Brachial-ankle Pulse Wave Velocity Research Articles

PS-BPC12-1: AGE-RELATED DIFFERENCES IN LONGITUDINAL ASSOCIATIONS BETWEEN ALCOHOL INTAKE AND ARTERIAL STIFFNESS, PRESSURE WAVE REFLECTION, AND INFLAMMATION IN MALE EMPLOYEES

Backgrounds: The effect of alcohol intake on arterial stiffness related to macro-vascular damage, pressure wave reflection related to both macro- and micro- vascular damages and inflammation have not been fully concluded. Aims: In the present longitudinal observational study, which conducted in annually repeated measurements data, mixed model analyses were applied to examine the difference of longitudinal associations of amount of alcohol intake (i.e., non, mild, moderate and heavy) with arterial stiffness, pressure wave reflection and inflammation. Methods: In 4016 middle-aged (43 ± 9 years) healthy Japanese men without cardiovascular disease (CVD) at the study baseline, alcohol intake, which obtained by questionnaire, risk factors for CVD, brachial-ankle pulse wave velocity (brachial-ankle PWV), radial augmentation index (rAI), and serum C-reactive protein levels (CRP) were measured annually during a 9-year study period. Results: In this repeated measurements data, mix model linear regression analyses demonstrated that alcohol intake had a significant longitudinal association with brachial-ankle PWV and rAI in dose-dependent manner {i.e., non, Mild (1–10 g/day), Moderate (10–30 g/day) and heavy (Over 30 g/day) ethanol intake} (Figure). When baPWV was included as a covariate, the association of alcohol intake with rAI was significant. On the other hand, the serum CRP levels were significantly lower in mild to moderate alcohol intake groups as compared to other groups (i.e., U-shaped) (Figure). Conclusion: The amount of alcohol intake may have longitudinal linear association with increased arterial stiffness and abnormal pressure wave reflection, but it may have a U-shaped relationship with inflammation reflected by serum CRP levels. Thus, the alcohol intake may longitudinally affect both macro- and micro- vascular damages in a linear dose-dependent manner without mediating inflammation.

PS-C26-4: ASSOCIATIONS BETWEEN ARTERIAL STIFFNESS INDICES AND CHRONIC KIDNEY DISEASE CATEGORIES IN ESSENTIAL HYPERTENSIVE PATIENTS

Background: This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients by using oscillometric device. Methods: Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria. Results: The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P < 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P < 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P < 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change. Conclusions: In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.

PS-BPC02-4: RELATIONSHIP BETWEEN EXERCISE CAPACITY AND CHANGES OF PULSE WAVE VELOCITY AFTER CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: Guidelines strongly recommend exercise-based cardiac rehabilitation (CR) to reduce cardiovascular mortality in patients with acute myocardial infarction (AMI). Reduction of central aortic systolic pressure, augmentation index, and pulse wave velocity (PWV) after aerobic exercise may be associated with better clinical outcomes after CR. However, the change of pulse wave velocity after CR in patients with AMI has been rarely investigated. Design and Method: Sixty-five patients (age 55.3 ± 10.1 years, 63 men) with AMI who completed the 6-month CR and evaluation program were included in this study. Maximal oxygen uptake (VO2max) during cardiopulmonary exercise (CPX) testing and brachial-ankle PWV (baPWV) were measured before exercise program and after 6 months. Based on the results of baseline CPX testing, each exercise program which included target metabolic equivalent, target heart rate, and exercise duration, was prescribed. Patients were recommended to attend the outpatient CR program which composed of 8 to 12 visits during 4 to 6 weeks. Self-exercise program was educated for each patient who finished or denied the outpatient CR program. Results: After 6 months, VO2max was increased from 28.9 ± 5.79 to 31.7 ± 6.5 mL/kg/min (p < 0.001) and baPWV was decreased from 14.68 ± 2.66 to 13.54 ± 2.92 m/sec (p < 0.001). Changes of baPWV (Delta-baPWV) showed a significant negative correlation with 6-month VO2max (r = -0.339, p = 0.006). Patient were divided into group 1 (n = 32, Delta-baPWV <-1.13 m/sec) and group 2 (n = 33, Delta-baPWV > = -1.13 m/sec). Group 1 showed higher 6-month VO2max (33.5 ± 6.7 vs. 29.9 ± 5.9 mL/kg/min; p = 0.023). On logistic regression analysis, 6-month VO2max was a significant determining factor for Delta-baPWV (OR 1.159, 95% CI 1.030–1.305, p = 0.014) after adjustment of age, sex, height and baseline baPWV. Conclusions: Patients with better exercise capacity after CR program showed more decreased PWV.

