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Alghamdi YA, Al-Shahrani FS, Alanazi SS, Alshammari FA, Alkhudair AM, Jatoi NA. The Association of Blood Glucose Levels and Arterial Stiffness (Cardio-Ankle Vascular Index) in Patients With Type 2 Diabetes Mellitus. Cureus 2021; 13:e20408. [PMID: 34926096 PMCID: PMC8671052 DOI: 10.7759/cureus.20408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetes mellitus causes a major burden on healthcare systems all around the world. It has been documented that type 2 diabetes mellitus (T2DM) is associated with long-term vascular complications including micro-vascular, macro-vascular, and mixed-vascular disorders. Several studies have concluded that the increment of arterial wall stiffness is correlated with an increase in the risk of cardiovascular adverse events and the mortality associated with it. AIMS This study purposed to evaluate the arterial stiffness measurements, using Cardio-Ankle Vascular Index (CAVI), in T2DM patients, and the relationship with the fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and other factors that may increase the risk of elevated arterial stiffness in T2DM patients. METHODOLOGY A total of 200 patients were recruited from the outpatient setting at King Fahd Hospital of the University, Al Khobar. A total of 181 patients fit the inclusion criteria. The charts of the patients who fit the inclusion criteria were reviewed and data related to age, gender, body mass index, smoking history, FBG, HbA1c levels, blood pressure (mmHg) measurements, and CAVI scores were collected. RESULTS The elevation in CAVI readings was noted to be more prominent in the senior age group. Hypertensive patients also showed a significant increase in CAVI readings. In addition, higher CAVI readings were more associated with the male gender rather than females. All of which showed a significant correlation. Furthermore, although it was not significant, higher FBG levels and HbA1c readings were correlated with higher CAVI readings. CONCLUSION The results of the study suggest that factors like age, smoking status, gender, and the increase in blood pressure as well as the increase in blood glucose levels are correlated with higher CAVI readings in T2DM patients. This demonstrates their important effect on arterial wall stiffness while showing that CAVI can be used in predicting the prognosis of arterial wall health in patients with diabetes.
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Affiliation(s)
- Yazid A Alghamdi
- Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Faisal S Al-Shahrani
- Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Saif S Alanazi
- Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Fahad A Alshammari
- Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Abdullah M Alkhudair
- Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Noor-Ahmed Jatoi
- Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
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Kostopoulou M, Nikolopoulos D, Parodis I, Bertsias G. Cardiovascular Disease in Systemic Lupus Erythematosus: Recent Data on Epidemiology, Risk Factors and Prevention. Curr Vasc Pharmacol 2020; 18:549-565. [DOI: 10.2174/1570161118666191227101636] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/20/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022]
Abstract
Systemic Lupus Erythematosus (SLE) is associated with increased risk for accelerated atherosclerosis
and cardiovascular (CV) events including coronary heart disease, cerebrovascular and peripheral
artery disease. CV events occur both early and late during the disease course, with younger
patients being at much higher risk than age-matched counterparts. The risk cannot be fully accounted for
by the increased prevalence of traditional atherosclerotic factors and may be due to pathophysiologic
intermediates such as type I interferons and other inflammatory cytokines, oxidative stress, activated
granulocytes and production of extracellular chromatin traps, antiphospholipid and other autoantibodies
causing dysfunction of lipoproteins, altogether resulting in endothelial injury and pro-atherogenic
dyslipidaemia. These mechanisms may be further aggravated by chronic intake of prednisone (even at
doses <7.5 mg/day), whereas immunomodulatory drugs, especially hydroxychloroquine, may exert antiatherogenic
properties. To date, there is a paucity of randomized studies regarding the effectiveness of
preventative strategies and pharmacological interventions specifically in patients with SLE. Nevertheless,
both the European League Against Rheumatism recommendations and extrapolated evidence from
the general population emphasize that SLE patients should undergo regular monitoring for atherosclerotic
risk factors and calculation of the 10-year CV risk. Risk stratification should include diseaserelated
factors and accordingly, general (lifestyle modifications/smoking cessation, antihypertensive and
statin treatment, low-dose aspirin in selected cases) and SLE-specific (control of disease activity, minimization
of glucocorticoids, use of hydroxychloroquine) preventive measures be applied as appropriate.
Further studies will be required regarding the use of non-invasive tools and biomarkers for CV assessment
and of risk-lowering strategies tailored to SLE.
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Affiliation(s)
- Myrto Kostopoulou
- 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dionysis Nikolopoulos
- 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - George Bertsias
- Department of Rheumatology, Clinical Rheumatology and Allergy, University of Crete Medical School, Iraklio, Greece
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Wang H, Zeng Y, Zheng H, Liu B. Association Between sRAGE and Arterial Stiffness in Women with Systemic Lupus Erythematosus. Endocr Metab Immune Disord Drug Targets 2020; 21:504-510. [PMID: 32370733 DOI: 10.2174/1871530320666200506082848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND sRAGE (soluble receptor for advanced glycation end products) is known to play a protective role in chronic inflammatory diseases, and has been found to be related to arterial stiffness in hypertensive or diabetic patients. This cross-sectional study was designed to study the potential association of sRAGE with arterial stiffness in systemic lupus erythematosus(SLE) patients. METHODS A total of 94 female SLE patients were enrolled. Brachial-ankle pulse wave velocity (baPWV) was measured by an automatic pulse wave analyzer. The patients were divided into two groups according to the baPWV values, those with values greater than 1400cm/s were placed in the high arterial stiffness group. Biochemical parameters were compared between the two groups. Linear and logistic regression analysis was used to observe the association between sRAGE and arterial stiffness in these patients. RESULTS Thirty-five patients were placed in the high arterial stiffness group in which sRAGE levels were lower (P<0.05). sRAGE levels were significantly related to baPWV(standardized β=1.18, P<0.01) by linear regression analysis. Multivariate logistic regression analysis showed that sRAGE, SLE duration, systolic blood pressure, and low-density lipoprotein cholesterol were independent predictors of arterial stiffness in these patients. CONCLUSION The results revealed that sRAGE was negatively associated with arterial stiffness in Chinese female SLE patients.
