenerative changes in vascular wall structure and vasodilatory function, forming the pathophysiological basis for the onset and progression of cardiovascular disease (CVD). Pulse wave velocity (PWV), a non-invasive method for evaluating and detecting early vascular aging, has achieved significant results in predicting CVD risk and evaluating the efficacy of pharmacological treatments. PWV can effectively predict CVD risk across various populations, including healthy individuals, patients with hypertension, diabetes, and chronic inflammatory diseases. In patients with comorbidities such as hypertension, pharmacological interventions, such as anti-inflammatory, lipid-lowering, anti-hypertensive, and anti-diabetic treatments, can effectively reduce PWV and thus slow down vascular aging. Therefore, PWV is not only a vital tool for assessing early vascular aging but also an important indicator for evaluating treatment outcomes. Regular monitoring of PWV levels is of great significance in predicting CVD risk, evaluating therapeutic efficacy, and guiding clinical decision-making.

Evaluation of Arterial Stiffness Parameters Measurement With Noninvasive Methods-A Systematic Review

Objective: Arterial stiffness, as determined by pulse wave velocity (PWV), is a recognized marker of cardiovascular risk. Noninvasive technologies have enabled easier and more accessible assessments of PWV. The current gold standard for measuring carotid-femoral PWV (cfPWV)-a reliable indicator of arterial stiffness-utilizes applanation tonometry devices, as recommended by the Artery Society Guidelines. The objective of this study was to compare the performance of various noninvasive arterial stiffness measurement methods, specifically the Mobil-O-Graph and SphygmoCor/SphygmoCor XCEL, and evaluate their alignment with the Artery Society Guidelines for accuracy and reliability. Methods: A comprehensive search was conducted in the PubMed and Scopus databases to identify studies that compared and validated noninvasive PWV measurements, focusing on their repeatability. The search covered studies from inception through March 31, 2024. A total of 2092 papers were identified. Following the selection process, 21 studies met the inclusion criteria. Additionally, 2 more studies, not retrieved by the initial search but deemed relevant from other databases, were included. The included studies focused on populations with chronic diseases who were hemodynamically stable. Studies involving participants in specific conditions, such as pregnancy, hemodynamic shock, or undergoing stress tests, were excluded from the analysis. Results: Several devices have been developed and validated for the noninvasive measurement of arterial stiffness, utilizing applanation tonometry (e.g., SphygmoCor, SphygmoCor XCEL) and cuff-based oscillometry (e.g., Arteriograph, Mobil-O-Graph). The analyses reviewed included studies using both invasive and noninvasive devices. A notable finding was the relative heterogeneity of study populations across different research, with variations in sample size, BMI, sex proportions, and age groups often falling short of guideline recommendations. In most of the included validation studies, the sample sizes were smaller than the minimum recommended by guidelines. Moreover, factors such as BMI, sex distribution, and age group sizes were inconsistent with established standards. Despite these limitations, validation studies comparing invasive and noninvasive methods consistently highlighted the superiority of cfPWV assessment devices. Applanation tonometry devices demonstrated smaller discrepancies in PWV measurements and better overall agreement with invasive methods than oscillometry-based devices. Three studies comparing the SphygmoCor XCEL with the standard SphygmoCor showed an excellent level of agreement, with one study confirming the SphygmoCor XCEL's superior adherence to validation criteria. Oscillometric devices showed a stronger reliance on algorithmic adjustments based on factors such as age and systolic blood pressure. This dependence likely contributes to the underestimation of PWV, particularly in populations with chronic diseases or other conditions promoting arterial stiffness. Despite this, oscillometric devices demonstrated lower PWV variability in short-term repeatability assessments. Conclusions: More research on a larger population should be performed in order to introduce noninvasive devices into daily medical practice.

Brachial-Ankle Pulse Wave Velocity as a Predictor of Diabetes Development: Elevated Risk Within Normal Range Values in a Low-Risk Population

BACKGROUND

Recent studies have suggested that increased brachial-ankle pulse wave velocity (baPWV) is a risk factor for diabetes. Exploring its relationship with insulin resistance is of interest, necessitating further studies across different sexes and age groups.

METHODS AND RESULTS

This cohort study involved 119 170 Korean adults with an average age of 39.8 years, none of whom had diabetes at baseline. As part of a health screening, baPWV measurements were taken. Over a median follow-up period of 5.6 years, fasting blood glucose, glycated hemoglobin, insulin levels, and questionnaire responses were collected. The risk of developing diabetes was evaluated using a flexible parametric proportional hazards model with data stratified by sex and age group (<40 versus ≥40 years). During the follow-up period, diabetes was diagnosed in 5966 participants (5.0%). A fully adjusted model found that the hazard ratios for diabetes onset associated with baPWV quartiles Q2 (1171.0-1270.5 cm/s), Q3 (1271.0-1376.0 cm/s), and Q4 (≥1376.5 cm/s) compared with Q1 (<1171.0 cm/s) were 1.06 (95% CI, 0.96-1.17), 1.25 (1.14-1.38), and 1.48 (1.34-1.62), respectively (P for trend <0.001). A significant sex-based interaction was noted in this association, with women showing a higher risk of diabetes development. Furthermore, higher baPWV quartiles were associated with an increased risk of developing insulin resistance, defined as the homeostatic model assessment of insulin resistance.

CONCLUSIONS

These findings highlight the importance of arterial stiffness, as measured by elevated baPWV, in the development of diabetes and insulin resistance. Notably, this study highlighted a strong association, particularly among women.

openBF: an open-source finite volume 1D blood flow solver

Computational simulations are widely adopted in cardiovascular biomechanics because of their capability of producing physiological data otherwise impossible to measure with non-invasive modalities.Objective.This study presents openBF, a computational library for simulating the blood dynamics in the cardiovascular system.Approach.openBF adopts a one-dimensional viscoelastic representation of the arterial system, and is coupled with zero-dimensional windkessel models at the outlets. Equations are solved by means of the finite-volume method and the code is written in Julia. We assess its predictions by performing a multiscale validation study on several domains available from the literature.Main results.At all scales, which range from individual arteries to a population of virtual subjects, openBF's solution show excellent agreement with the solutions from existing software. For reported simulations, openBF requires low computational times.Significance.openBF is easy to install, use, and deploy on multiple platforms and architectures, and gives accurate prediction of blood dynamics in short time-frames. It is actively maintained and available open-source on GitHub, which favours contributions from the biomechanical community.

Chinese Visceral Adipose Index is Associated with Arterial Stiffness in Type 2 Diabetes Patients: A Cross-Sectional Study

Purpose

The purpose of this study is to investigate the association between Chinese Visceral Adipose Index(CVAI) and brachial-ankle pulse wave velocity (baPWV) in type 2 diabetes (T2D) patients, in order to provide scientific evidence for the prevention and treatment of macrovascular complications in T2D.