PS-BPP03-6: HIGHER ARTERIAL STIFFNESS IS ASSOCIATED WITH SILENT CEREBRAL SMALL VESSEL DISEASE IRRESPECTIVE OF BLOOD PRESSURE

Objectives: Arterial stiffness and hypertension are important risk factors for cerebral small vessel diseases (CSVD). Arterial stiffness assessed by pulse wave velocity (PWV) is closely related with hypertension. Higher PWV represents an organ damage from hypertension. However, there are hypertensive patients with lower PWV and non-hypertensive subjects with higher PWV in clinical practice. The aim of the study is to determine the impact of PWV on CSVD in non-hypertensive and hypertensive individuals. Design and method: An observational cross-sectional study was conducted in 1894 stroke-free participants who underwent a brain magnetic resonance imaging and brachial-ankle PWV (baPWV) at a health checkup between 2013 and 2020. baPWV were measured using an automatic oscillometric device. The presence of CSVD, including white matter hyperintensities, cerebral microbleeds, silent lacunar infarcts, and dilated periventricular spaces, were determined by brain magnetic resonance imaging. Participants were divided into 4 groups according to blood pressure (BP, 120/80 mmHg) and baPWV (14.63 m/s, a cutoff value that predicted the presence of CSVD). Results: The mean age was 57 years (41% women). The prevalence of CSVD was 718 (38%), and it was higher in low BP with high baPWV group (56%) and high BP with high baPWV group (55%) compared to high BP with low baPWV group (24%) and low BP with low baPWV group (22%). Both low BP with high baPWV group (odds ratio 1.89; 95% CI, 1.00–3.56) and high BP with high baPWV group (odds ratio 2.12; 95% CI, 1.41–3.21), but not high BP with low baPWV group (odds ratio 1.19, 95% CI 0.76–1.86), had significantly higher odds ratio for the presence of CSVD compared with low BP with low baPWV group, after adjustment for age, sex, and other conventional risk factors, and use of any agents for hypertension, dyslipidemia, and diabetes. Conclusions: Individuals with high baPWV had higher prevalence of CSVD, irrespective of BP status. It is likely that higher arterial stiffness is an important risk for CSVD in stroke-free healthy populations.

PS-BPP02-1: EFFECTS OF INCREASED ARTERIAL STIFFNESS ON HEMODYNAMIC RESPONSE DURING AND AFTER SUBMAXIMAL STEP EXERCISE TEST IN MIDDLE-AGED NORMOTENSIVE INDIVIDUALS

Objective: This study was designed to examine the effects of increased arterial stiffness on hemodynamic response during and after simple step exercise test in middle-aged normotensive individuals. Design and method: The study participants consisted of 819 untreated normotensive individuals (aged 54.8 years; 39.6% men) without a history of cardiovascular disease, stroke, and renal disease. The participants underwent a submaximal step exercise test (25 steps/min for 2 min). Brachial arterial blood pressure (BP) and pulse rate were measured at 1-min interval before, during, and after the step exercise test. During the end of exercise (exercise SBP) and 2 min after exercise (recovery SBP) were evaluated. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness using an oscillometric device. Results: The mean values of resting SBP, exercise SBP, and recovery SBP were 121 ± 12 mmHg, 153 ± 17 mmHg, and 130 ± 14 mmHg, respectively. The individuals with increased baPWV (> = 1400 cm/s, n = 305) showed significantly higher exercise SBP and recovery SBP than those with normal baPWV (Exercise, 162 ± 16 mmHg vs. 148 ± 16 mmHg, P < 0.001; Recovery, 138 ± 13 mmHg vs. 125 ± 13 mmHg, P < 0.001). The odds ratios for an exaggerated exercise SBP (> = 180 mmHg) and delayed recovery SBP (> = 150 mmHg) in individuals with increased baPWV were 2.7 (95%CI, 1.8–4.9; P = 0.001) and 3.3 (95%CI, 1.8–6.2; P < 0.001) after adjusting for age, gender, body mass index, and resting SBP. When participants were divided according to a combination of exercise SBP and recovery SBP, the baPWV of the subgroup with exaggerated exercise SBP and delayed SBP recovery was higher than that of those with only exaggerated exercise SBP and delayed SBP recovery (Both, 1585 ± 301 cm/s; Exercise, 1505 ± 232 cm/s; Recovery, 1475 ± 160 cm/s). Conclusion: Exaggerated BP increase and delayed BP recovery during submaximal step exercise test are associated with increased arterial stiffness in normotensive individuals. Subclinical vascular impairment may influence vascular reactivity to a greater degree than basal tone and could be identified by an abnormal BP response to exercise even before clinical manifestation of hypertension.

