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Mansfield R, Cecula P, Pedraz CT, Zimianiti I, Elsaddig M, Zhao R, Sathiyamurthy S, McEniery CM, Lees C, Banerjee J. Impact of perinatal factors on biomarkers of cardiovascular disease risk in preadolescent children. J Hypertens 2023; 41:1059-1067. [PMID: 37115847 DOI: 10.1097/hjh.0000000000003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND This review aims to summarize associations of the perinatal environment with arterial biophysical properties in childhood, to elucidate possible perinatal origins of adult cardiovascular disease (CVD). METHODS A systematic search of PubMed database was performed (December 2020). Studies exploring associations of perinatal factors with arterial biophysical properties in children 12 years old or less were included. Properties studied included: pulse wave velocity; arterial stiffness or distensibility; augmentation index; intima-media thickness of aorta (aIMT) or carotids; endothelial function (laser flow Doppler, flow-mediated dilatation). Two reviewers independently performed study selection and data extraction. RESULTS Fifty-two of 1084 identified records were included. Eleven studies explored associations with prematurity, 14 explored maternal factors during pregnancy, and 27 explored effects of low birth weight, small-for-gestational age and foetal growth restriction (LBW/SGA/FGR). aIMT was consistently higher in offspring affected by LBW/SGA/FGR in all six studies examining this variable. The cause of inconclusive or conflicting associations found with other arterial biophysical properties and perinatal factors may be multifactorial: in particular, measurements and analyses of related properties differed in technique, equipment, anatomical location, and covariates used. CONCLUSION aIMT was consistently higher in LBW/SGA/FGR offspring, which may relate to increased long-term CVD risk. Larger and longer term cohort studies may help to elucidate clinical significance, particularly in relation to established CVD risk factors. Experimental studies may help to understand whether lifestyle or medical interventions can reverse perinatal changes aIMT. The field could be advanced by validation and standardization of techniques assessing arterial structure and function in children.
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Affiliation(s)
- Roshni Mansfield
- Department of Neonatology, Queen Charlotte's and Chelsea Hospital
- Biomedical Research Centre, Imperial College Healthcare NHS Trust
| | - Paulina Cecula
- St Marys Campus, Medical School, Imperial College London, London
| | | | - Ioanna Zimianiti
- St Marys Campus, Medical School, Imperial College London, London
| | - Malaz Elsaddig
- Department of Neonatology, Queen Charlotte's and Chelsea Hospital
| | - Rebecca Zhao
- University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge
| | - Christoph Lees
- Institute of Reproductive and Developmental Biology, Imperial College London
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare Trust, Du Cane Rd, White City
| | - Jayanta Banerjee
- Department of Neonatology, Queen Charlotte's and Chelsea Hospital
- Institute of Reproductive and Developmental Biology, Imperial College London
- Origins of Health and Disease, Centre for Child Health, Imperial College London, London, UK
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2
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Pavey H, Polkey MI, Bolton CE, Cheriyan J, McEniery CM, Wilkinson I, Mohan D, Casaburi R, Miller BE, Tal-Singer R, Fisk M. Circulating testosterone levels and health outcomes in chronic obstructive pulmonary disease: results from ECLIPSE and ERICA. BMJ Open Respir Res 2023; 10:e001601. [PMID: 37316306 PMCID: PMC10277522 DOI: 10.1136/bmjresp-2022-001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
The relationship of circulating testosterone levels with health outcomes in people with chronic obstructive pulmonary disease (COPD) is unknown. AIM To determine whether serum testosterone levels predict hospitalised acute exacerbations of COPD (H-AECOPD), cardiovascular disease outcome, and mortality in people with COPD. METHODS Separate analyses were carried out on two observational, multicentre COPD cohorts, Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) and Evaluation of the Role of Inflammation in Chronic Airways Disease (ERICA), both of which had serum testosterone measured using a validated liquid chromatography assay at the same laboratory. Data from 1296 male participants in ECLIPSE and 386 male, 239 female participants in ERICA were analysed. All analyses were sex-specific. Multivariate logistic regression was used to determine associations with H-AECOPD during follow-up (3 years ECLIPSE, 4.5 years ERICA), a composite endpoint of cardiovascular hospitalisation and cardiovascular death, and all-cause mortality. RESULTS Mean (SD) testosterone levels were consistent across cohorts; 459 (197) and 455 (200) ng/dL for males in ECLIPSE and ERICA, respectively, and in ERICA females: 28 (56) ng/dL. Testosterone was not associated with H-AECOPD (ECLIPSE: OR: 0.76, p=0.329, ERICA males: OR (95% CI): 1.06 (0.73 to 1.56), p=0.779, ERICA females: OR: 0.77 (0.52 to 1.12), p=0.178) or cardiovascular hospitalisation and death. Testosterone was associated with all-cause mortality in Global Initiative for Obstructive Lung Disease (GOLD) stage 2 male patients only, in ECLIPSE (OR: 0.25, p=0.007) and ERICA (OR: (95% CI): 0.56 (0.32 to 0.95), p=0.030). CONCLUSIONS Testosterone levels do not relate to H-AECOPD or cardiovascular outcome in COPD, but are associated with all-cause mortality in GOLD stage 2 COPD male patients, although the clinical significance of this finding is uncertain.
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Affiliation(s)
- Holly Pavey
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Michael I Polkey
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Charlotte E Bolton
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Ian Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Divya Mohan
- Former employee of GSK, Collegeville, Pennsylvania, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | | | | | - Marie Fisk
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
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Valencia-Hernández CA, Lindbohm JV, Shipley MJ, Wilkinson IB, McEniery CM, Ahmadi-Abhari S, Singh-Manoux A, Kivimaki M, Brunner EJ. Aortic Pulse Wave Velocity as Adjunct Risk Marker for Assessing Cardiovascular Disease Risk: Prospective Study. Hypertension 2022; 79:836-843. [PMID: 35139665 PMCID: PMC9148390 DOI: 10.1161/hypertensionaha.121.17589] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic pulse wave velocity is a noninvasive measure of aortic stiffness and arterial aging. Its current value in cardiovascular risk estimation practice is unknown. We aimed to establish whether aortic pulse wave velocity identified individuals with higher risk of incident major adverse cardiovascular events and improved performance of the American Heart Association/American College of Cardiology atherosclerotic cardiovascular disease risk score. METHODS This prospective analysis included 3837 Whitehall II cohort participants screened in 2008 to 2009, and followed for 11.7 years (mean=10.3, SD=1.81), without history of stroke, myocardial infarction, or coronary heart disease. RESULTS Mean age of the sample was 65.0 years (SD=5.6), 2831 participants (73.8%) were male and mean atherosclerotic cardiovascular disease risk score was 13.8%. At the end of follow-up, 411 individuals (10.7%) had suffered a major cardiovascular event. Those in the highest aortic pulse wave velocity quartile were at high risk (hazard ratio, 2.99 [95% CI, 2.25-3.97]) and reached the threshold for statin medication (7.5% risk) after 5 years whereas others reached it after 10 years (difference P<0.001). The addition of aortic pulse wave velocity to the risk score improved the C statistic (0.68 versus 0.67, P=0.03) and net reclassification index (4.6%, P=0.04 and 11.3%, P=0.02). CONCLUSIONS Our results show that aortic stiffness predicted major adverse cardiovascular events in a cohort of elderly individuals, improving the performance of a widely used cardiovascular disease risk estimator. Aortic pulse wave velocity measurement is scalable, radiation-free, and easy to perform. Further studies on its applicability in cardiovascular disease risk assessment in primary care settings are needed.
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Affiliation(s)
| | - Joni V. Lindbohm
- Research Department of Epidemiology and Public Health, University College London, London, UK
- Clinicum, Department of Public Health, University of Helsinki
| | - Martin J. Shipley
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Ian B. Wilkinson
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, UK
| | | | | | - Archana Singh-Manoux
- Research Department of Epidemiology and Public Health, University College London, London, UK
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
| | - Mika Kivimaki
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Eric J. Brunner
- Research Department of Epidemiology and Public Health, University College London, London, UK
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4
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Bikia V, McEniery CM, Roussel EM, Rovas G, Pagoulatou S, Wilkinson IB, Stergiopulos N. Validation of a Non-invasive Inverse Problem-Solving Method for Stroke Volume. Front Physiol 2022; 12:798510. [PMID: 35153811 PMCID: PMC8826540 DOI: 10.3389/fphys.2021.798510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Stroke volume (SV) is a major biomarker of cardiac function, reflecting ventricular-vascular coupling. Despite this, hemodynamic monitoring and management seldomly includes assessments of SV and remains predominantly guided by brachial cuff blood pressure (BP). Recently, we proposed a mathematical inverse-problem solving method for acquiring non-invasive estimates of mean aortic flow and SV using age, weight, height and measurements of brachial BP and carotid-femoral pulse wave velocity (cfPWV). This approach relies on the adjustment of a validated one-dimensional model of the systemic circulation and applies an optimization process for deriving a quasi-personalized profile of an individual’s arterial hemodynamics. Following the promising results of our initial validation, our first aim was to validate our method against measurements of SV derived from magnetic resonance imaging (MRI) in healthy individuals covering a wide range of ages (n = 144; age range 18–85 years). Our second aim was to investigate whether the performance of the inverse problem-solving method for estimating SV is superior to traditional statistical approaches using multilinear regression models. We showed that the inverse method yielded higher agreement between estimated and reference data (r = 0.83, P < 0.001) in comparison to the agreement achieved using a traditional regression model (r = 0.74, P < 0.001) across a wide range of age decades. Our findings further verify the utility of the inverse method in the clinical setting and highlight the importance of physics-based mathematical modeling in improving predictive tools for hemodynamic monitoring.
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Affiliation(s)
- Vasiliki Bikia
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
- *Correspondence: Vasiliki Bikia,
| | - Carmel M. McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Emma Marie Roussel
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Georgios Rovas
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Stamatia Pagoulatou
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
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5
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McEniery CM. Preeclampsia and Altered Cognitive Performance: A Glimpse Into the Future? Am J Hypertens 2021; 34:1261-1263. [PMID: 34447988 DOI: 10.1093/ajh/hpab136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
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6
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Weber T, Protogerou AD, Agharazii M, Argyris A, Aoun Bahous S, Banegas JR, Binder RK, Blacher J, Araujo Brandao A, Cruz JJ, Danninger K, Giannatasio C, Graciani A, Hametner B, Jankowski P, Li Y, Maloberti A, Mayer CC, McDonnell BJ, McEniery CM, Antonio Mota Gomes M, Machado Gomes A, Lorenza Muiesan M, Nemcsik J, Paini A, Rodilla E, Schutte AE, Sfikakis PP, Terentes-Printzios D, Vallée A, Vlachopoulos C, Ware L, Wilkinson I, Zweiker R, Sharman JE, Wassertheurer S. Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals. Hypertension 2021; 79:251-260. [PMID: 34775789 PMCID: PMC8654125 DOI: 10.1161/hypertensionaha.121.17765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.
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Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Mohsen Agharazii
- Centre de Recherche Du CHU de Québec, Université Laval, Canada (M.A.)
| | - Antonis Argyris
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Sola Aoun Bahous
- Lebanese American University School of Medicine, Byblos, Lebanon (S.A.B.)
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Ronald K Binder
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Jacques Blacher
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre de diagnostic et de thérapeutique, France (J.B., A.V.)
| | | | - Juan J Cruz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Kathrin Danninger
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Cristina Giannatasio
- School of Medicine and Surgery, Milano-Bicocca University and Cardiology 4, ASST GOM Niguarda, Milan, Italy (C.G., A.M.)
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Bernhard Hametner
- Austrian Institute of Technology, Vienna, Austria (B.H., C.C.M., S.W.)
| | - Piotr Jankowski
- Institute of Cardiology, Jagellonian University, Krakow, Poland (P.J.)
| | - Yan Li
- Centre for Vascular Evaluations, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L.)
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University and Cardiology 4, ASST GOM Niguarda, Milan, Italy (C.G., A.M.)
| | - Christopher C Mayer
- Austrian Institute of Technology, Vienna, Austria (B.H., C.C.M., S.W.).,Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, United Kingdom (C.M.M., I.W.)
| | - Barry J McDonnell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (B.J.M.)
| | - Carmel M McEniery
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | | | | | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell'ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Italy (M.L.M., A.P.)
| | - Janos Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary (J.N.)
| | - Anna Paini
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell'ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Italy (M.L.M., A.P.)
| | - Enrique Rodilla
- Universidad Cardenal Herrera-CEU, CEU Universities, Hospital de Sagunto, Valencia, Spain (E.R.)
