Baseline cfPWV Research Articles

Greater Progression of Age-Related Aortic Stiffening in Adults with Poor Trunk Flexibility: A 5-Year Longitudinal Study.

Purpose: Having a low level of physical fitness, especially cardiorespiratory fitness, appears to accelerate age-related aortic stiffening. Whereas, some studies have reported that trunk flexibility is a component of physical fitness, it is also negatively associated with arterial stiffening independent of cardiorespiratory fitness in cross-sectional studies. However, no long-term longitudinal study has determined whether poor trunk flexibility accelerates the progression of age-related aortic stiffening. We examined trunk flexibility and aortic stiffness progression in a 5-year longitudinal study.Methods and Results: A total of 305 apparently healthy men and women participated in this study (49.6 ± 9.5 years of age). Trunk flexibility was measured using a sit-and-reach test. Aortic stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV) at baseline and after 5 years. Analysis of covariance (ANCOVA) was used to assess the association of the annual rate of cfPWV across flexibility levels (low, middle, high). There were no significant differences in baseline cfPWV among the three groups (835 ± 164, 853 ± 140, 855 ± 2.68 cm/s; P = 0.577). Annual ΔcfPWV was significantly higher in the low-flexibility group than in the high-flexibility group (P = 0.009). ANCOVA revealed an inverse relationship between flexibility level and annual ΔcfPWV (14.41 ± 2.73, 9.79 ± 2.59, 2.62 ± 2.68 cm/s/year; P for trend = 0.011). Multiple regression analysis revealed that baseline sit and reach (β = −0.12, −0.70 to −0.01) was independently correlated with ΔcfPWV following adjustment for baseline peak oxygen uptake, age, sex, body fat, heart rate, and cfPWV. The 5-year change in cfPWV was not significantly correlated with 5-year change in sit-and-reach performance (P = 0.859).Conclusion: Poor trunk flexibility is associated with greater progression of age-related aortic stiffening in healthy adults. However, we failed to confirm a significant association between 5-year change in aortic stiffness and 5-year change in trunk flexibility. The association between increased age-related increase in aortic stiffness and deterioration in flexibility due to age may require observation for more than 5 years.

Baseline predictors of aortic stiffness progression among multi-ethnic Asians with type 2 diabetes

Background and aimsThis 3-year prospective study aimed to identify baseline parameters that predicted the progression of carotid-femoral pulse wave velocity (cf-PWV), which was used to evaluate aortic stiffness, among Singapore's multi-ethnic Asians with type 2 diabetes (T2DM). MethodsThe cf-PWV was measured by the gold-standard tonometry method in 994 T2DM subjects at baseline and follow-up. The annual rate of cf-PWV change was calculated, and individuals above the 90th percentile with rate≥1.42 m/s per year were regarded as rapid progressors (n = 104). In a subgroup analysis of subjects with normal cf-PWV at 1st visit (n = 611), incident aortic stiffness was defined as follow-up cf-PWV≥10 m/s (n = 188). ResultsThe total cohort (mean age:57 ± 10 years; 53.4% Chinese, 20.4% Malay, 22.9% Indian, 3.2% ‘Others’) displayed a median annual cf-PWV progression rate of 0.2 m/s. Adjusted multivariate regression analyses showed that baseline age, cf-PWV and body mass index (BMI) constantly predicted follow-up cf-PWV, annual cf-PWV progression rate, rapid cf-PWV progression, and incident aortic stiffness. Paradoxically, lower baseline cf-PWV was associated with elevated annual cf-PWV progression rate and rapid progressors. This inverse relationship remained significant across ethnicities after ethnic stratification. Higher BMI independently predicted cf-PWV progression in Chinese and Indians, but not in Malay and ‘Others’ ethnic groups. Increased age was a significant predictor in Chinese and ‘Others’ ethnicities. ConclusionsWe demonstrated that baseline BMI is a modifiable independent risk factor of cf-PWV progression and incident aortic stiffness. Therefore, better obesity management may impede aortic stiffness in Singapore's T2DM patients, especially in the Chinese and Indians.

