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Yang S, Huang S, Daniels LB, Yeboah J, Lima JAC, Cannone V, Burnett JC, Beckman JA, Carr JJ, Wang TJ, Gupta DK. NT-proBNP, race and endothelial function in the Multi-Ethnic Study of Atherosclerosis. Heart 2019; 105:1590-1596. [PMID: 31152069 DOI: 10.1136/heartjnl-2019-314707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/04/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Natriuretic peptides (NPs) are hormones with cardioprotective effects. NP levels vary by race; however, the pathophysiological consequences of lower NP levels are not well understood. We aimed to quantify the association between NPs and endothelial function as measured by flow-mediated dilation (FMD) and the contribution of NP levels to racial differences in endothelial function. METHODS In this cross-sectional study of 2938 Multi-Ethnic Study of Atherosclerosis participants (34% Caucasian, 20% African-American, 20% Asian-American and 26% Hispanic) without cardiovascular disease at baseline, multivariable linear regression models were used to examine the association between serum N-terminal pro-B-type NP (NT-proBNP) and natural log-transformed FMD. We also tested whether NT-proBNP mediated the relationship between race and FMD using the product of coefficients method. RESULTS Among African-American and Chinese-American individuals, lower NT-proBNP levels were associated with lower FMD, β=0.06 (95% CI: 0.03 to 0.09; p<0.001) and β=0.06 (95% CI: 0.02 to 0.09; p=0.002), respectively. Non-significant associations between NT-proBNP and FMD were found in Hispanic and Caucasian individuals. In multivariable models, endothelial function differed by race, with African-American individuals having the lowest FMD compared with Caucasians, p<0.001. Racial differences in FMD among African-Americans and Chinese-Americans were mediated in part by NT-proBNP levels (African-Americans, mediation effect: -0.03(95% CI: -0.05 to -0.01); Chinese-Americans, mediation effect: -0.03(95% CI: -0.05 to -0.01)). CONCLUSIONS Lower NP levels are associated with worse endothelial function among African-Americans and Chinese-Americans. A relative NP deficiency in some racial/ethnic groups may contribute to differences in vascular function.
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Affiliation(s)
- Sushan Yang
- Department of Medicine-Cardiology, University of Washington System, Seattle, Washington, USA
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lori B Daniels
- Department of Medicine, UC San Diego, La Jolla, California, USA
| | - Joseph Yeboah
- Medicine-Cardiovascular, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Joao A C Lima
- Departments of Radiology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Valentina Cannone
- Cardiorenal Research Laboratory, Mayo Clinic Minnesota, Rochester, Minnesota, USA.,Department of Clinical and Experimental Medicine, University of Parma Medical School, Parma, Italy
| | - John C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joshua A Beckman
- Department of Medicine-Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas J Wang
- Department of Medicine-Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Deepak K Gupta
- Department of Medicine-Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Kim EJ, Soh S, Kim SY, Kil HK, Lee JH, Kim JM, Kim TW, Koo BN. Impact of Diabetes Mellitus on Radial and Ulnar Arterial Vasoreactivity after Radial Artery Cannulation: A Randomized Controlled trial. Int J Med Sci 2016; 13:701-7. [PMID: 27648000 PMCID: PMC5027189 DOI: 10.7150/ijms.16007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Endothelial dysfunction associated with diabetes mellitus (DM) may influence arterial vasoreactivity after arterial stimulus, such as cannulation, and cause changes in diameter and blood flow. Despite the frequent use of arterial cannulation during anesthesia and critical care, little information is available regarding vasoreactivity of the radial and ulnar arteries and its influence on underlying DM. METHODS Forty non-DM and 40 DM patients, who required arterial cannulation during general anesthesia, were enrolled. Using duplex Doppler ultrasonography, we measured the patients' arterial diameter, peak systolic velocity, end-diastolic velocity, resistance index, and mean volume flow of both arteries at five different time points. RESULTS After radial artery cannulation, ulnar arterial diameter and blood flow did not significantly increase in DM group, as they did in non-DM group. Ulnar arterial resistance index significantly increased in both groups, but the degree of decrease in DM group was significantly less than non-DM. CONCLUSION Ulnar artery's ability to increase blood flow for compensating the sudden reduction of radial arterial flow in DM patients was significantly less than that in non-DM patients under general anesthesia. Such attenuated vasoreactivity of ulnar artery to compensate the reduced radial arterial flow may have to be considered in radial arterial cannulation for DM patients.
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Affiliation(s)
- Eun Jung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sarah Soh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Keum Kil
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Whan Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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