Arterial Stiffness In Elderly Patients Research Articles

Arterial Stiffness following Endurance and Resistance Exercise Sessions in Older Patients with Coronary Artery Disease.

Arterial stiffness (AS) is associated with coronary artery disease (CAD). Acute endurance training decreases AS, whereas acute resistance training increases it. However, these results are from studies in apparently healthy adults, and there is no information on the effects of such afterload AS in elderly patients with CAD. We aimed to investigate the effect of acute endurance or resistance training on the time course of changes in the indices of AS in elderly patients with CAD in order to understand how stiffness responds after training. We tested 18 trained men with CAD. AS was measured using central and peripheral pulse wave velocity (PWV) after 15 min of rest and after 5, 15, and 30 min of endurance and resistance training sessions. The endurance session consisted of high-intensity interval walking at 85-90% of maximum heart rate, and the resistance session consisted of 70% of the maximum of one repetition. An interaction effect was found for central and peripheral PWV (p ≤ 0.001; carotid, η2 = 0.72; aortic, η2 = 0.90; femoral, η2 = 0.74), which was due to an increase in PWV after resistance and a decrease in central and peripheral PWV after endurance. This study demonstrates that training mode influences the time course of AS responses to acute exercise in these patients. Acute endurance training decreased AS, whereas resistance training significantly increased it.

THE ACTION OF ANTIHYPERTENSIVES ON CENTRAL VESSEL STIFFNESS IN THE ELDERLY: A SUBSTUDY OF EVOUPIU (BRAZILIAN STUDY OF PULSE WAVE VELOCITY IN ELDERLY)

Objective: Central arterial stiffness (CAS) is increased in the elderly, and its acceleration may be induced by systemic hypertension. The increased pulsatile pressure may promote damage to vital organs. Antihypertensive drugs can act on the CAS and decrease these patients’ cardiovascular risk. The present study aimed to compare the CAS of hypertensive elderly patients with different therapeutic schemes, using only two antihypertensive drugs: hydrochlorothiazide (HCTZ) as monotherapy or HCTZ associated with another class of antihypertensive drugs Design and method: This study is a cross-sectional analysis of elderly patients included in the data bank of EVOPIU. The data were extracted from the first medical consultation of the study. A total of 293 elderly hypertensive patients were separated into seven groups: those taking no antihypertensive medication (NAM, n = 47); hydrochlorothiazide alone (HCTZ, n = 25), HCTZ, and beta-blockers (n = 51); HCTZ and calcium channel blockers (n = 24); HCTZ and AII receptor blockers (n = 59); HCTZ and AII-converting enzyme inhibitors (n = 61); and HCTZ and spironolactone (HCTZ +SPIRO, n = 27). CAS was measured by femoral-carotid wave velocity (c-fPWV). Results: When compared to NAM patients, only the HCTZ + SPYRO group showed significantly lower values in c-fPWV (12.1 ± 0.44 vs. 10.5 ± 0.56 ms; P < 0.05, respectively), central pulse pressure (PP) augmentation index (Alx) (52.0 ± 1.9 vs. 45.6 ± 2.5 mmHg, P < 0.05), brachial PP (68.6 ± 2.1 vs. 61.5 ± 2.7 mmHg, P < 0.05). This group did not show higher serum potassium levels than the other groups studied. Conclusions: The results suggest that arterial stiffness in elderly patients may be, at least in part, caused by an effect of aldosterone on the arterial wall. CAS may be partially reversible with spironolactone. Its effect seems independent of observed effects on systemic arterial blood pressure.

Association between diabetes mellitus and central arterial stiffness in elderly patients with systemic arterial hypertension