Responsiveness to curcumin intervention is associated with reduced aortic stiffness in young, obese men with higher initial stiffness

Obesity results in greater aortic stiffness assessed by carotid-femoral Pulse Wave Velocity (cfPWV), which is an independent predictor of cardiovascular (CV) events. We hypothesized that a novel curcumin formulation with enhanced bioavailability, CurQfen®, would reduce cfPWV and inflammation in young, obese men. In the present placebo-controlled pilot study, 22 obese subjects (BMI⩾30.0kg/m2) were randomized into placebo (n=11, BMI=33.18±3.38kg/m2) and curcumin (n=11, BMI=33.29±3.69kg/m2) supplemented groups. When CurQfen® was supplemented at 500mg/day for 12weeks, it was found that individuals who did respond to the treatment (n=6) entered the study with higher baseline cfPWV versus those who did not respond (n=5) (6.81±0.83m/s v. 5.84±0.41m/s, p=0.045, group by time interaction). The curcumin responders also had increased plasma IL-13 concentrations (p=0.018, 12weeks v. baseline). These findings suggest CurQfen curcumin has potential to de-stiffen arteries in young, obese men with greater aortic stiffness.

Abstract 13728: Poor Trunk Flexibility is Associated With Greater Progression of Age-related Arterial Stiffening: A 5-year Longitudinal Study

Introduction: Low level of physical fitness, especially cardiorespiratory fitness, appear to accelerate age-related aortic stiffening. Whereas, some studies have reported that flexibility, is one of the components of physical fitness, is also associated with arterial stiffening independent of cardiorespiratory fitness in cross sectional studies. However, no longitudinal study has determined whether poor trunk flexibility might accelerate the progression of age-related aortic stiffening. Hypothesis: Poor trunk flexibility is associated with greater progression of age-related aortic stiffening in apparently healthy adults. Methods: We examined trunk flexibility and aortic stiffness progression in a 5-year follow-up study of 361 healthy men and women aged 27-73 years. Trunk flexibility was measured by a sit-and-reach test. Aortic stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV) at baseline and after 5 years. To assess the effects of flexibility level on the progression of aortic stiffening, the participants were categorized into tertiles (Low, Middle, High) based on their sit-and-reach test values at baseline. ANCOVA was used to analyze the association of the annual rate of cfPWV (cm/ sec/ year) [annual ΔcfPWV = (follow-up cfPWV- baseline cfPWV) / follow-up years] across flexibility levels. Baseline age, BMI, cfPWV, brachial systolic blood pressure, cardiorespiratory fitness and sex were entered as covariates for adjustment. Results: The annual ΔcfPWV was significantly greater in the low (poor) flexibility group (10.95±2.49 cm/sec/year) than in the high flexibility group (2.19±2.41 cm/sec/year) (P=0.041). An inverse relationship was observed between flexibility level and the annual ΔcfPWV (P for trend = 0.042). The multiple regression analysis revealed that baseline sit and reach (β = -0.125), age (β = 0.197), cfPWV (β = - 0.432), cardiorespiratory fitness (β = -0.144), and sex (β = - 0.174) were independent correlates of ΔcfPWV. These data indicate that flexibility is associated with aortic stiffness, independent of other factors already known to be related to arterial stiffness. Conclusions: Poor flexibility is associated with greater progression of age-related aortic stiffening.

The predictive value of arterial stiffness on major adverse cardiovascular events in individuals with mildly impaired renal function.