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, Australia (A.E.S.).,The George Institute for Global Health, Sydney, Australia (A.E.S.).,Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa (A.E.S.)
| | - Petros P Sfikakis
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece (D.T.-P., C.V.)
| | - Alexandre Vallée
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre de diagnostic et de thérapeutique, France (J.B., A.V.)
| | - Charalambos Vlachopoulos
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.).,SAMRC/Wits Developmental Pathways for Health Research Unit, South Africa (L.W.)
| | - Lisa Ware
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, South Africa (L.W.)
| | - Ian Wilkinson
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, United Kingdom (C.M.M., I.W.)
| | - Robert Zweiker
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - James E Sharman
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
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- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
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7
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Ikeda A, Steptoe A, Shipley M, Abell J, Kumari M, Tanigawa T, Iso H, Wilkinson IB, McEniery CM, Singh-Manoux A, Kivimaki M, Brunner EJ. Diurnal pattern of salivary cortisol and progression of aortic stiffness: Longitudinal study. Psychoneuroendocrinology 2021; 133:105372. [PMID: 34517196 PMCID: PMC8543075 DOI: 10.1016/j.psyneuen.2021.105372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/01/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The positive direct relation between stress and the development of cardiovascular disease has increasingly been recognized. However, the link between hypothalamic-pituitary-adrenal (HPA) dysregulation and subclinical cardiovascular disease has not been studied longitudinally. We investigated the relation of diurnal salivary cortisol, as a biological marker of stress levels, with progression of aortic stiffness over five years. METHODS A total of 3281 people (mean age 65.5) in the Whitehall II prospective study provided six saliva samples on a single weekday. We assessed the diurnal salivary cortisol using the daytime slope and bedtime level. Aortic stiffness was measured by carotid-femoral pulse wave velocity (PWV) at baseline (2007-2009) and five years later (2012-2013). Linear mixed models were used to estimate the association of diurnal salivary cortisol with baseline PWV and five-year longitudinal changes. RESULTS Diurnal salivary cortisol were not associated with PWV at baseline. Among women but not men, a 1-SD shallower salivary cortisol slope at baseline was associated with a five-year increase in PWV (β = 0.199; 95% CI = 0.040, 0.358 m/s) and higher bedtime cortisol level (β = 0.208, 95% CI = 0.062, 0.354 m/s). CONCLUSIONS Dysregulation of the HPA axis measured using salivary cortisol (shallower slope, higher bedtime level) predicted the rate of progression of aortic stiffness among women.
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Affiliation(s)
- Ai Ikeda
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK; Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Martin Shipley
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Jessica Abell
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Meena Kumari
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK; Institute for Social and Economic Research, University of Essex, Essex, UK
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK; Université de Paris, Inserm U1153, Epidemiology of Ageing & Neurodegenerative diseases, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Eric J Brunner
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, London, UK.
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8
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Vass L, Fisk M, Cheriyan J, Mohan D, Forman J, Oseni A, Devaraj A, Mäki-Petäjä KM, McEniery CM, Fuld J, Hopkinson NS, Lomas DA, Cockcroft JR, Tal-Singer R, Polkey MI, Wilkinson IB. Quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography to assess pulmonary inflammation in COPD. ERJ Open Res 2021; 7:00699-2020. [PMID: 34476245 PMCID: PMC8405867 DOI: 10.1183/23120541.00699-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/12/2021] [Indexed: 11/07/2022] Open
Abstract
Rationale COPD and smoking are characterised by pulmonary inflammation. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging may improve knowledge of pulmonary inflammation in COPD patients and aid early development of novel therapies as an imaging biomarker. Objectives To evaluate pulmonary inflammation, assessed by FDG uptake, in whole and regional lung in “usual” (smoking-related) COPD patients, alpha-1 antitrypsin deficiency (α1ATD) COPD patients, smokers without COPD and never-smokers using FDG PET/CT. Secondly, to explore cross-sectional associations between FDG PET/CT and systemic inflammatory markers in COPD patients and repeatability of the technique in COPD patients. Methods Data from two imaging studies were evaluated. Pulmonary FDG uptake (normalised Ki; nKi) was measured by Patlak graphical analysis in four subject groups: 84 COPD patients, 11 α1ATD-COPD patients, 12 smokers and 10 never-smokers. Within the COPD group, associations between nKi and systemic markers of inflammation were assessed. Repeatability was evaluated in 32 COPD patients comparing nKi values at baseline and at 4-month follow-up. Results COPD patients, α1ATD-COPD patients and smokers had increased whole lung FDG uptake (nKi) compared with never-smokers (0.0037±0.001, 0.0040±0.001, 0.0040±0.001 versus 0.0028±0.001 mL·cm−3·min−1, respectively, p<0.05 for all). Similar results were observed in upper and middle lung regions. In COPD participants, plasma fibrinogen was associated with whole lung nKi (β=0.30, p=0.02) in multivariate analysis adjusted for current smoking, forced expiratory volume in 1 s % predicted, systemic neutrophils and C-reactive protein levels. Mean percentage difference in nKi between the baseline and follow-up was 3.2%, and the within subject coefficient of variability was 7.7%. Conclusions FDG PET/CT has potential as a noninvasive tool to enable whole lung and regional quantification of FDG uptake to assess smoking- and COPD-related pulmonary inflammation. FDG PET/CT has potential utility to noninvasively evaluate pulmonary inflammation in COPD. Pulmonary FDG uptake is increased in COPD patients, positively associated with systemic inflammatory markers and shows low inter-occasion variability.https://bit.ly/3dELYAW
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Affiliation(s)
- Laurence Vass
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,These authors contributed equally
| | - Marie Fisk
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,These authors contributed equally
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Julia Forman
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Adelola Oseni
- Dept of Radiology, St George's Hospital NHS Trust, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College, London, UK
| | - Kaisa M Mäki-Petäjä
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Jonathan Fuld
- Division of Respiratory Medicine, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Lomas
- UCL Respiratory, Division of Medicine, University College London, London, UK
| | - John R Cockcroft
- Dept of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | | | | | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
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9
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Mäki-Petäjä KM, McGeoch A, Yang LL, Hubsch A, McEniery CM, Meyer PAR, Mir F, Gajendragadkar P, Ramenatte N, Anandappa G, Franco SS, Bond SJ, Schönlieb CB, Boink Y, Brune C, Wilkinson IB, Jodrell DI, Cheriyan J. Mechanisms Underlying Vascular Endothelial Growth Factor Receptor Inhibition-Induced Hypertension: The HYPAZ Trial. Hypertension 2021; 77:1591-1599. [PMID: 33775123 PMCID: PMC7610566 DOI: 10.1161/hypertensionaha.120.16454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/02/2021] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kaisa M Mäki-Petäjä
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
| | - Adam McGeoch
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
| | - Lucy L Yang
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
| | - Annette Hubsch
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
| | - Paul A R Meyer
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
- Department of Medical Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, U.K
| | - Fraz Mir
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
| | - Parag Gajendragadkar
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
| | - Nicola Ramenatte
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, U.K
| | | | - Sara Santos Franco
- GlaxoSmithKline R&D Clinical Unit, Addenbrooke’s Hospital, Cambridge, U.K
| | - Simon J Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, U.K
| | | | - Yoeri Boink
- Department of Applied Mathematics, University of Twente, Netherlands
- Multi-Modality Medical Imaging group, Technical Medical Centre, University of Twente, Netherlands
| | - Christoph Brune
- Department of Applied Mathematics, University of Twente, Netherlands
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, U.K
| | - Duncan I. Jodrell
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, U.K
- Department of Oncology, University of Cambridge, U.K
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, U.K
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, U.K
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10
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Moran C, McEniery CM, Schoenmakers N, Mitchell C, Sleigh A, Watson L, Lyons G, Burling K, Barker P, Chatterjee K. Dyslipidemia, Insulin Resistance, Ectopic Lipid Accumulation, and Vascular Function in Resistance to Thyroid Hormone β. J Clin Endocrinol Metab 2021; 106:e2005-e2014. [PMID: 33524107 PMCID: PMC8063262 DOI: 10.1210/clinem/dgab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE In resistance to thyroid hormone due to mutations in thyroid hormone receptor β, peripheral tissues are variably refractory to the action of circulating thyroid hormones. We evaluated parameters contributing to atherosclerotic risk in this disorder. METHODS We measured low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), nonesterified fatty acids (NEFA), intrahepatic lipid (IHL) and intramyocellular lipid (IMCL), Homeostasis-model assessment of insulin resistance (HOMA-IR), augmentation index (AIx) and pulse wave velocity (PWV), flow-mediated dilatation, and carotid intima-media thickness (cIMT) in an unselected, genetically confirmed cohort of adult RTHβ patients (n = 27-77) and compared these with measurements in healthy subjects (up to n = 100) and thyrotoxic patients (n = 40). RESULTS Resistance to thyroid hormone beta (RTHβ) patients exhibited higher LDL-C (P = 0.008) and TG (P = 0.002) and lower HDL-C concentrations (P = 0.015 × 10-2) than control subjects, with LDL-C being higher than in thyrotoxic patients with comparable hyperthyroxinemia. Proprotein convertase subtilisin/kexin 9 (P = 0.002) and apolipoprotein B (P = 0.0009) levels were reduced in thyrotoxic patients but not lower in RTHβ patients or control subjects. Intrahepatic lipid (P = 0.02 × 10-4), IMCL (P = 0.002), HOMA-IR (P = 0.01 × 10-2), and NEFA (P = 0.04 × 10-6) were significantly higher in RTHβ patients than control subjects. Flow-mediated dilatation was increased (P = 0.04) but cIMT (P = 0.71), PWV P = 0.81), and AIx (P = 0.95) were unaltered in RTHβ patients. CONCLUSIONS We have documented mixed dyslipidemia with hepatic and IMCL accumulation in RTHβ, suggesting that surveillance for these metabolic abnormalities is warranted. How they combine with enhanced endothelial function and unaltered vessel wall thickness and compliance to determine overall cardiometabolic risk in this disorder remains to be defined.
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Affiliation(s)
- Carla Moran
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Nadia Schoenmakers
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Alison Sleigh
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Laura Watson
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Greta Lyons
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Keith Burling
- NIHR Cambridge BRC Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter Barker
- NIHR Cambridge BRC Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Krishna Chatterjee
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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11
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Cacciottolo PJ, Kostapanos MS, Hernan Sancho E, Pavey H, Kaloyirou F, Vamvaka E, Helmy J, Hubsch A, McEniery CM, Wilkinson IB, Cheriyan J. Investigating the Lowest Threshold of Vascular Benefits from LDL Cholesterol Lowering with a PCSK9 mAb Inhibitor (Alirocumab) in Patients with Stable Cardiovascular Disease (INTENSITY-HIGH): protocol and study rationale for a randomised, open label, parallel group, mechanistic study. BMJ Open 2021; 11:e037457. [PMID: 33849844 PMCID: PMC8051397 DOI: 10.1136/bmjopen-2020-037457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 01/04/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Elevated low-density lipoprotein cholesterol (LDL-C) is a strong independent risk predictor of cardiovascular (CV) events, while interventions to reduce it remain the only evidence-based approach to reduce CV morbidity and mortality. Secondary prevention statin trials in combination with ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors showed that there is no 'J shaped curve' in LDL-C levels with regard to CV outcomes. The lowest threshold beyond which reduction of LDL-C confers no further CV benefits has not been identified.The INTENSITY-HIGH study seeks to explore physiological mechanisms mediating CV benefits of LDL-C lowering by PCSK9 inhibition in patients with established cardiovascular disease (CVD). The study examines the changes in measures of endothelial function and vascular inflammation imaging following intervention with PCSK9 and against standard of care. METHODS AND ANALYSIS This is a single-centre, randomised, open label, parallel group, mechanistic physiological study. It will include approximately 60 subjects with established CVD, with LDL-C of <4.1 mmol/L on high-intensity statins. All eligible participants will undergo 18-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) scanning of the aorta and carotid arteries, as well as baseline endothelial function assessment. Subsequently, they will be randomised on a 1:1 basis to either alirocumab 150 mg or ezetimibe 10 mg/day. Repeat FDG-PET/CT scan and vascular assessments will be undertaken after 8 weeks of treatment. Any changes in these parameters will be correlated with changes in lipid levels and systemic inflammation biomarkers. ETHICS AND DISSEMINATION The study received a favourable opinion from the Wales Research Ethics Committee 4, was registered on clinicaltrials.gov and conformed to International Conference for Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use Good Clinical Practice. The results of this study will be reported through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT03355027.
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Affiliation(s)
- Paul J Cacciottolo
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | | | - Elena Hernan Sancho
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Holly Pavey
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fotini Kaloyirou
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Evangelia Vamvaka
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Joanna Helmy
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Annette Hubsch
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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12
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Fermont JM, Fisk M, Bolton CE, MacNee W, Cockcroft JR, Fuld J, Cheriyan J, Mohan D, Mäki-Petäjä KM, Al-Hadithi AB, Tal-Singer R, Müllerova H, Polkey MI, Wood AM, McEniery CM, Wilkinson IB. Cardiovascular risk prediction using physical performance measures in COPD: results from a multicentre observational study. BMJ Open 2020; 10:e038360. [PMID: 33372069 PMCID: PMC7772292 DOI: 10.1136/bmjopen-2020-038360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Although cardiovascular disease (CVD) is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), it is unknown how to improve prediction of cardiovascular (CV) risk in individuals with COPD. Traditional CV risk scores have been tested in different populations but not uniquely in COPD. The potential of alternative markers to improve CV risk prediction in individuals with COPD is unknown. We aimed to determine the predictive value of conventional CVD risk factors in COPD and to determine if additional markers improve prediction beyond conventional factors. DESIGN Data from the Evaluation of the Role of Inflammation in Chronic Airways disease cohort, which enrolled 729 individuals with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV COPD were used. Linked hospital episode statistics and survival data were prospectively collected for a median 4.6 years of follow-up. SETTING Five UK centres interested in COPD. PARTICIPANTS Population-based sample including 714 individuals with spirometry-defined COPD, smoked at least 10 pack years and who were clinically stable for >4 weeks. INTERVENTIONS Baseline measurements included aortic pulse wave velocity (aPWV), carotid intima-media thickness (CIMT), C reactive protein (CRP), fibrinogen, spirometry and Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) Index, 6 min walk test (6MWT) and 4 m gait speed (4MGS) test. PRIMARY AND SECONDARY OUTCOME MEASURES New occurrence (first event) of fatal or non-fatal hospitalised CVD, and all-cause and cause-specific mortality. RESULTS Out of 714 participants, 192 (27%) had CV hospitalisation and 6 died due to CVD. The overall CV risk model C-statistic was 0.689 (95% CI 0.688 to 0.691). aPWV and CIMT neither had an association with study outcome nor improved model prediction. CRP, fibrinogen, GOLD stage, BODE Index, 4MGS and 6MWT were associated with the outcome, independently of conventional risk factors (p<0.05 for all). However, only 6MWT improved model discrimination (C=0.727, 95% CI 0.726 to 0.728). CONCLUSION Poor physical performance defined by the 6MWT improves prediction of CV hospitalisation in individuals with COPD. TRIAL REGISTRATION NUMBER ID 11101.
