Adjustment For Systolic Blood Pressure Research Articles

The association between circulating fatty acids and stroke in hypertensive patients

BackgroundStroke is prevalent in hypertensive population. It has been suggested that unsaturated fatty acids (USFA) have protective effect on stroke. The effect of saturated fatty acids (SFAs) on stroke is still unclear. Therefore, we studied the relationship between circulating fatty acids and acute ischemic stroke (AIS) in hypertensive patients. MethodsEighty-nine pairs including 100 men and 78 women matched by sex and age were recruited. Each pair included a hypertensive patient within 48h of AIS onset and a hypertensive patient without stroke. Six circulating fatty acids were methylated before concentration determination which was repeated twice with percent recovery estimated. ResultsThere were differences in educational level (P = 0.002) and occupation (P < 0.001) between stroke and non-stroke participants. All the 6 fatty acid levels were higher in non-stroke participants (P = 0.017 for palmitoleic acid, 0.001 for palmitic acid, <0.001 for linoleic acid, <0.001 for behenic acid, <0.001 for nervonic acid and 0.002 for lignoceric acid). In logistic regression analysis, AIS was inversely associated with fatty acid levels except for lignoceric acid. After adjustment for education and occupation, the palmitoleic acid and palmitic acid levels were no longer inversely associated with AIS. After further adjustment for systolic blood pressure, smoking, drinking, total cholesterol and triglyceride, the inverse associations of linoleic acid (OR = 0.965, 95%CI = 0.942-0.990, P = 0.005), behenic acid (OR = 0.778, 95%CI = 0.664-0.939, P = 0.009), nervonic acid (OR = 0.323, 95%CI = 0.121-0.860, P = 0.024) with AIS remained significant. ConclusionsCirculating fatty acids except lignoceric acid were inversely associated with AIS. Both USFAs and SFAs may have beneficial effect on stroke prevention in hypertensive population.

Early life cardiovascular risk factor trajectories and vascular aging in midlife: a 30-year prospective cohort study

Abstract Background Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. We aimed to explore the associations of individual cardiovascular risk factors from childhood to midlife and their accumulation over a 30-year span with vascular aging in midlife. Methods Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2180 participants aged 6 to 18 years at baseline were followed for over 30 years. Distinct trajectories of systolic blood pressure (SBP), body mass index (BMI), and heart rate (HR) from childhood to midlife were identified by group-based trajectory modeling. Vascular aging was assessed by carotid intima–media thickness (cIMT) or brachial-ankle pulse wave velocity (baPWV). Results We identified 4 distinct SBP trajectories, 3 distinct BMI trajectories and 2 distinct HR trajectories from childhood to midlife. Persistently-increasing SBP, high-increasing BMI, and high-stable HR were all shown to have a positive association with baPWV in midlife. For cIMT, similar associations were observed for persistently-increasing SBP and high-increasing BMI. After further adjustment for SBP, BMI and HR at the time of vascular assessment in 2017, associations were also observed for cardiovascular risk factor trajectories accumulation with baPWV (β=0.656 (95%CI, 0.265-1.047)] and with cIMT [β=0.045 (95%CI, 0.011-0.079)] in adulthood. Conclusions Longitudinal exposure to individual cardiovascular risk factors from childhood to midlife and cardiovascular risk factor accumulation were associated with an increased risk of vascular aging in midlife. Our study lends support for early targeting of risk factors in order to prevent cardiovascular disease later in life.Long-term SBP, BMI, HR trajectories

Type 2 Diabetes and Atrial Fibrillation: Evaluating Causal and Pleiotropic Pathways Using Mendelian Randomization.