ObjectivesDespite growing evidence that arterial stiffness has important predictive value for cardiovascular disease in patients with advanced stages of chronic kidney disease, the predictive significance of arterial stiffness in individuals with mildly impaired renal function has not been established. The aim of this study was to evaluate the predictive value of arterial stiffness on cardiovascular disease in this specific population.Materials and methodsWe analyzed measurements of arterial stiffness (carotid–femoral pulse-wave velocity [cf-PWV]) and the incidence of major adverse cardiovascular events (MACEs) in 1,499 subjects from a 4.8-year longitudinal study.ResultsA multivariate Cox proportional-hazard regression analysis showed that in individuals with normal renal function (estimated glomerular filtration rate [eGFR] ≥90 mL/min/1.73 m2), the baseline cf-PWV was not associated with occurrence of MACEs (hazard ratio 1.398, 95% confidence interval 0.748–2.613; P=0.293). In individuals with mildly impaired renal function (eGFR <90 mL/min/1.73 m2), a higher baseline cf-PWV level was associated with a higher risk of MACEs (hazard ratio 2.334, 95% confidence interval 1.082–5.036; P=0.031).ConclusionArterial stiffness is a moderate and independent predictive factor for MACEs in individuals with mildly impaired renal function (eGFR <90 mL/min/1.73 m2).

Correlates of aortic stiffness progression in patients with resistant hypertension: importance of clinic and ambulatory blood pressure changes.

Correlates of serial aortic stiffness changes were scarcely evaluated. We aimed to evaluate them in patients with resistant hypertension, with particular attention to the importance of changes in clinic and ambulatory blood pressures (BP). In a prospective study, two carotid-femoral pulse wave velocity (cf-PWV) measurements (three measures in each occasion) were performed with the Complior equipment in 442 resistant hypertensive patients over a mean follow-up of 4.6 years. Multivariable regressions assessed the independent correlates of changes in cf-PWV. All analyses were further adjusted for baseline cf-PWV and BP values, and for the time interval between measurements. Carotid-femoral PWV had a median increase of 0.11 m/s per year (1.1% per year). Overall, 224 patients (51%) had an increase or persisted with high cf-PWV, whereas 218 (49%) reduced or persisted with low values. On multivariable regressions, both changes in clinic SBP (partial correlation 0.34, P < 0.001) and in 24-h SBP (partial correlation 0.40, P < 0.001) were correlates of changes in cf-PWV. This means that the white-coat effect, defined as the difference between clinic and daytime BPs, affected cf-PWV changes (partial correlation 0.19, P < 0.001). The other independent correlates of aortic stiffness progression were older age, presence of diabetes, higher waist circumference and worse renal function. The exaggerated white-coat effect, by acutely increasing clinic BPs during cf-PWV examination, may partially obscure the beneficial effects of reducing ambulatory BP levels on aortic stiffness attenuation. Arterial stiffness measurements under ambulatory conditions may be needed to correctly assess aortic stiffness changes in resistant hypertensive patients.

Effects of Smoking on Arterial Stiffness in Male Adolescents in Lusaka, Zambia.

Tobacco smoke is harmful to health. In the acute phase it causes changes in the cardiovascular system that result in an increase in blood pressure (BP). An increase in arterial stiffness due to arteriolar endothelial dysfunction has been cited among the causes. Pulse Wave Velocity (PWV) and Arterial Stiffness Index (ASI) are used as measures of arterial stiffness in the adult population. To determine the acute effects of tobacco smoke on arterial stiffness in black male adolescents in Lusaka, Zambia. This was an observational study done at the University of Zambia School of Medicine Cardiovascular Research Laboratory in the month of December 2014. Twenty-two (22) black, male-adolescent (age range 19-25 years), active-smokers, consented to participate in the study. The Complior Analyse Unit (V1.9 Beta Version 2013; ALAM-Medical, France) protocol was used to obtain the carotid-femoral PWV (cfPWV) and carotid-femoral ASI (cfASI) starting 15 minutes before smoking, on immediate cessation of smoking and thereafter every 15 minutes up to an hour after smoking. ASI was a surrogate measure of the loss of elasticity in the arteries. The mean baseline cfPWV was 7.9±1.94 m/s and cfASI was 26.1±6.0 m/s. Smoking two tobacco cigarettes (2.8 mg Nicotine) in 15 minutes caused an increase in mean cfPWV and cfASI from their baseline values to cfPWV of 8.5±1.87 m/s and cfASI of 28.6±6.19 m/s respectively. These values reverted to baseline within 15 minutes post-smoking cessation. There was further reduction in both cfPWV and cfASI to more stable values at 45th and 60th minutes which were statistically significantly lower than the peak values recorded. The mean baseline cfPWV and cfASI in these late adolescents were comparatively higher than those recorded in non-smoking black adolescents and smoking white men and women. These recordings were also much higher than the values recorded 60 minutes after cessation of smoking. Compared to these values, we conclude that tobacco smoke may be the cause of the significant acute increase in cfPWV and cfASI in African male adolescents presumably signifying an increase in arterial stiffness probably due to endothelial dysfunction in elastic arteries. These alterations in vascular compliance may predispose these individuals to developing hypertension and other cardiovascular complications. There is need for further investigation of this phenomenon.

