Carotid Arterial Stiffness Research Articles

Atherosclerosis of peripheral arteries in patients with coronary artery disease and type 2 diabetes mellitus

To study the features of atherosclerosis of peripheral arteries in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (T2DM) and to identify factors associated with multifocal atherosclerosis. The study included 140 patients (77 men and 63 women) with CAD (mean age 62.0 (56.0-66.0) years). The first group included 70 people with CAD and T2DM, and the second group included 70 patients with CAD without T2DM. All patients underwent duplex scanning of the carotid and lower limb arteries (LLA). Local vascular stiffness of the common carotid artery (CCA) was assessed by ultrasound scanning. The Peterson elasticity modulus, distensibility and strain of the CCA were determined. The ankle - brachial index (ABI) was measured by the Doppler method. In the group of patients with T2D, there were statistically more patients with atherosclerotic plaques in both carotid arteries and LLA. Also among patients with T2DM the severity of stenosis of carotid arteries and LLA at all levels was significantly greater. Local carotid stiffness was higher in the first group of patients. The proportion of individuals with reduced ABI.

Carotid arterial stiffness is increased and related to left ventricular function in patients with hypertrophic cardiomyopathy.

To assess the carotid mechanical properties in patients with hypertrophic cardiomyopathy and the relation between arterial stiffness and left ventricular function in this setting. We have prospectively enrolled 71 patients (52 ± 16 years, 34 men) with hypertrophic cardiomyopathy, divided into two groups depending on the presence (46 patients) or absence (25 patients) of cardiovascular risk factors associated with increased arterial stiffness. Twenty-five normal subjects similar by age and gender with hypertrophic cardiomyopathy patients without risk factors formed the control group. A comprehensive echocardiography was performed in all subjects. Carotid arterial stiffness index (β index), pressure-strain elastic modulus, arterial compliance, and pulse wave velocity were also obtained using an echo-tracking system. β index, pulse wave velocity, and pressure-strain elastic modulus were significantly higher in hypertrophic cardiomyopathy patients without risk factors compared to controls. After linear regression analysis, the increase in carotid β index was independently correlated with the presence of hypertrophic cardiomyopathy [beta = 0.49, 95% confidence interval (CI) = 1.04-3.02; P < 0.001]. In the entire hypertrophic cardiomyopathy population arterial stiffness parameters correlated with age, gender, hypertension degree, presence of hypercholesterolaemia, and the E/e' ratio. In multivariable analysis, β index (beta = 0.36, 95% CI = 0.32-1.25; P = 0.001), global left ventricular longitudinal strain, and the presence of left ventricular outflow tract obstruction were independently correlated with the E/e' ratio. In patients with hypertrophic cardiomyopathy arterial stiffness is increased independently of age or presence of cardiovascular risk factors. Carotid artery stiffness is independently related to left ventricular filling pressure, increased arterial stiffness representing a possible marker of a more severe phenotype.

Body composition is a strong predictor of local carotid stiffness in Swedish, young adults \u2013 the cross sectional Lifestyle, biomarkers, and atherosclerosis study

BackgroundObesity has nearly tripled worldwide during the last four decades, especially in young adults, and is of growing concern since it is a risk factor for cardiovascular diseases (CVD). We explored how different body composition measurements are associated with intima media thickness (cIMT) and local stiffness in the common carotid artery, in a subsample of healthy, young women and men, from the Swedish Lifestyle, Biomarkers, and Atherosclerosis (LBA) Study.MethodsFrom the LBA study, a subsample of 220 randomly selected, self-reported healthy individuals, 18–25 years old, were collected for the automatized local stiffness measurements; arterial distensibility, Young’s elastic modulus, and β stiffness index. Blood pressure and mean arterial pressure (MAP) was measured using automatic blood pressure equipment. Body mass index (BMI) was calculated, waist circumference was measured, and percentage of body fat assessed using an impedance body composition analyzer. The carotid artery was scanned by ultrasound and analyzed using B-mode edge wall tracking. cIMT was measured and local stiffness measurements were calculated with carotid blood pressure, measured with applanation tonometry.ResultsNo association was found between cIMT and body composition. Local carotid stiffness was associated with body composition, and women had less stiff arteries than men (p < 0.001). Of the local stiffness measurements, arterial distensibility had the strongest associations with body composition measurements in both women and men (p < 0.05). Multiple regression analyses showed that BMI in women and BMI and percentage of body fat in men had the highest impact on arterial distensibility (p < 0.01 in both women and men).ConclusionsArterial distensibility was the local stiffness measurement with the strongest associations to different body composition measurements, in both women and men. In this age group, body composition measurements seem to be stronger predictors of common carotid arterial stiffness than MAP, and is a convenient way of detecting young adults who need cardiovascular risk follow-up and lifestyle counseling.