ABSTRACT Background Aging increases the risk of chronic diseases, especially cardiovascular diseases, leading to changes in cardiovascular anatomy and physiology even in the absence of other comorbidities. Numerous cardiovascular risk factors (CVRFs), such as diabetes mellitus (DM) and systemic arterial hypertension (SAH), can modify the functional and structural properties of large vessels, increasing arterial stiffness. Objective To determine whether elderly patients with hypertension with DM have greater central arterial stiffness than elderly patients with SAH without DM. Methods The Study of Pulse Wave Velocity in the Elderly in an Urban Area in Brazil (EVOPIU) included 1,192 patients aged ≥ 60 years who underwent applanation tonometry (AT) to evaluate carotid-femoral pulse wave velocity (cfPWV). From this database, 1,133 patients were selected from 6 groups: NDN (nondiabetic normotensives; n: 127); DN (diabetic normotensives; n: 64); NDCH (nondiabetic controlled hypertensives; n: 168); DCH (diabetic controlled hypertensives; n: 275); NDH (nondiabetic hypertensives; n: 217) and DH (diabetic hypertensives; n: 282). All groups underwent AT to obtain cfPWV and central and peripheral arterial pressures. Results The pulse wave velocities found were as follows: NDN vs DN (8.9 ± 0.2 m/s vs 9.4 ± 0.2; P = .103); NDCH vs DCH (9.0 ± 0.2 m/s vs. 9.6 ± 0.1 m/s; P= .04) and NDH vs DH (9.2 ± 0.1 m/s vs. 9.6 ± 0.1 m/s; P= .045). When the diabetic groups were compared, there were no differences in cfPWV values, and the same occurred when the nondiabetic groups were compared. Conclusions Elderly patients with diabetes and hypertension have greater central arterial stiffness than patients without diabetes and hypertension, regardless of systemic blood pressure control. The central arterial stiffness caused by vascular aging seems to be a common factor among all the studied groups.

Angiotensin II type 1 receptor blockers prevent aortic arterial stiffness in elderly patients with hypertension

ABSTRACTBackgrounds and aims: Increased arterial stiffness may increase cardiovascular morbidity and mortality. Angiotensin II type 1 receptor blockers (ARBs) are potentially useful in controlling the central blood pressure and arterial stiffness in mild to moderate essential hypertension, while the effects of ARBs in aged patients with essential hypertension are not entirely investigated.Methods: The carotid-femoral arterial pulse wave velocity (PWV) was measured in aged patients with essential hypertension.Results: In a cross-sectional study, PWV value was significantly higher in these old patients with essential hypertension, compared to patients without essential hypertension. In correlation analysis, PWV was associated positively with age, hypertension duration, and carotid atherosclerosis. However, there was no relationship between PWV and gender in aged patients with essential hypertension. In a perspective study, 6–12 months administration of ARBs (losartan, 50 mg/day; telmisartan, 40 mg/day; valsartan 80 mg/day; irbesartan, 150 mg/day) remarkably reduced PWV in aged patients with essential hypertension. Regression analyses of multiple factors indicated that the effects of ARBs on arterial stiffness were not associated with the reduction of blood pressure.Conclusion: ARB treatment is a negative risk factor of arterial stiffness in aged patients with essential hypertension.

Arterial stiffness in elderly patients with normotension and hypertension in Brazil.

Data on arterial stiffness in older populations, according to blood pressure (BP) levels, are scarce in Brazil. The objective of this study was to establish reference values for core measures of arterial stiffness, including carotid-femoral pulse wave velocity (cf-PWV) and aortic augmentation index (AIx), in a cohort of older individuals with normotension (NT) and hypertension. Cross-sectional analysis was performed with applanation tonometry data from 1192 patients aged 60years or older. The authors classified patients according to their BP levels as having NT, controlled hypertension (CH), and uncontrolled hypertension (UH). The cf-PWV values were 9.11±0.16m/s (NT), 9.12±0.18m/s (CH), and 9.42±2.2m/s (UH) (P<0.005; UH vs NT and CH). The AIx was 33.3% for the entire cohort and similar across all groups. The cf-PWV increased with age but reached a ceiling at 75years. Compared with men, women had a higher AIx but similar cf-PWV levels. In conclusion, the markers of arterial stiffness were similar among individuals with NT/CH and higher among individuals with UH.

Correlation between serum vitamin D level and arterial stiffness in elderly patients with impaired renal function

Objective To investigate the relationship between serum level of 25-hydroxyvitamin D and arterial stiffness in elderly patients with impaired renal function. Methods A cross-sectional study was conducted. Serum creatinine and 25-hydroxyvitamin D levels in elderly patients aged 60 years and over were detected at admission. The estimated glomerular filtration rate (eGFR) was calculated. Patients were divided into 2 groups of the normal eGFR (≥60 ml/min) group and the impaired eGFR (<60 ml/min) group. Carotid-femoral pulse wave velocity (cfPWV) was used to assess the arterial stiffness. The differences in serum 25-hydroxyvitamin D levels and arterial stiffness were compared between the two groups. Results A total of 256 patients were enrolled in this study. The mean(SD) age at admission was (74.5±9.4) years, with a range of 60~92 years, 172 males and 84 females. There were 143 cases in the normal eGFR group (control) and 113 cases in the impaired eGFR group. No differences in baseline clinical data including age, gender, body mass index, blood lipids, etc. were found between the two groups. Compared with the control group, serum 25-hydroxyvitamin D level was decreased and cfPWV was increased in the impaired eGFR group 〔(12.31 ±9.56)μg/L vs. (20.76 ± 12.97)μg/L, (15.1 ± 3.8) m/s vs. (12.9 ± 2.9) m/s, both P<0.05〕. Multiple liner regression analysis showed that serum 25-hydroxyvitamin D level was negatively associated with cfPWV (r=-0.59, P<0.05) after adjusting for age, gender and other confounders. Conclusions Serum vitamin D level is decreased and the arterial stiffness is increased in elderly patients with impaired renal function. Key words: Kidney function tests; Vitamin D; Arteriosclerosis