Temporal Response of Arterial Stiffness to Ultra-Marathon

The purpose of this investigation was to characterize the arterial stiffness of male ultra-marathon runners (n = 9) using pulse wave velocity (cfPWV) and radial tonometry over the course of an ultra-marathon and during recovery. Measures were collected at rest, immediately following 45 km/75 km of running, then following 60 and 90 min of recovery. No statistical difference was found between baseline cfPWV and normative values. The cfPWV of ultra-endurance runners decreased at 45 km (3.4 ± 1.6 m/s, p=0.006), followed by an increase (1.6 ± 1.8 m/s, p = 0.04) toward baseline levels at the 75 km mark. Radial tonometry measures also indicated small artery stiffness was transiently increased after 75 km. The amount of training time (r = 0.82, p = 0.007) and the duration of a typical training session (r = 0.73, p = 0.03) were correlated strongly with persisting decrements in large artery compliance at 60 min of recovery. The finding that arterial stiffness decreased at the 45 km distance and then reverted back toward baseline levels with prolonged running, may indicate a role of exercise duration or accumulated stress for affecting vascular compliance. At present, it is premature to suggest that athletes should alter training or racing practices to protect vascular health.

Assessment of arterial stiffness during a five-years follow up in a general population in northern Italy

Background: Carotid-femoral pulse wave velocity (cfPWV) is an independent predictor of cardiovascular events and its measurement is recommended by current hypertension guidelines. Very few data are available on the progression of PWV over time. The aim of the present longitudinal study was to compare the progression of aortic stiffness over a 5-year period in a general population in Northern Italy (Vobarno Study). Methods: 227 subjects, 42% males (age 50 4 years and hypertension in 51% at baseline visit), underwent a baseline (BL) and a follow up (FU) visit, after 5.1 0.4 years. In all subjects laboratory examinations, measurement of clinic and 24 hours blood pressure (BP) and of PWV were performed at BL and at FU. Results: In the overall population cfPWV increased from 8.28 1.27 at BL to 8.51 3.2 m/s at FU (p<0.05), change: 0.22 1.25. cfPWV significantly increased from BL to FU in hypertensive subjects (HT) (from 8.61 1.41 to 8.90 1.40, p<0.01) but not in normotensives (NT) (from 7.97 1.03 to 8.11 1.11, p n.s). The absolute change in cfPWV from BL to FU progressively increased from -0.052 0.108 in NT, to 0.480 0.163 in treated HT and to 0.483 0.138 in untreated HT (p for linear trend<0.01); after adjustment for possible confounders (age, gender, BMI, baseline cfPWV and change in mean BP from baseline) the difference remained statistically significant. At multivariate analysis the variables independently related to the progression of cfPWV were age (beta 0.18, p<0.01) and cfPWV, mean BP at BL (beta -0.55, p<0.01, and beta 0.18, p<0.01, respectively) and the change in mean BP during follow-up (beta 0.20, p1⁄40.001). Conclusions: In a general population sample in Northern Italy the main determinants of the increase in arterial stiffness during a 5 years FU were age, cfPWV and mean BP at BL and change in mean BP over time.