Patients and Methods

This research adopts the cross-sectional study design. Anthropometric assessment, baPWV assessment and biochemical assessment were performed in 2906 T2D patients. CVAI was calculated from the combination of triglycerides, age, high-density lipoprotein cholesterol, waist circumference, body mass index. Multivariate regression analysis and generalized additive model were used to analyze the association between bapwv and CVAI. Subgroup analysis and interaction analysis were used to analyze the influencing factors.

Results

After adjustment for covariates, baPWV tended to increase in the quartiles of CVAI. In males, As CVAI increases by a unit, baPWV was increased by 0.28 cm/s (95% CI: -0.05, 0.61 P=0.0934). In females, As CVAI increases by a unit, baPWV was increased by 1.60 cm/s (95% CI: 1.07, 2.14). A non-linear connection in males and a linear connection in females between the CVAI and baPWV was revealed. In males, we found that CVAI interacted with baPWV in different duration of diabetes (P interaction = 0.0052), alcohol consumption status (P interaction = 0.0375). In females, CVAI interacted with baPWV in glycated hemoglobin (P interaction = 0.0003), systolic blood pressure (P interaction = 0.0001), diastolic blood pressure (P interaction<0.0001), duration of diabetes (P interaction = 0.0014), the use or non-use of glucose-lowering drugs (P interaction = 0.0006), the use or non-use antihypertensive drugs (P interaction = 0.0004), females' menopausal status (P interaction = 0.0012).

Conclusion

The relationship between CVAI and baPWV in T2D patients is positively non-linear in males and linear in females. In all subjects, this relationship was influenced by diabetes duration. In males, drinking status affected this relationship, and in females, It is influenced by blood pressure, glycemic control, menopausal status, and the use of glucose-lowering and hypotensive drug, highlighting the complex interplay between visceral fat and arterial stiffness in the T2D population.

Association of central arterial stiffness with atrial myopathy: the Atherosclerosis Risk in Communities (ARIC) study

Atrial myopathy-defined as abnormal left atrial (LA) size and function-is associated with an increased risk of atrial fibrillation, heart failure, and dementia. Central arterial stiffness is associated with increased atrial afterload and fibrosis and may be a risk factor for atrial myopathy. We examined the association of carotid-femoral pulse wave velocity (cfPWV) with LA function and assessed potential causal relationships. We included 2825 Atherosclerosis Risk in Communities (ARIC) study participants from Visit 5 (2011-2013). cfPWV was related to echocardiographic LA function continuously per 1-SD and categorically in quartiles. Mendelian randomization (MR) analysis was performed using U.K. Biobank-derived genetic variants associated with arterial stiffness index and cardiac magnetic resonance measures of LA function. When analyzed per SD increment (297.6 cm/s), higher cfPWV was significantly associated with lower LA reservoir and conduit strain (β = -0.53%, 95% CI [-0.81, -0.25] and β = -0.46%, 95% CI [-0.68, -0.25], respectively) after adjusting for demographics, clinical characteristics, systolic blood pressure, and left ventricular (LV) morphology and function. In MR analyses there was a non-significant inverse association of arterial stiffness index with LA total, passive, and active emptying fractions. Higher cfPWV is associated with lower LA reservoir and conduit strain, independent of systolic blood pressure and LV morphology and function. No evidence for a causal relationship between arterial stiffness index and alterations in LA function was found. Future studies should examine the prospective association of central arterial stiffness with LA function alterations.

Contralateral differences in ankle SBP and pulse wave velocity: associations with incident heart failure and mortality

BACKGROUND

Contralateral differences in brachial SBP are indicative of underlaying cardiovascular issues.

OBJECTIVES

To examine the association of contralateral differences in ankle SBP, brachial-ankle pulse wave velocity (baPWV), and heart-ankle pulse wave velocity (haPWV) with incident heart failure and all-cause and cardiovascular mortality.

METHODS

Cox proportional-hazards models were used to calculate hazard ratios and 95% confidence intervals (95% CIs) in 5077 participants (75 ± 5 years) of the Atherosclerosis Risk in Communities study.

RESULTS

Over a mean follow-up of 7.5 ± 2.2 years, there were 457 heart failure events, 1275 all-cause and 363 cardiovascular deaths. Interankle SBP difference of at least 10 mmHg [hazard ratio = 1.12; confidence interval (CI) 1.00-1.28], at least 15 mmHg (hazard ratio = 1.21; CI 1.03-1.43), contralateral difference in baPWV more than 240 cm/s (hazard ratio = 1.22; CI 1.02-1.46), and haPWV more than 80 cm/s (hazard ratio = 1.24; CI 1.04-1.48) were each independently associated with all-cause mortality after adjustment for confounders. Contralateral differences in ankle SBP of at least 15 mmHg (hazard ratio = 1.56; CI 1.17-2.09), and haPWV more than 80 cm/s (hazard ratio = 1.42; CI 1.03-1.96) were both independently associated with cardiovascular mortality. Unadjusted analysis revealed that those with contralateral differences in ankle SBP of at least 10 and at least 15 mmHg, baPWV more than 240, and haPWV more than 80 cm/s had higher risks of heart failure (all P  < 0.05).

CONCLUSION

These results underscore the significance of evaluating contralateral differences in ankle SBP and PWV as potential markers of increased mortality risk among older adults.

Association between Mixed Heavy Metal Exposure and Arterial Stiffness, with Alkaline Phosphatase Identified as a Mediator

Elevated arterial stiffness has been associated with exposure to heavy metals such as lead (Pb) and cadmium (Cd). However, the collective impact of multiple metals and the underlying mechanisms are not fully elucidated. The purpose of this study was to assess the combined effects of exposure to nine heavy metals on arterial stiffness and explore whether serum alkaline phosphatase (ALP) acts as a mediator in this relationship. In the retrospective analysis, data from 8,700 participants were retrieved from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Arterial stiffness was measured by estimated pulse wave velocity (ePWV). The cumulative impact of exposure to multiple metals was examined using adaptive elastic-net, environmental risk score, weighted quantile sum regression, and quantile g-computation. Additionally, mediation analysis was conducted to explore the potential mediating role of serum ALP. We found that combined exposure to multiple metals was consistently associated with elevated ePWV, with Ba, Pb, and Sb exhibiting the greatest contributions. Notably, serum ALP partially mediated the associations between individual (Pb, Sb) and mixed metal exposure with ePWV, with mediation proportions at 10.76% for Pb, 18.22% for Sb, and 11.07% for mixed metal exposure. In conclusion, this study demonstrates a clear association between exposure to heavy metals, either individually or in combination, and heightened arterial stiffness. Furthermore, the findings suggest that serum ALP activity may act as a mediator in these relationships.

Aortic Stiffness Measured by Carotid Femoral-Pulse Wave Velocity at Different Stages of Normal Glucose, Prediabetes, and Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background

To explore aortic stiffness measured by carotid femoral-pulse wave velocity (cf-PWV) at different stages of normal glucose, prediabetes, and diabetes mellitus (DM).