Age-specific reference values for carotid arterial stiffness estimated by ultrasonic wall tracking

Interaction between arterial stiffness and hypertension plays an important role in the development of cardiovascular disease. Accordingly, assessment of arterial stiffness may provide a tool for estimating cardiovascular risk and monitoring therapy in hypertensive patients. Radiofrequency-based vascular ultrasound allows accurate noninvasive assessment of local mechanical properties of large arteries, but for its use in clinical practice, reference values according to age and sex are mandatory for each vascular site. To provide reference values for common carotid artery stiffness as assessed by an echo-tracking imaging system Hitachi-Aloka, we pooled measurements collected in 1847 healthy subjects aged 3–74 years (1008 males and 839 females) recruited in 14 European centers in the E-tracking International Collaboration (ETIC). Statistical models were developed to describe relationships of different stiffness indices with age and to calculate median values and Z-scores corresponding to ± 1 and ± 2 standard deviations. In our apparently healthy population, age accounted for 53% of variability in the elastic modulus (epsilon), 39% in arterial compliance, 47% in stiffness index (β), and 56% in local pulse wave velocity; on average, blood pressure accounted for a further 7.5% of variability. Dependence on age was not linear; changes in mean values increased at older ages, especially for epsilon and β. There was an interaction between age and gender for arterial compliance, which was higher in males. We present nomograms and a software that can be used for the automated calculation of Z-scores for local carotid stiffness in individual patients. These tools can be used to establish prognostic indicators or surrogate targets for treatment monitoring.

Effect of golimumab on endothelial vasomotor function and arterial stiffness in ankylosing spondylitis

Objective: to evaluate the effect of golimumab (GLM) on endothelial vasomotor function and arterial stiffness in patients with ankylosing spondylitis (AS).Subjects and methods. A total of 42 patients with advanced-stage AS, who were older than 18 years and met the 1984 modified New York criteria with a disease duration of ≤5 years, were examined. The investigators visualized carotid arteries to determine local vascular wall stiffness, studied regional arterial stiffness to assess a pulse wave contour analysis, and a reactive hyperemia test before and after 104-week therapy.Results and discussion. RA patients without cardiovascular comorbidity were found to have signs of subclinical great artery involvement accompanied by endothelial vasoregulatory dysfunction in both the small resistance and large muscular arteries; by increases in common carotid artery (CCA) intima-media thickness (IMT) and stiffness index (SI); by rises in peripheral augmentation index (AIp), SI and reflection index (RI), the intensity of a change in which correlated with disease duration and activity assessed by ASDAS; as well as with the modified Schober test value, cervical rotation, and tragus-to-wall distance. In addition to a decrease in the Ankylosing Spondylitis Disease Activity Score (ASDAS), GML treatment in patients with AS caused a statistically significant increase in the amplitude occlusion index to the control values and a rise in the phase shift between the channels by an average of 2 times (p&lt;0.01) as compared to the baseline values; a decrease in CCA IMT by an average by 20% (p=0.01) and in the local stiffness of the (carotid) vascular bed by 31% (p=0.01). The pulse wave contour analysis after 104-week GLM therapy revealed that AIp, SI and RI decreased by an average of 5 (р&lt;0.001), 1.3 (р&lt;0.01), and 2 (p&lt;0.05) times, respectively, with the remaining statistically significant differences from the control values.Conclusion. In addition to the effectively reduced inflammatory activity, GLM therapy in patients with AS provides restoration of endothelial function in both the small resistance vessels (an increase in the amplitude occlusion index) and the large muscular arteries (a rise in the phase shift between the channels) and also has a vasoprotective effect on the wall of large elastic vessels (reductions in CCA IMT, SI, AIp, and SI) and small muscular arteries (a decrease in RI).

AORTIC STIFFNESS IS NOT ONLY ASSOCIATED WITH STRUCTURAL BUT ALSO WITH FUNCTIONAL PARAMETERS OF MICROCIRCULATION

Objective: The aim of the study was to test the hypothesis if arterial stiffness is linked to reduction of retinal capillary blood flow and development of retinal microvascular remodelling. Design and method: The study group comprised of 88 patients with essential hypertension (n = 88, 54.3 ± 8.3 years, 44.3% were female) and 32 healthy controls. Inclusion criteria were: essential hypertension, age of 40–70 years old. Exclusion criteria were: secondary hypertension, any cardiovascular disease including heart failure, coronary artery disease, arrhythmia, moderate or severe valve disease, history of stroke or transient ischemic attack, chronic kidney disease with eGFR < 60 mml/min/1.73 m2, diabetes mellitus, eye disease, pregnancy. Retinal microcirculation was evaluated by scanning laser Doppler flowmetry. Macrovascular changes were assessed on the basis of measurement of arterial stiffness (by carotid-femoral pulse wave velocity, central pulse pressure, augmentation pressure and augmentation index) and intima media thickness of common carotid artery. Diastolic dysfunction and left ventricular hypertrophy were analysed by echocardiography. Results: Pulse wave velocity was inversely correlated with mean retinal capillary blood flow in a group of hypertensive patients (R = −0.32, p < 0.01). This relationship remained significant in multivariate regression analysis even after adjustment for age, systolic blood pressure and waist to hip ratio (β = −40.275, p < 0.001). Central pulse pressure was positively correlated with retinal wall thickness (R = 0.44, p < 0.05), wall cross sectional area (R = 0.44, p < 0.05) and wall to lumen ratio (R = 0.43, p < 0.05). Brachial pulse pressure was positively correlated with wall thickness (R = 0.43, p < 0.05), wall cross sectional area (R = 0.41, p < 0.05) and wall to lumen ratio (R = 0.47, p < 0.05). In contrast, the relationship between augmentation pressure or augmentation index and structural indicators of retinal remodelling was not observed. Conclusions: In conclusion, the study provides an evidence that microcirculation is coupled with macrocirculation not only in terms of structural but also functional parameters. Pulse wave velocity was independently associated with retinal capilary flow. Central and brachial pulse pressure were significantly related to retinal wall thickness, wall cross sectional area and wall to lumen ratio.