The effect of arteriosclerosis on new-onset renal damage in diabetic patients.

The aim of this study was to investigate the effect of arteriosclerosis on new-onset renal damage in a Chinese community population with diabetes. Patients with diabetes who had attended at least one physical examination after the Brachial-ankle pulse wave velocity (BaPWV) test from 2010 to 2018 were selected as subjects. A total of 4,462 patients were included in the study cohort. BaPWV levels <1,400 cm/s, 1,400-1,799 cm/s, and ≥1,800 cm/s were applied to divide the subjects into a normal arterial stiffness group, borderline atherosclerosis group and atherosclerosis group. Renal damage was defined by isolated proteinuria, isolated eGFR <60 mL/min/1.73 m2, proteinuria and eGFR <60 mL/min/1.73 m2. A Cox proportional risk model was used to analyze the effect of different groups on new-onset renal damage. After a median follow-up of 2.85 (1.88-4.90) years, Cox proportional risk models showed that after adjusting for risk factors, compared with the normal group, the HR and 95% CI of the risk of new-onset renal damage were 1.29 (95% CI: 0.95-1.76) and 1.59 (95% CI: 1.14-2.22) in the borderline atherosclerosis group and the atherosclerosis group, respectively. Atherosclerosis is a risk factor for new-onset renal damage, especially new-onset proteinuria, in diabetic patients.

Association of baseline and dynamic arterial stiffness status with dyslipidemia: a cohort study.

Dyslipidemia is known to contribute to arterial stiffness, while the inverse association remains unknown. This study aimed to explore the association of baseline arterial stiffness and its changes, as determined by brachial-ankle pulse wave velocity (baPWV), with dyslipidemia onset in the general population. This study enrolled participants from Beijing Health Management Cohort using measurements of the first visit from 2012 to 2013 as baseline, and followed until the dyslipidemia onset or the end of 2019. Unadjusted and adjusted Cox proportional regression models were used to evaluate the associations of baseline baPWV and baPWV transition (persistent low, onset, remitted and persistent high) with incident dyslipidemia. Of 4362 individuals (mean age: 55.5 years), 1490 (34.2%) developed dyslipidemia during a median follow-up of 5.9 years. After adjusting for potential confounders, participants with elevated arterial stiffness at baseline had an increased risk of dyslipidemia (HR, 1.194; 95% CI, 1.050-1.358). Compared with persistent low baPWV, new-onset and persistent high baPWV were associated with a 51.2% and 37.1% excess risk of dyslipidemia. The findings indicated that arterial stiffness is an early risk factor of dyslipidemia, suggesting a bidirectional association between arterial stiffness and lipid metabolism.

Changes in Lp-PLA 2 are associated with elevated alanine aminotransferase levels: A nested case-control study in a three-year prospective cohort

Background/Aim: Elevation in liver enzymes and hepatic fat may indicate a higher susceptibility to cardiovascular disease (CVD). This research sought to find anthropometric/biochemical variables significantly related to the alanine aminotransferase (ALT) increase in healthy populations. Methods: Nine hundred healthy subjects were included in a 3-year prospective cohort study. The initial screening revealed that 538 were found to be nondiabetic (fasting glucose &lt; 126 mg/dL) and had normal ALT levels. Among them, 79 individuals with slightly elevated ALT levels after three years were assigned to the elevated ALT group. Of the remaining 459 participants, 241 subjects matched to the increased ALT group were the control group. Results: After three years of follow-up, individuals with elevated ALT showed notably higher aspartate aminotransferase (AST), ALT, gamma-glutamyl-transferase (g-GT), high sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2 (Lp-PLA2 ) activity, oxidised low-density lipoprotein (ox-LDL), urinary 8-epi-prostaglandin F2a (8-epi-PGF2a) levels and brachial-ankle pulse wave velocity (ba-PWV) in comparison to the control group. Changes (D) in ALT showed a positive correlation with D AST, D gammaGT, D hs-CRP, D Lp-PLA2 activity, D ox-LDL, D urinary 8-epi-PGF2a and D ba-PWV. Furthermore, a direct positive link was observed between the D Lp-PLA2 activity and D AST, D ox-LDL and D ba-PWV. Conclusion: Increased Lp-PLA2 activity and other CVD risk indicators were observed to have a pronounced association with elevated ALT levels. This mild ALT elevation could potentially contribute to chronic low-grade inflammation.