Methods

The literature comparing aortic stiffness (AS) with cf-PWV between DM and non-DM samples was systematically retrieved from Pubmed, Ovid Medline, Web of Science, Embase, Scopus, CNKI, and Wanfang databases. The Newcastle-Ottawa Scale was used to assess the quality of the literature. The primary endpoint was the mean difference (MD) of cf-PWV between the normal glucose and DM samples and normal glucose and prediabetes samples. The secondary endpoints were the MD of carotid intima-media thickness (cIMT) and carotid-radial pulse wave velocity (cr-PWV). Aggregated MD and 95% confidence intervals were calculated. When the I2 value was >50% or p < 0.01, the heterogeneity was considered large, and the random-effect model was used; otherwise, the fixed-effect model was used. A sensitivity analysis was conducted to identify the source of heterogeneity, and a funnel plot and the regression Egger test was utilized to assess the publication bias.

Results

A total of 37 studies were finally enrolled. Samples with DM had a higher cf-PWV value and cIMT value than those without DM, and the differences were statistically significant. The cr-PWV measurements tended to be higher in the DM group than in the non-DM group, but the difference was not significant. Samples with prediabetes also had a significantly higher cf-PWV value than samples with normal glucose.

Conclusions

Samples with DM and prediabetes were associated with a higher cf-PWV value, indicating that DM patients had a higher central AS. Central AS progresses at the prediabetes stage. These data provide insight into understanding the mechanism of adverse effects of DM and prediabetes on artery stiffness.

Association of Arterial Stiffness with Chronic Kidney Disease: A Systematic Review

INTRODUCTION

Significant kidney function may be lost before CKD is diagnosed. Arterial stiffness may be a risk factor for CKD and the relationship may be bi-directional. A systematic review of cohort studies was undertaken to ascertain the temporal relationship of arterial stiffness and CKD.

METHODS

MEDLINE and Embase were searched to 4 October 2023 to identify studies that investigated whether arterial stiffness, as estimated by pulse wave velocity, was predictive of the development or progression of CKD, rapid decline in kidney function, and vice versa. The characteristics and outcomes of the included studies were set out in a qualitative summary. The review protocol is registered with PROSPERO (CRD42019129563).

RESULTS

Forty-two studies were included, all of which were high quality with respect to bias. Thirteen of seventeen studies that investigated arterial stiffness as a predictor of incident CKD found a positive association (p < 0.05). Of the 10 studies that controlled for CKD risk factors, 6 found a positive association. Eight of seventeen studies that investigated arterial stiffness as a predictor of progression of CKD, and five out of eight studies, which investigated rapid kidney decline, found a positive association. One study of six found kidney function was able to predict future elevated arterial stiffness.

CONCLUSION

Arterial stiffness may predict incident CKD and a rapid decline in CKD. It is uncertain if arterial stiffness is associated with CKD progression or whether reduced kidney function is predictive of increased arterial stiffness. Further longitudinal research is required.

Association between the oxidative balance score and estimated pulse wave velocity from the National Health and Nutrition Examination Survey (2005-2018)

BACKGROUND

No research report has been conducted to investigate the impact of oxidation balance score (OBS) on the estimated pulse wave velocity(ePWV).We aimed to examine the association between OBS and ePWV.

METHOD

We evaluated data for 13,073 patients from the National Health and Nutrition Examination Survey (NHANES). The exposure variable was OBS. The outcome variables was combination of ePWV and arterial stiffness.

RESULTS

We observed a significant negative correlation between OBS (Per 1SD increase) and ePWV in the gradually adjusted models. Based on the aforementioned results, a two-piecewise logistic regression adjusted model was subsequently employed to establish the association between OBS and elevated ePWV, and the inflection point was determined as 5. The increased risk of elevated ePWV (OR:0.70; 95%CI:0.51-0.94) gradually decreases with the increase of OBS on the left side of the inflection point; however, when OBS exceeds 5, this decrease in risk of elevated ePWV(OR:1.00; 95%CI:0.96-1.04) is no longer observed (P for log likelihood ratio test = 0.028).

CONCLUSIONS

There exists a significant association between OBS and ePWV in the context of American adults. Specifically, OBS exhibits a negative correlation with ePWV; however, when considering an elevated ePWV, a saturation effect is observed in relation to OBS.

Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary syndrome

BACKGROUND

Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment.

METHODS

NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV). Long-term outcomes included major adverse cardiovascular events (MACE), a composite of death, reinfarction, urgent revascularization, stroke/transient ischemic attack, and significant bleeding.

RESULTS

Recruitment resulted in 214 patients assessed for LnRHI, 190 patients assessed for CIMT and 245 patients assessed for cfPWV. For LnRHI group (median follow-up 4.73 years [IQR: 1.41-5.00]), Cox regression analysis revealed a trend towards increased risk of MACE (HR: 1.24 [95% CI: 0.80-1.93]; P  = 0.328) and mortality (HR: 1.49 [95% CI: 0.86-2.59]; P  = 0.157), but no significance was reached. No difference for other components of MACE was found. For CIMT group (median follow up 4.74 years [IQR: 1.55-5.00]), no statistically significant difference in MACE was found (HR: 0.92 [95% CI: 0.53-1.59]; P  = 0.754). Similarly, for cfPWV group (median follow-up 4.96 years [IQR: 1.55-5.00]), results did not support prognostic significance (for MACE, HR: 0.95 [95% CI: 0.65-1.39]; P  = 0.794).

CONCLUSION

Endothelial function, CIMT and vascular stiffness were proven unsuitable as strong prognostic predictors in older patients with NSTEACS.

CLINICAL TRIAL REGISTRATION

NCT01933581.

Dexamethasone-Induced Arterial Stiffening Is Attenuated by Training due to a Better Balance Between Aortic Collagen and Elastin Levels

PURPOSE

Although the cardioprotective benefits of exercise training are well known, the effects of training on dexamethasone (DEX)-induced arterial stiffness are still unclear. This study was aimed at investigating the mechanisms induced by training to prevent DEX-induced arterial stiffness.

METHODS

Wistar rats were allocated into 4 groups and submitted to combined training (aerobic and resistance exercises, on alternate days, 60% of maximal capacity, for 74 d) or were kept sedentary: sedentary control rats (SC), DEX-treated sedentary rats (DS), combined training control (CT), and DEX-treated trained rats (DT). During the last 14 d, rats were treated with DEX (50 μg/kg per body weight, per day, s.c.) or saline.

RESULTS

DEX increased PWV (+44% vs +5% m/s, for DS vs SC, p<0.001) and increased aortic COL 3 protein level (+75%) in DS. In addition, PWV was correlated with COL3 levels (r=0.682, p<0.0001). Aortic elastin and COL1 protein levels remained unchanged. On the other hand, the trained and treated groups showed lower PWV values (-27% m/s, p<0.001) vs DS and lower values of aortic and femoral COL3 compared with DS.

CONCLUSION

As DEX is widely used in several situations, the clinical relevance of this study is that the maintenance of good physical capacity throughout life can be crucial to alleviate some of its side effects, such as arterial stiffness.