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Affiliation(s)
- Hongru Wang
- Department of Family Medicine, Gumei Community Hospital, Shanghai, China
| | - Yibin Zeng
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, China
| | - Huan Zheng
- Department of Cardiology, Worldpath Clinic International, Shanghai, China
| | - Bin Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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Mendoza-Pinto C, Rojas-Villarraga A, Molano-González N, García-Carrasco M, Munguía-Realpozo P, Etchegaray-Morales I, Morales-Sánchez H, Berra-Romani R, Cervera R. Endothelial dysfunction and arterial stiffness in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Atherosclerosis 2020; 297:55-63. [PMID: 32078830 DOI: 10.1016/j.atherosclerosis.2020.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Non-invasive surrogates of cardiovascular (CV) disease such as endothelial dysfunction (ED) and peripheral arterial stiffness (AS) have been evaluated in systemic lupus erythematosus (SLE) patients. The aim of this study was to systematically review and meta-analyze reports of cardiovascular disease (CVD) in SLE patients, as measured by ED and AS. METHODS Studies analyzing the relationship of SLE with ED (flow-mediated dilatation [FMD], nitroglycerin-mediated dilatation [NMD] and peripheral arterial tonometry [PAT]) and AS (augmentation index [AIx], pulse wave velocity [PWV]) were systematically searched for in PubMed, Cochrane library, EMBASE, VHL, SciELO and Web of Science databases. Inclusion criteria included peer-review and English language. Mean differences (MD) and 95% confidence intervals (CIs) were estimated using the random effect model. The study was registered with PROSPERO, number CRD42019121068. RESULTS The meta-analysis included 49 studies. FMD data from 18 studies including 943 SLE subjects (mean age = 38.71 [95%CI 36.21, 41.21] years) and 644 unaffected controls (mean age = 38.63 [95%CI 36.11, 41.15] years) were included. When compared with unaffected controls, FMD in SLE subjects was decreased by 4.3% (95%CI: -6.13%, -2.47%): p < 0.001). However, NMD did not significantly differ between SLE patients and controls (MD = - 2.68%; 95% CI -6.00, 0.62; p = 0.11). A significantly increased AS between SLE patients and controls according to overall PWV (MD = 1.12 m/s; 95% CI 0.72-1.52; p < 0.001) was observed, but not for the brachial-ankle PWV. AIx was also increased in SLE patients compared with healthy controls (MD = 4.55%; 95% CI 1.48-7.63; p = 0.003). CONCLUSIONS Overall, SLE patients showed impaired FMD, an independent predictor of CV events. There was a higher degree of AS in SLE patients compared with controls. ED and AS in SLE should be considered when planning preventive strategies and therapies.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | - Nicolás Molano-González
- Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Héctor Morales-Sánchez
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Roberto Berra-Romani
- Department of Biomedicine, School of Medicine, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
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Kobayashi R, Sato K, Sakazaki M, Nagai Y, Iwanuma S, Ohashi N, Hashiguchi T. Acute effects of difference in glucose intake on arterial stiffness in healthy subjects. Cardiol J 2019; 28:446-452. [PMID: 31702047 DOI: 10.5603/cj.a2019.0108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/26/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Post-prandial hyperglycemia is associated with higher cardiovascular risk, which causes arterial stiffening and impaired function. Although post-prandial increases in blood glucose are proportional to the level of intake, the acute effects of different glucose intakes on arterial stiffness have not been fully characterized. The present study aimed to determine the acute effects of differences in glucose intake on arterial stiffness. METHODS Six healthy middle-aged and elderly individuals (mean age, 60.0 ± 12.1 years) were orally administered 15, 20, and 25 g of glucose on separate days in a randomized, controlled, cross-over fashion. Brachial-ankle pulse wave velocity, heart-brachial pulse wave velocity, cardio-ankle vascular index, brachial and ankle blood pressure, heart rate, and blood glucose and serum insulin concentrations before and 30, 60, and 90 min after glucose ingestion were measured. RESULTS Compared to baseline, brachial-ankle pulse wave velocity was higher at 30, 60 and 90 min after ingestion of 25 g glucose, and higher at 90 min after ingestion of 20 g glucose, but at no time points after ingestion of 15 g. Cardio-ankle vascular index was higher at 60 min than at baseline after ingestion of 25 g glucose, but not after ingestion of 15 or 20 g. CONCLUSIONS These results suggest that brachial-ankle pulse wave velocity and cardio-ankle vascular index is affected by the quantity of glucose ingested. Proposed presently is that glucose intake should be reduced at each meal to avoid increases in brachial-ankle pulse wave velocity and cardio-ankle vascular index during acute hyperglycemia.