PS-C29-8: EFFECT OF WEIGHT GAIN ON ARTERIAL STIFFNESS AND PRESSURE WAVE REFLECTION: A 9-YEAR LONGITUDINAL STUDY

Background and Aim: Obesity is a causal factor for conventional risk factors for cardiovascular disease (CVD), and these risk factors affect increased arterial stiffness and also abnormal pressure wave reflection in arterial tree. Even so, because of the potent direct influences of these risk factors on arterial stiffness and pressure wave reflection, the direct effect of obesity on these vascular abnormalities has been still controversial. Then, the present study examined the effect of weight gain on those vascular abnormalities. Methods and Results: In 4016 middle-aged (43 ± 9 years) healthy Japanese men without CVD at the study baseline, body weight, risk factors for CVD, brachial-ankle pulse wave velocity (baPWV), and radial augmentation index (rAI) were measured at the baseline and end of study period (mean duration of follow-up was 6.3 years). The study subjects were divided into 3 groups by the change of BMI during the study period. While the change of baPWV in the highest tertile range of increase in BMI (57 ± 138 cm/sec) was larger than that in the lowest tertile range of increase in BMI (46 ± 136 cm/sec)(P &lt; 0.05), these differences were not significant after the adjustment of changes of blood pressure. In addition, the change of rAI was similar between both groups. Conclusions: Weight gain may affect increase in arterial stiffness rather than abnormal pressure wave reflection, and this effect may be mediated by increase in blood pressure related to weight gain rather than the direct effect of weight gain.

Cardiovascular Risk Age Reflects Arterial Status: Middle-Aged People Showed Equivalent Arterial Stiffness to Older People in the Same Risk Category.

The concept of risk age may help overcome an excessive weight of age in cardiovascular risk functions. This study aimed to evaluate the equivalence of risk age with arterial stiffness by comparing people with increased risk age and individuals with the same chronological and risk age. In order to materialize this aim, we categorized individuals based on cardiovascular risk and compared groups with increased risk factors (other than age) and groups with normal levels. This is a cross-sectional population-level study carried out in Girona province within the context of the REGICOR study (Girona Heart Registry). In this study, individuals aged 35-90 years who had a brachial-ankle pulse wave velocity measurement and with no previous cardiovascular disease or peripheral arterial disease were included. Cardiovascular risk was estimated with the FRESCO (in 35-79 year-olds), SCORE2 (in 35-69 year-olds), and SCORE2-OP (in 70-90 year-olds) functions and categorized to calculate and compare (in each category) the median chronological age in the group with increased risk factors and the reference. Arterial stiffness was assessed with the brachial-ankle pulse wave velocity (baPWV). The analyses were carried out separately by sex. In this study, 2499 individuals were included, with a mean age of 59.7 and 46.9% of men. Men presented worse health condition, including a higher mean cardiovascular disease risk score. Both men and women with increased levels of risk factors showed worse health condition than the respective men and women with optimal levels. In each risk category, the groups with higher risk age than chronological age (increased risk factors) were similar in baPWV values to the groups with the same chronological and risk ages (reference), who were consistently older. In categories with the same cardiovascular risk, the arterial stiffness of participants with a higher risk factor burden (increased risk age) matched that of older participants with the rest of the risk factors at optimal levels (same chronological and risk age). These results support the guidelines on the utilization of risk age to explain heightened cardiovascular risk, particularly among individuals in middle age.