Background Observational associations between type 2 diabetes (T2D) and atrial fibrillation (AF) have been established, but causality remains undetermined. We performed Mendelian randomization (MR) to study causal effects of genetically predicted T2D on AF risk, independent of cardiometabolic risk factors. Methods and Results Instrumental variables included 182 uncorrelated single nucleotide polymorphisms associated with T2D at genome-wide significance (P <5×10-8). Genetic association estimates for cardiometabolic exposures were obtained from genome-wide association studies including 188 577 individuals for low-density lipoprotein-C, 694 649 individuals for body mass index, and 757 601 for systolic blood pressure. Two-sample, inverse-variance weighted MR formed the primary analyses. The MR-TRYX approach was used to dissect potential pleiotropic pathways, with multivariable MR performed to investigate cardiometabolic mediation. Genetically predicted T2D associated with increased AF liability in univariable MR (odds ratio [OR], 1.08 [95% CI, 1.02-1.13], P=0.003). Sensitivity analyses indicated potential pleiotropy, with radial MR identifying 4 outlier single nucleotide polymorphisms that were likely contributors. Phenomic scanning on MR-base and subsequent least absolute shrinkage and selection operator regression allowed prioritization of 7 candidate traits. The outlier-adjusted effect estimate remained consistent with the original inverse-variance weightedestimate (OR, 1.07 [95% CI, 1.02-1.12], P=0.008). On multivariable MR, T2D remained associated with increased AF liability after adjustment for low-density lipoprotein-C and body mass index. Following adjustment for systolic blood pressure, the relationship between T2D and AF became nonsignificant (OR, 1.04 [95% CI, 0.95-1.13], P=0.40). Conclusions These data provide novel genetic evidence that while T2D likely causally associates with AF, mediation via systolic blood pressure exists. Endeavoring to lower systolic blood pressure alongside achieving normoglycemia may provide particular benefit on AF risk in patients with T2D.

EARLY LIFE CARDIOVASCULAR RISK FACTOR TRAJECTORIES AND VASCULAR AGING IN MIDLIFE: A 30-YEAR PROSPECTIVE COHORT STUDY

Objective: Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. We aimed to explore the associations of individual cardiovascular risk factors from childhood to midlife and their accumulation over a 30-year span with vascular aging in midlife. Design and method: Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2180 participants aged 6 to 18 years at baseline were followed for over 30 years. Distinct trajectories of systolic blood pressure (SBP), body mass index (BMI), and heart rate (HR) from childhood to midlife were identified by group-based trajectory modeling. Vascular aging was assessed by carotid intima–media thickness (cIMT) or brachial-ankle pulse wave velocity (baPWV). Results: We identified 4 distinct SBP trajectories, 3 distinct BMI trajectories and 2 distinct HR trajectories from childhood to midlife. Persistently-increasing SBP, high-increasing BMI, and high-stable HR were all shown to have a positive association with baPWV in midlife. For cIMT, similar associations were observed for persistently-increasing SBP and high-increasing BMI. After further adjustment for SBP, BMI and HR at the time of vascular assessment in 2017, associations were also observed for cardiovascular risk factor trajectories accumulation with baPWV (↓ = 0.656 (95%CI, 0.265 - 1.047)] and with cIMT [↓ = 0.045 (95%CI, 0.011 - 0.079)] in adulthood. Conclusions: Longitudinal exposure to individual cardiovascular risk factors from childhood to midlife and cardiovascular risk factor accumulation were associated with an increased risk of vascular aging in midlife. Our study lends support for early targeting of risk factors in order to prevent cardiovascular disease later in life.

Cardiac MRI to Predict Sudden Cardiac Death Risk in Dilated Cardiomyopathy.

Background Sudden cardiac death (SCD) is one of the leading causes of death in individuals with nonischemic dilated cardiomyopathy (DCM). However, the risk stratification of SCD events remains challenging in clinical practice. Purpose To determine whether myocardial tissue characterization with cardiac MRI could be used to predict SCD events and to explore a SCD stratification algorithm in nonischemic DCM. Materials and Methods In this prospective single-center study, adults with nonischemic DCM who underwent cardiac MRI between June 2012 and August 2020 were enrolled. SCD-related events included SCD, appropriate implantable cardioverter-defibrillator shock, and resuscitation after cardiac arrest. Competing risk regression analysis and Kaplan-Meier analysis were performed to identify the association of myocardial tissue characterization with outcomes. Results Among the 858 participants (mean age, 48 years; age range, 18-83 years; 603 men), 70 (8%) participants experienced SCD-related events during a median follow-up of 33.0 months. In multivariable competing risk analysis, late gadolinium enhancement (LGE) (hazard ratio [HR], 1.87; 95% CI: 1.07, 3.27; P = .03), native T1 (per 10-msec increase: HR, 1.07; 95% CI: 1.04, 1.11; P < .001), and extracellular volume fraction (per 3% increase: HR, 1.26; 95% CI: 1.11, 1.44; P < .001) were independent predictors of SCD-related events after adjustment of systolic blood pressure, atrial fibrillation, and left ventricular ejection fraction. An SCD risk stratification category was developed with a combination of native T1 and LGE. Participants with a native T1 value 4 or more SDs above the mean (1382 msec) had the highest annual SCD-related events rate of 9.3%, and participants with a native T1 value 2 SDs below the mean (1292 msec) and negative LGE had the lowest rate of 0.6%. This category showed good prediction ability (C statistic = 0.74) and could be used to discriminate SCD risk and competing heart failure risk. Conclusion Myocardial tissue characteristics derived from cardiac MRI were independent predictors of sudden cardiac death (SCD)-related events in individuals with nonischemic dilated cardiomyopathy and could be used to stratify participants according to different SCD risk categories. Clinical trial registration no. ChiCTR1800017058 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sakuma in this issue.