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Affiliation(s)
- Jilles M Fermont
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marie Fisk
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Charlotte E Bolton
- Division of Respiratory Medicine and NIHR Nottingham BRC respiratory theme, University of Nottingham, Nottingham, UK
| | - William MacNee
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - John R Cockcroft
- Department of Cardiology, Columbia University Medical Center, New York City, New York, USA
| | - Jonathan Fuld
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Divya Mohan
- Medical Innovation, Value Evidence Outcomes, GSK R&D, Philadelphia, Pennsylvania, USA
| | - Kaisa M Mäki-Petäjä
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Ali B Al-Hadithi
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Tal-Singer
- Medical Innovation, Value Evidence Outcomes, GSK R&D, Philadelphia, Pennsylvania, USA
| | | | - Michael I Polkey
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
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13
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McEniery CM, Fisk M, Miles K, Kaloyirou F, Hubsch A, Smith J, Wilkinson IB, Cheriyan J. Correction to: ChemoPROphyLaxIs with hydroxychloroquine For covId-19 infeCtious disease (PROLIFIC) to prevent covid-19 infection in frontline healthcare workers: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:641. [PMID: 32665001 PMCID: PMC7358337 DOI: 10.1186/s13063-020-04578-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Hurst JR, Beckmann J, Ni Y, Bolton CE, McEniery CM, Cockcroft JR, Marlow N. Respiratory and Cardiovascular Outcomes in Survivors of Extremely Preterm Birth at 19 Years. Am J Respir Crit Care Med 2020; 202:422-432. [PMID: 32302489 DOI: 10.1164/rccm.202001-0016oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Growth and development during adolescence may modify the respiratory and vascular differences seen among extremely preterm (EP) individuals in childhood and early adolescence.Objectives: To assess the trajectory of respiratory and cardiovascular outcomes during transition to adulthood in a national longitudinal cohort study of births before 26 weeks of gestation in the United Kingdom and Ireland.Methods: A total of 129 EP participants and 65 control subjects attended for a center-based evaluation at 19 years of age. Standardized measures of spirometry, hemodynamics, functional capacity, and markers of inflammation were obtained from EP subjects with and without neonatal bronchopulmonary dysplasia and term-born control subjects at 19 years of age and compared with previous assessments.Measurements and Main Results: Compared with the control group, the EP group was significantly impaired on all spirometric parameters (mean FEV1 z-score, -1.08 SD [95% confidence interval, -1.40 to -0.77]) and had lower fractional exhaled nitric oxide concentrations (13.9 vs. 24.4 ppb; P < 0.001) despite a higher proportion with bronchodilator reversibility (27% vs. 6%). The EP group had significantly impaired exercise capacity. All respiratory parameters were worse after neonatal bronchopulmonary dysplasia, and respiratory function differences were similar at 11 and 19 years. The augmentation index was 6% higher in the EP group and associated with increased total peripheral resistance (difference in means, 96.4 [95% confidence interval, 26.6-166.2] dyne/s/cm-5) and elevation in central, but not peripheral, blood pressure. Central systolic and diastolic blood pressures increased more quickly during adolescence in the EP group than in the control group.Conclusions: Clinicians should address both cardiovascular and respiratory risks in adult survivors of extremely preterm birth.
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Affiliation(s)
| | - Joanne Beckmann
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Yanyan Ni
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Charlotte E Bolton
- Division of Respiratory Medicine and.,National Institute of Health Research Nottingham Biomedical Research Centre Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom; and
| | - John R Cockcroft
- Department of Advanced Cardiology, Columbia Presbyterian Medical Center, New York, New York
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
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15
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Ikeda A, Steptoe A, Shipley M, Wilkinson IB, McEniery CM, Tanigawa T, Singh-Manoux A, Kivimaki M, Brunner EJ. Psychological Wellbeing and Aortic Stiffness: Longitudinal Study. Hypertension 2020; 76:675-682. [PMID: 32654561 PMCID: PMC7418936 DOI: 10.1161/hypertensionaha.119.14284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated 2 distinct aspects of positive wellbeing: affective wellbeing and eudaimonia with progression of aortic stiffness, an index of subclinical cardiovascular disease. A total of 4754 participants (mean age 65.3 years, 3466 men, and 1288 women) from the Whitehall II cohort study provided data on affective and eudaimonic wellbeing using subscales from the control, autonomy, self-realization and pleasure-19 questionnaire. Aortic stiffness was measured by aortic pulse wave velocity (PWV) at baseline (2008-2009) and 5 years later (2012-2013). Linear mixed models were used to measure the effect of affective and eudaimonic wellbeing on baseline PWV and 5-year PWV longitudinal change. A 1-SD higher eudaimonic wellbeing was associated with lower baseline PWV in men (β=-0.100 m/s [95% CI=-0.169 to -0.032]), independent of social, behavioral, and biological factors. This association persisted over 5 years. No such association was found in women (β=-0.029 m/s [95% CI=-0.126 to 0.069]). We did not find any association of positive wellbeing with change in PWV over time in either men or women. In older men, higher levels of eudaimonic wellbeing were associated with lower long-term levels of arterial stiffness. These findings support the notion that the pattern of association between positive wellbeing and cardiovascular health outcomes involves eudaimonic rather than affective wellbeing and is sex-specific.
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Affiliation(s)
- Ai Ikeda
- From the Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, United Kingdom (A.I., A.S., M.S., A.S.-M., M.K., E.J.B.).,Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan (A.I., T.T.)
| | - Andrew Steptoe
- From the Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, United Kingdom (A.I., A.S., M.S., A.S.-M., M.K., E.J.B.)
| | - Martin Shipley
- From the Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, United Kingdom (A.I., A.S., M.S., A.S.-M., M.K., E.J.B.)
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.B.W., C.M.M.)
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.B.W., C.M.M.)
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan (A.I., T.T.)
| | - Archana Singh-Manoux
- From the Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, United Kingdom (A.I., A.S., M.S., A.S.-M., M.K., E.J.B.).,Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France (A.S.-M.)
| | - Mika Kivimaki
- From the Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, United Kingdom (A.I., A.S., M.S., A.S.-M., M.K., E.J.B.)
| | - Eric J Brunner
- From the Department of Epidemiology and Public Health, Institute of Epidemiology and Health, Faculty of Population Health Sciences, University College London, United Kingdom (A.I., A.S., M.S., A.S.-M., M.K., E.J.B.)
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16
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McEniery CM, Fisk M, Miles K, Kaloyirou F, Hubsch A, Smith J, Wilkinson IB, Cheriyan J. ChemoPROphyLaxIs with hydroxychloroquine For covId-19 infeCtious disease (PROLIFIC) to prevent covid-19 infection in frontline healthcare workers: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:604. [PMID: 32616067 PMCID: PMC7330261 DOI: 10.1186/s13063-020-04543-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES PRIMARY OBJECTIVE: To determine whether chemoprophylaxis with hydroxychloroquine versus placebo increases time to contracting coronavirus disease 2019 (COVID-19) in frontline healthcare workers. SECONDARY OBJECTIVES 1) To determine whether chemoprophylaxis with daily versus weekly dosing of hydroxychloroquine increases time to contracting COVID-19 disease in frontline healthcare workers. 2) To compare the number of COVID-19 cases between each trial arm on the basis of positive tests (as per current clinical testing methods and/or serology) 3) To compare the percentage of COVID-19 positive individuals with current testing methods versus serologically-proven COVID-19 in each trial arm 4) To compare COVID-19 disease severity in each trial arm 5) To compare recovery time from COVID-19 infection in each trial arm EXPLORATORY OBJECTIVES: 1) To determine compliance (as measured by trough pharmacokinetic hydroxychloroquine levels) on COVID-19 positive tests 2) To determine if genetic factors determine susceptibility to COVID-19 disease or response to treatment 3) To determine if blood group determines susceptibility to COVID-19 disease 4) To compare serum biomarkers of COVID-19 disease in each arm TRIAL DESIGN: Double-blind, multi-centre, 2-arm (3:3:2 ratio) randomised placebo-controlled trial PARTICIPANTS: National Health Service (NHS) workers who have direct patient contact delivering care to patients with COVID-19. Participants in the trial will be recruited from a number of NHS hospitals directly caring for patients with COVID-19. INCLUSION CRITERIA To be included in the trial the participant MUST: 1) Have given written informed consent to participate 2) Be aged 18 years to 70 years 3) Not previously have been diagnosed with COVID-19 4) Work in a high-risk secondary or tertiary healthcare setting (hospitals accepting COVID-19 patients) with direct patient-facing care EXCLUSION CRITERIA: The presence of any of the following will mean participants are ineligible: 1) Known COVID-19 positive test at baseline (if available) 2) Symptomatic for possible COVID-19 at baseline 3) Known hypersensitivity reaction to hydroxychloroquine, chloroquine or 4-aminoquinolines 4) Known retinal disease 5) Known porphyria 6) Known chronic kidney disease (CKD; eGFR<30ml/min) 7) Known epilepsy 8) Known heart failure or conduction problems 9) Known significant liver disease (Gilbert's syndrome is permitted) 10) Known glucose-6-phosphate dehydrogenase (G6PD) deficiency 11) Currently taking any of the following contraindicated medications: Digoxin, Chloroquine, Halofantrine, Amiodarone, Moxifloxacin, Cyclosporin, Mefloquine, Praziquantel, Ciprofloxacin, Clarithromycin, Prochlorperazine, Fluconazole 12) Currently taking hydroxychloroquine or having a clinical indication for taking hydroxychloroquine 13) Currently breastfeeding 14) Unable to be followed-up during the trial 15) Current or future involvement in the active treatment phase of other interventional research studies (excluding observational/non-interventional studies) before study follow-up visit 16) Not able to use or have access to a modern phone device/web-based technology 17) Any other clinical reason which may preclude entry in the opinion of the investigator INTERVENTION AND COMPARATOR: Interventions being evaluated are: A) Daily hydroxychloroquine or B) Weekly hydroxychloroquine or C) Placebo The maximum treatment period is approximately 13 weeks per participant. Hydroxychloroquine-identical matched placebo tablets will ensure that all participants are taking the same number and dosing regimen of tablets across the three trial arms. There is no variation in the dose of hydroxychloroquine by weight. The dosing regimen for the three arms of the study (A, B, C) are described in further detail below. Arm A: Active Hydroxychloroquine (- daily dosing and placebo-matched hydroxychloroquine - weekly dosing). Form: Tablets Route: Oral. Dose and Frequency: Active hydroxychloroquine: Days 1-2: Loading phase - 400mg (2 x 200mg tablets) taken twice a day for 2 days Days 3 onwards: Maintenance Phase - 200mg (1 x 200mg tablet) taken once daily, every day for 90 days (~3 months) Matched Placebo hydroxychloroquine: Days 3 onwards: Maintenance Phase - 2 tablets taken once a week on the same day each week (every 7th day) for 90 days (~3 months) Arm B: Active Hydroxychloroquine (- weekly dosing and placebo matched hydroxychloroquine - daily dosing.) Form: Tablets Route: Oral. Dose and Frequency: Active hydroxychloroquine: Days 1-2: Loading Phase - 400mg (2 x 200mg tablets) taken twice daily for 2 days Days 3 onwards: Maintenance Phase - 400mg (2 x 200mg tablets) taken once a week on the same day each week (every 7th day) for 90 days (~3 months) Matched Placebo hydroxychloroquine: Days 3 onwards: Maintenance Phase - 1 tablet taken once daily for 90 days (~3 months) Arm C: Matched placebo Hydroxychloroquine (- daily dosing and matched placebo hydroxychloroquine - weekly dosing.) Form: Table. Route: Oral. Frequency: Matched placebo hydroxychloroquine - daily dosing: Days 1-2: Loading Phase - 2 tablets taken twice daily for 2 days Days 3 onwards: Maintenance Phase - 1 tablet taken once daily for 90 days (~3 months) Matched placebo hydroxychloroquine - weekly dosing: Days 3 onwards: Maintenance Phase - 2 tablets taken once a week on the same day each week (every 7th day) for 90 days (~3 months) A schematic of the dosing schedule can be found in the full study protocol (Additional File 1). MAIN OUTCOMES Time to diagnosis of positive COVID-19 disease (defined by record of date of symptoms onset and confirmed by laboratory test) RANDOMISATION: Participants will be randomised to either hydroxychloroquine dosed daily with weekly placebo, HCQ dosed weekly with daily placebo, or placebo dosed daily and weekly. Randomisation will be in a 3:3:2 ratio [hydroxychloroquine-(daily), hydroxychloroquine-(weekly), placebo], using stratified block randomisation. Random block sizes will be used, and stratification will be by study site. BLINDING (MASKING) Participants and trial investigators consenting participants, delivering trial assessments and procedures will be blinded to intervention. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) A sufficient number of participants will be enrolled so that approximately 1000 participants in total will have data suitable for the primary statistical analysis. It is anticipated that approximately 1,200 participants will need to be enrolled in total, to allow for a 20% dropout over the period of the trial. This would result in approximately 450:450:300 participants randomised to hydroxychloroquine daily, hydroxychloroquine weekly+daily matched placebo or matched-placebo daily and weekly. TRIAL STATUS V 1.0, 7th April 2020 EU Clinical Trials Register EudraCT Number: 2020-001331-26 Date of registration: 14th April 2020 Trial registered before first participant enrolment. Trial site is Cambridge University Hospitals NHS Foundation Trust. Recruitment started on 11th May 2020. It is anticipated that the trial will run for 12 months. The recruitment end date cannot yet be accurately predicted. FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
- Carmel M McEniery
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Marie Fisk
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Cambridge, UK. .,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Karen Miles
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fotini Kaloyirou
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Annette Hubsch
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jane Smith
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Clinical Trials Unit, University of Cambridge, Cambridge, UK
| | - Joseph Cheriyan
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Clinical Trials Unit, University of Cambridge, Cambridge, UK
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Affiliation(s)
- Carmel M. McEniery
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom
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Yu S, Middlemiss JE, Nardin C, Hickson SS, Miles KL, Yasmin, Maki-Petaja KM, McDonnell BJ, Cockcroft JR, Wilkinson IB, McEniery CM. Role of Vascular Adaptation in Determining Systolic Blood Pressure in Young Adults. J Am Heart Assoc 2020; 9:e014375. [PMID: 33044913 PMCID: PMC7428627 DOI: 10.1161/jaha.119.014375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Two individuals can have a similar pulse pressure (PP) but different levels of systolic blood pressure (SBP), although the underlying mechanisms have not been described. We hypothesized that, for a given level of PP, differences in SBP relate to peripheral vascular resistance (PVR); and we tested this hypothesis in a large cohort of healthy young adults. Methods and Results Demographic, biochemical, and hemodynamic data from 3103 subjects were available for the current analyses. In both men and women, for a given level of PP, higher SBP was associated with significantly higher body weight, body mass index, heart rate, and PVR (P<0.05 versus those with lower BP for all comparisons). Moreover, stratifying individuals by quartiles of PP and PVR revealed a stepwise increase in SBP from the lowest to highest quartile for each variable, with the highest SBP occurring in those in the highest quartile of both PP and PVR (P<0.001 for overall trend for both sexes). PVR was also increased with increasing tertile of minimum forearm vascular resistance, in both men (P=0.002) and women (P=0.03). Conclusions Increased PVR, mediated in part through altered resistance vessel structure, strongly associates with the elevation of SBP for a given level of PP in young adults. An impaired ability to adapt PVR appropriately to a given level of PP may be an important mechanism underlying elevated SBP in young adults.