Associations of circulating T-cell subsets in carotid artery stiffness: the Multi-Ethnic Study of Atherosclerosis

Background

Arterial stiffness measured by total pulse wave velocity (T-PWV) is associated with increased risk of multiple age-related diseases. T-PWV can be described by structural (S-PWV) and load-dependent (LD-PWV) arterial stiffening. T-cells have been associated with arterial remodeling, blood pressure, and arterial stiffness in humans and animals; however, it is unknown whether T-cells are related to S-PWV or LD-PWV. Therefore, we evaluated the cross-sectional associations of peripheral T-cell subpopulations with T-PWV, S-PWV, and LD-PWV stiffness.

Methods

Peripheral blood T-cells were characterized using flow cytometry and the carotid artery was measured using B-mode ultrasound to calculate T-PWV at the baseline examination in a subset of the Multi-Ethnic Study of Atherosclerosis (MESA, n=1,984). A participant-specific exponential model was used to calculate S-PWV and LD-PWV based on elastic modulus and blood pressure gradients. The associations between five primary (p-significance<0.01) and twenty-five exploratory (p-significance<0.05) immune cell subpopulations, per 1-SD increment, and arterial stiffness measures were assessed using adjusted, linear regressions.

Results

For the primary analysis, higher CD4+CD28-CD57+ T-cells were associated with higher LD-PWV (β=0.04 m/s, p<0.01) after adjusting for co-variates. For the exploratory analysis, T-cell subpopulations that commonly shift with aging towards memory and differentiated/immunosenescent phenotypes were associated with greater T-PWV, S-PWV, and LD-PWV after adjusting for co-variates.

Conclusions

In this cross-sectional study, several T-cell subpopulations commonly associated with aging were related with measures of arterial stiffness. Longitudinal studies that examine changes in T-cell subpopulations and measures of arterial stiffness are warranted.

Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

Increased diameter and stiffness of elastic but not muscular arteries in men with abdominal aortic aneurysm

It has been proposed that formation of abdominal aortic aneurysm (AAA) is part of a systemic arterial dilatative disease. However, arteries in the upper extremities are scarcely studied and it remains unclear whether both muscular and elastic arteries are affected by the proposed systemic arterial dilatation. The aim of this study was to investigate the diameter and stiffness of muscular and elastic arteries in arterial branches originating from the aortic arch. Twenty-six men with AAA (69 ± 4 yr) and 57 men without AAA (70 ± 5 yr) were included in the study. Ultrasound was used to examine the distal and proximal brachial artery, axillary artery, and common carotid artery (CCA), and measurement of diameter and diameter change was performed with wall-tracking software. Blood pressure measurements were used to calculate local arterial wall stiffness indices. The AAA cohort presented larger arterial diameters in the CCA and axillary artery after adjustment for body surface area (P = 0.002, respectively), whereas the brachial artery diameters were unchanged. Indices of increased stiffness in CCA (e.g., lower distensibility, P = 0.003) were seen in subjects with AAA after adjustments for body mass index and mean arterial blood pressure. This study supports the theory of a systemic arterial dilating diathesis in peripheral elastic, but not in muscular, arteries. Peripheral elastic arteries also exhibited increased stiffness, in analogy with findings in the aorta in AAA.NEW & NOTEWORTHY We present data partially supporting the notion of abdominal aortic aneurysm being a systemic vascular disease with focal manifestation in the abdominal aorta, from two well-defined groups recruited from a regional screening program. We show that elastic arteries distal from the aorta exhibit vascular alterations without aneurysmal formation in subjects with AAA compared with controls while muscular arteries seem unaffected.

Role of the circulating milieu in age-related arterial dysfunction: a novel ex vivo approach

The circulating milieu, bioactive molecules in the bloodstream, is altered with aging and interfaces constantly with the vasculature. This anatomic juxtaposition suggests that circulating factors may actively modulate arterial function. Here, we developed a novel, translational experimental model that allows for direct interrogation of the influence of the circulating milieu on age-related arterial dysfunction (aortic stiffening and endothelial dysfunction). To do so, we exposed young and old mouse arteries to serum from young and old mice and young and midlife/older (ML/O) adult humans. We found that old mouse and ML/O adult human, but not young, serum stiffened young mouse aortic rings, assessed via elastic modulus (mouse and human serum, P = 0.003 vs. young serum control), and impaired carotid artery endothelial function, assessed by endothelium-dependent dilation (EDD) (mouse serum, P < 0.001; human serum, P = 0.006 vs. young serum control). Furthermore, young mouse and human, but not old, serum reduced aortic elastic modulus (mouse serum, P = 0.009; human serum, P < 0.001 vs. old/MLO serum control) and improved EDD (mouse and human serum, P = 0.015 vs. old/MLO serum control) in old arteries. In human serum-exposed arteries, in vivo arterial function assessed in the human donors correlated with circulating milieu-modulated arterial function in young mouse arteries (aortic stiffness, r = 0.634, P = 0.005; endothelial function, r = 0.609, P = 0.004) and old mouse arteries (aortic stiffness, r = 0.664, P = 0.001; endothelial function, r = 0.637, P = 0.003). This study establishes novel experimental approaches for directly assessing the effects of the circulating milieu on arterial function and implicates changes in the circulating milieu as a mechanism of in vivo arterial aging.NEW & NOTEWORTHY Changes in the circulating milieu with advancing age may be a mechanism underlying age-related arterial dysfunction. Ex vivo exposure of young mouse arteries to the circulating milieu from old mice or midlife/older adults impairs arterial function whereas exposure of old mouse arteries to the circulating milieu from young mice or young adults improves arterial function. These findings establish that the circulating milieu directly influences arterial function with aging.

Arterial stiffness is associated with prehypertension in both non-hypertensives and treated hypertensives-A matched case control study

BACKGROUND

Prehypertension (PHT) is a cardiovascular health risk defined by blood pressure (BP). Arterial stiffness (AS) provides beyond brachial BP inference on vascular ageing and pulse wave analysis (PWA) can measure it non-invasively.We compared association between AS and PHT using age and gender matched case-controls.

METHODS

This is a sub analysis of previous PWA studies of hypertensives and non-hypertensives. Using oscillometric PWA by Mobil-o-Graph (IEM, Stolberg, Germany), parameters of AS (augmentation pressure and index, reflection magnitude, aortic pulse wave velocity, pulse pressure amplification), brachial hemodynamics (BH), and central hemodynamics (CH; aortic BP, cardiac output related parameters, stroke work) were derived. Age and gender matched case controls were compared as: 1) Nonhypertensives with BP at prehypertensive level (PHT) versus normotensives (NT) (n = 217 each), 2) Under treatment hypertensives with BP at prehypertensive level (PHT-T) versus untreated, nonhypertensives with BP at prehypertensive level (PHT-UT) (n = 74 each).

RESULTS

PHTs had higher AS, BH and CH than NTs, with statistical significance for all but few parameters. PHT-T had comparable BH but higher AS, CH than PHT-UT with significance for few parameters.