Early-Life Cardiovascular Risk Factor Trajectories and Vascular Aging in Midlife: A 30-Year Prospective Cohort Study.

Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. We aimed to explore the associations of individual cardiovascular risk factors from childhood to midlife and their accumulation over a 30-year span with vascular aging in midlife. Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2180 participants aged 6 to 18 years at baseline were followed for over 30 years. Distinct trajectories of systolic blood pressure (SBP), body mass index (BMI), and heart rate from childhood to midlife were identified by group-based trajectory modeling. Vascular aging was assessed by carotid intima media thickness or brachial-ankle pulse wave velocity. We identified 4 distinct SBP trajectories, 3 distinct BMI trajectories, and 2 distinct heart rate trajectories from childhood to midlife. Persistently increasing SBP, high-increasing BMI, and high-stable heart rate were all shown to have a positive association with brachial-ankle pulse wave velocity in midlife. For carotid intima-media thickness, similar associations were observed for persistently increasing SBP and high-increasing body mass index. After further adjustment for SBP, body mass index and heart rate at the time of vascular assessment in 2017, associations were also observed for cardiovascular risk factor trajectories accumulation with brachial-ankle pulse wave velocity (β, 0.656 [95% CI, 0.265-1.047]) and with carotid intima media thickness (β, 0.045 [95% CI, 0.011-0.079]) in adulthood. Longitudinal exposure to individual cardiovascular risk factors from childhood to midlife and cardiovascular risk factor accumulation were associated with an increased risk of vascular aging in midlife. Our study lends support for early targeting of risk factors in order to prevent cardiovascular disease later in life.

Association of Hypertensive Disorders of Pregnancy With Future Cardiovascular Disease

The findings of this study provide genetic evidence supporting an association between HDPs and higher risk of coronary artery disease and stroke, which is only partially mediated by cardiometabolic factors. This supports classification of HDPs as risk factors for cardiovascular disease. A genome-wide genetic association study using mendelian randomization (MR) was performed from February 16 to March 4, 2022. Primary analysis was conducted using inverse-variance-weighted MR. Mediation analyses were performed using a multivariable MR framework. All studies included patients predominantly of European ancestry. Female-specific summary-level data from FinnGen (sixth release). Uncorrelated (r2<0.001) single-nucleotide variants (SNVs) were selected as instrumental variants from the FinnGen consortium summary statistics for exposures of any HDP, gestational hypertension, and preeclampsia or eclampsia. Hypertensive disorders in pregnancy (HDPs) are major causes of maternal and fetal morbidity and are observationally associated with future maternal risk of cardiovascular disease. However, observational results may be subject to residual confounding and bias. Genetic association estimates for outcomes were extracted from genome-wide association studies of 122 733 cases for coronary artery disease, 34 217 cases for ischemic stroke, 47 309 cases for heart failure, and 60 620 cases for atrial fibrillation. To investigate the association of HDPs with multiple cardiovascular diseases. Genetically predicted HDPs were associated with a higher risk of coronary artery disease (odds ratio [OR], 1.24; 95% CI, 1.08-1.43; P = .002); this association was evident for both gestational hypertension (OR, 1.08; 95% CI, 1.00-1.17; P = .04) and preeclampsia/eclampsia (OR, 1.06; 95% CI, 1.01-1.12; P = .03). Genetically predicted HDPs were also associated with a higher risk of ischemic stroke (OR, 1.27; 95% CI, 1.12-1.44; P = 2.87 × 10-4). Mediation analysis revealed a partial attenuation of the effect of HDPs on coronary artery disease after adjustment for systolic blood pressure (total effect OR, 1.24; direct effect OR, 1.10; 95% CI, 1.02-1.08; P = .02) and type 2 diabetes (total effect OR, 1.24; direct effect OR, 1.16; 95% CI, 1.04-1.29; P = .008). No associations were noted between genetically predicted HDPs and heart failure (OR, 0.97; 95% CI, 0.76-1.23; P = .79) or atrial fibrillation (OR, 1.11; 95% CI, 0.65-1.88; P = .71).