PS-C06-12: HETEROGENEITY AND OVERLAP OF THE LONGITUDINAL ASSOCIATIONS AMONG INCREASED ARTERIAL STIFFNESS, HYPERTENSION AND DIABETES MELLITUS: A 16-YEAR PROSPECTIVE OBSERVATIONAL STUDY

Background: Hypertension and diabetes mellitus frequently coexist; however, differences in the bi-directional longitudinal relationships of arterial stiffness with hypertension and diabetes mellitus have not yet been clarified. Methods: In this 16-year prospective observational study, 3981 middle-aged Japanese subjects without hypertension/diabetes mellitus at the study baseline underwent annual measurements of the blood pressure, serum glycosylated hemoglobin A1c (HbA1c), and brachial-ankle pulse wave velocity (baPWV). Results: By the end of the study period, 664, 779, 154 and 406 subjects developed hypertension, prehypertension, diabetes mellitus and prediabetes, respectively. Increased baPWV at the baseline was associated with a significant odds ratio for new onset of prehypertension/hypertension without (beta = 5.0 x 10–3, P &lt; 0.01) or with (beta = 4.0 x 10–3, P &lt; 0.01) coexisting prediabetes/diabetes mellitus; no such association was found with new onset of prediabetes/diabetes mellitus alone. Furthermore, baPWV showed significant longitudinal associations with the development of all of the above conditions. Conversely, elevated mean blood pressure, even in the pre-hypertensive range, showed a significant longitudinal association with increase of the baPWV. Conclusions: In middle-aged Japanese subjects, a vicious cycle may be triggered between elevated blood pressure, even from the prehypertensive stage, and arterial stiffening and development of diabetes mellitus may be observed as a cross phenomenon of this vicious cycle with a collateral event. Arterial stiffness may be a key element in the development of hypertension, so that its contribution to cardiovascular risk may be greater in patients with hypertension than in those with diabetes mellitus.

PS-C11-8: RELATIONS BETWEEN WHITE COAT EFFECT OF BLOOD PRESSURE AND ARTERIAL STIFFNESS

The aim of this study was to analyze the relationship between brachial-ankle pulse wave velocity (b-a PWV) and white coat effect (WCE), that is the difference between the elevated office blood pressure (BP) and the lower mean daytime pressure of ambulatory BP. A total of 444 patients with WCE for systolic BP (54.1% female, age 61.86 ± 13.3 years) were enrolled in the study. Patients were separated into low white coat effect (&lt; 9.5mmHg) and high white coat effect (&gt; = 9.5mmHg) according to the median of WCE. The subjects with a high WCE showed a greater degree of arterial stiffness than those with a low WCE for systolic BP values (P &lt; 0.05). The b-a PWV were 17.2 ± 3.3m/s and 18.4 ± 3.4 m/s in low WCE and high WCE, respectively. The b-a PWV increased with the increase of WCE, showing a positive correlation between them (P &lt; 0.05 for non-linearity). The significant association between the high WCE (β = 87.95, 95% Cl 35.97–139.93, P = . 001) and the b-a PWV was confirmed by the results of multiple regression analysis after adjusting for confounding factors. Similar results were observed in subgroups. In conclusion, WCE is significantly associated with arterial stiffness. More research is needed to determine the WCE and target organ damage.

S-46-3: ANTIHYPERTENSIVE TREATMENT IN MASKED HYPERTENSION FOR TARGET ORGAN PROTECTION (ANTI-MASK): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Objective: Masked hypertension is associated with target organ damage and adverse outcomes. However, up to now there is no interventional evidence that antihypertensive therapy will be beneficial to the patients. Design and methods: The ANTIhypertensive treatment in MASKed hypertension for target organ protection (ANTI-MASK) trial is a multicenter, randomized, double-blind, placebo-controlled clinical trial (NCT02893358). Eligible patients were 30 to 70 years old, had untreated masked hypertension and at least one sign of target organ damage (TOD). Masked hypertension was defined as a normal office blood pressure (BP, &lt; 140/90 mmHg) and an elevated 24-hour (&gt; = 130/80 mmHg), daytime (&gt; = 135/85 mmHg) or nighttime BP (&gt; = 120/70 mmHg) at both screening visits. TOD included electrocardiogram diagnosed left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (ba-PWV) &gt; = 1400 cm/s, or a random urinary albumin-to-creatinine ratio (ACR) &gt; = 2.5 mg/mmol in men and &gt; = 3.5 mg/mmol in women. Randomized patients were treated with alisartan 80 mg per day or placebo. If ambulatory BP was uncontrolled, drug dosage was doubled at the 2-month visit, and amlodipine 2.5 mg or matching placebo was added at the 4-month visit. The primary endpoint was the improvement rate of TOD after 12 months treatment, defined as the reverse (yes to no) of TOD or a significant decrease of ba-PWV or ACR by &gt; = 20% of the baseline level. Results: From Feb 2017 to Oct 2020, 317 patients with masked hypertension (43.2% women, mean age 54 years) were randomized in 13 hospitals in China. Overall, baseline office, 24-h, daytime and nighttime BPs averaged 130/81,137/85, 141/87, and 126/77 mmHg, respectively. At baseline, 98% had an elevated ba-PWV, 12% microalbuminuria, and 8% LVH. 252 patients completed the 12-month treatment and 65 (20.5%) withdrew from the trial. In the intention-to-treat analyses, the improvement rate of TOD was significantly higher in the antihypertensive treatment group than the placebo group (47.4% vs 26.1%, P &lt; 0.0001), as well as the decrease of the 24-h systolic/diastolic BPs (-9.1/-5.7 vs -1.5/-1.0 mmHg, P &lt; 0.0001). Conclusions: Antihypertensive treatment was beneficial for patients with masked hypertension in terms of TOD protection.