CONCLUSION

Pulse wave analysis derived arterial stiffness is associated with prehypertension compared to normal, after age and gender matching. In hypertensives, arterial stiffness is significantly higher despite being treated to prehypertension level as compared to control. It hints arterial stiffness to be better parameter than brachial BP to study prehypertension.

The Impact of Medical Physical Training and a Structured Personalized Exercise Training Program on Hemodynamic Parameters and Arterial Stiffness in Pregnant Women

INTRODUCTION

In developed countries, heart disease is the primary cause of maternal mortality during pregnancy. Arterial stiffness, an independent risk factor for atherosclerosis and a predictor of cardiovascular complications, can be assessed using the augmentation index (AIx) and pulse wave velocity (PWV). In this prospective study, we aimed to evaluate diverse hemodynamic parameters and arterial stiffness in pregnant women before and after participating in a structured, personalized exercise training program.

MATERIALS AND METHODS

Forty healthy pregnant women, non-smokers, who agreed to participate daily for 12 weeks in a physical exercise training program under the supervision of a team made up of an obstetrician, a cardiologist, and a physiotherapist were included. Anthropometric characteristics, arterial function, and physical activity data were collected from the participants at two different time points: at the beginning of the exercise training program (T0) and at the end, after 12 weeks (T1).

RESULTS

Upon conducting a statistical analysis, it was discovered that there were noteworthy disparities (p = 0.05) in body mass index, brachial AIx, systolic blood pressure, and pulse pressure values between the two time points. The regression analysis for the AIx brachial values and the PWVao values from Trim II (T0) and Trim III (T1) showed major differences between these two time points; the association between the AIx brachial values in the second and third trimesters of pregnancy revealed a strong direct significant correlation (p < 0.001), and the correlation between the PWVao values in the second (T0) and third trimester (T1) of pregnancy was weak and insignificant (p = 0.12).

CONCLUSIONS

The findings of our study indicate that a personalized exercise training program positively impacts the physical and psychological well-being of pregnant women, leading to a reduction in PWV.

Assessment of Registered Clinical Trial Designs: Comparison of L-Arginine and/or L-Citrulline Interventions for Hypertension

BACKGROUND

L-Arginine (Arg) is an essential amino acid and a precursor for the synthesis of vascular nitric oxide, while L-Citrulline is a non-essential amino acid substrate for increasing L-arginine. Both L-arginine and L-Citrulline in translational studies may acutely lower the blood pressure. Current meta-analysis for L-arginine or L-Citrulline interventions in blood pressure have identified significant heterogeneity. Clinical trial evidence for L-arginine or L-Citrulline in chronic blood pressure reduction in the general population requires an examination of trial designs, as not all translational studies may have influenced vascular reactivity. Our aims are to explore whether L-arginine and L-citrulline intervention trials in chronic blood pressure consider standardized end points relevant to the general adult populations.

METHODS

A step-wise search on clinicaltrials.gov, the U.S. Library of Medicine registry for clinical trials, was performed including the following keyword search parameters: "completed" "L-Citrulline" "L-arginine" trial", and "adults", involving "blood pressure" reduction as a primary end point in adult humans.

RESULTS

Of the forty-four completed trials, only five were included for analysis. Following the careful evaluation of trial design, we observed heterogeneity across participant inclusion criteria (population sample size, age range, sex), interventional design (dosages, duration), and primary outcomes, measured with respect to changes in diastolic or systolic blood pressure.

CONCLUSION

In conclusion, there is a lack of robust trial design evidence to suggest that L-arginine or L-Citrulline, based on current RCTs in the general population, have an overall positive effect on vascular endothelial reactivity and a beneficial chronic blood pressure-lowering effect. Indeed, conclusions drawn from human meta-analysis studies have been heterogenous between studies, which may be attributed to study design heterogeneity, including differences in sample population, age, and blood pressure at the time of entry. Inconsistencies in the study design poses a challenge for systematic reviews and meta-analysis to accurately assess the effect size and impact of L-arginine or L-citrulline on both systolic and diastolic blood pressure.

Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study

BACKGROUND

Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension.

OBJECTIVE

This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up.

METHODS

At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures.

RESULTS

Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47% hypertension), 1 SD increment in FWA was associated with 0.16 (95% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05).

CONCLUSIONS

In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span.

Evaluation of vascular aging on measures of cardiac function and mechanical efficiency: insights from in-silico modeling

Introduction

This study evaluated the hypothesis that vascular aging (VA) reduces ventricular contractile function and mechanical efficiency (ME) using the left ventricular pressure-volume (PV) construct.

Methods

A previously published in-silico computational model (CM) was modified to evaluate the hypothesis in two phases. In phase I, the CM included five settings of aortic compliance (CA) from normal to stiff, studied at a heart rate of 80 bpm, and phase II included the normal to stiff CA settings evaluated at 60, 100, and 140 bpm. The PV construct provided steady-state and transient data through a simulated vena caval occlusion (VCO). The steady-state data included left ventricular volumes (EDV and ESV), stroke work (SW), and VCO provided the PV area (PVA) data in addition to the three measures of contractile state (CS): end-systolic pressure-volume relationship (ESPVR), dP/dtmax-EDV and preload recruitable stroke work (PRSW). Finally, ME was calculated with the SW/PVA parameter.

Results

In phase I, EDV and ESV increased, as did SW and PVA. The impact on the CS parameters demonstrated a small decrease in ESPVR, no change in dP/dtmax-EDV, and a large increase in PRSW. ME decreased from 71.5 to 60.8%, respectively. In phase II, at the normal and stiff CA settings, across the heart rates studied, EDV and ESV decreased, ESPVR and dP/dtmax-EDV increased and PRSW decreased. ME decreased from 76.4 to 62.6% at the normal CA and 65.8 to 53.2% at the stiff CA.

Discussion

The CM generated new insights regarding how the VA process impacts the contractile state of the myocardium and ME.

Intermittent supplementation with fisetin improves arterial function in old mice by decreasing cellular senescence

Cellular senescence and the senescence-associated secretory phenotype (SASP) contribute to age-related arterial dysfunction, in part, by promoting oxidative stress and inflammation, which reduce the bioavailability of the vasodilatory molecule nitric oxide (NO). In the present study, we assessed the efficacy of fisetin, a natural compound, as a senolytic to reduce vascular cell senescence and SASP factors and improve arterial function in old mice. We found that fisetin decreased cellular senescence in human endothelial cell culture. In old mice, vascular cell senescence and SASP-related inflammation were lower 1 week after the final dose of oral intermittent (1 week on-2 weeks off-1 weeks on dosing) fisetin supplementation. Old fisetin-supplemented mice had higher endothelial function. Leveraging old p16-3MR mice, a transgenic model allowing genetic clearance of p16INK4A -positive senescent cells, we found that ex vivo removal of senescent cells from arteries isolated from vehicle- but not fisetin-treated mice increased endothelium-dependent dilation, demonstrating that fisetin improved endothelial function through senolysis. Enhanced endothelial function with fisetin was mediated by increased NO bioavailability and reduced cellular- and mitochondrial-related oxidative stress. Arterial stiffness was lower in fisetin-treated mice. Ex vivo genetic senolysis in aorta rings from p16-3MR mice did not further reduce mechanical wall stiffness in fisetin-treated mice, demonstrating lower arterial stiffness after fisetin was due to senolysis. Lower arterial stiffness with fisetin was accompanied by favorable arterial wall remodeling. The findings from this study identify fisetin as promising therapy for clinical translation to target excess cell senescence to treat age-related arterial dysfunction.