S-46-4: NONDIPPER PULSE RATE PATTERN WAS ASSOCIATED WITH BLOOD PRESSURE VARIABILITY AND INCREASE OF BNP: J-HOP STUDY

Background: The association between nondipper pulse rate (PR) pattern was reported. However, the association between nondipper PR pattern, blood pressure variability and hypertensive target organ damage remains unclear. Methods: Ambulatory BP monitoring (ABPM) was conducted in 1,003 hypertensive patients enrolled in the Japan Morning Surge Home Blood Pressure (J HOP) Study. Ambulatory BP monitoring was performed on a weekday with an automatic system that recorded the wearers BP and PR every 30 minutes for 24 hours. Nondipper PR status was defined as (awake PR minus sleep PR)/awake PR &lt; 0.1, and we evaluated standard deviation (SD) of systolic BP in daytime and nighttime as BP variability. We also measured the brain natriuretic peptide level (BNP), and conducted echocardiography to estimate the left ventricular mass index (LVMI). Results: The SD of systolic BP in nighttime, BNP and LVMI in patients with nondipper PR (N = 247) were higher than that in patients with dipper PR (N = 756, SD of systolic BP: 13.3 ± 4.6 vs. 12.7 ± 4.1 mmHg, p = 0.041; median BNP: 25.2 vs. 17.6 pg/dL, p &lt; 0.001, LVMI: 101.4 ± 29.1 vs. 97.3 ± 42.2 g/m2, p = 0.021). Systolic BP in nighttime in patient with nondipper PR was similar to that in patient with dipper PR (119.5 ± 15.2 vs. 119.9 ± 15.1 mmHg, p = 0.63). The SD of systolic BP in nighttime was associated with BNP and LVMI (BNP: r = 0.08, p = 0.006; LVMI r = 0.10, p = 0.001). Nondipper PR was independently associated with BNP (β = 0.10, p &lt; 0.001), but not with LVMI (β = 0.03, p = 0.37) after adjustment for systolic BP and SD of systolic BP in nighttime. Conclusions: Nondipper PR pattern was associated with blood pressure variability and hypertensive target organ damage in patients with cardiovascular risk factor.

Effect of Telmisartan on the Peak Wall Stress and Peak Wall Rupture Index of Small Abdominal Aortic Aneurysms: An Exploratory Analysis of the TEDY Trial

This study was an unplanned exploratory analysis of a subset of participants from the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial. It aimed to assess the efficacy of the angiotensin 1 receptor blocker telmisartan in reducing abdominal aortic aneurysm (AAA) peak wall stress (PWS) and peak wall rupture index (PWRI) among individuals with small AAAs. Participants with AAAs measuring 35 - 49 mm in maximum diameter were randomised to receive telmisartan 40 mg or identical placebo in the TEDY trial. Participants who had computed tomography angiography performed at entry and at least one other time point during the trial (12 or 24 months) were included in the current study. Orthogonal AAA diameter, PWS, and PWRI were measured using previously validated methods. The annual change in PWS and PWRI from baseline was compared between participants allocated telmisartan or placebo using linear mixed effects models. These models were either unadjusted or adjusted for risk factors that were different in the groups at entry (p < .100) or systolic blood pressure (SBP) at one year. Of the 207 participants recruited to TEDY, 124 were eligible for inclusion in this study. This study included 65 and 59 participants from the telmisartan and placebo groups, respectively. The PWS and PWRI were not significantly different in the two groups at baseline. Participants allocated telmisartan had a slower annual increase in PWS (-4.19; 95% CI -8.24, -0.14 kPa/year; p= .043) and PWRI (-0.014; 95% CI -0.026, -0.001; p= .032) compared with those allocated placebo after adjusting for risk factors. After adjustment for SBP at one year, telmisartan did not significantly reduce annual increases in PWS or PWRI. The findings of this study suggest that telmisartan limits the rate of increase in PWS and PWRI of small AAAs by reducing blood pressure.