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Affiliation(s)
- Ryota Kobayashi
- Teikyo University of Science, 2-2-1 Senju, Sakuragi, Adachi- ku, 120-0045 Tokyo,, Japan.
| | | | | | | | - Soichiro Iwanuma
- Teikyo University of Science, 2-2-1 Senju, Sakuragi, Adachi- ku, 120-0045 Tokyo,, Japan
| | - Nobuyuki Ohashi
- Teikyo University of Science, 2-2-1 Senju, Sakuragi, Adachi- ku, 120-0045 Tokyo,, Japan
| | - Takeo Hashiguchi
- Teikyo University of Science, 2-2-1 Senju, Sakuragi, Adachi- ku, 120-0045 Tokyo,, Japan
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Stewart S, Brenton-Rule A, Dalbeth N, Aiyer A, Frampton C, Rome K. Foot and ankle characteristics in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:847-859. [PMID: 30093237 DOI: 10.1016/j.semarthrit.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/14/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine characteristics of the foot and ankle in people with systemic lupus erythematosus (SLE). METHODS Medline, CINAHL, Sports-Discus, Scopus and Cochrane Library databases were searched up to January 2018. Studies reporting foot- and ankle-related outcomes in the following domains were included: vascular, neurological, musculoskeletal, cutaneous (skin and nail) or pain/function. The Quality Index tool was used to assess methodological quality. Where appropriate, odds ratio (OR) and mean difference meta-analyses were conducted for case-control studies; and pooled mean prevalence meta-analyses for studies assessing characteristics in SLE. RESULTS Forty-nine studies were included with mean (range) quality scores of 75% (38-100%). Twenty-three studies assessed vascular characteristics, followed by musculoskeletal (n = 16), neurological (n = 11), cutaneous (n = 5) and pain/function (n = 4). Foot and ankle characteristics in people with SLE included impaired vascular supply, abnormal nerve function, musculoskeletal pathology, skin and nail pathology, and pain and functional disability. Twenty-four studies were included in meta-analyses. Pooled OR for abnormal ankle brachial index was 3.08 for SLE compared with controls. Pooled mean difference in brachial-ankle pulse-wave velocity between SLE and controls was significant (161.39 cm/s, P = 0.004). Pooled prevalence was 0.54 for intermittent claudication, 0.50 for Raynaud's phenomenon, 0.28 for chilblains, 0.00 for gangrene, 0.30 for hallux valgus, 0.15 for onychomycosis, 0.76 for history of foot pain, and 0.36 for current foot pain. CONCLUSION People with SLE experience a wide range of foot and ankle manifestations. Published research highlights the impact of peripheral arterial disease, peripheral neuropathy, musculoskeletal deformity, skin and nail pathology and patient-reported foot pain and disability.
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Affiliation(s)
- Sarah Stewart
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Angela Brenton-Rule
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Department of Rheumatology, Auckland District Health Board, New Zealand
| | - Ashok Aiyer
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Christopher Frampton
- Biostatistics Department, University of Otago, PO Box 7343, Wellington South, New Zealand
| | - Keith Rome
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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Chou CH, Ho CS, Tsai WC, Wang MC, Tsai YS, Chen JY. Effects of chronic hepatitis C infection on arterial stiffness. ACTA ACUST UNITED AC 2017; 11:716-723. [PMID: 28923555 DOI: 10.1016/j.jash.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/06/2017] [Accepted: 08/18/2017] [Indexed: 02/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is associated with increased arterial stiffness. Although chronic hepatitis C virus (HCV) infection was shown to be associated with metabolic disorder and chronic inflammation, the effects of chronic HCV infection on arterial stiffness remain unclear. This study recruited 221 patients including 32 normal controls, 72 NAFLD patients, and 117 subjects with HCV infection. Arterial stiffness was assessed by peripheral arterial stiffness index, Compliance Index (CI), and central arterial stiffness index, Stiffness Index derived from digital volume pulse by photoplethysmography. Levels of oxidative stress marker and inflammatory markers were also measured. The HCV group had significantly lower CI (4.8 ± 3.1 units vs. 3.9 ± 2.1 units vs. 3.0 ± 1.7 units; P for trend <.001) and higher Stiffness Index (7.0 ± 1.6 m/s vs. 8.3 ± 2.3 m/s vs. 8.4 ± 2.3 m/s; P for trend = .001) compared with the normal controls and NAFLD groups. Multivariate linear regression analysis showed that CI was independently correlated with systolic blood pressure (beta = -0.202, P = .013) and HCV infection (beta = -0.216, P = .036). Chronic HCV infection was independently associated with peripheral arterial stiffness. Peripheral arterial stiffness in chronic HCV infection was not associated with a marker of general inflammation (high-sensitivity C-reactive protein); however, a role for more specific markers of inflammation cannot be ruled out.