The combined effects of arteriosclerosis and diabetes on cardiovascular disease risk

The morbidity and mortality of cardiovascular disease (CVD) rank first among common diseases. Arteriosclerosis and diabetes are risk factors for CVDs, which influence each other. However, their combined effects on CVDs are still unclear. In this study, people who participated in brachial-ankle pulse wave velocity (baPWV) testing and the annual physical examination of the Kailuan Group Finance Co., Ltd., from January 1, 2010, to December 31, 2020, were selected, and their anthropometric, biochemical and epidemiological data were collected. The participants were divided into four groups according to diabetes and arteriosclerosis diagnosis and follow-up. Cox proportional hazards regression and subdistribution hazard models were used to analyse the combined effects of arteriosclerosis and diabetes on CVDs. Multiple sensitivity analyses were also performed. A total of 59,268 Asian populations were selected, including 14,425 females (28.11%) with an average age of 48.10 (± 12.72) years. During follow-up, 1830 subjects developed CVDs (mean follow-up period, 4.72 years). The cumulative incidence rates of the healthy control, diabetes, arteriosclerosis, and comorbidity groups were 5.04% (807/38781), 15.17% (253/3860), 17.04% (465/5987), and 25.59% (305/2684), respectively. The results of multivariate Cox regression analysis showed that compared with the healthy control group, the risk of CVD in the diabetes, arteriosclerosis, and comorbidity groups was significantly increased. Their HR values were 1.88 (95% CI 1.62-2.18), 1.40 (95% CI 1.23-1.60), and 2.10 (95% CI 1.80-2.45), respectively. The results of the sensitivity analysis were robust. For each one standard increase in fasting blood glucose or baPWV, the HR values for CVDs were 1.16 (95% CI 1.12-1.20) and 1.22 (95% CI 1.16-1.28), respectively. The results indicated that both arteriosclerosis and diabetes lead to an increased risk of CVDs. The risk of CVDs, coronary atherosclerotic heart disease, heart failure, stroke, coronary artery bypass grafting and ischemic stroke in patients with arteriosclerosis and diabetes was significantly higher than that in patients with arteriosclerosis or diabetes alone. Therefore, the primary prevention of CVDs in patients with arteriosclerosis complicated with diabetes needs more attention.

Incremental values of AOPP, IL-6, and GDF15 for identifying arteriosclerosis in patients with obstructive sleep apnea

BACKGROUND

The objective of this study was to determine the independent and incremental values of advanced oxidative protein product (AOPP), interleukin 6 (IL-6), and growth differentiation factor 15 (GDF15) in identifying arteriosclerosis in patients with obstructive sleep apnea (OSA).

METHODS

A total of 104 individuals diagnosed with OSA by polysomnography were recruited in our study. Arteriosclerosis was defined by measuring the ultrafast pulse wave velocity of the carotid artery. Peripheral venous blood samples were collected to analyze the levels of AOPP, IL-6, and GDF15 utilizing commercially available enzyme-linked immunosorbent assays.

RESULTS

Compared to OSA patients without arteriosclerosis, those with arteriosclerosis exhibited significantly higher levels of AOPP, IL-6, and GDF15. GDF15 remained significantly associated with arteriosclerosis even after accounting for clinical factors such as age, gender, body mass index, systolic blood pressure, fasting blood glucose, smoking, and the apnea-hypoxia index (AHI). GDF15 demonstrated the largest area under the curve (AUC) for identifying arteriosclerosis in OSA patients (AUC, 0.85 [0.77-0.94]). The logistic regression model, combining clinical factors and AHI, was enhanced by the inclusion of AOPP and IL-6 (Chi-square = 25.06), and even further improved when GDF15 was added (Chi-square = 50.74). The integrated discrimination index increased by 0.06 to 0.16 when GDF15 was added to the models including clinical factors, AOPP, and IL-6.

CONCLUSIONS

This study verified the independent and incremental value of GDF15 in identifying arteriosclerosis in OSA patients, surpassing clinical risk factors and other serum biomarkers such as AOPP and IL-6.

Arterial stiffness is associated with handgrip strength in relatively healthy Chinese older adults

Background

Increased arterial stiffness and low handgrip strength (HGS) are associated with poor health outcomes and are a severe health risk for older adults. However, there is limited evidence and mixed results on whether there is an association between them. Therefore, this study focused on the association between arterial stiffness and HGS in relatively healthy older adults in Beijing, China.

Methods

In 2016, 2,217 adult volunteers were recruited in Beijing. Brachial-ankle pulse wave velocity (baPWV) and the ankle-brachial index were measured using an automatic vascular profiling system. Carotid artery intima-media thickness and common carotid artery-internal diameter (CCAID) were evaluated using Doppler ultrasound, and HGS was measured with a dynamometer. Low HGS was determined using the Asian Sarcopenia Working Group 2019 criteria. Multivariate linear and logistic regressions evaluated the relationship between arterial stiffness and HGS.

Results

Ultimately, 776 relatively healthy older adults (mean age 69.05 ± 6.46 years) were included. Based on the AWGS2019 criteria, 137 participants were defined as having low HGS. Compared to the normal HGS group, the low HGS group was older and had higher baPWV (p < 0.001) but lower CCAID, body mass index (BMI) and hemoglobin (Hb) (p < 0.05). The multiple linear regression analysis revealed that baPWV was negatively correlated with HGS (β = -0.173, t = -2.587, p = 0.01). Multivariate logistic regression analysis showed that baPWV and CCAID were associated with an increased risk of low HGS (odds ratio (OR) per SD increase: 1.318, p = 0.007; OR per SD increase: 0.541, p < 0.001).

Conclusion

Arterial stiffness and HGS were significantly negatively correlated in relatively healthy Chinese older adults. Low HGS is associated with increased arterial stiffness. Encouraging exercise training to improve HGS, thereby reducing arterial stiffness and the risk of cardiovascular events, may be a simple and effective intervention.

Menopause and accelerated aortic stiffness

BACKGROUND

The menopausal transition is widely believed to increase the risk of cardiovascular disease, based on the notion that estrogen is cardioprotective in women. While aortic stiffness is an independent predictor of cardiovascular disease, it has been unclear whether this risk increases during menopause.

OBJECTIVE

This study aimed to determine the association between changes in menopausal status and aortic stiffness.