Analysis of Microvascular Abnormalities in Obesity: A Comparative Study with Healthy Subjects Using Swept Source Optical Coherence Tomography Angiography and Adaptive Optics

Purpose: The aim of this study was to analyze retinal microvasculature in obese subjects as compared to a normal-weight population. Methods: In this case-control observational study, swept-source optical coherence tomography angiography (SS-OCTA) and adaptive optics (AO) were performed in eyes of nondiabetic, nonhypertensive, obese patients and in healthy controls. AO was used to calculate the wall-to-lumen ratio (WLR). The foveal avascular zone (FAZ), the macular vessel density, and the macular perfusion density of the superficial and deep capillary plexuses were analyzed in 6 × 6 mm macular OCTA cubes. SS-OCTA was also used to measure the choroidal thickness, the retinal nerve fiber layer (RNFL), and the vascular density of the retinal peripapillary capillary plexus. Results: The obese group included 45 eyes (24 patients), and the control group included 46 eyes (23 subjects). The central macular density and perfusion density were significantly lower in obese patients compared to controls, in the deep retinal layer (0.28 [0.01–0.69] vs. 1.24 [0.82–1.66], p = 0.006 and 0.006 [0.001–0.015] vs. 0.025 [0.016–0.034], p = 0.01), respectively, after adjustment for systolic blood pressure. No differences were found in macular vascular density in other areas, FAZ (circularity, area, perimeter), choroidal thickness, RNFL. WLR was increased in obese patients (0.252 [0.246–0.259] vs. 0.239 [0.231–0.245] in controls, p = 0.016). Conclusion: Obesity was associated with retinal microvascular changes regardless of the presence of diabetes and hypertension. Our findings suggest the presence of infraclinical microvascular changes directly associated with obesity, which can be identified noninvasively through retinal imaging.

Dairy intake and risk of major cardiovascular events: a prospective cohort study of 0.5 million Chinese adults

Abstract Background Evidence on the association between dairy consumption and risk of cardiovascular disease has been highly inconsistent, with findings suggesting either harmful, neutral or beneficial effects. In addition, a very large majority of the previous studies on this topic were conducted among populations in Europe and North America who usually consume a higher amount of dairy products and very few data, particularly prospective data, come from China where the dairy consumption level is low. Purpose We therefore investigated the associations between intake of dairy products and incidence of several major types of cardiovascular diseases in Chinese adults. Methods During 2004–2008, the prospective China Kadoorie Biobank Study recruited slightly over 0.5 million adults from ten diverse regions (five urban and five rural) across China. Information on the consumption frequency of dairy products was collected at baseline and periodic resurveys, using a validated interviewer-administered laptop-based questionnaire. Over a mean follow-up of 10.9 years, there were 47,128 incident ischaemic heart disease events, 43,481 ischaemic strokes and 9749 intracerebral haemorrhages among 489,595 study participants, who did not report a prior history of cardiovascular disease at baseline. Cox regression analyses were performed to estimate multivariable-adjusted hazard ratios (HRs) for incident events associated with dairy intake. Results Overall, 69.3% of participants reported never or rare consumption (i.e. non-consumers) and 11.3% of them reported regular consumption (i.e. ≥4 days/week) of dairy products, with milk accounting for the largest proportion of total dairy intake (∼77%). Male and female regular dairy consumers had 2.1/1.5 and 1.7/1.1 mmHg lower systolic/diastolic blood pressure, respectively compared to non-consumers. In a subset (∼18,000) of participants with blood lipid levels measured, regular dairy consumers had ∼0.1 mmol/L higher LDL levels than non-consumers. After adjusting for a range of potential confounders, including sociodemographic and lifestyle factors, BMI and other dietary factors, dairy consumption was positively and significantly associated with risk of ischaemic heart disease, with the adjusted HR per 50 g/day increase in usual dairy consumption being 1.11 (95% confidence interval [CI] 1.09–1.14). Dairy consumption was not significantly associated with risk of ischemic stroke but was inversely associated with risk of intracerebral haemorrhage, with each 50 g/day increase in usual dairy consumption being associated with 17% lower risk (HR 0.83, 0.78–0.88). These associations remained significant after additional adjustment for systolic blood pressure. Conclusion In this large study of Chinese adults, higher intake of dairy products was associated with a higher risk of ischaemic heart disease but a lower risk of intracerebral haemorrhage. The exact mechanisms underlying such associations require further investigation. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The CKB baseline survey and the first re-survey were supported by the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up has been supported by Wellcome grants to Oxford University (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z) and grants from the National Key Research and Development Program of China (2016YFC0900500, 2016YFC0900501, 2016YFC0900504, 2016YFC1303904) and from the National Natural Science Foundation of China (91843302). The UK Medical Research Council (MC_UU_00017/1,MC_UU_12026/2 MC_U137686851), Cancer Research UK (C16077/A29186; C500/A16896) and the British Heart Foundation (CH/1996001/9454), provide core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University for the project.