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Affiliation(s)
- Chang-Hua Chou
- Division of Gastroenterology, Department of Internal Medicine, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chin-Shan Ho
- Department of Adapted Physical Education, National Taiwan Sport University, Taoyuan, Taiwan
| | - Wei-Chuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Sheng Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Cardiovascular Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Yi Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Korsten P, Patschan D, Henze E, Niewold TB, Müller GA, Patschan S. Dynamics of pulse wave velocity and vascular augmentation index in association with endothelial progenitor cells in SLE. Lupus Sci Med 2016; 3:e000185. [PMID: 28176918 PMCID: PMC5237712 DOI: 10.1136/lupus-2016-000185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/11/2016] [Accepted: 10/26/2016] [Indexed: 11/11/2022]
Abstract
Patients with SLE display a significantly higher cardiovascular risk (CVR). Pulse wave velocity (PWV) has meanwhile been established as a reliable parameter of end-organ damage. Endothelial progenitor cells (EPCs) are critically involved in vascular repair under both physiological and pathological conditions. The aim of the study was to analyse PWV and the Vascular Augmentation Index (VAI) and EPC numbers/regeneration in a well-defined German SLE cohort. Thirty patients were included. Only two individuals displayed a PWV of above 10 m/s. There was no correlation between PWV percentiles and disease activity as reflected by the SLE Disease Activity Index. Neither EPC colonies nor percentages of circulating EPCs (CD133+/KDR+) correlated with PWV/VAI in a positive or negative manner. Thus, it can be questioned whether pulse wave analysis and/or EPC proliferation and circulating cell numbers are truly useful for CVR assessment in SLE.
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Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology , University Medicine Göttingen , Göttingen , Germany
| | - Daniel Patschan
- Department of Nephrology and Rheumatology , University Medicine Göttingen , Göttingen , Germany
| | - Elvira Henze
- Department of Nephrology and Rheumatology , University Medicine Göttingen , Göttingen , Germany
| | - Timothy B Niewold
- Department of Rheumatology , Mayo Clinic , Rochester, Minnesota , USA
| | - Gerhard Anton Müller
- Department of Nephrology and Rheumatology , University Medicine Göttingen , Göttingen , Germany
| | - Susann Patschan
- Department of Nephrology and Rheumatology , University Medicine Göttingen , Göttingen , Germany
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Liu J, Wang Y, An H, Liu J, Wei J, Wang H, Wang G. Correlation between arterial stiffness and coronary flow velocity reserve in subjects with pulse wave velocity >1400 cm/s. Clin Exp Hypertens 2015; 38:89-94. [PMID: 26362523 DOI: 10.3109/10641963.2015.1060988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Brachial-ankle pulse wave velocity (ba-PWV) is an independent predictor for cardiovascular events. Coronary flow velocity reserve (CFVR) provides important information for coronary endothelial function. In the present study, we investigated the possible relationship between PWV and CFVR, especially in subjects with PWV > 1400 cm/s. Seventy five subjects were divided into two groups based on baPWV value (baPWV > 1400 cm/s versus baPWV < 1400 cm/s). PWV and CFVR were measured by Colin VP-1000 apparatus and non-invasive Doppler echocardiography, respectively. Our results showed that CFVR was significantly lower in patients with baPWV > 1400 cm/s than in patients with baPWV < 1400 cm/s (2.57 ± 0.68 versus 3.04 ± 0.73, p < 0.01). baPWV was negatively correlated with CFVR in the entire study group (r = -0.45, p < 0.0001) even adjusting for age, prevalence of diabetes mellitus and systolic blood pressure (r = -0.33, p = 0.044). Moreover, baPWV was markedly negatively correlated with CFVR in patients with baPWV > 1400 cm/s (r = -0.42, p < 0.01). Multiple linear regressions showed that baPWV was independently associated with CFVR in the entire study group (β = -0.702, p < 0.001). Our results showed that large arterial stiffness was negatively correlated with decreased CFVR especially in subjects with baPWV > 1400 cm/s, and baPWV was independently associated with CFVR.
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Affiliation(s)
- Jinbo Liu
- a Department of Vascular Medicine , Peking University Shougang Hospital , Beijing , P.R. of China
| | - Ying Wang
- b Physical Examination Center, Beijing Chao-yang Hospital, Capital Medical University , Beijing , China
| | - Huijie An
- c Department of Endocrinology , Beijing Chaoyang Hospital Affiliated to Capital Medical University , Beijing , P.R. of China , and
| | - Jia Liu
- c Department of Endocrinology , Beijing Chaoyang Hospital Affiliated to Capital Medical University , Beijing , P.R. of China , and
| | - Jinru Wei
- d The First People's Hospital of Nanning Affiliated to the Guangxi Medical University , Nanning , P.R. of China
| | - Hongyu Wang
- a Department of Vascular Medicine , Peking University Shougang Hospital , Beijing , P.R. of China
| | - Guang Wang
- c Department of Endocrinology , Beijing Chaoyang Hospital Affiliated to Capital Medical University , Beijing , P.R. of China , and
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Kwankaew J, Leelawattana R, Saignam A, Siripaitoon B, Uea-Areewongsa P, Juthong S. Apolipoprotein B as an independent predictor of arterial stiffness in systemic lupus erythematosus patients. Int J Rheum Dis 2014; 18:447-51. [PMID: 24797872 DOI: 10.1111/1756-185x.12384] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To determine the relationship of apolipoprotein B (Apo-B) and arterial stiffness determined by brachial-ankle pulse wave velocity (baPWV) in systemic lupus erythematosus (SLE) subjects. METHODS Eighty-seven Thai SLE subjects with inactive disease activity were studied. Fasting blood was collected for creatinine, glucose, lipid profiles, Apo-B and Apo-A1. Pearson correlation and stepwise-linear regression were used for the analysis. RESULTS The mean age of the subjects was 36.69 ± 10.85 years; 6.90% of them had stage 3 or more severe chronic kidney disease, 49.40% took anti-hypertensive drugs and 4.60% had abnormal glucose metabolism. The mean value for baPWV was 1332 ± 274.12 cm/s. Thirty-six percent of the subjects had increased arterial stiffness with mean Apo-B levels of 1.05 ± 0.31 g/L compared to 0.94 ± 0.24 in normal arterial stiffness. There were correlations of baPWV with age, systolic blood pressure (BP), diastolic BP and creatinine clearance. Apo-B tended to be associated with baPWV (P = 0.06) whereas low-density lipoprotein cholesterol did not (P = 0.2). By multiple regression analysis, systolic BP, age and Apo-B were the significant predictors of baPWV. CONCLUSION Apo-B was independently associated with arterial stiffness in SLE subjects.