PS-BPC02-3: EVALUATION OF VASCULAR FUNCTION FOR PREDICTION OF RENAL PROGNOSIS IN JAPANESE PATIENTS WITH LIFESTYLE-RELATED DISEASES.

Background: Since chronic kidney disease (CKD) is associated with the development of serious cardiovascular diseases such as stroke, coronary artery disease and heart failure, prevention and early diagnosis of CKD are important clinical issues. Many risk factors including diabetes, hypertension, dyslipidemia, obesity, and cigarette smoking are known to be involved in the development of CKD; however, there is no available biomarker that can predict the progression of CKD at an early stage. Although it has been reported that glomerular endothelial injury causes development of CKD, it remains unclear whether evaluation of vascular endothelial function can predict renal prognosis. Therefore, in the present study, we examined the association between vascular endothelial function and longitudinal eGFR change in patients with lifestyle-related diseases. Methods: We retrospectively evaluated 341 Japanese patients (176 males and 165 females; mean age, 63.87 ± 12.02 years) with lifestyle-related diseases in whom baseline vascular function was evaluated by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV) and in whom 24-month longitudinal eGFR values were recorded after vascular testing at Tokushima University Hospital and Anan Medical Center, Tokushima Japan. The association between values of FMD and eGFR slope and the association between values of baPWV and eGFR slope were statistically analyzed. Statistical significance was set at p &lt; 0.05. Results: Single regression analysis showed that value of FMD was positively associated with eGFR slope in females (p &lt; 0.001) and non-smoking males (p = 0.033) but not in smoking males (p = 0.133). Multiple regression analysis including confounding factors demonstrated that the value of FMD remained a contributor against annual eGFR decline in females (p = 0.002) and non-smoking males (p = 0.046) but not in smoking males (p = 0.266). On the other hand, the value of baPWV had no significant association with eGFR slope regardless of sex and smoking. Conclusions: In patients with lifestyle-related diseases, FMD value can be used for prediction of renal prognosis represented by the eGFR slope in females and non-smoking males. Thus, early comprehensive intervention for improving vascular endothelial function might lead to a better renal prognosis in female and non-smoking male patients with lifestyle-related diseases.

Assessment of Arterial Stiffness in Patients Recovered from Mild COVID-19 Disease using Pulse Wave Velocity: A Cross-sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) may manifest with different grades, such as mild, moderate, or severe. COVID-19 has many post-viral implications on different organ systems, including the vascular system. As the pandemic load increases, it is vital to identify any post-recovery complications and functional impairments of the arteries in patients who have recovered from mild COVID-19 disease. Aim: Present study aimed to evaluate the functional impairment of the arteries, specifically arterial stiffness, in patients recovered from mild COVID-19 disease by assessing Pulse Wave Velocity (PWV). Materials and Methods: The present cross-sectional study was conducted at Shri BM Patil Medical College and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India, from April 2021 to June 2021. A total of 18 patients who had recovered from mild COVID-19 disease (Group 1: n=18) and age- and sex-matched healthy participants (Group 2: n=18) accessing health services at the hospital were included in the study. Data were collected for physiological parameters such as height, weight, Body Mass Index (BMI), Pulse Rate (PR), Blood Pressure (BP), and arterial stiffness parameters like PWV. The data were statistically analysed using the Mann-Whitney U test and Spearman’s correlation. Results: The study included 36 participants aged between 18 and 65 years. In the present study, patients recovered from mild COVID-19 disease showed a statistically significant increase in brachial-ankle Pulse Wave Velocity (b-a PWV) (p=0.001) and carotid-femoral Pulse Wave Velocity (c-f PWV) (p&lt;0.01) compared to the controls and positively correlated with Mean Arterial Pressure (MAP). Conclusion: The present study concluded that even a mild degree of COVID-19 enhanced PWV, reflecting an increase in arterial stiffness. This study may assist clinicians in follow-up visits and rehabilitation to reduce the burden of the disease.