Association of Adipocytokines and Inflammatory Biomarkers with Blood Pressure in Adolescents: A Longitudinal Analysis

Background and aimsSeveral cross-sectional, but few prospective, studies suggest that inflammation may be involved in the development of high blood pressure. We examined markers of inflammation for their associations with blood pressure levels over a two-year period in healthy adolescents. Methods and resultsThe sample comprised 406 adolescents (209 girls) aged 12–18 years in the LabMed Physical Activity Study were followed-up for 2 years. Anthropometric (weigh, height, BMI), markers of inflammation (high sensitivity C-reactive protein, complement factors C3 and C4, fibrinogen, leptin and adiponectin) and ambulatory blood pressure (BP) were collected. Socioeconomic status, pubertal development, adherence to Mediterranean diet and cardiorespiratory fitness were measured for adjustment for potential confounders. Adjusted linear regression models revealed a significant association of Leptin/Adiponectin (L/A) Ratio (baseline) with systolic BP (β = 0.120; p < 0.034) and with diastolic BP (β = 0.125; p < 0.036) at follow-up (full adjusted model). Leptin was associated with systolic BP at follow-up (β = 0.102; p < 0.038) after adjustment for systolic BP at baseline, height, pubertal stage, socioeconomic status, adherence to Mediterranean diet, cardiorespiratory fitness, however, not independently of BMI. ConclusionL/A ratio was positively associated with systolic BP and diastolic BP even after adjusting confounding variables. Therefore, a higher misbalance between leptin and adiponectin (higher L/A ratio) early adolescence may exert a negative effect BP levels in late adolescence regardless of several confounders factors.

Atherosclerosis impacts the link between hepatocyte growth factor and cognition

Background. There is a controversy about the association between Hepatocyte growth factor (HGF) and cognition. Increased serum level of HGF has been reported in patients with hypertension, peripheral arteriosclerosis and carotid atherosclerosis. Ankle-brachial index (ABI) is considered as a marker of atherosclerosis. we hypothesized that hypertension or atherosclerosis with hypertension could alter the relation between HGF serum level and cognitive function. Aim. To study HGF and cognitive function in hypertensives with and without atherosclerosis versus healthy controls. Methods. This case-control study included ninety elderly subjects attending outpatient primary care geriatric clinics. They were subdivided into 3 groups; Group A (30 normotensives with normal Ankle-brachial index (ABI) as controls, group B (30 hypertensives with normal ABI) and group C (30 hypertensives with abnormal ABI) as cases. Cognitive function was assessed by Rowland Universal Dementia Assessment Scale (RUDAS). Results. Group C had worse score in RUDAS than controls (P = 0.01). HGF was negatively correlated with ABI in group C (p = 0.007). HGF was positively associated with RUDAS score, in group A (p < 0.001), in group B; after further adjustment for systolic blood pressure (SBP) (p = 0.024) and in group C; after adjustment for ABI (p = 0.031) or ABI and SBP (p = 0.05). Conclusions. The potential beneficial link between HGF serum concentration and cognition was met in normotensive subjects with normal ABI. However, this link is halted in the presence of hypertension or atherosclerosis as assessed by ABI. Alternatively, the raised HGF serum level may be an epiphenomenon of atherosclerosis.

Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults

ObjectiveTo estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH).DesignMatched cohort study.SettingPopulation based, electronic primary healthcare databases...

Diastolic Blood Pressure J-Curve Phenomenon in a Tertiary-Care Hypertension Clinic.

Concerns exist regarding the potential increased cardiovascular risk from lowering diastolic blood pressure (DBP) in hypertensive patients. We analyzed 30-year follow-up data of 10 355 hypertensive patients attending the Glasgow Blood Pressure Clinic. The association between blood pressure during the first 5 years of treatment and cause-specific hospital admissions or mortality was analyzed using multivariable adjusted Cox proportional hazard models. The primary outcome was a composite of cardiovascular admissions and deaths. DBP showed a U-shaped association (nadir, 92 mm Hg) for the primary cardiovascular outcome hazard and a reverse J-shaped association with all-cause mortality (nadir, 86 mm Hg) and noncardiovascular mortality (nadir, 92 mm Hg). The hazard ratio for the primary cardiovascular outcome after adjustment for systolic blood pressure was 1.38 (95% CI, 1.18-1.62) for DBP <80 compared with DBP of 80 to 89.9 mm Hg (referrant), and the subdistribution hazard ratio after accounting for competing risk was 1.33 (1.17-1.51) compared with DBP ≥80 mm Hg. Cause-specific nonfatal outcome analyses showed a reverse J-shaped relationship for myocardial infarction, ischemic heart disease, and heart failure admissions but a U-shaped relationship for stroke admissions. Age-stratified analyses showed DBP had no independent effect on stroke admissions among the older patient subgroup (≥60 years of age), but the younger subgroup showed a clear U-shaped relationship. Intensive blood pressure reduction may lead to unintended consequences of higher healthcare utilization because of increased cardiovascular morbidity, and this merits future prospective studies. Low on-treatment DBP is associated with increased risk of noncardiovascular mortality, the reasons for which are unclear.