MAIN OUTCOME MEASURES

Menopausal status was classified using the Stages of Reproductive Aging in Women criteria in a stratified random sample of Australian women aged 40-80 years, at three time-points over 14 years (n = 469 in 2001-02 and 2005, and n = 323 in 2014). Aortic stiffness was measured non-invasively via carotid-femoral pulse wave velocity at each time point. Mixed modeling was employed to determine the independent associations between menopausal status and aortic stiffness accounting for multiple covariates including age, systolic blood pressure, heart rate, medications, cholesterol, waist circumference, smoking and diabetes status.

RESULTS

There was no evidence to support an association between the menopausal transition and an acceleration of aortic stiffness. However, there was an acceleration of aortic stiffness in the late (8+ years) postmenopause phase, after accounting for age and traditional cardiovascular risk factors (0.122 [95%CI: 0.106, 0.139] m/s/year; p < 0.001).

CONCLUSIONS

The menopausal transition is not associated with major changes in aortic stiffness beyond normal age-related effects. However, the clinically significant acceleration in aortic stiffness observed in late postmenopause may contribute to greater cardiovascular risk in this later life phase. Study registered in the Australian and New Zealand Clinical Trials Registry, reference ACTRN12618000005257.

Arterial stiffness mediates the association between age and processing speed at low levels of microvascular function in humans across the adult lifespan

The function of micro- and macrovessels within the peripheral vasculature has been identified as a target for the investigation of potential cardiovascular-based promoters of cognitive decline. However, little remains known regarding the interaction of the micro- and macrovasculature as it relates to cognitive function, especially in cognitively healthy individuals. Therefore, our purpose was to unravel peripheral factors that contribute to the association between age and processing speed. Ninety-nine individuals (51 men, 48 women) across the adult life span (19-81 yr) were used for analysis. Arterial stiffness was quantified as carotid-femoral pulse-wave velocity (cfPWV) and near-infrared spectroscopy assessed maximal tissue oxygenation (Sto2max) following a period of ischemia. Processing speed was evaluated with Trail Making Test (TMT) Parts A and B. Measures of central (cPP) and peripheral pulse pressure (pPP) were also collected. Moderated mediation analyses were conducted to determine contributions to the age and processing speed relation, and first-order partial correlations were used to assess associations while controlling for the linear effects of age. A P ≤ 0.05 was considered statistically significant. At low levels of Sto2max, there was a significant positive (b = 1.92; P = 0.005) effect of cfPWV on time to completion on TMT part A. In addition, cPP (P = 0.028) and pPP (P = 0.027) remained significantly related to part A when controlling for age. These results suggested that the peripheral microvasculature may be a valuable target for delaying cognitive decline, especially in currently cognitively healthy individuals. Furthermore, we reinforced current evidence that pulse pressure is a key endpoint for trials aimed at preventing or delaying the onset of cognitive decline.NEW & NOTEWORTHY Arterial stiffness partially mediates the association between age and processing speed in the presence of low microvascular function, as demarcated by maximum tissue oxygenation following ischemia. Central and peripheral pulse pressure remained associated with processing speed even after controlling for age. Our findings were derived from a sample that was determined to be cognitively healthy, which highlights the potential for these outcomes to be considered during trials aimed at the prevention of cognitive decline.

Change of HeART: Cardiovascular Implications of Assisted Reproductive Technology

Cardiovascular (CV) disease is the leading cause of death in women, and it may manifest differently than in men, in part related to sex-specific CV risk factors. In females, assisted reproductive technologies (ARTs) are commonly used to treat infertility, and they utilize controlled ovarian stimulation involving the administration of exogenous sex hormones. ARTs, and especially controlled ovarian stimulation, have been associated with an increased pregnancy and short-term CV risk, although the long-term CV implications of these treatments in individuals treated with ARTs and their offspring remain unclear. This review endeavors to provide a comprehensive examination of what is known about the relationship between ART and CV outcomes for females treated with ARTs, as well as their offspring, and recommendations for future research. Novel insights into female-specific CV risk factors are critical to reduce the disproportionate burden of CV disease in Canadian women. ART has revolutionized reproductive medicine, offering hope to millions of individuals with infertility worldwide, and a further understanding of the CV implications of this important sex-specific CV risk factor is warranted urgently.

Genetic and biomarker modulation of arterial stiffness change in the SardiNIA population cohort

Background and aims

Arterial stiffness (AS), quantified by pulse wave velocity (PWV), arises due to impaired arterial elastic tissue and smooth muscle dysfunction. We aimed to examine the longitudinal association of genetic, lipid and inflammation biomarkers with PWV and how these associations may change with aging.

Materials and methods

We utilized genotype and four time-point biomarker data from the SardiNIA cohort [n = 6,301; mean baseline age 43.3 (SD 17.3); 58% females]. To investigate the association of PWV with genetic variants, lipid, and inflammation biomarkers, we employed linear mixed modeling, using age as the time scale. Biomarkers exhibiting significant longitudinal associations were categorized into tertiles and individuals within the second tertile or those with heterozygous alleles were excluded, leaving a cohort of 2,000 individuals. This cohort was further divided into four risk groups: low genetic and low biomarker (L-L), low genetic and high biomarker (L-H), high genetic and low biomarker (H-L), and high genetic and high biomarker risk (H-H). Subsequent analyses focused on these risk groups to assess their association to PWV with time.

Results

Using the complete dataset, we found a significant longitudinal association of total cholesterol (TC), triglycerides (TG), fibrinogen (FGN), and total white blood cell count (TWBC) with PWV, all with p < 3.33 × 10-3. After grouping, individuals with homogeneous risk alleles of SNP rs3742207 and high baseline TG levels (H-H group) exhibited a 1.39-fold higher PWV (m/s) (95% CI, 1.17-1.64, p = 1.21 × 10-4) compared to the L-L group. Similarly, individuals in the H-H group of rs3742207-TWBC combination showed 1.75 times higher PWV (95% CI, 1.48-0.2.07, p = 1.01 × 10-10) compared to the L-L group. Similar patterns were observed for groups based on SNP rs7152623-TWBC risk. Furthermore, these associations became more pronounced with increasing age (p < 3.33 × 10-3).

Conclusion

The longitudinal association of TG and TWBC biomarkers with PWV varied by SNPs rs3742207 and rs7152623 genotype. Further studies are warranted to investigate the function of genetics, lipids, and inflammation biomarkers on PWV change.

Association of COVID-19 and Arterial Stiffness Assessed using Cardiovascular Index (CAVI)

BACKGROUND

COVID-19 is characterized by an acute inflammatory response with the formation of endothelial dysfunction and may affect arterial stiffness. Studies of cardio-ankle vascular index in COVID-19 patients with considered cardiovascular risk factors have not been conducted.

OBJECTIVE

The purpose of our study was to assess the association between cardio-ankle vascular index and COVID-19 in hospitalized patients adjusted for known cardiovascular risk factors.