PS-C04-2: LONGITUDINAL CONSTANCY OF VASCULAR AGEING PHENOTYPES AND FACTORS ASSOCIATED WITH THE PHENOTYPE CONSTANCY OVER TIME

Background: The concept of two phenotypes of vascular aging, healthy vascular aging (HVA) and early vascular aging (EVA) has been proposed. Objectives: To examine the: (1) constancy of these phenotypes over time; (2) validity of assuming that a constantly maintained phenotype reflects the rate of structural arterial stiffening; and (3) longitudinal associations between the vascular phenotypes and cardiovascular risk factors/heart rate (HR). Methods: The brachial-ankle pulse wave velocity (baPWV) was measured annually over a 16-year period in 4682 middle-aged Japanese subjects. The vascular phenotypes of 4682 middle-aged Japanese subjects were measured at the start and end of a 16-year study period, by measuring the arterial stiffness as a function of the age and blood pressure. Results: Of 4682 subjects, 158 (3.4%) showed constancy of the HVA phenotype, and 192 (4.1%) subjects showed constancy of the EVA phenotype throughout the study periods. The baPWV adjusted for the mean blood pressure differed significantly between the two groups. Elevated mean blood pressure, serum HbA1c levels and HR were significantly associated with constancy of the EVA phenotype, whereas only a low HR was significantly associated with constancy of the HVA phenotype. Conclusions: In middle-aged Japanese subjects with the HVA/EVA phenotype at the study baseline, while the phenotype changed during the study period in many subjects, phenotype constancy appeared to reflect the rate of structural arterial stiffening. Elevated blood pressure and abnormal glucose metabolism were associated with constancy of the EVA phenotype. On the other hand, HR was a robust marker of the presence/constancy of the HVA/EVA phenotype.

PS-C04-3: DIFFERENTIAL EFFECT OF A XANTHINE OXIDASE INHIBITOR ON ARTERIAL STIFFNESS AND CAROTID ATHEROSCLEROSIS: A SUBANALYSIS OF THE PRIZE STUDY

Atherosclerosis and arterial stiffness are phenotypes of atherosclerotic vascular damage. Atherosclerosis originates from endothelial vascular damage and forms focal morphological lesions; arterial stiffness originates from diffuse medial-layer damage in the arterial tree. Thus, the two phenomena reflect different facets of atherosclerotic vascular damage, and they both gradually progress. We conducted a subanalysis to compare the long-term effects of febuxostat on atherosclerosis and arterial stiffness in the PRIZE study (a multicenter, prospective, randomized, open-label, blinded-endpoint clinical trial to examine the effect of febuxostat on carotid atherosclerosis). Among 514 study participants, arterial stiffness parameters (brachial-ankle pulse wave velocity or cardio-ankle vascular index) were obtained at baseline, 12 months, and 24 months in 100 subjects. Among them, 48 subjects were allocated to the control group (i.e., nonpharmacological lifestyle modification for hyperuricemia), and 52 subjects were allocated to the febuxostat treatment group. While the decrease in serum uric acid was greater in the febuxostat group than in the control group, the adjusted percentage decrease in arterial stiffness parameters at month 24 was greater in the febuxostat group than in the control group, with a mean between-group difference (febuxostat - control) of -5.099% (95% confidence interval (CI) -10.009% to -0.188%, p = 0.042). Thus, long-term treatment with febuxostat may exert beneficial effects on arterial stiffness without improving carotid atherosclerosis. A long-term study to examine the effect of febuxostat on cardiovascular outcomes related to increased arterial stiffness is warranted.

Positive correlation between lipid accumulation product index and arterial stiffness in Chinese patients with type 2 diabetes.