Associations of Cardiorespiratory Fitness and Adiposity With Arterial Stiffness and Arterial Dilatation Capacity in Response to a Bout of Exercise in Children.

Purpose: To investigate the associations of directly measured peak oxygen uptake ( ) and body fat percentage (BF%) with arterial stiffness and arterial dilatation capacity in children. Methods: Findings are based on 329 children (177 boys and 152 girls) aged 8-11 years. was assessed by a maximal cardiopulmonary exercise test on a cycle ergometer and scaled by lean body mass (LM). BF% and LM were measured by bioelectrical impedance. Stiffness index (measure of arterial stiffness) and change in reflection index (ΔRI, measure of arterial dilatation capacity) were assessed by pulse contour analysis. Data were analyzed by linear regression models. Results: was positively associated with ΔRI in boys adjusted for age and BF% (β = 0.169, P = .03). Further adjustments for systolic blood pressure, heart rate, and the study group had no effect on this association, but additional adjustment for clinical puberty attenuated it (β = 0.171, P = .07). BF% was inversely related to ΔRI in boys adjusted for age and (β = -0.171, P = .03). or BF% was not associated with ΔRI in girls or with stiffness index in either boys or girls. Conclusion: Increasing cardiorespiratory fitness and decreasing adiposity may improve arterial health in childhood, especially among boys.

Collagen Biomarkers and Incidence of New Onset of Atrial Fibrillation in Subjects With No Overt Cardiovascular Disease at Baseline: The Multi-Ethnic Study of Atherosclerosis.

Atrial fibrosis is a hallmark of structural remodeling in atrial fibrillation (AF). Plasma procollagen type III N-terminal propeptide (PIIINP) reflects collagen synthesis and degradation while collagen type I carboxy-terminal telopeptide (ICTP) reflects collagen degradation. We aimed to study baseline plasma PIIINP and ICTP and their associations with incident AF in participants initially free of overt cardiovascular disease. In a stratified sample of the Multi-Ethnic Study of Atherosclerosis, initially aged 45-84 years, 3071 participants had both PIIINP and ICTP measured at baseline. Incident AF in 10-year follow-up was based on a hospital International Classification of Diseases code for AF or atrial flutter, in- or outpatient Medicare claims through 2011 (primarily in those aged 65-84 years), or ECG 10 years after baseline (n=357). The associations of PIIINP and ICTP with incident AF were estimated using Poisson regression with follow-up time offset. Baseline PIIINP (5.50±1.55 µg/L) and ICTP (mean±SD, 3.41±1.37 µg/L) were positively related (both P<0.0001) to incident AF in a model adjusting for age, race/ethnicity, and sex, with an apparent threshold (relative incidence density 2.81 [1.94-4.08] for PIIINP ≥8.5 µg/L [3.5% of the sample] and 3.46 [2.36-5.07] for ICTP ≥7 µg/L [1.7% of the sample]). Findings were attenuated but remained statistically significant after further adjustment for systolic blood pressure, height, body mass index, smoking, and renal function. Additional adjustment for other risk factors and biomarkers of inflammation did not alter conclusions. Plasma collagen biomarkers, particularly at elevated levels, were associated with excess risk for AF.

Abstract P271: Relationship of Resting Heart Rate and Subclinical Arteriosclerosis Markers in Apparently Normal Participants From China