As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout

We prospectively evaluated whether an effective 12-month uric acid-lowering therapy (ULT) with the available xanthine oxidase (XO) inhibitors allopurinol and febuxostat in patients with chronic tophaceous gout has an impact on oxidative stress and/or vascular function. Patients with chronic tophaceous gout who did not receive active ULT were included. After clinical evaluation, serum uric acid levels (SUA) and markers of oxidative stress were measured, and carotid-femoral pulse wave velocity (cfPWV) was assessed. Patients were then treated with allopurinol (n = 9) or with febuxostat (n = 8) to target a SUA level ≤ 360 μmol/L. After 1 year treatment, the SUA levels, markers of oxidative stress and the cfPWV were measured again. Baseline characteristics of both groups showed no significant differences except a higher prevalence of moderate impairment of renal function (estimated glomerular filtration rate <60 ml/min) in the febuxostat group. Uric acid lowering with either inhibitors of XO resulted in almost equally effective reduction in SUA levels. The both treatment groups did not differ in their baseline cfPWV (allopurinol group: 14.1 ± 3.4 m/s, febuxostat group: 13.7 ± 2.7 m/s, p = 0.80). However, after 1 year of therapy, we observed a significant cfPWV increase in the allopurinol group (16.8 ± 4.3 m/s, p = 0.001 as compared to baseline), but not in the febuxostat patients (13.3 ± 2.3 m/s, p = 0.55). Both febuxostat and allopurinol effectively lower SUA levels in patients with severe gout. However, we observed that febuxostat also appeared to be beneficial in preventing further arterial stiffening. Since cardiovascular events are an important issue in treating patients with gout, this unexpected finding may have important implications and should be further investigated in randomized controlled trials.

SAT0357 As Compared with Allopurinol Only Febuxostat Preserves Vascular Function in Patients with Chronic Tophaceous Gout

BackgroundGout patients often suffer from metabolic comorbidities, such as arterial hypertension, hyperlipoproteinaemia, or diabetes which, presumably via deteriorating endothelial function, frequently result in increased vascular stiffness. Increased arterial stiffness has...

Effects of CPAP on &amp;quot;vascular&amp;quot; risk factors in patients with obstructive sleep apnea and arterial hypertension

BackgroundThe aim of this study was to assess the effects of continuous positive airway pressure (CPAP) on arterial stiffness, central blood pressure, and reflected pulse wave characteristics in patients with severe obstructive sleep apnea (OSA) and stage 2–3 arterial hypertension.MethodsForty-four patients with hypertension and severe OSA (apnea/hypopnea index > 30) received stepped dose titration of antihypertensive treatment, consisting of valsartan 160 mg + amlodipine 5–10 mg + hydrochlorothiazide 25 mg. CPAP therapy was added after 3 weeks of continuous antihypertensive treatment with BP < 140/90 mmHg or after adjusting triple treatment in patients with resistant arterial hypertension. The patients were randomized to effective CPAP (4–15 mm H2O) or placebo CPAP (pressure 4 mm H2O) for three weeks, then crossed over to the alternative treatment in a single-blind manner. Office blood pressure (BP), ambulatory BP monitoring, ambulatory arterial stiffness index (AASI), aortic BP, carotid-femoral pulse wave velocity (cfPWV), and systolic wave augmentation index were measured using a Sphygmocor® device at baseline, after antihypertensive treatment, placebo CPAP, and effective CPAP.ResultsBaseline cfPWV was above the normal range in 94% of patients. After reaching target BP, the cfPWV decreased by 1.9 ± 1.0 msec (P = 0.007). Effective CPAP achieved a further cfPWV reduction of 0.7 msec (P = 0.03). Increased arterial stiffness (pulse wave velocity > 12 msec) persisted in 35% of patients on antihypertensive treatment and effective CPAP, in 56% of patients on antihypertensive treatment alone, and in 53% of patients on placebo CPAP. Only the combination of antihypertensive treatment with effective CPAP achieved a significant reduction in augmentation index and AASI, along with a further reduction in aortic and brachial BP.ConclusionEffective CPAP for 3 weeks resulted in a significant additional decrease in office BP, ambulatory BP monitoring, central BP, and augmentation index, together with an improvement in arterial stiffness parameters, ie, cfPWV and AASI, in a group of hypertensive patients with OSA.