Many studies have confirmed that lipid accumulation products (LAP) predict arterial stiffness (AS) in hypertensive patients. But there is little research on the use of LAP in identifying early atherosclerosis in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to determine the relationship between the LAP index and brachial-ankle pulse wave velocity (baPWV) in Chinese patients with T2DM. A total of 1471 Chinese participants with T2DM, ranging in age from 18 to 80, were included in this cross-sectional study. BaPWV measurements were used to calculate the AS. A baPWV greater than the 75th percentile (1700 cm/s) was defined as indicating increased AS. The LAP index was calculated from the combination of waist circumference (WC) and triglycerides (TG). According to the quartiles of the LAP index, baPWV tended to increase after adjusting for sex and age. Multiple linear regression analysis showed that the beta coefficient (β) of baPWV increased by 31.0 cm/s for each unit of lnLAP that was increased, and the 95% confidence interval (CI) was (6.5, 55.5) cm/s. In multivariate logistic regression analyses, after fully adjusting for confounders, the risk of elevated baPWV increased with each unit increase in lnLAP, with an odds ratio (OR) of 1.3 (95% CI: 1.0, 1.8). According to the generalized additive model (GAM), we found that lnLAP was positively correlated with baPWV and baPWV elevation. The results were the same for males and females. Subgroup analyses showed that the positive correlation between lnLAP and elevated baPWV did not interact across all subgroups. In Chinese patients with T2DM, LAP was strongly and positively correlated with baPWV and elevated baPWV.

PS-BPP01-2: ASSOCIATIONS OF ARTERIAL STIFFNESS AND ATHEROSCLEROTIC BURDEN WITH BRAIN STRUCTURAL CHANGES AMONG JAPANESE MEN

Objective: To assess whether arterial stiffness and atherosclerotic burden are each independently associated with brain structural changes (i.e., volume and vascular damage) among healthy Japanese men. Design and method: Healthy Japanese men (n = 853) aged 46–83 years participated in the examination of the Shiga Epidemiological Study of Subclinical Atherosclerosis II (SESSA II), and underwent assessments of arterial stiffness using brachial-ankle pulse wave velocity (baPWV) and of atherosclerotic burden using coronary artery calcification (CAC) between 2010–2014. Of 853 men, 740 underwent brain magnetic resonance imaging (MRI) between 2012 and 2015, and brain volumes (i.e., total brain volume, gray matter, Alzheimer disease [AD] signature and prefrontal) and white matter lesion volume (WMLV, reflecting cerebral small vessel disease) were assessed. Results: We excluded 54 participants with history of stroke and myocardial infarction at SESSA II, leaving a final sample size of 686 for analyses. After multivariable adjustment including age and blood pressure (see footnote in Table), higher baPWV was associated with lower volumes of AD signature and of hippocampus volume (see Table). Higher CAC score was associated with greater WMLV (ml). Both baPWV and CAC were entered into a same model, higher baPWV was associated with lower volumes of AD signature, and higher CAC score was associated with greater WMLV. Conclusions: Among general Japanese men, higher arterial stiffness was associated with lower brain volumes related to cognition. Higher CAC score was associated with greater vascular damage. Arterial stiffness and atherosclerotic burden may each independently link to brain structural changes among healthy Japanese men. Keywords: Arterial stiffness; coronary artery calcification; brain volume; Alzheimer disease; atherosclerosis

Relationship Between MicroRNA Signature and Arterial Stiffness in Patients With Ischemic Stroke.

We investigated whether circulating microRNAs (miRNAs) is associated with arterial stiffness in patients with acute ischemic stroke. We recruited patients with acute ischemic stroke who were admitted to a university hospital stroke center and underwent carotid-femoral pulse wave velocity (cfPWV) measurement using SphygmoCor (AtCor Medical, Sydney, Australia) and brachial-ankle PWV using a volume-plethysmography device (VP-1000, Omron Colin, Komaki, Japan). Circulating miRNAs were measured in venous blood samples stored in EDTA. We selected five miRNAs (miR-17, miR-93, miR-450, miR-629, and let-7i) related to atherosclerosis based on a literature review. Pearson's correlation analysis was applied to the correlations between miRNAs and arterial stiffness parameters. Finally, multivariable linear regression analysis was performed to identify the independent factors for cfPWV. This study included 70 patients (age=71.1±10.3 years [mean±SD], 29 females). The expression levels of miR-93 (r=-0.27, p=0.049) and let-7i (r=-0.27, p=0.039) were inversely correlated with cfPWV. Multivariable linear regression analysis including age, hypertension, and estimated glomerular filtration rate showed that let-7i was independently related with cfPWV (standardized coefficient=-0.262, p=0.036). Correlation analysis indicated that let-7i was positively associated with visceral muscle Hounsfield units on computed tomography (r=0.264, p=0.043). The expression level of let-7i was independently related to arterial stiffness in patients with cerebral infarction, suggesting that it plays a pathophysiological role in atherosclerosis.