Objective: To evaluate the relationship between resting heart rate and arterial stiffness in natural and apparently normal population of She minority from Fujian province in China. Method: 6 natural village 511 participants were enrolled into our study using cluster sampling method in 2009. Eventually 325 subjects with full data were analyzed. All subjects carried on detection of carotid femoral pulse wave velocity(CF-PWV), carotid radial pulse wave velocity (CR-PWV), cardio ankle vascular index(CAVI), ankle brachial index(ABI), carotid intima media thickness(CIMT) by Doppler ultrasound and blood test (fasting plasma glucose[FPG], blood lipids, blood uric acid(UA), high sensitive C reactive protein(hs-CRP). Resting heart rate(RHR) was the mean of three values measured by VS-1000 vascular detection equipment and ultrasound equipment. Results: In different quartiles of RHR, that were RHR1≤61beats/min, RHR2:62-69beats/min, RHR3:70-77beats/min, RHR4≥78beats/min, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol to high density lipoprotein cholesterol ratio (TC/HDL-C), HDL-C, CF-PWV and CR-PWV were significantly different between RHR groups (p&lt;0.05); SBP, DBP, TC/HDL-C, CF-PWV and CR-PWV in RHR4 group were significantly higher than RHR1 group, and HDL-C was lower than RHR1 group (all p&lt;0.05). However, there were no statistical significance of CAVI, ABI and CIMT in different RHR groups (p&gt;0.05). Logistic regression analysis indicated in the model without adjustment, the RHR4 was associated with higher CF-PWV(CF-PWV&gt;9m/s) with odds ratios (ORs) was 3.074 (95% confidence interval was 1.555-6.075, p&lt;0.05) compared with RHR1; After adjustment of age and gender, the OR of RHR4 was 4.542 (95% confidence interval was 2.078-9.928, p&lt;0.05); And after further adjustment of SBP, DBP, plasma lipids, FPG and hs-CRP, the OR of RHR4 was 5.336 (95% confidence interval was 1.512-18.831, p&lt;0.05). Conclusion: In natural population of She minority of Fujian province in China, high resting heart rate was followed by a high level of blood pressure, plasma lipids and arterial stiffness. Furthermore, a higher rest heart rate was independently associated with arterial stiffness.

Obstructive sleep apnea during rapid eye movement sleep is associated with early signs of atherosclerosis in women.

Although obstructive sleep apnea (OSA) is associated with overall cardiovascular disease and mortality, the association with atherosclerotic cardiovascular disease is less clear, especially in women. Recently, it has been suggested that OSA during rapid eye movement (REM) sleep, associated with long apneas and deep desaturations, could have severe cardiometabolic consequences. The aim of this study was to investigate whether OSA during REM sleep is associated with early signs of atherosclerosis in a population-based sample of women. In the community-based "Sleep and Health in Women" (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements, blood sampling, blood pressure measurement, and answered questionnaires. Ten years later, 201 of the original participants, free of known atherosclerotic disease at baseline and without continuous positive airway pressure treatment for OSA, underwent a high-frequency ultrasound of the common carotid artery to assess the individual thickness of the layers of the artery wall. Severe OSA during REM sleep (REM apnea-hypopnea index [AHI] ≥ 30) was associated with a thicker intima. This association was still significant after adjustment for age, body mass index, alcohol, and smoking, as well as for further adjustment for systolic blood pressure, low-density lipoprotein, C-reactive protein, and diabetes (β-coefficient, 0.008; p-value, 0.022). The association between a REM AHI of ≥30 and intima thickness was also seen in women with no or mild OSA and normal non-REM AHI. In this study of a community-based sample of women, severe OSA during REM sleep was independently associated with early signs of atherosclerosis.

Relation of Orthostatic Hypotension With New-Onset Atrial Fibrillation (From the Framingham Heart Study)

Previous studies have reported that orthostatic hypotension (OH) is associated with increased risk of atrial fibrillation (AF). We sought to determine whether the association persists after adjusting for hypertension and other cardiovascular risk factors. We studied the Framingham Heart Study Original cohort participants evaluated between 1981 and 1984 without baseline AF. OH was defined as drop in standing systolic blood pressure (BP) of at least 20 mm Hg or standing diastolic BP of at least 10 mm Hg from their supine values after standing for 2 minutes. We estimated Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HR) for association between OH and risk of incident AF, adjusting for age, sex, seated systolic BP and diastolic BP, resting heart rate, height, weight, current tobacco use, hypertension treatment, diabetes, and history of myocardial infarction and heart failure. Of 1,736 participants (mean age, 71.7 ± 6.5 years, 60% women), 256 (14.8%) had OH at baseline. During 10 years of follow-up, 224 participants developed new AF. In our multivariable-adjusted model, OH (HR 1.61, 95% confidence interval 1.17 to 2.20) and greater orthostatic decrease in mean arterial pressure (MAP) (HR 1.11, 95% confidence interval 1.02 to 1.22 per 8.6 mm Hg change in MAP) were both associated with higher risk of new AF. In conclusion, in our longitudinal community-based sample, OH and orthostatic decline in MAP were significantly associated with increased risk of incident AF after adjustment for systolic BP, diastolic BP, and hypertension treatment.