Prognostic Value of Arterial Pulse Wave Velocity in Peritoneal Dialysis Patients

Background: Cardiovascular disease is the most common cause of mortality in chronic peritoneal dialysis (PD) patients. Increased arterial stiffness may be related to a high peritoneal permeability, resulting in fluid overload of PD patients. We examined the prognostic value and factors that govern the longitudinal change of arterial pulse wave velocity (PWV) in Chinese PD patients. Method: We enrolled 155 new PD patients. PWV was measured at baseline and then repeated after 2 years of follow-up. Results: At 24 months, the survival of patients with baseline carotid-femoral (CF)-PWV above 10 m/s was significantly worse than that of those with CF-PWV below 10 m/s (76.1 vs. 88.6%, p = 0.006). However, after adjusting for confounding factors, CF-PWV was not an independent predictor of survival. Amongst the 100 patients who had repeated PWV measurement after 2 years, the average CF-PWV increased from 9.92 ± 2.04 to 11.00 ± 2.30 m/s (p < 0.0001). The change in CF-PWV over 2 years significantly correlated with systolic blood pressure (r = 0.241, p = 0.036), serum calcium level (r = 0.231, p = 0.044), and normalized protein nitrogen appearance (NPNA) (r = –0.337, p = 0.001). Conclusions: A high baseline CF-PWV was associated with a lower overall survival of Chinese PD patients, but the prognostic value of CF-PWV disappeared after adjusting for confounding factors. After 2 years of PD, most patients had progressive increase in CF-PWV; the magnitude of increase is related to systolic blood pressure, serum calcium level, and baseline NPNA. Further study is needed to determine whether serial measurement of CF-PWV provides additional prognostic information.

Telmisartan Versus Valsartan in Patients With Hypertension: Effects on Cardiovascular, Metabolic, and Inflammatory Parameters

Background and ObjectivesAngiotensin-receptor blockers (ARBs) have beneficial effects on cardiovascular, metabolic, and inflammatory parameters in addition to controlling blood pressure (BP). However, few comparative clinical studies have been conducted with different ARBs. We compared these effects in patients with uncomplicated hypertension who were receiving telmisartan or valsartan.Subjects and MethodsThe subjects were patients with essential hypertension (48.4±9.6 years) who were randomly assigned to take either telmisartan (80 mg/day, n=30) or valsartan (160 mg/day, n=30) for 12 weeks. Their anthropometric, laboratory, vascular, and echocardiographic data were measured at baseline and at the end of the study.ResultsBaseline characteristics were not significantly different between the two groups, except for the carotid-femoral pulse wave velocity (cfPWV; telmisartan group vs. valsartan group; 841.2±131.0 vs. 761.1±104.4 cm/s, p<0.05). After 12 weeks, BP had fallen to a similar extent with mean reductions in the systolic and diastolic BP of 20.7±18.1 and 16.3±13.0 mm Hg (p<0.001, respectively) for the telmisartan and 22.5±17.0 and 16.8±9.3 mm Hg (p<0.001, respectively) for the valsartan group. Although the cfPWV and left ventricular mass index (LVMI) fell significantly only with the administration of telmisartan, they were not significantly different when baseline cfPWV was considered. The differences in the cfPWV and LVMI changes from baseline between the two groups were also not significant after adjusting for baseline cfPWV. No significant changes in other vascular, metabolic, or inflammatory parameters were observed with either treatment.ConclusionThe effects of a 12-week treatment with the two ARBs, telmisartan and valsartan, on cardiovascular, metabolic, and inflammatory parameters were not different in patients with uncomplicated hypertension.