Relationship of insulin resistance with serum 25-hydroxyvitamin D levels and arterial stiffness in elderly patients

Objective To explore the relationship of insulin resistance with serum 25-hydroxyvitamin D levels and arterial stiffness in elderly patients. Methods A total of 162 elderly inpatients (aged 60 years or over) were recruited from 2012 to 2014. Levels of fasting serum insulin, fasting serum glucose, creatinine and vitamin D were determined. Insulin resistance (IR) was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR). The patients were divided into the following three groups according to HOMA-IR: the low IR group with HOMA-IR less than 2 (n=78), the median IR group with HOMA-IR between 2 and 6 (n=43), and the high IR group with HOMA-IR greater than 6 (n=41). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Arterial stiffness and serum vitamin D levels were compared among the three groups. Results cfPWV was increased and the serum 25-hydroxyvitamin D level was decreased in the high insulin resistance group compared with the low insulin resistance group〔(13.2±5.7) μg/L vs. (17.8±6.2) μg/L, (14.3±5.2) m/s vs. (11.9±3.0) m/s〕. Multiple liner regression analysis showed that IR was negatively correlated with the serum 25-hydroxyvitamin D level (r=-0.63, P<0.05) and positively correlated with arterial stiffness (r=0.45, P<0.05) after adjustment for age, sex and other confounders. Conclusions Elderly patients with high insulin resistance may have lower levels of serum vitamin D and higher arterial stiffness. Key words: Insulin resistance; Vitamin D deficiency; Arteriosclerosis

Inflammation and thoracic aortic structure assessed by PET/CT scan and arterial stiffness in elderly patients

Introduction.– Many physical, psychological and social factors have an impact on the well-being of elderly. We studied the psychological well-being and alcohol use of Finnish elderly people living over 2months/year in Spain compared to those living in capital area of Finland, city of Espoo. Methods.– A structured questionnairewas delivered to elderly people over 65years in Espoo 2007 and in Costa del Sol area, Spain, 2011. Random sample included 2100 persons in Espoo and 500 persons in Spain, of which the response rate was 71,6% and 62,8%, respectively. We had 1395 answered questionnaires from Espoo and314 fromSpain after purifying thedata. Questionnaire included demographics and physical, psychological and social issues and alcohol use. We studied the psychological well-being by PSYCHSCORE, including loneliness, depression, zest for life, plans for the future, feeling of being needed and life satisfaction. Results.– Mean age was 72.6 years in Espoo and 70.9 years in Spain. Elderly living in Spain had higher education, better incomes, lived more oftenwith a partner and had better health (all P<0.001) compared to people living in Espoo. Elderly in Spain used more alcohol than those inEspoo (P<0.001), experiencedmore falls (P=0.09) and fractures (P=0.03), but had better psychological well-being (85,7% vs 60.3%, P<0.001). Conclusions.– Psychological well-being among elderly in our sample is linked to higher education, better incomes, better health and living with a partner. Elderly living in Spain used more alcohol and had better psychological well-being compared to elderly in Espoo.

Effects of combination of amlodipine and aminoacridine or telmisartan anti-hypertension and in improving arterial stiffness in elderly patients with essential hypertension

Effects of combination of amlodipine and aminoacridine or telmisartan anti-hypertension and in improving arterial stiffness in elderly patients with essential hypertension

Lipoprotein (a) as a determinant of arterial stiffness in elderly patients with type 2 diabetes mellitus