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Affiliation(s)
- Shikai Yu
- Department of Cardiology Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai China.,Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Jessica E Middlemiss
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Chiara Nardin
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom.,Dipartimento di Medicina (DIMED) University of Padova Italy
| | - Stacey S Hickson
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Karen L Miles
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Yasmin
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Kaisa M Maki-Petaja
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Barry J McDonnell
- Cardiff School of Health Sciences Cardiff Metropolitan University Cardiff United Kingdom
| | - John R Cockcroft
- Cardiff School of Health Sciences Cardiff Metropolitan University Cardiff United Kingdom
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics University of Cambridge United Kingdom
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Li Y, Hickson SS, McEniery CM, Wilkinson IB, Khir AW. Stiffening and ventricular-arterial interaction in the ascending aorta using MRI: ageing effects in healthy humans. J Hypertens 2020; 37:347-355. [PMID: 30645209 PMCID: PMC6365245 DOI: 10.1097/hjh.0000000000001886] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text Objectives: The aim of this study was to investigate the effect of age and sex on nPWV and ndI in the ascending aorta of healthy humans. Background: Local pulse wave velocity (nPWV) and wave intensity (ndI) in the human ascending aorta have not been studied adequately, because of the need for invasive pressure measurements. However, a recently developed technique made the noninvasive determination of nPWV and ndI possible using measurements of flow velocity and arterial diameter. Methods: Diameter and flow velocity were measured at the level of the ascending aorta in 144 healthy participants (aged 20–77 years, 66 men), using MRI. nPWV, ndI parameters; forward (FCW); backward (BCW) compression waves, forward decompression wave (FDW), local aortic distensibility (nDs) and reflection index (nRI) were calculated. Results: nPWV increased significantly with age from 4.7 ± 0.3 m/s for those 20–30 years to 6.4 ± 0.2 m/s for those 70–80 years (P < 0.001) and did not differ between sexes. nDs decreased with age (5.3 ± 0.5 vs. 2.6 ± 0.2 10−5 1/Pa, P < 0.001) and nRI increased with age (0.17 ± 0.03 vs. 0.39 ± 0.06, P < 0.01) for those 20–30 and 70–80 years, respectively. FCW, BCW and FDW decreased significantly with age by 86.3, 71.3 and 74.2%, respectively (P < 0.001), all compared to the lowest age-band. Conclusion: In healthy humans, ageing results in stiffer ascending aorta, with increase in nPWV and decrease in nDs. A decrease in FCW and FDW indicates decline in left ventricular early and late systolic functions with age in healthy humans with no differences between sexes. nRI is more sensitive than BCW in establishing the effects of ageing on reflected waves measured in the ascending aorta.
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Affiliation(s)
- Ye Li
- King's College London, British Heart Foundation Centre, London.,Brunel Institute for Bioengineering, Brunel University, Uxbridge, Middlesex, UK
| | - Stacey S Hickson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University, Uxbridge, Middlesex, UK
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Abstract
The large elastic arteries fulfill an important role in buffering the cyclical changes in blood pressure, which result from intermittent ventricular ejection. With aging and accrual of cardiovascular risk factors, the elastic arteries stiffen, and this process holds a number of deleterious consequences for the cardiovascular system and major organs. Indeed, arterial stiffness is now recognized as an important, independent determinant of cardiovascular disease risk. Additional, important information concerning the mechanisms underlying arterial stiffening has come from longitudinal studies of arterial stiffness. More recently, attention has focused on the role of peripheral, muscular arteries in cardiovascular disease risk prediction and, in particular, the clinical consequences of reversal of the normal gradient of arterial stiffness between central and peripheral arteries, with aging and disease.
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Affiliation(s)
- Shikai Yu
- From the Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China (S.Y.).,Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (S.Y., C.M.M.)
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (S.Y., C.M.M.)
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Araghi M, Shipley MJ, Wilkinson IB, McEniery CM, Valencia-Hernández CA, Kivimaki M, Sabia S, Singh-Manoux A, Brunner EJ. Association of aortic stiffness with cognitive decline: Whitehall II longitudinal cohort study. Eur J Epidemiol 2019; 35:861-869. [PMID: 31776832 PMCID: PMC7441227 DOI: 10.1007/s10654-019-00586-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022]
Abstract
Aortic stiffness is associated with an increased risk of cardio- and cerebrovascular disease and mortality and may increase risk of dementia. The aim of the present study is to examine the association between arterial stiffness and cognitive decline in a large prospective cohort study with three repeated cognitive assessment over 7 years of follow-up. Aortic pulse wave velocity (PWV) was measured among 4300 participants (mean ± standard deviation age 65.1 ± 5.2 years) in 2007-2009 and categorized based on the tertiles: (lowest third: < 7.41 m/s), (middle third: 7.41-8.91 m/s), and (highest third: > 8.91 m/s). A global cognitive score was calculated in 2007-2009, 2012-2013, and 2015-2016 based on responses to memory, reasoning and fluency tests. Standardized global cognitive score (mean = 0, SD = 1) in highest third versus lowest third of PWV category was lower at baseline (- 0.12, 95% CI - 0.18, - 0.06). Accelerated 7-year cognitive decline was observed among individuals with the highest PWV [difference in 7-year cognitive change for highest third versus lowest third PWV: - 0.06, 95% CI - 0.11, - 0.01, P < 0.01]. Higher aortic stiffness was associated with faster cognitive decline. Clinicians may be able to use arterial stiffness severity as an indicator to administer prompt treatments to prevent or delay the onset of cognitive decline or dementia. Future studies need to determine whether early intervention of vascular stiffness is effective in delaying these outcomes.
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Affiliation(s)
- Marzieh Araghi
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Carlos A Valencia-Hernández
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.,Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.,Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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Yu S, McEniery CM. Heart-Thigh Cuff Pulse Wave Velocity: Aiming for the Best of Both Worlds? Am J Hypertens 2019; 32:1048-1050. [PMID: 31504130 DOI: 10.1093/ajh/hpz141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shikai Yu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
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Provan SA, Rollefstad S, Ikdahl E, Mathiessen A, Berg IJ, Eeg I, Wilkinson IB, McEniery CM, Kvien TK, Hammer HB, Østerås N, Haugen IK, Semb AG. Biomarkers of cardiovascular risk across phenotypes of osteoarthritis. BMC Rheumatol 2019; 3:33. [PMID: 31410391 PMCID: PMC6686275 DOI: 10.1186/s41927-019-0081-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/24/2019] [Indexed: 01/19/2023] Open
Abstract
Background The objective of this study was to explore the associations between ultrasonographic and radiographic joint scores and levels of arterial CVD risk markers in patients with osteoarthritis (OA). Secondly, to compare the levels of arterial CVD risk markers between OA phenotypes and controls. Method The "Musculoskeletal pain in Ullensaker" Study (MUST) invited residents of Ullensaker municipality with self-reported OA to a medical examination. OA was defined according to the American College of Rheumatology (ACR) criteria and phenotyped based on joint distribution. Joints of the hands, hips and knees were examined by ultrasonography and conventional radiography, and scored for osteosteophytes. Hands were also scored for inflammation by grey scale (GS) synovitis and power Doppler (PD) signal. Control populations were a cohort of inhabitants of Oslo (OCP), and for external validation, a UK community-based register (UKPC).Pulse pressure augmentation index (AIx) and pulse wave velocity (PWV) were measured using the Sphygmocor apparatus (Atcor®). Ankel-brachial index (ABI) was estimated in a subset of patients. In separate adjusted regression models we explored the associations between ultrasonography and radiograph joint scores and AIx, PWV and ABI. CVD risk markers were also compared between phenotypes of OA and controls in adjusted analyses. Results Three hundred and sixty six persons with OA were included (mean age (range); 63.0 (42.0-75.0)), (females (%); 264 (72)). Of these, 155 (42.3%) had isolated hand OA, 111 (30.3%) had isolated lower limb OA and 100 (27.3%) had generalized OA. 108 persons were included in the OCP and 963 persons in the UKPC; (mean age (range); OCP: 57.2 (40.4-70.4), UKPC: 63.9 (40.0-75.0), females (%); OCP: 47 (43.5), UKPC: 543 (56.4%). Hand osteophytes were associated with AIx while GS and PD scores were not related to CVD risk markers. All OA phenotypes had higher levels of AIx compared to OCP in adjusted analyses. External validation against UKPC confirmed these findings. Conclusions Hand osteophytes might be related to higher risk of CVD. People with OA had higher augmented central pressure compared to controls.Words 330.
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Affiliation(s)
- S A Provan
- Department of Rheumatology, Oslo, Norway
| | - S Rollefstad
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - I J Berg
- Department of Rheumatology, Oslo, Norway
| | - I Eeg
- Department of Rheumatology, Oslo, Norway
| | - I B Wilkinson
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - C M McEniery
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - T K Kvien
- Department of Rheumatology, Oslo, Norway
| | - H B Hammer
- Department of Rheumatology, Oslo, Norway
| | - N Østerås
- 4National Resource Centre for rehabilitation in Rheumatology. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - I K Haugen
- Department of Rheumatology, Oslo, Norway
| | - A G Semb
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Okamoto M, Shipley MJ, Wilkinson IB, McEniery CM, Valencia-Hernández CA, Singh-Manoux A, Kivimaki M, Brunner EJ. Does Poorer Pulmonary Function Accelerate Arterial Stiffening?: A Cohort Study With Repeated Measurements of Carotid-Femoral Pulse Wave Velocity. Hypertension 2019; 74:929-935. [PMID: 31378105 PMCID: PMC6756258 DOI: 10.1161/hypertensionaha.119.13183] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whether poorer pulmonary function accelerates progression of arterial stiffness remains unknown as prior observational studies have not examined longitudinal changes in arterial stiffness in relation to earlier pulmonary function. Data (N=5342, 26% female) were drawn from the Whitehall II cohort study. Participants completed repeated assessments of forced expiratory volume in 1 second (FEV1, L) and carotid-femoral pulse wave velocity (cf-PWV, m/s) over 5 years. The effect of FEV1 on later cf-PWV and its progression was estimated using linear mixed-effects modeling. Possible explanatory mechanisms, such as mediation by low-grade systemic inflammation, common-cause explanation by preexisting cardiometabolic risk factors, and reverse-causation bias, were assessed. Poorer pulmonary function was associated with later higher cf-PWV and its subsequent progression (cf-PWV 5-year change 0.09, 95% CI 0.03–0.17 per SD lower FEV1) after adjustment for age, sex, ethnicity, heart rate, and mean arterial pressure. Decrease in pulmonary function was associated with later higher cf-PWV (0.17, 95% CI 0.04–0.30 in the top compared to bottom quartile of decline in FEV1). There was no evidence to support mediation by circulating CRP (C-reactive protein) or IL (interleukin)-6. Furthermore, arterial stiffness was not associated with later FEV1 after accounting for cardiometabolic status. In conclusion, poorer pulmonary function predicted future arterial stiffness. These findings support pulmonary function as a clinically important risk factor for arterial stiffness and provide justification for future intervention studies for pulmonary function based on its relationship with arterial stiffness.
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Affiliation(s)
- Masaki Okamoto
- From the Department of Epidemiology and Public Health, University College London, United Kingdom (M.O., M.J.S., C.A.V.-H., A.S.-M., M.K., E.J.B.).,Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan (M.O.)
| | - Martin J Shipley
- From the Department of Epidemiology and Public Health, University College London, United Kingdom (M.O., M.J.S., C.A.V.-H., A.S.-M., M.K., E.J.B.)
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.B.W., C.M.M.)
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.B.W., C.M.M.)
| | - Carlos A Valencia-Hernández
- From the Department of Epidemiology and Public Health, University College London, United Kingdom (M.O., M.J.S., C.A.V.-H., A.S.-M., M.K., E.J.B.)
| | - Archana Singh-Manoux
- From the Department of Epidemiology and Public Health, University College London, United Kingdom (M.O., M.J.S., C.A.V.-H., A.S.-M., M.K., E.J.B.).,Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France (A.S.-M.)
| | - Mika Kivimaki
- From the Department of Epidemiology and Public Health, University College London, United Kingdom (M.O., M.J.S., C.A.V.-H., A.S.-M., M.K., E.J.B.)
| | - Eric J Brunner
- From the Department of Epidemiology and Public Health, University College London, United Kingdom (M.O., M.J.S., C.A.V.-H., A.S.-M., M.K., E.J.B.)
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McEniery CM, Middlemiss J, Maki‐Petaja K, Wilkinson I. Mechanisms Underlying Obesity‐Related Hypertension: An Experimental Weight Gain Study in Humans. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.691.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pearson J, Watkeys LJ, Coulson JM, Schlader ZJ, Crandall CG, Cockcroft JR, McEniery CM, McDonnell BJ. Association between Aortic Stiffness and Cerebral Pulsatility is Modestly Influenced by Augmentation Index. Artery Res 2019. [DOI: 10.2991/artres.k.191212.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tay J, Masini G, McEniery CM, Giussani DA, Shaw CJ, Wilkinson IB, Bennett PR, Lees CC. Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function. Am J Obstet Gynecol 2019; 220:96.e1-96.e8. [PMID: 30243605 DOI: 10.1016/j.ajog.2018.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The mechanism underlying fetal-placental Doppler index changes in preeclampsia and/or fetal growth restriction are unknown, although both are associated with maternal cardiovascular dysfunction. OBJECTIVE We sought to investigate whether there was a relationship between maternal cardiac output and vascular resistance and fetoplacental Doppler findings in healthy and complicated pregnancy. STUDY DESIGN Women with healthy pregnancies (n=62), preeclamptic pregnancies (n=13), preeclamptic pregnancies with fetal growth restriction (n=15), or fetal growth restricted pregnancies (n=17) from 24-40 weeks gestation were included. All of them underwent measurement of cardiac output with the use of an inert gas rebreathing technique and derivation of peripheral vascular resistance. Uterine and fetal Doppler indices were recorded; the latter were z scored to account for gestation. Associations were determined by polynomial regression analyses. RESULTS Mean uterine artery pulsatility index was higher in fetal growth restriction (1.37; P=.026) and preeclampsia+fetal growth restriction (1.63; P=.001) but not preeclampsia (0.92; P=1) compared with control subjects (0.8). There was a negative relationship between uterine pulsatility index and cardiac output (r2=0.101; P=.025) and umbilical pulsatility index z score and cardiac output (r2=0.078; P=.0015), and there were positive associations between uterine pulsatility index and peripheral vascular resistance (r2=0.150; P=.003) and umbilical pulsatility index z score and peripheral vascular resistance (r2= 0.145; P=.001). There was no significant relationship between cardiac output and peripheral vascular resistance with cerebral Doppler indices. CONCLUSION Uterine artery Doppler change is abnormally elevated in fetal growth restriction with and without preeclampsia, but not in preeclampsia, which may explain the limited sensitivity of uterine artery Doppler changes for all these complications when considered in aggregate. Furthermore, impedance within fetoplacental arterial vessels is at least, in part, associated with maternal cardiovascular function. This relationship may have important implications for fetal surveillance and would inform therapeutic options in those pathologic pregnancy conditions currently, and perhaps erroneously, attributed purely to placental maldevelopment. Uterine and fetal placental Doppler indices are associated significantly with maternal cardiovascular function. The classic description of uterine and fetal Doppler changes being initiated by placental maldevelopment is a less plausible explanation for the pathogenesis of the conditions than that relating to maternal cardiovascular changes.
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Nardin C, Maki-Petaja KM, Miles KL, Yasmin, McDonnell BJ, Cockcroft JR, Wilkinson IB, McEniery CM. Cardiovascular Phenotype of Elevated Blood Pressure Differs Markedly Between Young Males and Females: The Enigma Study. Hypertension 2018; 72:1277-1284. [PMID: 30763511 PMCID: PMC6221425 DOI: 10.1161/hypertensionaha.118.11975] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/25/2018] [Accepted: 09/19/2018] [Indexed: 01/12/2023]
Abstract
Blood pressure (BP) in young adults predicts BP in later life. We aimed to identify metabolic, hemodynamic, and autonomic characteristics associated with raised BP in young adults and whether these differ between males and females. Three thousand one hundred forty-five healthy subjects, aged 18 to 40 years, were grouped according to sex and BP category following the recent reclassification of BP as part of American Heart Association/American College of Cardiology 2017 guidelines. All individuals undertook a lifestyle and medical history questionnaire and detailed metabolic, hemodynamic, and autonomic assessments. Stage 1 hypertension and normal BP were the most common BP phenotypes in males (29%) and females (68%), respectively. In both sexes, cardiac output was positively associated with increasing BP category (P<0.001 for both). Similar positive trends were observed for heart rate and stroke volume in males (P<0.001 for both) and heart rate in females (P<0.001). Unlike in males, peripheral vascular resistance, aortic pulse wave velocity, and augmentation index were significantly increased in hypertensive females (P<0.001 for all) compared with the other BP categories. Most heart rate variability indices decreased across the BP categories, particularly in males. In young adults, metabolic and hemodynamic abnormalities associated with hypertension are already present at the elevated BP stage and the overall phenotype differed markedly between sexes. Whereas a cardiac phenotype was associated with elevated BP and hypertension in males, a vascular phenotype, characterized by elevated peripheral vascular resistance, aortic pulse wave velocity, and augmentation index, was dominant in females.
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Affiliation(s)
- Chiara Nardin
- From the Department of Medicine-DIMED, University of Padova, Italy (C.N.)
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.N., K.M.M.-P., K.L.M., Y., I.B.W., C.M.M.)
| | - Kaisa M. Maki-Petaja
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.N., K.M.M.-P., K.L.M., Y., I.B.W., C.M.M.)
| | - Karen L. Miles
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.N., K.M.M.-P., K.L.M., Y., I.B.W., C.M.M.)
| | - Yasmin
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.N., K.M.M.-P., K.L.M., Y., I.B.W., C.M.M.)
| | - Barry J. McDonnell
- Cardiff School of Health Sciences, Cardiff Metropolitan University, United Kingdom (B.J.M., J.R.C.)
| | - John R. Cockcroft
- Cardiff School of Health Sciences, Cardiff Metropolitan University, United Kingdom (B.J.M., J.R.C.)
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.N., K.M.M.-P., K.L.M., Y., I.B.W., C.M.M.)
| | - Carmel M. McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.N., K.M.M.-P., K.L.M., Y., I.B.W., C.M.M.)
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Namasivayam M, McEniery CM, Wilkinson IB, Yasmin, Cockroft JR, McDonnell BJ, Adji A, O’Rourke MF. Different Effects of Vascular Aging on Ischemic Predisposition in Healthy Men and Women. Hypertension 2018; 72:1294-1300. [DOI: 10.1161/hypertensionaha.118.11642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Mayooran Namasivayam
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
| | - Carmel M. McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Yasmin
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - John R. Cockroft
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Barry J. McDonnell
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Audrey Adji
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia (A.A.)
| | - Michael F. O’Rourke
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
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D'Sa L, Senaratne N, Woodcock-Smith J, Miles KM, Wilkinson IB, McEniery CM. Evaluation of the Omron HEM-907 automated blood pressure device: comparison with office and ambulatory blood pressure readings. Hypertens Res 2018; 42:52-58. [PMID: 30374040 DOI: 10.1038/s41440-018-0120-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/12/2018] [Accepted: 06/29/2018] [Indexed: 11/09/2022]
Abstract
Blood pressure (BP) measured in the clinic is subject to the white coat effect and does not always indicate the 'usual' BP. Ambulatory BP is the current gold standard, but remains inconvenient for routine use. Interest in automated BP, where the healthcare professional is absent from the examination room during BP measurement, is growing, as this reduces the white coat effect and yields BP values that are close to ambulatory readings. The aim of this study was to investigate how well automated office BP (AOBP), measured using the Omron HEM-907 device, compares with observed office BP (OOBP, healthcare professional remains in the examination room) and awake ambulatory BP (AABP) measurements. OOBP, AOBP and AABP were measured in 108 participants, with OOBP and AOBP measurements repeated 1 week later, following a standardised protocol. Average BP readings for visit one were 134 ± 18/77 ± 11 for OOBP, 131 ± 16/75 ± 11 for AOBP, and 133 ± 15/82 ± 12 for AABP. On both visits, automated readings were significantly lower than observed readings for both systolic and diastolic BP (P < 0.001 for both). Automated readings were also significantly lower than ambulatory readings, with a mean difference in systolic/diastolic BP of - 2 ± 11/- 7 ± 10 (P < 0.001 for both), with high correlations between the two modalities (r = 0.75 and r = 0.64, for systolic and diastolic BP, respectively, P < 0.001 for both). AOBP measured by the Omron HEM-907 is not associated with a white coat effect, unlike observed readings, and provides reproducible results and good correlations with ambulatory readings. Automated BP measured using the Omron HEM-907 is, therefore, a useful alternative to observed office readings.
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Affiliation(s)
- Lauren D'Sa
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Box 98, Cambridge, CB2 0QQ, UK
| | - Nipuna Senaratne
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Box 98, Cambridge, CB2 0QQ, UK
| | - Jean Woodcock-Smith
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Box 98, Cambridge, CB2 0QQ, UK
| | - Karen M Miles
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Box 98, Cambridge, CB2 0QQ, UK
| | - Ian B Wilkinson
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Box 98, Cambridge, CB2 0QQ, UK
| | - Carmel M McEniery
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Box 98, Cambridge, CB2 0QQ, UK.
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Masini G, Foo LF, Cornette J, Tay J, Rizopoulos D, McEniery CM, Wilkinson IB, Lees CC. Cardiac output changes from prior to pregnancy to post partum using two non-invasive techniques. Heart 2018; 105:715-720. [PMID: 30377262 DOI: 10.1136/heartjnl-2018-313682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES We aimed to describe cardiac output (CO) trend from prepregnancy to post partum using an inert gas rebreathing (IGR) device and compare these measurements with those obtained by a pulse waveform analysis (PWA) technique, both cross-sectionally and longitudinally. METHODS Non-smoking healthy women, aged 18-44 years, with body mass index <35 were included in this prospective observational study. CO measurements were collected at different time points (prepregnancy, at four different gestational epochs and post partum) using IGR and PWA. A linear mixed model analysis tested whether the longitudinal change in CO differed between the techniques. Bland-Altman analysis and intraclass correlation coefficient (ICC) were used for cross-sectional and a four-quadrant plot for longitudinal comparisons. RESULTS Of the 413 participants, 69 had a complete longitudinal assessment throughout pregnancy. In this latter cohort, the maximum CO rise was seen at 15.2 weeks with IGR (+17.5% from prepregnancy) and at 10.4 weeks with PWA (+7.7% from prepregnancy). Trends differed significantly (p=0.0093). Cross-sectional analysis was performed in the whole population of 413 women: the mean CO was 6.14 L/min and 6.38 L/min for PWA and IGR, respectively, the percentage of error was 46% and the ICC was 0.348, with similar results at all separate time points. Longitudinal concordance was 64%. CONCLUSIONS Despite differences between devices, the maximum CO rise in healthy pregnancies is more modest and earlier than previously reported. The two methods of CO measurement do not agree closely and cannot be used interchangeably. Technique-specific reference ranges are needed before they can be applied in research and clinical settings.
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Affiliation(s)
- Giulia Masini
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lin F Foo
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jérôme Cornette
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Jasmine Tay
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Carmel M McEniery
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, Cambridge, UK
| | - Ian B Wilkinson
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, Cambridge, UK
| | - Christoph C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Mukhtar O, Cheriyan J, Cockcroft JR, Collier D, Coulson JM, Dasgupta I, Faconti L, Glover M, Heagerty AM, Khong TK, Lip GYH, Mander AP, Marchong MN, Martin U, McDonnell BJ, McEniery CM, Padmanabhan S, Saxena M, Sever PJ, Shiel JI, Wych J, Chowienczyk PJ, Wilkinson IB. A randomized controlled crossover trial evaluating differential responses to antihypertensive drugs (used as mono- or dual therapy) on the basis of ethnicity: The comparIsoN oF Optimal Hypertension RegiMens; part of the Ancestry Informative Markers in HYpertension program-AIM-HY INFORM trial. Am Heart J 2018; 204:102-108. [PMID: 30092411 PMCID: PMC6234107 DOI: 10.1016/j.ahj.2018.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/18/2018] [Indexed: 02/06/2023]
Abstract
Background Ethnicity, along with a variety of genetic and environmental factors, is thought to influence the efficacy of antihypertensive therapies. Current UK guidelines use a “black versus white” approach; in doing so, they ignore the United Kingdom's largest ethnic minority: Asians from South Asia. Study design The primary purpose of the AIM-HY INFORM trial is to identify potential differences in response to antihypertensive drugs used as mono- or dual therapy on the basis of self-defined ethnicity. A multicenter, prospective, open-label, randomized study with 2 parallel, independent trial arms (mono- and dual therapy), AIM-HY INFORM plans to enroll a total of 1,320 patients from across the United Kingdom. Those receiving monotherapy (n = 660) will enter a 3-treatment (amlodipine 10 mg od; lisinopril 20 mg od; chlorthalidone 25 mg od), 3-period crossover, lasting 24 weeks, whereas those receiving dual therapy (n = 660) will enter a 4-treatment (amlodipine 5 mg od and lisinopril 20 mg od; amlodipine 5 mg od and chlorthalidone 25 mg od; lisinopril 20 mg od and chlorthalidone 25 mg od; amiloride 10 mg od and chlorthalidone 25 mg od), 4-period crossover, lasting 32 weeks. Equal numbers of 3 ethnic groups (white, black/black British, and Asian/Asian British) will ultimately be recruited to each of the trial arms (ie, 220 participants per ethnic group per arm). Seated, automated, unattended, office, systolic blood pressure measured 8 weeks after each treatment period begins will serve as the primary outcome measure. Conclusion AIM-HY INFORM is a prospective, open-label, randomized trial which aims to evaluate first- and second-line antihypertensive therapies for multiethnic populations.
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Affiliation(s)
- Omar Mukhtar
- Experimental Medicine & Immunotherapeutics Division, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
| | - Joseph Cheriyan
- Experimental Medicine & Immunotherapeutics Division, Department of Medicine, University of Cambridge, and Cambridge, and Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - John R Cockcroft
- Department of Cardiology, Columbia University Medical Center, New York
| | - David Collier
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - James M Coulson
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, United Kingdom
| | - Indranil Dasgupta
- Department of Renal Medicine, Heartlands Hospital, Birmingham, United Kingdom
| | - Luca Faconti
- Department of Clinical Pharmacology, King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Mark Glover
- Division of Therapeutics and Molecular Medicine, University of Nottingham, and NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Anthony M Heagerty
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Teck K Khong
- Blood Pressure Unit, Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, London, United Kingdom
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Adrian P Mander
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mellone N Marchong
- Office for Translational Research, Cambridge University Health Partners and University of Cambridge, Cambridge, United Kingdom
| | - Una Martin
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Barry J McDonnell
- Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Carmel M McEniery
- Experimental Medicine & Immunotherapeutics Division, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Manish Saxena
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Peter J Sever
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Julian I Shiel
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Julie Wych
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Phil J Chowienczyk
- Department of Clinical Pharmacology, King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Ian B Wilkinson
- Experimental Medicine & Immunotherapeutics Division, Department of Medicine, University of Cambridge, and Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Foo FL, Mahendru AA, Masini G, Fraser A, Cacciatore S, MacIntyre DA, McEniery CM, Wilkinson IB, Bennett PR, Lees CC. Association Between Prepregnancy Cardiovascular Function and Subsequent Preeclampsia or Fetal Growth Restriction. Hypertension 2018; 72:442-450. [PMID: 29967040 DOI: 10.1161/hypertensionaha.118.11092] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/23/2018] [Accepted: 06/04/2018] [Indexed: 12/14/2022]
Abstract
Preeclampsia and fetal growth restriction during pregnancy are associated with increased risk of maternal cardiovascular disease later in life. It is unclear whether this association is causal or driven by similar antecedent risk factors. Clarification requires recruitment before conception which is methodologically difficult with high attrition rates and loss of outcome numbers to nonconception/miscarriage. Few prospective studies have, therefore, been adequately powered to address these questions. We recruited 530 healthy women (mean age: 35.0 years) intending to conceive and assessed cardiac output, cardiac index, stroke volume, total peripheral resistance, mean arterial pressure, and heart rate before pregnancy. Participants were followed to completion of subsequent pregnancy with repeat longitudinal assessments. Of 356 spontaneously conceived pregnancies, 15 (4.2%) were affected by preeclampsia and fetal growth restriction. Women who subsequently developed preeclampsia/fetal growth restriction had lower preconception cardiac output (4.9 versus 5.8 L/min; P=0.002) and cardiac index (2.9 versus 3.3 L/min per meter2; P=0.031) while mean arterial pressure (87.1 versus 82.3 mm Hg; P=0.05) and total peripheral resistance (1396.4 versus 1156.1 dynes sec cm-5; P<0.001) were higher. Longitudinal trajectories for cardiac output and total peripheral resistance were similar between affected and healthy pregnancies, but the former group showed a more exaggerated fall in mean arterial pressure in the first trimester, followed by a steeper rise and a steeper fall to postpartum values. Significant relationships were observed between cardiac output, total peripheral resistance, and mean arterial pressure and gestational epoch. We conclude that in healthy women, an altered prepregnancy hemodynamic phenotype is associated with the subsequent development of preeclampsia/fetal growth restriction.
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Affiliation(s)
- Fung L Foo
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Amita A Mahendru
- Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.M.M., C.M.M., I.B.W.)
| | - Giulia Masini
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School (A.F.).,MRC Integrative Epidemiology Unit (A.F.)
| | - Stefano Cacciatore
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.).,University of Bristol, United Kingdom; and International Centre for Genetic Engineering and Biotechnology, Cancer Genomics Group, Cape Town, South Africa (S.C.)
| | - David A MacIntyre
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Carmel M McEniery
- Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.M.M., C.M.M., I.B.W.)
| | - Ian B Wilkinson
- Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.M.M., C.M.M., I.B.W.)
| | - Phillip R Bennett
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Christoph C Lees
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
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Yasmin, Maskari RA, McEniery CM, Cleary SE, Li Y, Siew K, Figg NL, Khir AW, Cockcroft JR, Wilkinson IB, O'Shaughnessy KM. The matrix proteins aggrecan and fibulin-1 play a key role in determining aortic stiffness. Sci Rep 2018; 8:8550. [PMID: 29867203 PMCID: PMC5986773 DOI: 10.1038/s41598-018-25851-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022] Open
Abstract
Stiffening of the aorta is an important independent risk factor for myocardial infarction and stroke. Yet its genetics is complex and little is known about its molecular drivers. We have identified for the first time, tagSNPs in the genes for extracellular matrix proteins, aggrecan and fibulin-1, that modulate stiffness in young healthy adults. We confirmed SNP associations with ex vivo stiffness measurements and expression studies in human donor aortic tissues. Both aggrecan and fibulin-1 were found in the aortic wall, but with marked differences in the distribution and glycosylation of aggrecan reflecting loss of chondroitin-sulphate binding domains. These differences were age-dependent but the striking finding was the acceleration of this process in stiff versus elastic young aortas. These findings suggest that aggrecan and fibulin-1 have critical roles in determining the biomechanics of the aorta and their modification with age could underpin age-related aortic stiffening.
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Affiliation(s)
- Yasmin
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
| | - Raya Al Maskari
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Sarah E Cleary
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Ye Li
- Brunel Institute of Bioengineering, Brunel University, Uxbridge, Middlesex, UK
| | - Keith Siew
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Nichola L Figg
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Ashraf W Khir
- Brunel Institute of Bioengineering, Brunel University, Uxbridge, Middlesex, UK
| | - John R Cockcroft
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University, New York, USA
| | - Ian B Wilkinson
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin M O'Shaughnessy
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Fisk M, Cheriyan J, Mohan D, McEniery CM, Forman J, Cockcroft JR, Rudd JHF, Tal-Singer R, Hopkinson NS, Polkey MI, Wilkinson IB. Vascular inflammation and aortic stiffness: potential mechanisms of increased vascular risk in chronic obstructive pulmonary disease. Respir Res 2018; 19:100. [PMID: 29793484 PMCID: PMC5968523 DOI: 10.1186/s12931-018-0792-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/27/2018] [Indexed: 01/09/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a complex inflammatory condition in which an important extra-pulmonary manifestation is cardiovascular disease. We hypothesized that COPD patients would have increased aortic inflammation and stiffness, as candidate mechanisms mediating increased cardiovascular risk, compared to two negative control groups: healthy never-smokers and smokers without COPD. We also studied patients with COPD due to alpha− 1 antitrypsin deficiency (α1ATD) as a comparator lung disease group. Methods Participants underwent 18F-Fluorodeoxyglucose (FDG) positron emission tomography imaging to quantify aortic inflammation as the tissue-to-blood-ratio (TBR) of FDG uptake. Aortic stiffness was measured by carotid-femoral aortic pulse wave velocity (aPWV). Results Eighty-five usual COPD (COPD due to smoking), 12 α1ATD-COPD patients and 12 each smokers and never-smokers were studied. There was no difference in pack years smoked between COPD patients and smokers (45 ± 25 vs 37 ± 19, p = 0.36), but α1ATD patients smoked significantly less (19 ± 11, p < 0.001 for both). By design, spirometry measures were lower in COPD and α1ATD-COPD patients compared to smokers and never-smokers. Aortic inflammation and stiffness were increased in COPD (TBR: 1.90 ± 0.38, aPWV: 9.9 ± 2.6 m/s) and α1ATD patients (TBR: 1.94 ± 0.43, aPWV: 9.5 ± 1.8 m/s) compared with smokers (TBR: 1.74 ± 0.30, aPWV: 7.8 ± 1.8 m/s, p < 0.05 all) and never-smokers (TBR: 1.71 ± 0.34, aPWV: 7.9 ± 1.7 m/s, p ≤ 0.05 all). Conclusions In this cross-sectional prospective study, novel findings were that both usual COPD and α1ATD-COPD patients have increased aortic inflammation and stiffness compared to smoking and never-smoking controls, regardless of smoking history. These findings suggest that the presence of COPD lung disease per se may be associated with adverse aortic wall changes, and aortic inflammation and stiffening are potential mechanisms mediating increased vascular risk observed in COPD patients. Electronic supplementary material The online version of this article (10.1186/s12931-018-0792-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Fisk
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Divya Mohan
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.,GSK R&D, King of Prussia, Pennsylvania, USA
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Julia Forman
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John R Cockcroft
- Department of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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36
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Mohan D, Forman JR, Allinder M, McEniery CM, Bolton CE, Cockcroft JR, MacNee W, Fuld J, Marchong M, Gale NS, Fisk M, Nagarajan S, Cheriyan J, Lomas DA, Calverley PMA, Miller BE, Tal-Singer R, Wilkinson IB, Polkey MI. Fibrinogen does not relate to cardiovascular or muscle manifestations in COPD: cross-sectional data from the ERICA study. Thorax 2018; 73:1182-1185. [PMID: 29618495 DOI: 10.1136/thoraxjnl-2018-211556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 01/07/2023]
Abstract
Cardiovascular and skeletal muscle manifestations constitute important comorbidities in COPD, with systemic inflammation proposed as a common mechanistic link. Fibrinogen has prognostic role in COPD. We aimed to determine whether aortic stiffness and quadriceps weakness are linked in COPD, and whether they are associated with the systemic inflammatory mediator-fibrinogen. Aortic pulse wave velocity (aPWV), quadriceps maximal volitional contraction (QMVC) force and fibrinogen were measured in 729 patients with stable, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II-IV COPD. The cardiovascular and muscular manifestations exist independently (P=0.22, χ2). Fibrinogen was not associated with aPWV or QMVC (P=0.628 and P=0.621, respectively), making inflammation, as measured by plasma fibrinogen, an unlikely common aetiological factor.
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Affiliation(s)
- Divya Mohan
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College, London, UK.,R&D, GlaxoSmithKline King of Prussia, Philadelphia, Pennsylvania, USA
| | - Julia R Forman
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Matthew Allinder
- R&D, GlaxoSmithKline King of Prussia, Philadelphia, Pennsylvania, USA
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Charlotte Emma Bolton
- Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, City Hospital NUH Trust Campus, University of Nottingham, Nottingham, UK
| | - John R Cockcroft
- Department of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - William MacNee
- MRC Centre for Inflammation, University of Edinburgh, Edinburgh, UK
| | - Jonathan Fuld
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Mellone Marchong
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Nichola Sian Gale
- Department of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Marie Fisk
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sridevi Nagarajan
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - David A Lomas
- Division of Medicine, UCL Respiratory, University College London, London, UK
| | - Peter M A Calverley
- School of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Bruce E Miller
- R&D, GlaxoSmithKline King of Prussia, Philadelphia, Pennsylvania, USA
| | - Ruth Tal-Singer
- R&D, GlaxoSmithKline King of Prussia, Philadelphia, Pennsylvania, USA
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Cambridge Clinical Trials Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College, London, UK
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37
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Fisk M, Cheriyan J, Mohan D, Forman J, Mäki-Petäjä KM, McEniery CM, Fuld J, Rudd JHF, Hopkinson NS, Lomas DA, Cockcroft JR, Tal-Singer R, Polkey MI, Wilkinson IB. The p38 mitogen activated protein kinase inhibitor losmapimod in chronic obstructive pulmonary disease patients with systemic inflammation, stratified by fibrinogen: A randomised double-blind placebo-controlled trial. PLoS One 2018; 13:e0194197. [PMID: 29566026 PMCID: PMC5863984 DOI: 10.1371/journal.pone.0194197] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/16/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a major cause of morbidity and mortality in COPD patients. Systemic inflammation associated with COPD, is often hypothesised as a causal factor. p38 mitogen-activated protein kinases play a key role in the inflammatory pathogenesis of COPD and atherosclerosis. OBJECTIVES This study sought to evaluate the effects of losmapimod, a p38 mitogen-activated protein kinase (MAPK) inhibitor, on vascular inflammation and endothelial function in chronic obstructive pulmonary disease (COPD) patients with systemic inflammation (defined by plasma fibrinogen >2·8g/l). METHODS This was a randomised, double-blind, placebo-controlled, Phase II trial that recruited COPD patients with plasma fibrinogen >2.8g/l. Participants were randomly assigned by an online program to losmapimod 7·5mg or placebo tablets twice daily for 16 weeks. Pre- and post-dose 18F-Fluorodeoxyglucose positron emission tomography co-registered with computed tomography (FDG PET/CT) imaging of the aorta and carotid arteries was performed to quantify arterial inflammation, defined by the tissue-to-blood ratio (TBR) from scan images. Endothelial function was assessed by brachial artery flow-mediated dilatation (FMD). RESULTS We screened 160 patients, of whom, 36 and 37 were randomised to losmapimod or placebo. The treatment effect of losmapimod compared to placebo was not significant, at -0·05 for TBR (95% CI: -0·17, 0·07), p = 0·42, and +0·40% for FMD (95% CI: -1·66, 2·47), p = 0·70. The frequency of adverse events reported was similar in both treatment groups. CONCLUSIONS In this plasma fibrinogen-enriched study, losmapimod had no effect on arterial inflammation and endothelial function at 16 weeks of treatment, although it was well tolerated with no significant safety concerns. These findings do not support the concept that losmapimod is an effective treatment for the adverse cardiovascular manifestations of COPD.
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Affiliation(s)
- Marie Fisk
- Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Joseph Cheriyan
- Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Divya Mohan
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
- GSK R&D, King of Prussia, Pennsylvania, United States of America
| | - Julia Forman
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Kaisa M. Mäki-Petäjä
- Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Carmel M. McEniery
- Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan Fuld
- Department of Respiratory Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James H. F. Rudd
- Department of Cardiovascular Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Nicholas S. Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - David A. Lomas
- Department of UCL Respiratory, Division of Medicine, Rayne Building, University College London, London, United Kingdom
| | - John R. Cockcroft
- Department of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Ruth Tal-Singer
- GSK R&D, King of Prussia, Pennsylvania, United States of America
| | - Michael I. Polkey
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ian B. Wilkinson
- Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
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38
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Weir-McCall JR, Brown L, Summersgill J, Talarczyk P, Bonnici-Mallia M, Chin SC, Khan F, Struthers AD, Sullivan F, Colhoun HM, Shore AC, Aizawa K, Groop L, Nilsson J, Cockcroft JR, McEniery CM, Wilkinson IB, Ben-Shlomo Y, Houston JG. Development and Validation of a Path Length Calculation for Carotid-Femoral Pulse Wave Velocity Measurement: A TASCFORCE, SUMMIT, and Caerphilly Collaborative Venture. Hypertension 2018; 71:937-945. [PMID: 29555666 PMCID: PMC5902134 DOI: 10.1161/hypertensionaha.117.10620] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 11/19/2022]
Abstract
Supplemental Digital Content is available in the text. Current distance measurement techniques for pulse wave velocity (PWV) calculation are susceptible to intercenter variability. The aim of this study was to derive and validate a formula for this distance measurement. Based on carotid femoral distance in 1183 whole-body magnetic resonance angiograms, a formula was derived for calculating distance. This was compared with distance measurements in 128 whole-body magnetic resonance angiograms from a second study. The effects of recalculation of PWV using the new formula on association with risk factors, disease discrimination, and prediction of major adverse cardiovascular events were examined within 1242 participants from the multicenter SUMMIT study (Surrogate Markers of Micro- and Macrovascular Hard End-Points for Innovative Diabetes Tools) and 825 participants from the Caerphilly Prospective Study. The distance formula yielded a mean error of 7.8 mm (limits of agreement =−41.1 to 56.7 mm; P<0.001) compared with the second whole-body magnetic resonance angiogram group. Compared with an external distance measurement, the distance formula did not change associations between PWV and age, blood pressure, or creatinine (P<0.01) but did remove significant associations between PWV and body mass index (BMI). After accounting for differences in age, sex, and mean arterial pressure, intercenter differences in PWV persisted using the external distance measurement (F=4.6; P=0.004), whereas there was a loss of between center difference using the distance formula (F=1.4; P=0.24). PWV odds ratios for cardiovascular mortality remained the same using both the external distance measurement (1.14; 95% confidence interval, 1.06–1.24; P=0.001) and the distance formula (1.17; 95% confidence interval, 1.08–1.28; P<0.001). A population-derived automatic distance calculation for PWV obtained from routinely collected clinical information is accurate and removes intercenter measurement variability without impacting the diagnostic utility of carotid–femoral PWV.
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Affiliation(s)
- Jonathan R Weir-McCall
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Liam Brown
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Jennifer Summersgill
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Piotr Talarczyk
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Michael Bonnici-Mallia
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Sook C Chin
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Faisel Khan
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Allan D Struthers
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Frank Sullivan
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Helen M Colhoun
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Angela C Shore
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Kunihiko Aizawa
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Leif Groop
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Jan Nilsson
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - John R Cockcroft
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Carmel M McEniery
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Ian B Wilkinson
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Yoav Ben-Shlomo
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - J Graeme Houston
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.).
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Fisk M, McEniery CM, Gale N, Mäki-Petäjä K, Forman JR, Munnery M, Woodcock-Smith J, Cheriyan J, Mohan D, Fuld J, Tal-Singer R, Polkey MI, Cockcroft JR, Wilkinson IB. Surrogate Markers of Cardiovascular Risk and Chronic Obstructive Pulmonary Disease: A Large Case-Controlled Study. Hypertension 2018; 71:499-506. [PMID: 29358458 PMCID: PMC5805278 DOI: 10.1161/hypertensionaha.117.10151] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 08/31/2017] [Accepted: 12/13/2017] [Indexed: 01/13/2023]
Abstract
Cardiovascular disease is a common comorbidity and cause of mortality in chronic obstructive pulmonary disease. A better understanding of mechanisms of cardiovascular risk in chronic obstructive pulmonary disease patients is needed to improve clinical outcomes. We hypothesized that such patients have increased arterial stiffness, wave reflections, and subclinical atherosclerosis compared with controls and that these findings would be independent of smoking status and other confounding factors. A total of 458 patients with a diagnosis of chronic obstructive pulmonary disease and 1657 controls (43% were current or ex-smokers) with no airflow limitation were matched for age, sex, and body mass index. All individuals underwent assessments of carotid-femoral (aortic) pulse wave velocity, augmentation index, and carotid intima-media thickness. The mean age of the cohort was 67±8 years and 58% were men. Patients with chronic obstructive pulmonary disease had increased aortic pulse wave velocity (9.95±2.54 versus 9.27±2.41 m/s; P<0.001), augmentation index (28±10% versus 25±10%; P<0.001), and carotid intima-media thickness (0.83±0.19 versus 0.74±0.14 mm; P<0.001) compared with controls. Chronic obstructive pulmonary disease was associated with increased levels of each vascular biomarker independently of physiological confounders, smoking, and other cardiovascular risk factors. In this large case-controlled study, chronic obstructive pulmonary disease was associated with increased arterial stiffness, wave reflections, and subclinical atherosclerosis, independently of traditional cardiovascular risk factors. These findings suggest that the cardiovascular burden observed in this condition may be mediated through these mechanisms and supports the concept that chronic obstructive pulmonary disease is an independent risk factor for cardiovascular disease.
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Affiliation(s)
- Marie Fisk
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.).
| | - Carmel M McEniery
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Nichola Gale
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Kaisa Mäki-Petäjä
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Julia R Forman
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Margaret Munnery
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Jean Woodcock-Smith
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Joseph Cheriyan
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Divya Mohan
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Jonathan Fuld
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Ruth Tal-Singer
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Michael I Polkey
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - John R Cockcroft
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
| | - Ian B Wilkinson
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.)
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Nardin C, Maki-Petaja K, Yasmin Y, McDonnell B, Cockcroft JR, Wilkinson IB, McEniery CM. P116 CARDIAC OUTPUT IS INCREASED IN YOUNG PEOPLE WITH ELEVATED BP. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Selvarajah V, Mäki-Petäjä KM, Pedro L, Bruggraber SF, Burling K, Goodhart AK, Brown MJ, McEniery CM, Wilkinson IB. Novel Mechanism for Buffering Dietary Salt in Humans: Effects of Salt Loading on Skin Sodium, Vascular Endothelial Growth Factor C, and Blood Pressure. Hypertension 2017; 70:930-937. [PMID: 28974570 PMCID: PMC5640984 DOI: 10.1161/hypertensionaha.117.10003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/01/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
High dietary sodium intake triggers increased blood pressure (BP). Animal studies show that dietary salt loading results in dermal Na+ accumulation and lymphangiogenesis mediated by VEGF-C (vascular endothelial growth factor C), both attenuating the rise in BP. Our objective was to determine whether these mechanisms function in humans. We assessed skin electrolytes, BP, and plasma VEGF-C in 48 healthy participants randomized to placebo (70 mmol sodium/d) and slow sodium (200 mmol/d) for 7 days. Skin Na+ and K+ concentrations were measured in mg/g of wet tissue and expressed as the ratio Na+:K+ to correct for variability in sample hydration. Skin Na+:K+ increased between placebo and slow sodium phases (2.91±0.08 versus 3.12±0.09; P=0.01). In post hoc analysis, there was a suggestion of a sex-specific effect, with a significant increase in skin Na+:K+ in men (2.59±0.09 versus 2.88±0.12; P=0.008) but not women (3.23±0.10 versus 3.36±0.12; P=0.31). Women showed a significant increase in 24-hour mean BP with salt loading (93±1 versus 91±1 mm Hg; P<0.001) while men did not (96±2 versus 96±2 mm Hg; P=0.91). Skin Na+:K+ correlated with BP, stroke volume, and peripheral vascular resistance in men but not in women. No change was noted in plasma VEGF-C. These findings suggest that the skin may buffer dietary Na+, reducing the hemodynamic consequences of increased salt, and this may be influenced by sex.
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Affiliation(s)
- Viknesh Selvarajah
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (V.S., K.M.M-P., A.K.G., C.M.M., I.B.W.); MRC Human Nutrition Unit, Cambridge, United Kingdom (L.P., S.F.A.B.); NIHR Cambridge Biomedical Research Centre, Core Biochemical Assay Laboratory, United Kingdom (K.B.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.J.B.).
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42
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Foo FL, McEniery CM, Lees C, Khalil A. Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics. Ultrasound Obstet Gynecol 2017; 50:324-331. [PMID: 28667668 DOI: 10.1002/uog.17565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/29/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
There is strong evidence supporting the role of maternal arterial dysfunction in pregnancy-specific disorders such as pre-eclampsia and intrauterine growth restriction. As more work is focused towards this field, it is important that methods and interpretation of arterial function assessment are applied appropriately. Here, we summarize techniques and devices commonly used in maternal health studies, with consideration of their technical application in pregnant cohorts. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F L Foo
- Division of Cancer & Surgery, Imperial College London, Institute for Reproductive & Developmental Biology, London, UK
| | - C M McEniery
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, ACCI, Addenbrookes Hospital, Cambridge, UK
| | - C Lees
- Division of Cancer & Surgery, Imperial College London, Institute for Reproductive & Developmental Biology, London, UK
| | - A Khalil
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
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McEniery CM, Wilkinson IB, Johansen NB, Witte DR, Singh-Manoux A, Kivimaki M, Tabak AG, Brunner EJ, Shipley MJ. Nondiabetic Glucometabolic Status and Progression of Aortic Stiffness: The Whitehall II Study. Diabetes Care 2017; 40:599-606. [PMID: 28122839 PMCID: PMC5360278 DOI: 10.2337/dc16-1773] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/06/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Aortic stiffness is an important predictor of future morbidity and mortality. Diabetes is associated with increased aortic stiffness, but the importance of nondiabetic glucometabolic status for accelerated aortic stiffening is unclear. We tested the hypothesis that adverse glucometabolic status is associated with accelerated aortic stiffening in individuals without diabetes, independently of known risk factors for arterial stiffening. RESEARCH DESIGN AND METHODS Glucometabolic status and other cardiovascular risk factors were assessed at baseline in 2008-09, and carotid femoral pulse wave velocity (cfPWV) at baseline and follow-up in 2012-13, in 4,386 participants without diabetes of the Whitehall II Study. RESULTS The mean age of the cohort at cfPWV baseline was 60 years, and 74% were male. cfPWV increased from (mean ± SE) 8.30 ± 0.03 to 8.98 ± 0.04 m/s during 4 years of follow-up. At baseline, cfPWV was associated with fasting and 2-h postload glucose, HbA1c, and HOMA-insulin resistance (HOMA-IR). HbA1c and HOMA-IR were associated with progression of cfPWV after adjusting for physiological confounders and cardiovascular risk factors. A 1 SD higher HbA1c and HOMA-IR were associated with greater increases in cfPWV (0.11 m/s per 5 years [95% CI 0.04, 0.18], P = 0.003 and 0.09 m/s per 5 years [0.01, 0.17], P = 0.03, respectively). Additional adjustment for BMI weakened the association with HOMA-IR but not with HbA1c. CONCLUSIONS HbA1c is independently associated with accelerated progression of aortic stiffness in individuals without diabetes. These findings suggest that long-term glucometabolic status, even in individuals without diabetes, could be an important target for preventative strategies against vascular aging.
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Affiliation(s)
- Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, U.K.
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, U.K
| | - Nanna B Johansen
- Steno Diabetes Center A/S, Gentofte, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Daniel R Witte
- Danish Diabetes Academy, Odense, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Archana Singh-Manoux
- Research Department of Epidemiology and Public Health, University College London, London, U.K
| | - Mika Kivimaki
- Research Department of Epidemiology and Public Health, University College London, London, U.K
| | - Adam G Tabak
- Research Department of Epidemiology and Public Health, University College London, London, U.K.,1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Eric J Brunner
- Research Department of Epidemiology and Public Health, University College London, London, U.K
| | - Martin J Shipley
- Research Department of Epidemiology and Public Health, University College London, London, U.K
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McDonnell BJ, Yasmin, Butcher L, Cockcroft JR, Wilkinson IB, Erusalimsky JD, McEniery CM. The age-dependent association between aortic pulse wave velocity and telomere length. J Physiol 2017; 595:1627-1635. [PMID: 28247509 PMCID: PMC5330867 DOI: 10.1113/jp273689] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
Key points Age significantly modifies the relationship between aortic pulse wave velocity and telomere length. The differential relationships observed between aortic pulse wave velocity and telomere length in younger and older individuals suggest that the links between cellular and vascular ageing reflect a complex interaction between genetic and environmental factors acting over the life‐course.
Abstract Ageing is associated with marked large artery stiffening. Telomere shortening, a marker of cellular ageing, is linked with arterial stiffening. However, the results of existing studies are inconsistent, possibly because of the confounding influence of variable exposure to cardiovascular risk factors. Therefore, we investigated the relationship between telomere length (TL) and aortic stiffness in well‐characterized, younger and older healthy adults, who were pre‐selected on the basis of having either low or high aortic pulse wave velocity (aPWV), a robust measure of aortic stiffness. Demographic, haemodynamic and biochemical data were drawn from participants in the Anglo‐Cardiff Collaborative Trial. Two age groups with an equal sex ratio were examined: those aged <30 years (younger) or >50 years (older). Separately for each age group and sex, DNA samples representing the highest (n = 125) and lowest (n = 125) extremes of aPWV (adjusted for blood pressure) were selected for analysis of leukocyte TL. Ultimately, this yielded complete phenotypic data on 904 individuals. In younger subjects, TL was significantly shorter in those with high aPWV vs. those with low aPWV (P = 0.017). By contrast, in older subjects, TL was significantly longer in those with high aPWV (P = 0.001). Age significantly modified the relationship between aPWV and TL (P < 0.001). Differential relationships are observed between aPWV and TL, with an inverse association in younger individuals and a positive association in older individuals. The links between cellular and vascular ageing reflect a complex interaction between genetic and environmental factors acting over the life‐course. Age significantly modifies the relationship between aortic pulse wave velocity and telomere length. The differential relationships observed between aortic pulse wave velocity and telomere length in younger and older individuals suggest that the links between cellular and vascular ageing reflect a complex interaction between genetic and environmental factors acting over the life‐course.
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Affiliation(s)
- Barry J McDonnell
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Yasmin
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Lee Butcher
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - John R Cockcroft
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Ian B Wilkinson
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Jorge D Erusalimsky
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Carmel M McEniery
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, Cambridge, UK
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Mahendru AA, Foo FL, McEniery CM, Everett TR, Wilkinson IB, Lees CC. Change in maternal cardiac output from preconception to mid-pregnancy is associated with birth weight in healthy pregnancies. Ultrasound Obstet Gynecol 2017; 49:78-84. [PMID: 27859800 DOI: 10.1002/uog.17368] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/04/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Birth weight (BW) is thought to be determined by maternal health and genetic, nutritional and placental factors, the latter being influenced by anatomical development and perfusion. Maternal cardiovascular changes contribute to uteroplacental perfusion; however, they have not yet been investigated in relation to fetal growth or BW. Our aim was to explore the relationship between maternal cardiovascular adaptation, fetal growth and BW in healthy pregnancies. METHODS This was a longitudinal prospective study of women planning to conceive a pregnancy. Maternal cardiac output (CO), cardiac index (CI), pulse-wave velocity, aortic augmentation index, central blood pressure and peripheral vascular resistance were assessed prior to pregnancy and at 6, 23 and 33 weeks' gestation. Fetal growth was assessed using serial ultrasound measurements of biometry. RESULTS In total, 143 women volunteered to participate and were eligible for study inclusion. A total of 101 women conceived within 18 months and there were 64 live births with normal pregnancy outcome. There were positive correlations between BW and the pregnancy-induced changes in CO (ρ = 0.4, P = 0.004), CI (ρ = 0.3, P = 0.02) and peripheral vascular resistance (ρ = 0.3, P = 0.02). There were significant associations between second-to-third-trimester fetal weight gain and the prepregnancy-to-second-trimester increase in CO (Δ, 0.8 ± 1.2 L/min; ρ = 0.3, P = 0.02) and CI (Δ, 0.4 ± 0.6 L/min/m2 ; ρ = 0.3, P = 0.04) and reduction in aortic augmentation index (Δ, -10 ± 9%; ρ = -0.3, P = 0.04). CONCLUSIONS In healthy pregnancy, incremental changes in maternal CO in early pregnancy are associated with third-trimester fetal growth and BW. It is plausible that this association is causative as the changes predate third-trimester fetal growth and eventual BW. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Mahendru
- Fetal Medicine Department, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - F L Foo
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C M McEniery
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, Cambridge, UK
| | - T R Everett
- Fetal Medicine Department, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I B Wilkinson
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, Cambridge, UK
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Middlemiss JE, McEniery CM. Feeling the pressure: (patho) physiological mechanisms of weight gain and weight loss in humans. Hypertens Res 2016; 40:226-236. [PMID: 27760999 DOI: 10.1038/hr.2016.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
Obesity is an ongoing global epidemic and has adverse consequences for cardiovascular health. Obesity is often associated with hypertension, which is, itself, a common condition and an important cause of morbidity and mortality worldwide. Although animal models of obesity have provided extensive data on the links between obesity and hypertension, a greater understanding of the pathways linking obesity and hypertension in humans is likely to assist translation of animal data, and may, itself, identify important treatment strategies. Ultimately, this could have a substantial impact on human health, both at an individual and population level. The current review will focus specifically on studies of experimental weight gain and weight loss in humans and the following key areas, which are strongly related to blood pressure: cardiovascular function, autonomic nervous system function, metabolic function and the impact of cardiorespiratory fitness.
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Affiliation(s)
- Jessica E Middlemiss
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
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Hickson SS, Nichols WW, Yasmin, McDonnell BJ, Cockcroft JR, Wilkinson IB, McEniery CM. Influence of the central-to-peripheral arterial stiffness gradient on the timing and amplitude of wave reflections. Hypertens Res 2016; 39:723-729. [PMID: 27334244 PMCID: PMC5045714 DOI: 10.1038/hr.2016.64] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 12/22/2022]
Abstract
In individuals with compliant aortas, peripheral muscular artery stiffness exceeds central elastic artery stiffness. With aging, central stiffness increases with little change in peripheral stiffness, resulting in a reversal of the normal stiffness gradient. This reversal may reduce the wave reflection amplitude due to the movement of the major 'effective' reflection site further from the heart. To test this phenomenon, we investigated the relationship among arterial stiffness gradients (normal and reversed), wave reflection amplitude and reflection site distance. Subjects aged ⩾50 years were recruited from the Anglo-Cardiff Collaborative Trial. Central stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). In Study 1, peripheral PWV was also measured in the arm (carotid-radial pulse wave velocity) and, in Study 2, in the leg (femoral-dorsalis pedis). Reflection site distance was calculated from cfPWV and the reflected wave Tr. Subjects were dichotomized into those with a normal stiffness gradient (peripheral >central PWV) or a reversed gradient (peripheral
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Affiliation(s)
- Stacey S Hickson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Wilmer W Nichols
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Yasmin
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Barry J McDonnell
- Department of Biomedical Sciences, School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - John R Cockcroft
- Department of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
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48
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Mahendru AA, Wilhelm-Benartzi CS, Wilkinson IB, McEniery CM, Johnson S, Lees C. Gestational length assignment based on last menstrual period, first trimester crown-rump length, ovulation, and implantation timing. Arch Gynecol Obstet 2016; 294:867-76. [PMID: 27469987 PMCID: PMC5018029 DOI: 10.1007/s00404-016-4153-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/13/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Understanding the natural length of human pregnancy is central to clinical care. However, variability in the reference methods to assign gestational age (GA) confound our understanding of pregnancy length. Assignation from ultrasound measurement of fetal crown-rump length (CRL) has superseded that based on last menstrual period (LMP). Our aim was to estimate gestational length based on LMP, ultrasound CRL, and implantation that were known, compared to pregnancy duration assigned by day of ovulation. METHODS Prospective study in 143 women trying to conceive. In 71 ongoing pregnancies, gestational length was estimated from LMP, CRL at 10-14 weeks, ovulation, and implantation day. For each method of GA assignment, the distribution in observed gestational length was derived and both agreement and correlation between the methods determined. RESULTS Median ovulation and implantation days were 16 and 27, respectively. The gestational length based on LMP, CRL, implantation, and ovulation was similar: 279, 278, 276.5 and 276.5 days, respectively. The distributions for observed gestational length were widest where GA was assigned from CRL and LMP and narrowest when assigned from implantation and ovulation day. The strongest correlation for gestational length assessment was between ovulation and implantation (r = 0.98) and weakest between CRL and LMP (r = 0.88). CONCLUSIONS The most accurate method of predicting gestational length is ovulation day, and this agrees closely with implantation day. Prediction of gestational length from CRL and known LMP are both inferior to ovulation and implantation day. This information could have important implications on the routine assignment of gestational age.
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Affiliation(s)
- Amita A Mahendru
- Fetal Medicine Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Fetal Medicine, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
| | | | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Box 98, Cambridge, CB20QQ, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Box 98, Cambridge, CB20QQ, UK
| | | | - Christoph Lees
- Department of Fetal Medicine, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
- Department of Surgery and Cancer, Institute of Developmental and Reproductive Biology, Imperial College London, London, W12 0HS, UK.
- Department of Development and Regeneration, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000, Leuven, Belgium.
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49
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Mäki-Petäjä KM, Barrett SML, Evans SV, Cheriyan J, McEniery CM, Wilkinson IB. The Role of the Autonomic Nervous System in the Regulation of Aortic Stiffness. Hypertension 2016; 68:1290-1297. [PMID: 27672029 PMCID: PMC5058641 DOI: 10.1161/hypertensionaha.116.08035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Abstract
The autonomic nervous system is important in regulating blood pressure, but whether it regulates aortic stiffness is more contentious. We conducted 3 studies in young, healthy individuals to address this important question. Study 1 was a cross-sectional study of 347 subjects with detailed measurements of hemodynamics and heart rate variability. In study 2, 9 subjects were given a bolus of intravenous nicotinic ganglion blocker, pentolinium, or saline in a random order and hemodynamics and heart rate variability were assessed before and after. In study 3, changes in hemodynamics and heart rate variability were assessed during stimulation of the sympathetic nervous system with the use of isometric handgrip exercise in 12 subjects. Study 1: aortic pulse wave velocity (P=0.003) was lowest in the subjects with the highest parasympathetic activity, but after adjusting for mean arterial pressure, the effect was abolished (P=0.3). Study 2: after pentolinium, sympathetic and parasympathetic activity fell (P=0.001 for both), mean arterial pressure, and heart rate increased (P=0.004 and P=0.04, respectively), but there was no change in pulse wave velocity in comparison to placebo (P=0.1). Study 3: during handgrip exercise, sympathetic activity (P=0.003), mean arterial pressure (P<0.0001), and aortic pulse wave velocity increased (P=0.013). However, pulse wave velocity adjusted for mean arterial pressure did not change (P=0.1). The main finding of these studies is that in young healthy subjects, the autonomic nervous system does not have a pressure-independent role in the regulation of aortic stiffness. However, these findings may not apply to patients with increased sympathetic tone or hypertension.
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Affiliation(s)
- Kaisa M Mäki-Petäjä
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom.
| | - Sharon M L Barrett
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom
| | - Sarah V Evans
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom
| | - Joseph Cheriyan
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom
| | - Carmel M McEniery
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom
| | - Ian B Wilkinson
- From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom
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50
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Abstract
Vital organs are exposed to the central rather than the brachial blood pressure. To date, central blood pressure can be assessed noninvasively through the use of several devices. In this review, we critically discuss the clinical relevance of central blood pressure assessment. Considerable evidence suggests that central blood pressure is a better predictor of end-organ damage than brachial blood pressure. However, there is still uncertainty concerning the value of central pressure for predicting cardiovascular outcomes, as the existing studies are underpowered to address this issue. A full synthesis of the available data is needed in this regard. Among the different antihypertensive drug classes, beta-blockers appear to lower central blood pressure less than brachial blood pressure. This difference may, at least in part, explain the reduced efficacy of beta-blockers in the prevention of cardiovascular outcomes compared with the other antihypertensive drug classes, which may lower central and brachial blood pressure to a similar extent. Nevertheless, this differential effect might not be relevant to the newer beta-blockers with vasodilating properties, including nebivolol, celliprolol and carvedilol. However, whether a preferential reduction of central blood pressure results in better outcomes should be further assessed by appropriately powered clinical trials. Other emerging challenges include the assessment of the potential predictive value of central blood pressure variability and the development of new antihypertensive medications based on central blood pressure rather than brachial blood pressure.
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Affiliation(s)
- Michael Kostapanos
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Carmel M McEniery
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Ian B Wilkinson
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
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