METHODS

A cross-sectional study included 174 people hospitalized with a diagnosis of moderate COVID-19 and 94 people without COVID-19. Significant differences in the cardio-ankle vascular index values measured by VaSera VS - 1500N between the two groups were analyzed using parametric (Student's t-criterion) and nonparametric (Mann-Whitney) criteria. Independent association between COVID-19 and an increased cardio-ankle vascular index ≥ 9.0 adjusted for known cardiovascular risk factors was assessed by multivariate logistic regression.

RESULTS

There were significantly higher values of the right cardio-ankle vascular index 8.10 [7.00;9.40] and the left cardio-ankle vascular index 8.10 [6.95;9.65] in patients undergoing inpatient treatment for COVID-19 than in the control group - 7.55 [6.60;8.60] and 7.60 [6.60;8.70], respectively. A multivariate logistic regression model adjusted for age, hypertension, plasma glucose level, glomerular filtration rate and diabetes mellitus showed a significant association between increased cardio-ankle vascular index and COVID-19 (OR 2.41 [CI 1.09;5.30]).

CONCLUSION

Hospitalized patients with COVID-19 had significantly higher cardio-ankle vascular index values compared to the control group. An association between an increased cardio-ankle vascular index and COVID-19 was revealed, independent of age, hypertension, plasma glucose level, glomerular filtration rate and diabetes mellitus.

Arterial Stiffness and Incident Diabetes

Diabetes may induce multiple organ damage; therefore, early detection of individuals at high-risk of incident diabetes is important for timely risk assessment and intervention. Arterial stiffness (AS) occurs as a result of functional and structural changes in the arterial wall. Growing body of evidence suggests that AS is a risk factor for incident diabetes. Although each study could use different indicators for AS (ex cf-PWV, baPWV, etc.), they came to similar conclusion that AS was associated with higher risk of incident diabetes. The underlying mechanisms for the relationship of AS with risk of diabetes remain to be elucidated, but there could be several potential mechanisms. Diabetes and AS are expected to share common risk factors and influence each other, but recent research showed some evidence that AS can directly increase the risk of diabetes. The link between AS and incident diabetes has important clinical implications. First, it suggests that AS might be a useful marker for identifying people at high risk for developing diabetes. Second, it suggests that reducing AS may prevent or delay the onset of diabetes. Early detection and possible slowing of the vascular stiffening process with pharmacological agents and lifestyle interventions may reduce associated risks for diabetes.

Vascular Age Assessed From an Uncalibrated, Noninvasive Pressure Waveform by Using a Deep Learning Approach: The AI-VascularAge Model

BACKGROUND

Aortic stiffness, assessed as carotid-femoral pulse wave velocity, provides a measure of vascular age and risk for adverse cardiovascular disease outcomes, but it is difficult to measure. The shape of arterial pressure waveforms conveys information regarding aortic stiffness; however, the best methods to extract and interpret waveform features remain controversial.

METHODS

We trained a convolutional neural network with fixed-scale (time and amplitude) brachial, radial, and carotid tonometry waveforms as input and negative inverse carotid-femoral pulse wave velocity as label. Models were trained with data from 2 community-based Icelandic samples (N=10 452 participants with 31 126 waveforms) and validated in the community-based Framingham Heart Study (N=7208 participants, 21 624 waveforms). Linear regression rescaled predicted negative inverse carotid-femoral pulse wave velocity to equivalent artificial intelligence vascular age (AI-VA).

RESULTS

The AI-VascularAge model predicted negative inverse carotid-femoral pulse wave velocity with R2=0.64 in a randomly reserved Icelandic test group (n=5061, 16%) and R2=0.60 in the Framingham Heart Study. In the Framingham Heart Study (up to 18 years of follow-up; 479 cardiovascular disease, 200 coronary heart disease, and 213 heart failure events), brachial AI-VA was associated with incident cardiovascular disease adjusted for age and sex (model 1; hazard ratio, 1.79 [95% CI, 1.50-2.40] per SD; P<0.0001) or adjusted for age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, prevalent diabetes, hypertension treatment, and current smoking (model 2; hazard ratio, 1.50 [95% CI, 1.24-1.82] per SD; P<0.0001). Similar hazard ratios were demonstrated for incident coronary heart disease and heart failure events and for AI-VA values estimated from carotid or radial waveforms.

CONCLUSIONS

Our results demonstrate that convolutional neural network-derived AI-VA is a powerful indicator of vascular health and cardiovascular disease risk in a broad community-based sample.

The EVA (Early Vascular Aging) Study: Association of Central Obesity With Worse Arterial Health After Preeclampsia

Background Women with preeclampsia have a higher risk of cardiovascular disease. This is partly explained by the worse arterial health after preeclampsia. Central obesity (CO) is a risk factor for both preeclampsia and cardiovascular disease. Whether CO contributes to further worsening of arterial health after preeclampsia remains unclear. Our objective was to evaluate the effect of CO and previous preeclampsia on arterial hemodynamics. Methods and Results We studied 40 women with previous preeclampsia (<6 years) and 40 age-matched controls with previous normotensive pregnancy in the same timeframe. We estimated arterial hemodynamics with validated techniques combining applanation tonometry and echocardiography. CO was defined as a waist-to-hip ratio ≥0.85. Differences in arterial hemodynamics across the 3 groups (preeclampsia with CO, preeclampsia without CO, and controls) were assessed with multivariable linear regression models adjusted for potential confounders. Twenty-six (65%) of the participants with preeclampsia had CO compared with 18 (45%) controls. Mean waist-to-hip ratio in patients with preeclampsia with CO, those with preeclampsia and no CO, and controls was 0.94±0.05, 0.80±0.04, and 0.83±0.07, respectively. In multivariable analyses, women with preeclampsia and CO had higher central blood pressure, arterial stiffness (carotid-femoral pulse wave velocity), steady arterial load (systemic vascular resistance), and wave reflections (reflected pressure wave amplitude, augmentation index) compared with controls (P<0.05 for each). Fewer hemodynamic domains were altered in the preeclampsia with no CO group, with higher central diastolic blood pressure, systemic vascular resistance, and wave reflections than controls (P<0.05). Conclusions Women with previous preeclampsia who also experience CO have the greatest alterations in arterial health and hemodynamics. Patients with preeclampsia with CO may represent a higher-risk subgroup who could be targeted for risk stratification and primary prevention of cardiovascular disease.

Emerging Medical Therapies for the Treatment of Obesity in Women with Cardiovascular Diseases

PURPOSE OF REVIEW

In this review, the impact of obesity on cardiovascular disease in women and emerging anti-obesity pharmacologic treatments are discussed.

RECENT FINDINGS

Robust evidence demonstrates the burden of obesity across the lifespan in women and links obesity to a diverse set of cardiovascular diseases. Female-specific risk factors including sex hormones and pregnancy factors intersect with obesity and cardiovascular risk. Sustained weight loss has potential for cardiovascular benefits. Recent trials demonstrate cardiovascular benefits of emerging agents with weight loss effects including GLP-1 RA and SGLT2 inhibitors in women. Treatment and prevention strategies for cardiovascular disease in obese women should include integration of weight management strategies including the targeted use of emerging pharmacologic therapies.