Background Lipoprotein (a) [Lp(a)] is known to be a risk factor for atherosclerotic disease. However, the relationship between Lp(a) and arterial stiffness has not been clarified. We investigated whether atherosclerotic risk factors, including serum Lp(a), are associated with aortic stiffness in elderly patients with type 2 diabetes mellitus. Methods Aortic stiffness, evaluated by using aortic pulse wave velocity, and major atherosclerotic risk factors were measured in elderly (≥ 65 years) patients with type 2 diabetes mellitus. Relationships between aortic pulse wave velocity, Lp(a) and other atherosclerotic risk factors were analyzed. Results Among the atherosclerotic risk factors measured, age, pulse pressure, hemoglobin A1c (HbA1c), uric acid, fibrinogen, sialic acid and Lp(a) showed significant positive correlations with aortic pulse wave velocity. Lp(a) also showed significant positive correlations with pulse pressure, fibrinogen, sialic acid, apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio. The correlation between Lp(a) and aortic pulse wave velocity was independent of age, sex, blood hemoglobin A1c, uric acid and fibrinogen, history of diabetic nephropathy and therapy with lipid-lowering drugs. Apolipoprotein A-II showed a significant negative correlation with both aortic pulse wave velocity and Lp(a). The median level of Lp(a) in the highest tertile group of subjects divided by aortic pulse wave velocity was significantly higher than the median Lp(a) level in the lowest tertile. The middle and highest tertile groups of subjects divided by aortic pulse wave velocity showed significantly high odds ratios of high Lp(a) levels (≥ 30 mg/dl) vs the lowest tertile. Conclusions Lp(a) is an independent determinant of aortic stiffness in elderly patients with type 2 diabetes mellitus.

Relationship between Remaining Teeth and Arterial Stiffness in Elderly Patients

Relationship between Remaining Teeth and Arterial Stiffness in Elderly Patients

The prostacyclin analogue beraprost sodium prevents development of arterial stiffness in elderly patients with cerebral infarction

Prostacyclin (PGI 2) inhibits platelet aggregation, smooth muscle cell proliferation, and vasoconstriction. Arterial stiffness assessed by pulse wave velocity (PWV) predicts mortality in various cardiovascular diseases. To study the preventive effects of a prostacyclin analogue, beraprost sodium, on arterial PWV values in elderly patients with cerebral infarction. Forty-four patients with a history of cerebral infarction received beraprost sodium (120 μg/day p.o.) or no beraprost sodium (control) for 3 months. Arterial PWV and ankle brachial indices (ABI) were determined prior to starting the medication and after 3 months of medication. Initially, there were no differences in age, blood pressure, and body mass index. Further, PWV or ABI did not differ between the beraprost sodium group ( n=22) and the control group ( n=22). After 3 months, PWV in beraprost sodium group was significantly reduced (−123±282) when compared with the control group (147±274)( P=0.006). ABI was not significantly different when comparing the two groups at 3 months. Long-term administration of beraprost sodium prevents the decline in arterials biomechanics in elderly patients with cerebral infarction.

Arterial stiffness index: A new evaluation for arterial stiffness in elderly patients with essential hypertension

Background: Arterial stiffness is one of the predictors of cardiovascular event. Arterial stiffness is commonly measured by pulse wave velocity between the carotid and femoral arteries. Recently the arterial stiffness index which is measured by computerized oscillometry at the upper arm was developed. As this procedure is a convenient means of measuring pulse wave velocity, we considered it suitable to evaluate arterial stiffness in elderly patients. We evaluated this arterial stiffness index and compared it with other methods of evaluating arterial stiffness in hypertensive patients, including the elderly.Methods: Forty‐two patients with essential hypertension, including 26 subjects over 60 years old were enrolled. We evaluated the arterial stiffness index by computerized oscillometry, and also evaluated arterial stiffness between the carotid‐femoral artery and the brachial‐tibial artery, the second derivative of photoplethysmogram, the forearm vasodilator response to reactive hyperemia by strain‐gauge plethysmography.Results: Arterial stiffness index was positively correlated with pulse wave velocity between the carotid‐femoral artery (P &lt; 0.0001; r = 0.579), the heart‐carotid artery (r = 0.454) and right brachial‐tibial artery (r = 0.549). It was also correlated with b/a (r = 0.474) and d/a (r = 0.568) by a second derivative of photoplethysmogram, but not correlated with a reactive vasodilator response. In elderly patients, arterial stiffness index was also correlated with carotid‐femoral pulse wave velocity (P &lt; 0.05; r = 0.456) but not correlated with a vasodilator response to reactive hyperemia.Conclusion: These data suggest that arterial stiffness index is correlated to common pulse wave velocity between the carotid and femoral arteries, so this index might be useful to evaluate arterial stiffness in hypertensive patients including the elderly.

Cytokines and endothelial cell biology

Ce travail resume les etudes qui ont permi la caracterisation de l'action specifique des cytokines sur les cellules endotheliales. Les cytokines agissent aussi sur l'endothelium dans des cas pathologiques cites dans cet expose