Image-Free Technique for Flow Mediated Dilation Using ARTSENS® Pen.

Flow mediated dilation (FMD) is a clinically accepted non-invasive tool for assessing endothelial dysfunction. FMD is conventionally performed with B-mode ultrasound systems that involve recording of the image sequences as DICOM files or video-graphic files and processing them offline. Sometimes the examinations may have to be rejected due to poor or unstable image sequences resulting non-reliable diameter estimates. We had earlier developed and extensively validated an image-free ultrasound technology, ARTSENS®, for the measurement of carotid artery wall dynamics and arterial stiffness metrics. In this work, we evaluate the feasibility of using the technology for continuous real-time diameter measurement of the brachial artery and thereby FMD. To investigate the performance of the ARTSENS® device an in-vivo study was conducted on 5 subjects as pilot. As a reference the measurements were also performed by a B-mode imaging system with a help of a commercially available clinically validated offline FMD analysis tool. The brachial artery diameter and FMD measurements performed by the ARTSENS® device were consistent with the earlier reported literature. The beat-to-beat repeatability of the baseline diameter measurements was acceptable with a CoV <; 4% for all the subjects. The diameter measurements performed by the two devices exhibited a significant correlation (r-square = 0.81, p <; 0.05). The RMSE for the diameter and FMD% measurements was 0.32 mm and 0.63% respectively, illustrating the measurement accuracy. The study demonstrated that the ARTSENS® can be reliably employed for performing FMD measurements and assessing endothelial dysfunction. This would help realize a field deployable solution for real-time automated FMD measurement and consequently for the acceleration of large population studies in this research area.

Continuous Assessment of Carotid Diameter using an Accelerometer Patch Probe for Ambulatory Arterial Stiffness Monitoring.

We present a system with an accelerometer patch probe design for non-invasive evaluation of carotid arterial stiffness. The proposed system could continuously measure the acceleration signal derived due to the propagation of blood pulse wave through the left carotid artery, double integrating and scaling it to estimate the accelerometer-derived carotid wall displacement. This functional principle was proved by comparing the accelerometer-derived carotid wall displacement with the carotid distension signal from the reference system ARTSENS® (ARTerial Stiffness Evaluation for Noninvasive Screening device) for all the recruited human subjects. Assuming the relationship to be linear, a one-time subject-specific calibration was performed with the simultaneously acquired reference distension signal and the accelerometer-derived carotid displacement signals on its anachrotic limbs data points (at systolic phases) for each subject. This calibration equation was tested with latterly acquired accelerometer signals and results in the measurement of accelerometer-derived carotid distension and lumen-diameter values. The ability of the accelerometer system to measure real-time carotid distension and lumen diameter in a repeatable beat-by-beat manner for arterial stiffness index evaluation was validated in-vivo. The accuracy of the obtained results was studied with our clinically validated reference system. The experimental validation study results exhibit the feasibility of using the developed accelerometer system for continuous carotid distension and lumen diameter measurements, whereby the estimation of carotid arterial stiffness.

Carotid Artery Stiffness Accurately Predicts White Matter Hyperintensity Volume 20 Years Later: A Secondary Analysis of the Atherosclerosis Risk in the Community Study.

Arterial stiffness is a biomarker of cerebrovascular disease and dementia risk. Studies have shown an association between carotid artery stiffness and increased white matter hyperintensity volume and, as a result, reduced total brain volume on MR imaging, but none have had prolonged follow-up to fully evaluate the slow change seen in white matter hyperintensity volume and total brain volume with time. Our objective was to determine whether common carotid artery stiffness on sonography accurately predicts white matter hyperintensity volume and total brain volume on MR imaging more than 20 years later. We performed a secondary analysis of the Atherosclerosis Risk in the Community study to compare 5 measurements of carotid artery stiffness, including strain, distensibility, compliance, Stiffness index, and pressure-strain elastic modulus, with the white matter hyperintensity volume and total brain volume on a follow-up MR imaging using linear regression. We included 1402 patients enrolled in the Atherosclerosis Risk in the Community study. There was a significant relationship between increasing carotid artery stiffness and both higher white matter hyperintensity volume and lower total brain volume on MR imaging, measured at a mean of 21.5 years later. In multivariable linear regression models, the carotid strain, distensibility, