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Grogan T, Sanchez-Gonzalez MA, Illyés M, Rizvi SAA. Noninvasive central hemodynamic monitoring in the primary care setting: improving prevention and management of cardiovascular diseases. J Clin Transl Res 2023; 9:175-181. [PMID: 37275580 PMCID: PMC10238103] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 06/07/2023] Open
Abstract
Background Although cardiovascular disease (CVD) has markedly declined since the early 1960s due to medical advances and better management, this condition persists as the most critical and preventable cause of death in the US. For that reason, the identification and application of more sensitive, specific, validated, and noninvasive biomarkers of cardiovascular functioning in the primary care setting for the early identification of CVD risk at the subclinical level are warranted. Aim The goal of the present review is twofold: first, to familiarize the primary care practitioner with noninvasive aortic hemodynamic parameters, including how these could be integrated into primary care services and patient management, and second, to propose a model for earlier detection of CVD based on the noninvasive hemodynamic parameters in the primary care setting. Relevance for Patients Implementation of noninvasive hemodynamic monitoring in a primary care setting could help in the identification of heart disease risk at the early onset thus preventing the need for expensive treatment or death at later stages.
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Affiliation(s)
- Troy Grogan
- MedScience Research Group, Inc., West Palm Beach, Florida, United States of America
| | - Marcos A. Sanchez-Gonzalez
- School of Health Services Administration, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, United States of America
| | - Miklós Illyés
- Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Syed A. A. Rizvi
- College of Biomedical Sciences, Larkin University, Miami, Florida, United States of America
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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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Pahlevan NM, Yao T, Chu K, Cole S, Tran T, Wood JC, King KS. Group delay method for MRI aortic pulse wave velocity measurements in clinical protocols with low temporal resolution: Validation in a heterogeneous cohort. Magn Reson Imaging 2020; 69:8-15. [PMID: 32105671 DOI: 10.1016/j.mri.2020.02.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND MRI assessment of aortic pulse wave velocity (PWV) helps predict the risk of vascular events, but the recommended phase contrast sampling rate is faster than what is utilized in most clinical sequences. There are many existing MRI databases obtained for assessment of cardiac output using lower temporal frequency sampling where information might be obtained about aortic stiffness (PWV). In this work, we sought to evaluate whether the Group Delay (GD) method can generate a reproducible measure of stiffness and describe expected age-related stiffening of the aortic arch using lower sampling rates in standard clinical sequences. METHODS Phase contrast (PC) MRI was obtained on the ascending and descending aortic arch in a heterogeneous adult cohort (n = 23; 9 women) spanning over a wide range of ages (ages 24-89, mean 49.4 ± 18.4). Data was collected with standard cardiac MRI protocols for cardiac output evaluation (repetition time = 7.8 ms, views-per-segment = 4, encoding velocity = 200 cm/s). Pulse wave transit times (TT) were computed using the GD method, two other validated automated approaches (cross correlation TT Algorithm by Gaddum and Segment by Medviso), and the manual tangent method. Pressure waveforms from tonometry and flow waveforms from PC MRI were used to assess wave reflections. RESULTS Group Delay and TT-Algorithm showed significant and high retest reproducibility (r = 0.86 for both) as well as high PWV correlation with age (r = 0.93, P-value < 0.00005 and r = 0.96, P-value < 0.00005 respectively) and with each other (r = 0.94, P-value < 0.00001, RMSE = 0.94 m/s). Arbitrary altering of the image acquisition trigger in the GD method introduced error of 10%-13%, but the TT-algorithm error range was 11%-25%. CONCLUSION Group Delay enables reproducible assessment of transit time to derive PWV from low temporal resolution clinical cardiac MRI sequences that can also identify age-related stiffening.
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Affiliation(s)
- Niema M Pahlevan
- Department of Aerospace & Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - Timothy Yao
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Karen Chu
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - Soren Cole
- Department of Aerospace & Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA; Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - Thao Tran
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - John C Wood
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; Division of Pediatric Cardiology, Children's Hospital Los Angeles, CA 90027, USA.
| | - Kevin S King
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
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Cossío-Aranda JE, Berríos-Bárcenas EA, Rodríguez-Rosales F, Ávila-Vanzinni N, Araiza-Garaygordobil D, Flores-Morales A, Espinola-Zavaleta N, Rodríguez-Chávez L, Fajardo É, Domínguez I, La Reguera GFD, Verdejo-Paris J. Central blood pressure and vascular stiffness in Mexican population. Arch Cardiol Mex 2020; 90:21-27. [PMID: 31996862 DOI: 10.24875/acm.19000183] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry. Methods Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4. Results Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified. Conclusion CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.
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Affiliation(s)
- Jorge E Cossío-Aranda
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Enrique A Berríos-Bárcenas
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Fernando Rodríguez-Rosales
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Nydia Ávila-Vanzinni
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Diego Araiza-Garaygordobil
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Abelardo Flores-Morales
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Nilda Espinola-Zavaleta
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Laura Rodríguez-Chávez
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Érika Fajardo
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Israel Domínguez
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Juan Verdejo-Paris
- Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Abstract
Artificial Intelligence (AI), although well established in many areas of everyday life, has only recently been trialed in the diagnosis and management of common clinical conditions. This editorial review highlights progress to date and suggests further improvements in and trials of AI in the management of conditions such as hypertension.
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Styczyński G, Kalinowski P, Michałowski Ł, Paluszkiewicz R, Ziarkiewicz-Wróblewska B, Zieniewicz K, Tataj E, Szmigielski C, Jędrusik P. Reply to: "Hepatic fibrosis - and not steatosis - is the main determinant of arterial stiffness in non-alcoholic fatty liver disease". Atherosclerosis 2019; 290:224-225. [PMID: 31519330 DOI: 10.1016/j.atherosclerosis.2019.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Grzegorz Styczyński
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Łukasz Michałowski
- Department of Pathology, Center for Biostructure Research, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Rafał Paluszkiewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Bogna Ziarkiewicz-Wróblewska
- Department of Pathology, Center for Biostructure Research, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Emanuel Tataj
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Cezary Szmigielski
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Jędrusik
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
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Vallée A, Zhang Y, Protogerou A, Safar ME, Blacher J. Added value of aortic pulse wave velocity index for the detection of coronary heart disease by elective coronary angiography. Blood Press 2019; 28:375-384. [PMID: 31293183 DOI: 10.1080/08037051.2019.1641400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Non-invasive tests leading to elective coronary angiography (CAG) have low diagnostic yield for obstructive coronary heart disease (CHD). Aortic stiffness, an independent predictor of CHD events can be easily measured by pulse wave velocity (PWV). We aimed at retrospectively evaluating the diagnostic accuracy PWV index to detect CHD in consecutive patients with suspected CHD that underwent CAG.Method: In population of 86 healthy patients with available PWV data, a theoretical PWV was derived. In different population of 62 individuals who underwent CAG for suspected CHD, PWV index was calculated as index [(measured PWV - theoretical PWV)/theoretical PWV]. Logistic regression and comparisons between ROC curves were used to add value of CAG indication performance of PWV index.Results: Out of 62, seventeen patients presented obstructive CHD and 22 patients had non-obstructive CHD. PWV index and severity of CHD were positively correlated (p < 0.0001). After applying several models that included classical CHD predictor, the higher performance to detect abnormal CAG was obtained with the combined classifier PWV index/carotid plaque with 87% sensitivity, 93% specificity, 0.92 accuracy and 0.31 threshold. To detect obstructive CAG, individual classifier PWV index presents 94% sensitivity, 91% specificity, 0.95 accuracy and 0.46 threshold.Conclusion: PWV index is individualized approach that optimizes CHD diagnostic strategies and thus might be clinically useful for reducing the rate of unnecessary invasive CAG.
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Affiliation(s)
- Alexandre Vallée
- Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Diagnosis and Therapeutic Center, AP-HP, Paris-Descartes University, Paris, France
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Athanase Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Greece
| | - Michel E Safar
- Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Diagnosis and Therapeutic Center, AP-HP, Paris-Descartes University, Paris, France
| | - Jacques Blacher
- Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Diagnosis and Therapeutic Center, AP-HP, Paris-Descartes University, Paris, France
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Styczyński G, Kalinowski P, Michałowski Ł, Paluszkiewicz R, Ziarkiewicz-Wróblewska B, Zieniewicz K, Tataj E, Szmigielski C, Jędrusik P. No association between aortic stiffness and liver steatosis in morbidly obese patients. Atherosclerosis 2019; 287:165-170. [PMID: 31040024 DOI: 10.1016/j.atherosclerosis.2019.04.206] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Patients with non-alcoholic fatty liver disease are characterized by increased aortic stiffness, but it is unclear whether this is related to non-alcoholic fatty liver disease itself or concomitant metabolic syndrome components, including hypertension and diabetes. Previous studies were methodologically limited by ultrasound-based assessment of liver steatosis or performing liver biopsy in patients with more severe disease. Therefore, we prospectively measured aortic pulse wave velocity (aPWV) in non-selected obese subjects admitted for bariatric surgery with liver biopsy, allowing assessment of the association between aortic stiffness and biopsy-confirmed liver steatosis. METHODS We evaluated 120 consecutive severely obese patients (79 females; mean age 42 ± 10 years, mean body mass index 45.0 ± 5.3 kg/m2) without cardiac disease or alcohol-induced liver disease, who were admitted for bariatric surgery. The presence or absence of liver steatosis was defined by wedge liver biopsy. aPWV was measured with the Doppler method at the time of preoperative transthoracic echocardiography. RESULTS Based on liver biopsy results, 82 patients (68%) had liver steatosis and 38 (32%) had no steatosis. Univariate linear regression analysis showed that age, mean arterial pressure, liver steatosis, heart rate, female gender, and diabetes were significantly associated with aPWV. However, only age, mean arterial pressure, heart rate, and diabetes remained significant in the multivariate model (p ≤ 0.001). CONCLUSIONS We found no independent association between biopsy-confirmed liver steatosis and aortic stiffness measured by Doppler aPWV in morbidly obese individuals. Aortic stiffness in these subjects is related to comorbidities and not to non-alcoholic fatty liver disease itself.
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Affiliation(s)
- Grzegorz Styczyński
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Łukasz Michałowski
- Department of Pathology, Center for Biostructure Research, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Rafał Paluszkiewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Bogna Ziarkiewicz-Wróblewska
- Department of Pathology, Center for Biostructure Research, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Emanuel Tataj
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Cezary Szmigielski
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Jędrusik
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
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Lee DM, Battson ML, Jarrell DK, Hou S, Ecton KE, Weir TL, Gentile CL. SGLT2 inhibition via dapagliflozin improves generalized vascular dysfunction and alters the gut microbiota in type 2 diabetic mice. Cardiovasc Diabetol 2018; 17:62. [PMID: 29703207 PMCID: PMC5921754 DOI: 10.1186/s12933-018-0708-x] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/23/2018] [Indexed: 02/08/2023] Open
Abstract
Background Type 2 diabetes (T2D) is associated with generalized vascular dysfunction characterized by increases in large artery stiffness, endothelial dysfunction, and vascular smooth muscle dysfunction. Sodium glucose cotransporter 2 inhibitors (SGLT2i) represent the most recently approved class of oral medications for the treatment of T2D, and have been shown to reduce cardiovascular and overall mortality. Although it is currently unclear how SGLT2i decrease cardiovascular risk, an improvement in vascular function is one potential mechanism. The aim of the current study was to examine if dapagliflozin, a widely prescribed STLT2i, improves generalized vascular dysfunction in type 2 diabetic mice. In light of several studies demonstrating a bi-directional relation between orally ingested medications and the gut microbiota, a secondary aim was to determine the effects of dapagliflozin on the gut microbiota. Methods Male diabetic mice (Db, n = 24) and control littermates (Con; n = 23) were randomized to receive either a standard diet or a standard diet containing dapagliflozin (60 mg dapagliflozin/kg diet; 0.006%) for 8 weeks. Arterial stiffness was assessed by aortic pulse wave velocity; endothelial function and vascular smooth muscle dysfunction were assessed by dilatory responses to acetylcholine and sodium nitroprusside, respectively. Results Compared to untreated diabetic mice, diabetic mice treated with dapagliflozin displayed significantly lower arterial stiffness (Db = 469 cm/s vs. Db + dapa = 435 cm/s, p < 0.05), and improvements in endothelial dysfunction (area under the curve [AUC] Db = 57.2 vs. Db + dapa = 117.0, p < 0.05) and vascular smooth muscle dysfunction (AUC, Db = 201.7 vs. Db + dapa = 285.5, p < 0.05). These vascular improvements were accompanied by reductions in hyperglycemia and circulating markers of inflammation. The microbiota of Db and Con mice were distinctly different, and dapagliflozin treatment was associated with minor alterations in gut microbiota composition, particularly in Db mice, although these effects did not conclusively mediate the improvements in vascular function. Conclusions Dapagliflozin treatment improves arterial stiffness, endothelial dysfunction and vascular smooth muscle dysfunction, and subtly alters microbiota composition in type 2 diabetic mice. Collectively, the improvements in generalized vascular function may represent an important mechanism underlying the cardiovascular benefits of SGLT2i treatment.
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Affiliation(s)
- Dustin M Lee
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - Micah L Battson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - Dillon K Jarrell
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - Shuofei Hou
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - Kayl E Ecton
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - Tiffany L Weir
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA
| | - Christopher L Gentile
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, 80523, USA.
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10
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Mertens E, Markey O, Geleijnse JM, Lovegrove JA, Givens DI. Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study. Eur J Nutr 2018; 57:1245-1258. [PMID: 28293738 PMCID: PMC5861161 DOI: 10.1007/s00394-017-1408-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 02/19/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Epidemiological findings indicate that higher adherence to a healthy diet may lower cardiovascular disease (CVD) risk. The present study aimed to investigate whether adherence to a healthy diet, assessed by the Healthy Diet Indicator (HDI), Dietary Approaches to Stop Hypertension (DASH) score, and Alternative Healthy Eating Index 2010 (AHEI-2010), was associated with CVD incidence and risk markers. METHODS Included in the present analyses were data from 1867 middle-aged men, aged 56.7 ± 4.5 years at baseline, recruited into the Caerphilly Prospective Study. Adherence to a healthy diet was examined in relation to CVD, coronary heart disease (CHD), and stroke incidence (Cox regression), and risk markers (linear regression) with adjustment for relevant confounders. RESULTS The DASH score was inversely associated with CVD [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.66, 0.99], and stroke (HR 0.61; 95% CI 0.42, 0.88) incidence, but not with CHD after an average of 16.6 year follow-up, and with diastolic blood pressure, after 12 year follow-up. The AHEI-2010 was inversely associated with stroke (HR 0.66; 95% CI 0.42, 0.88) incidence, aortic pulse wave velocity, and C-reactive protein. The HDI was not associated with any single outcome. CONCLUSIONS Higher DASH and AHEI-2010 scores were associated with lower CVD and stroke risk, and favourable cardiovascular health outcomes, suggesting that encouraging middle-aged men to comply with the dietary recommendations for a healthy diet may have important implications for future vascular disease and population health.
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Affiliation(s)
- Elly Mertens
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands.
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Reading, RG6 6AP, UK.
| | - Oonagh Markey
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Reading, RG6 6AP, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Johanna M Geleijnse
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Reading, RG6 6AP, UK
| | - D Ian Givens
- Food Production and Quality Division, School of Agriculture, Policy and Development, Faculty of Life Sciences, University of Reading, Reading, RG6 6AP, UK
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11
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Mayer O, Seidlerová J, Wohlfahrt P, Filipovský J, Cífková R, Černá V, Kučerová A, Pešta M, Fuchsová R, Topolčan O, Jardon KMC, Drummen NEA, Vermeer C. Synergistic effect of low K and D vitamin status on arterial stiffness in a general population. J Nutr Biochem 2017; 46:83-89. [PMID: 28486172 DOI: 10.1016/j.jnutbio.2017.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 01/07/2023]
Abstract
Both vitamins K and D are nutrients with pleiotropic functions in human tissues. The metabolic role of these vitamins overlaps considerably in calcium homeostasis. We analyzed their potential synergetic effect on arterial stiffness. In a cross-sectional study, we analyzed aortic pulse wave velocity (aPWV) in 1023 subjects from the Czech post-MONICA study. Desphospho-uncarboxylated matrix γ-carboxyglutamate protein (dp-ucMGP), a biomarker of vitamin K status, was measured by sandwich ELISA and 25-hydroxyvitamin D3 (25-OH-D3) by a commercial immunochemical assay. In a subsample of 431 subjects without chronic disease or pharmacotherapy, we detected rs2228570 polymorphism for the vitamin D receptor. After adjustment for confounders, aPWV was independently associated with both factors: dp-ucMGP [β-coefficient(S.E.M.)=13.91(4.87); P=.004] and 25-OH-D3 [0.624(0.28); P=.027]. In a further analysis, we divided subjects according to dp-ucMGP and 25-OH-D3 quartiles, resulting in 16 subgroups. The highest aPWV had subjects in the top quartile of dp-ucMGP plus bottom quartile of 25-OH-D3 (i.e., in those with insufficient status of both vitamin K and vitamin D), while the lowest aPVW had subjects in the bottom quartile of dp-ucMGP plus top quartile of 25-OH-D3 [9.8 (SD2.6) versus 6.6 (SD1.6) m/s; P<.0001]. When we compared these extreme groups of vitamin K and D status, the adjusted odds ratio for aPWV≥9.3 m/s was 6.83 (95% CI:1.95-20.9). The aPWV was also significantly higher among subjects bearing the GG genotype of rs2228570, but only in those with a concomitantly poor vitamin K status. In conclusion, we confirmed substantial interaction of insufficient K and D vitamin status in terms of increased aortic stiffness.
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Affiliation(s)
- Otto Mayer
- 2(nd) Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
| | - Jitka Seidlerová
- 2(nd) Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Jan Filipovský
- 2(nd) Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Václava Černá
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic; Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Alena Kučerová
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic; Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Martin Pešta
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic; Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Radka Fuchsová
- Department of Immunodiagnostics, University Hospital, Pilsen; Czech Republic
| | - Ondřej Topolčan
- Department of Immunodiagnostics, University Hospital, Pilsen; Czech Republic
| | | | | | - Cees Vermeer
- R&D Group VitaK, Maastricht University, The Netherlands
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12
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Borner A, Murray K, Trotter C, Pearson J. Baseline aortic pulse wave velocity is associated with central and peripheral pressor responses during the cold pressor test in healthy subjects. Physiol Rep 2017; 5:5/14/e13357. [PMID: 28733312 PMCID: PMC5532490 DOI: 10.14814/phy2.13357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 11/24/2022] Open
Abstract
Cold environmental temperatures increase sympathetic nerve activity and blood pressure, and increase the risk of acute cardiovascular events in aged individuals. The acute risk of cardiovascular events increases with aortic pulse wave velocity as well as elevated central and peripheral pulse pressures. The aim of this study was to examine the independent influence of aortic pulse wave velocity upon central and peripheral pressor responses to sympathetic activation via the cold pressor test (CPT). Twenty‐two healthy subjects (age: 18–73 years) completed a CPT with the left hand immersed in 2–4°C water for 3 min. During the CPT, central (from: 36 ± 7 to: 51 ± 12 mmHg) and peripheral pulse pressure increased (from: 54 ± 7 to: 66 ± 11; both P < 0.05). In all subjects the increase in central pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r2 = 0.221, P = 0.027) but not age (P > 0.05). In a subset of subjects with higher arterial stiffness, the increase in peripheral pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r2 = 0.415, P = 0.032) but not age (P > 0.05). These data indicate that central and peripheral pulse pressure responses during sympathetic activation are positively and independently associated with aortic pulse wave velocity through a wide age range. Decreasing aortic pulse wave velocity in aged individuals with elevated arterial stiffness may help reduce the incidence of acute cardiovascular events upon exposure to cold environmental temperatures.
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Affiliation(s)
- Anastasiya Borner
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - Kyle Murray
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - Claire Trotter
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - James Pearson
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
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13
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Sulemane S, Panoulas VF, Bratsas A, Grapsa J, Brown EA, Nihoyannopoulos P. Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction. Int J Cardiovasc Imaging 2017; 33:687-698. [PMID: 28120157 PMCID: PMC5383685 DOI: 10.1007/s10554-016-1059-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/30/2016] [Indexed: 01/20/2023]
Abstract
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.
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Affiliation(s)
- Samir Sulemane
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK.
| | - Vasileios F Panoulas
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
- Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Athanasios Bratsas
- Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Julia Grapsa
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Petros Nihoyannopoulos
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
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14
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Yeboah K, Antwi DA, Gyan B, Govoni V, Mills CE, Cruickshank JK, Amoah AGB. Arterial stiffness in hypertensive and type 2 diabetes patients in Ghana: comparison of the cardio-ankle vascular index and central aortic techniques. BMC Endocr Disord 2016; 16:53. [PMID: 27680212 PMCID: PMC5041289 DOI: 10.1186/s12902-016-0135-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/22/2016] [Accepted: 09/21/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Diabetes and hypertension increase arterial stiffness and cardiovascular events in all societies studied so far; sub-Saharan African studies are sparse. We investigated factors affecting arterial function in Ghanaians with diabetes, hypertension, both or neither. METHOD Testing the hypothesis that arterial stiffness would progressively increase from controls to multiply affected patients, 270 participants were stratified into those with diabetes or hypertension only, with both, or without either. Cardio-ankle vascular index (CAVI), heart-ankle pulse wave velocity (haPWV), aortic PWV (PWVao) by Arteriograph, aortic and brachial blood pressures (BP), were measured. RESULTS In patients with both diabetes and hypertension compared with either alone, values were higher of CAVI (mean ± SD, 8.3 ± 1.2 vs 7.5 ± 1.1 and 7.4 ± 1.1 units; p < 0.05), PWVao (9.1 ± 1.4 vs 8.7 ± 1.9 and 8.1 ± 0.9 m/s; p < 0.05) and haPWV (8.5 ± 1 vs 7.9 ± 1 and 7.2 ± 0.7 m/s; p < 0.05) respectively. In multivariate analysis, age, having diabetes or hypertension and BMI were independently associated with CAVI in all participants (β = 0.49, 0.2, 0.17 and -0.2 units; p < 0.01, respectively). Independent determinants of PWVao were heart rate, systolic BP and age (β = 0.42, 0.27 and 0.22; p < 0.01), and for haPWV were systolic BP, age, BMI, diabetes and hypertension status (β = 0.46, 0.32, -0.2, 0.2 and 0.11; p < 0.01). CONCLUSION In this sub-Saharan setting with lesser atherosclerosis than the western world, arterial stiffness is significantly greater in patients with coexistent diabetes and hypertension but did not differ between those with either diabetes or hypertension only. Simple, reproducibly measured PWV/CAVI may offer effective and efficient targets for intervention.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana.
| | - Daniel A Antwi
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana
| | - Ben Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Virginia Govoni
- Cardiovascular Medicine Group, Division of Diabetes and Nutrition, King's College and King's Health Partners, London, UK
| | - Charlotte E Mills
- Cardiovascular Medicine Group, Division of Diabetes and Nutrition, King's College and King's Health Partners, London, UK
| | - J Kennedy Cruickshank
- Cardiovascular Medicine Group, Division of Diabetes and Nutrition, King's College and King's Health Partners, London, UK
| | - Albert G B Amoah
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
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15
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El-Chilali K, Farouk H, Abdelhafez M, Neumann T, Alotaibi S, Wendt D, Thielmann M, Jakob HG, Ashour Z, Sorour K, Kahlert P, Erbel R. Predictors of aortic pulse wave velocity in the elderly with severe aortic stenosis. Aging Clin Exp Res 2016; 28:519-25. [PMID: 26349567 DOI: 10.1007/s40520-015-0443-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 08/17/2015] [Indexed: 01/20/2023]
Abstract
UNLABELLED Predictors of aortic pulse wave velocity (AoPWV) were not previously studied in the elderly with severe aortic stenosis (AS). We aimed to compare the AoPWV in these patients with matched controls and to study the predictors of AoPWV in this population. We measured the AoPWV during cardiac catheterisation in 40 patients with severe AS and 20 matched controls. AoPWV in both groups was similar (p = 0.198) and lied within normal reference value for age in 68 % of elderly with severe AS. Central systolic blood pressure (SBP) (adjusted β = 0.45, p = 0.001) and glomerular filtration rate (GFR) (adjusted β = -0.29, p = 0.023) were the only independent predictors of AoPWV in AS group. Central SBP >140 mmHg was the best predictor of abnormal AoPWV (≥14.6 m/s) with 100 % sensitivity and 70 % specificity, p < 0.001. CONCLUSION AoPWV is not increased in the elderly with severe AS compared to controls, and lies within the reference value for age in the majority of these patients. Central SBP >140 mmHg best predicts abnormal AoPWV in the elderly with severe AS.
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16
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Llauradó G, Ceperuelo-Mallafré V, Vilardell C, Simó R, Albert L, Berlanga E, Vendrell J, González-Clemente JM. Impaired endothelial function is not associated with arterial stiffness in adults with type 1 diabetes. Diabetes Metab 2013; 39:355-62. [PMID: 23643350 DOI: 10.1016/j.diabet.2013.03.006] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 01/12/2023]
Abstract
AIM This study investigated the relationship between endothelial dysfunction (ED) and arterial stiffness (AS) in adults with type 1 diabetes and no clinical cardiovascular (CV) disease. METHODS A total of 68 patients with type 1 diabetes and 68 age- and gender-matched healthy (non-diabetic) subjects were evaluated. ED was assessed by reactive hyperaemia peripheral arterial tonometry (RH-PAT) and by serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and E-selectin. AS was assessed by aortic pulse wave velocity (aPWV). All statistical analyses were stratified by gender. RESULTS Adults with type 1 diabetes had RH-PAT index scores similar to those of their matching controls [men: 1.55 (1.38-1.98)% versus 1.61 (1.40-2.17)%, P=0.556; women: 2.07 (1.55-2.31)% versus 2.08 (1.79-2.49)%; P=0.215]. However, after adjusting for potential confounders, type 1 diabetes emerged as the main determinant of the RH-PAT index in women. Also, differences between genders in both the controls and type 1 diabetes patients disappeared. Men with diabetes had higher serum concentrations of E-selectin, and women had higher serum concentrations of sICAM-1, sVCAM-1 and E-selectin than their respective controls. However, after adjusting for potential confounders, only the differences in sICAM-1 (women) and E-selectin (both genders) remained significant. No association was found between aPWV and the RH-PAT index and ED markers after adjusting for CV risk factors. CONCLUSION ED was increased in adults with type 1 diabetes compared with age-matched non-diabetic subjects. Also, gender differences in ED were lost in type 1 diabetes. However, ED was not associated with AS after adjusting for potential confounders. These findings suggest that ED occurs earlier than AS in type 1 diabetes.
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Affiliation(s)
- G Llauradó
- Department of Diabetes, Endocrinology and Nutrition, Hospital of Sabadell, Corporació Sanitària i Universitària Parc Taulí (Universitat Autònoma de Barcelona), 08208 Sabadell, Spain
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