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Affiliation(s)
- Jirateep Kwankaew
- Divisions of Endocrinology and Metabolism, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rattana Leelawattana
- Divisions of Endocrinology and Metabolism, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Anchalee Saignam
- Division of Rheumatology, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Boonjing Siripaitoon
- Division of Rheumatology, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Parichat Uea-Areewongsa
- Division of Rheumatology, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Siriporn Juthong
- Division of Rheumatology, Department of Medicine, Prince of Songkla University, Songkhla, Thailand
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Erdozain JG, Villar I, Nieto J, Ruiz-Irastorza G. Peripheral Arterial Disease in Systemic Lupus Erythematosus: Prevalence and Risk Factors. J Rheumatol 2014; 41:310-7. [DOI: 10.3899/jrheum.130817] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective.To analyze the prevalence of peripheral arterial disease (PAD) and cardiovascular (CV) risk factors in a cohort of patients with systemic lupus erythematosus (SLE) and to identify variables potentially related to PAD.Methods.The study included 216 patients with SLE from the Lupus-Cruces prospective observational cohort. The ankle brachial index (ABI) was determined in each patient, with values < 0.9 considered diagnostic of PAD. Demographic and clinical variables, presence of traditional risk factors and CV events, cardiovascular risk calculated by Systematic Coronary Risk Evaluation (SCORE), and treatments received by each patient were analyzed.Results.Ninety-two percent of patients were women. The mean age (SD) was 49 years (15), with a mean followup (SD) of 12 years (9). The prevalence of low ABI was 21%. CV risk factors were frequent: smoking, 30% of patients; high blood pressure, 32.7%; diabetes mellitus, 3.2%; hypercholesterolemia, 34.1%; and metabolic syndrome, 9.7%. The following variables were associated with low ABI in the univariate analysis: age (p < 0.001), hypertension (p = 0.002), diabetes (p = 0.018), hypercholesterolemia (p = 0.018), CV events (p < 0.001), SCORE (p = 0.004), cumulative dose of cyclophosphamide (p = 0.03), and fibrinogen levels (p = 0.002). In the multivariate analysis, the only independent variable in the final model was age (OR 1.04, 95% CI 1.02–1.07, p < 0.001), with a tendency for the presence of any vascular risk factor (diabetes, hypertension, hypercholesterolemia, or current smoking; OR 2.3, 95% CI 0.99–5.1, p = 0.053).Conclusion.The prevalence of low ABI in patients with SLE is higher than expected. While the association with CV risk factors and vascular disease in other territories was strong, we could not identify SLE-specific variables independently associated with PAD.
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Castejon R, Jimenez-Ortiz C, Valero-Gonzalez S, Rosado S, Mellor S, Yebra-Bango M. Decreased circulating endothelial progenitor cells as an early risk factor of subclinical atherosclerosis in systemic lupus erythematosus. Rheumatology (Oxford) 2013; 53:631-8. [PMID: 24273021 DOI: 10.1093/rheumatology/ket367] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Endothelial progenitor cells (EPCs) play an important role in vascular damage repair and it has been suggested that a decreased number of these cells is associated with increased subclinical atherosclerosis. Our study aim was to evaluate whether the number of circulating EPCs in patients with SLE is associated with subclinical atherosclerosis, the presence of cardiovascular (CV) risk factors and SLE-specific factors. METHODS Forty-six female SLE patients were included. At the time of each patient's appointment, CV risk factors, SLE-specific factors and EPCs were assessed in peripheral blood by flow cytometry. Simultaneously, atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by Doppler velocimetry, intima media thickness (IMT) and carotid plaque by B-mode US scanning. RESULTS Patients were classificated according to PWV following the reference values adjusted by age and blood pressure published by the European Society of Cardiology. Patients with pathological values of PWV showed a significant decrease of circulating EPC percentage compared with normal PWV patients. Decreased EPC counts were also associated with certain risk factors, including hypertension, tobacco use, impaired glucose metabolism, and metabolic syndrome, and correlate with high levels of high-sensitivity CRP (hsCRP) or fibrinogen. The presence of carotid plaque and IMT measurement were unrelated with EPC quantification. CONCLUSION Patients with a reduced percentage of EPCs showed pathological arterial stiffness and association with certain CV risk factors, suggesting that the measurement of circulating EPCs can be used as a biological marker to determine subclinical atherosclerosis in SLE.
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Affiliation(s)
- Raquel Castejon
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Joaquin Rodrigo 2, 28222 Majadahonda, Madrid, Spain.
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14
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15
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Williams AE, Crofts G, Teh LS. 'Focus on feet'--the effects of systemic lupus erythematosus: a narrative review of the literature. Lupus 2013; 22:1017-23. [PMID: 23877874 DOI: 10.1177/0961203313498805] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The manifestations of systemic lupus erythematosus (SLE) vary between individuals, from the severe and life-threatening renal and central nervous system involvement, to the involvement of skin, musculoskeletal and vascular system, and the complications of infection influencing the quality of life. However, as specific manifestations affecting the lower limb are perceived as receiving little focus, the purpose of this narrative literature review is to identify the specific factors associated with SLE that may have implications for lower limb and foot morbidity. METHOD A structured search of databases was conducted. The inclusion was restricted to publications in the English language, those that specifically investigate the feet as affected with SLE. No restriction on year of publication was imposed to reduce publication bias and to capture as many publication in relation to feet. RESULTS Eleven papers fulfilled the inclusion criteria. There were seven additional papers that made observations related to the articular or vascular complications of the feet. This narrative review provides some information on how SLE affects the lower limb and foot in relation to the musculoskeletal and vascular systems. However, there is a lack of literature that specifically focuses on all the manifestations of SLE and the complications associated with its management. DISCUSSION There are indications that SLE affects lower limb and foot morbidity but the scale of these problems is unclear and this is partly because of the absence of research and the lack of a 'gold standard' framework for the assessment of the lower limb and foot. In addition to clinical foot health assessment, ultrasonography may be a useful alternative to plain film radiography or magnetic resonance imaging (MRI) in capturing the extent of articular and extra-articular manifestations. Further, the Ankle Brachial Pressure Index (ABPI) may be useful in identifying those with atherosclerosis and ischaemia. CONCLUSION There are indications that SLE affects lower limb and foot morbidity but the scale of these problems and effective management of them is unclear. Therefore, further research is warranted in order to better understand the impact of SLE on the foot and lower limb and its impact on quality of life.
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Affiliation(s)
- A E Williams
- Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Manchester, UK.
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Kim OY, Paik JK, Lee JY, Lee SH, Lee JH. Follow-ups of metabolic, inflammatory and oxidative stress markers, and brachial-ankle pulse wave velocity in middle-aged subjects without metabolic syndrome. Clin Exp Hypertens 2012; 35:382-8. [PMID: 23148723 PMCID: PMC3740820 DOI: 10.3109/10641963.2012.739232] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study investigates the association among metabolic risk factors, inflammatory and oxidative stress markers, and brachial–ankle pulse wave velocity (ba-PWV). We conducted a 3-year longitudinal, observational study of 288 middle-aged adults not meeting the criteria for metabolic syndrome (MetS) at the initial screening. We measured metabolic risk factors, inflammatory and oxidative stress markers, and ba-PWV. Within the 3-year study period, 15.6% (45 out of 288) of participants developed MetS. At the 3-year follow-up, patients were categorized as those with MetS (n = 45) and those without MetS (n = 243). Patients with MetS had significantly unfavorable initial measurements of baseline body mass index (BMI), waist circumference (WC), blood pressure (BP), triglyceride (TG), high-density lipoprotein (HDL)-cholesterol, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) index, and ba-PWV. After 3 years, participants without MetS showed significant increases in WC, diastolic BP (DBP), total- and low-density lipoprotein (LDL)-cholesterol, malondialdehyde (MDA), oxidized-LDL (ox-LDL), and ba-PWV and a significant decrease in HDL-cholesterol and free fatty acids (FFA). Subjects who developed MetS showed significant increases in BMI, WC, BP, TG, glucose, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), MDA, ox-LDL, and ba-PWV and a significant decrease in HDL-cholesterol. Changes in BMI, WC, BP, TG, HDL-cholesterol, glucose, HOMA-IR index, FFA, C-reactive protein (P = .022), IL-6 (P = .004), leukocyte count (P < .001), MDA (P = .002), ox-LDL (P = .015), and ba-PWV (P = .001) differed significantly between the two groups after adjustment for baseline values. Changes in ba-PWV were positively correlated with the changes in systolic and DBP, total-cholesterol, glucose, leukocyte count, and MDA. The age-related increase in arterial stiffness is greater in the presence of MetS with higher levels of inflammatory and oxidative stress markers.
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Affiliation(s)
- Oh Yoen Kim
- Department of Food Science and Nutrition, Dong-A University, Busan, Republic of Korea
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Kim YS, Sung YK, Choi CB, Uhm WS, Kim TH, Shin JH, Jun JB. The major determinants of arterial stiffness in Korean patients with rheumatoid arthritis are age and systolic blood pressure, not disease-related factors. Rheumatol Int 2011; 32:3455-61. [DOI: 10.1007/s00296-011-2198-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
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Li CI, Kardia SL, Liu CS, Lin WY, Lin CH, Lee YD, Sung FC, Li TC, Lin CC. Metabolic syndrome is associated with change in subclinical arterial stiffness: a community-based Taichung community health study. BMC Public Health 2011; 11:808. [PMID: 21999611 PMCID: PMC3213226 DOI: 10.1186/1471-2458-11-808] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 10/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effect of MetS on arterial stiffness in a longitudinal study. METHODS Brachial-ankle pulse wave velocity (baPWV), a measurement interpreted as arterial stiffness, was measured in 1518 community-dwelling persons at baseline and re-examined within a mean follow-up period of 3 years. Multivariate linear regression with generalized estimating equations (GEE) were used to examine the longitudinal relationship between MetS and its individual components and baPWV, while multivariate logistic regression with GEE was used to examine the longitudinal relationship between MetS and its individual components and the high risk group with arterial stiffness. RESULTS Subjects with MetS showed significantly greater baPWV at the end point than those without MetS, after adjusting for age, gender, education, hypertension medication and mean arterial pressure (MAP). MetS was associated with the top quartile of baPWV (the high-risk group of arterial stiffness, adjusted odds ratio [95% confidence interval] 1.52 [1.21-1.90]), and a significant linear trend of risk for the number of components of MetS was found (p for trend < 0.05). In further considering the individual MetS component, elevated blood pressure and fasting glucose significantly predicted a high risk of arterial stiffness (adjusted OR [95% CI] 3.72 [2.81-4.93] and 1.35 [1.08-1.68], respectively). CONCLUSIONS MetS affects the subject's progression to arterial stiffness. Arterial stiffness increased as the number of MetS components increased. Management of MetS is important for preventing the progression to advanced arterial stiffness.
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Affiliation(s)
- Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Wang DZ, Tang Q, Hua Q. Prediction of coronary artery disease using pulse wave velocity and retinal artery lesions. TOHOKU J EXP MED 2011; 225:17-22. [PMID: 21841352 DOI: 10.1620/tjem.225.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary artery disease (CAD) is the leading cause of death worldwide. The prevention and early diagnosis of CAD is important for the treatment of this disease. Since the coronary angiographic examination is not available for every hospital, the convenient, quick and cheap prediction marker is needed for the screening of the suspected CAD patients. The aim of this study was to assess whether the combination of brachial-ankle pulse wave velocity (baPWV) and staging of retinal artery lesions could be a useful approach to predict CAD in symptomatic patients, including atypical chest pain. To prove this question, 472 Chinese patients with suspected CAD underwent coronary angiography, the eye fundus examination and measurement of baPWV. The results show that the frequency of baPWV of 1,400 cm/s or retinal artery atherosclerosis of ≥ Stage 2 is higher in patients with CAD (n = 312) than those without CAD (n = 160, p < 0.001). Both baPWV and retinal artery atherosclerosis are correlated with the presence of CAD with and without typical chest pain (p < 0.001), indicating that the combination of the two indexes is an independent predictor of the presence of CAD (OR: 10.37, 95% CI: 5.72-18.81, p < 0.001). Either baPWV over 1,400 cm/s or retinal artery atherosclerosis of ≥ Stage 2 is a useful marker to predict the presence of CAD even with atypical chest pain. The combination of the two non-invasive methods is also useful for predicting CAD in symptomatic Chinese patients.
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Affiliation(s)
- De-Zhao Wang
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Kim HJ, Nam JS, Park JS, Cho M, Kim CS, Ahn CW, Kwon HM, Hong BK, Yoon YW, Cha BS, Kim KR, Lee HC. Usefulness of brachial-ankle pulse wave velocity as a predictive marker of multiple coronary artery occlusive disease in Korean type 2 diabetes patients. Diabetes Res Clin Pract 2009; 85:30-4. [PMID: 19398141 DOI: 10.1016/j.diabres.2009.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 03/06/2009] [Accepted: 03/17/2009] [Indexed: 11/23/2022]
Abstract
Multiple coronary artery occlusive disease (multiple CAOD) is the most fatal and frequently observed coronary artery disease in type 2 diabetes patients, but no simple, non-invasive screening tool is available yet. The aim of this study is to evaluate the arterial stiffness in type 2 diabetes patients using brachial-ankle pulse wave velocity (baPWV), to demonstrate the correlation between arterial stiffness and multiple CAOD, and to suggest the cutoff point of baPWV for predicting multiple CAOD in Korean type 2 diabetes patients. One hundred and eighty-one diabetes and 262 non-diabetes patients were enrolled in the study. Routine anthropometric and serologic data were collected. baPWV was measured the day before coronary angiography, and the severity of CAOD was assessed with Gensini score after angiography. baPWV and Gensini score were significantly increased in diabetes patients and Gensini score had a positive correlation with baPWV. Subjects in the highest tertile of baPWV showed odds ratio of 3.06 for multiple CAOD compared to the lowest tertile. In ROC curve, baPWV at 1635 cm/s showed 73% sensitivity and 75% specificity with AUC 0.76 in diabetes patients in detecting multiple CAOD. Therefore, baPWV may be utilized a screening tool for predicting multiple CAOD, especially in type 2 diabetes patients.
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Affiliation(s)
- Hai Jin Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Qureshi G, Salciccioli L, Lee S, Qureshi M, Kapoor A, Ginzler E, Lazar JM. QPV interval as a measure of arterial stiffness in women with systemic lupus erythematosus. Clin Cardiol 2009; 32:154-8. [PMID: 19301291 PMCID: PMC6653342 DOI: 10.1002/clc.20301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 09/15/2007] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis and increased arterial stiffness. The QPV interval has been proposed as a measure of arterial stiffness. The QPV interval is based on the premise that transit time from cardiac ejection to brachial artery flow is shortened in patients with increased arterial stiffness. HYPOTHESIS The objective of this study was to determine the significance of the QPV interval as a measure of arterial stiffness in patients with SLE. METHODS We prospectively studied 46 female SLE patients. The QPV interval was calculated as the time from onset of the QRS complex to peak flow velocity of the brachial artery during ultrasound examination. Measurements of arterial stiffness: augmentation index (AI) and pulse wave velocity (PWV) were obtained by applanation tonometry while patients were on a stable medical regimen. RESULTS Mean age was 44+/-14 y and mean QPV interval was 198+/-18 msec QPV interval correlated inversely with age (r=-0.39, p=0.008), AI (r=-0.41, p=0.004), PWV (r=-0.39, p=0.007), and aortic pulse pressure (PP) (r=-0.45, p=0.002). On multivariate regression analysis, QPV interval was found to be an independent predictor of PWV after adjusting for age (R2=0.26, p<0.001). CONCLUSION In women with SLE, QPV decreases with age and is inversely related with measures of arterial stiffness. QPV may be useful in identifying SLE patients with higher arterial stiffness in the clinical or research setting. Further larger studies are needed to confirm these preliminary results.
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Affiliation(s)
- Ghazanfar Qureshi
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center
| | - Louis Salciccioli
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center
| | - Susan Lee
- Division of Rheumatology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Mohammad Qureshi
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center
| | - Amit Kapoor
- City University of New York, Brooklyn College
| | - Ellen Ginzler
- Division of Rheumatology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Jason M. Lazar
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center
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Tso TK, Huang WN. Elevation of fasting insulin and its association with cardiovascular disease risk in women with systemic lupus erythematosus. Rheumatol Int 2008; 29:735-42. [PMID: 19037607 DOI: 10.1007/s00296-008-0781-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 11/09/2008] [Indexed: 11/26/2022]
Abstract
Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis. We previously showed that SLE patients have a higher risk of insulin resistance (IR) and abnormal insulin secretion. The present study was to further investigate the relationship between fasting insulin levels and both classic and novel cardiovascular risk factors in patients with SLE. Body mass index (BMI), fasting glucose and insulin, lipid profile, oxidation markers, fibrinolytic factors, vascular function factors, and disease-specific variables were determined in a total of 87 female SLE patients. The homeostasis model assessment (HOMA) was used to evaluate the IR and secretion. SLE patients had significantly higher fasting insulin, HOMA IR, HOMA beta-cell, titers of autoantibodies against oxidized low density lipoprotein, systolic blood pressure, homocysteine, and brachial-ankle pulse wave velocity (baPWV) than age-matched healthy controls. There were no statistical differences in disease duration, anti-dsDNA, C3, C4, disease activity, and medication dosage between SLE patients stratified by fasting insulin levels. However, mean values for BMI, insulin, HOMA IR, HOMA beta-cell, triglyceride (TG), homocysteine, and baPWV were significantly higher in the SLE patients with hyperinsulinemia when compared with those SLE controls. In addition, fasting insulin levels were positively correlated with TG, homocysteine, blood pressure, plasminogen activator inhibitor 1, and baPWV in SLE patients. The elevation of fasting insulin levels in SLE patients is not only associated with IR, but is related to classic and novel cardiovascular risk factors. This study concludes that there is an insulin-related cardiovascular disease risk in SLE.
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Affiliation(s)
- Tim K Tso
- Department of Food Science, National Chiayi University, 300 University Road, Chia-Yi, 60004, Taiwan, ROC.
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Belizna CC, Richard V, Primard E, Kerleau JM, Cailleux N, Louvel JP, Marie I, Hamidou M, Thuillez C, Lévesque H. Early atheroma in primary and secondary antiphospholipid syndrome: an intrinsic finding. Semin Arthritis Rheum 2007; 37:373-80. [PMID: 17977581 DOI: 10.1016/j.semarthrit.2007.08.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 08/08/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The relationship between atherosclerosis and the antiphospholipid syndrome (APS) is unclear. This study compared intima-media thickness (IMT), arterial stiffness, and presence of plaques in APS patients and controls to evaluate the risk of atherosclerosis in this patient population. The study also explored the relationship between these parameters and cardiovascular risk factors. METHODS Carotid and femoral IMT and stiffness were measured in 58 APS patients and 58 controls. In addition, antiphospholipid antibodies and cardiovascular risk factors were investigated and other systemic lupus erythematosus (SLE)-related serologic parameters were measured. Details of the patients' previous medical history and information regarding disease treatment were analyzed. RESULTS A significant difference was found between IMT, arterial stiffness, and the presence of plaques in patients and controls (P<0.05). All of these parameters were independent of cardiovascular risk factors. No differences in these parameters were found between patients with primary APS and those with secondary APS, or between patients with thrombosis and those with obstetric manifestations. There was no correlation between SLE disease activity and atheroma. Patients with plaques had taken a lower total dose of corticosteroids and/or hydroxychloroquine. CONCLUSIONS Some markers of early atherosclerosis could be detected in both primary and secondary APS, irrespective of clinical manifestations. These data suggest that atherosclerosis might be an intrinsic finding in APS patients, independent of cardiovascular risk factors, and that immunosuppressive treatment may prevent atherosclerosis.
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Affiliation(s)
- Cristina C Belizna
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.
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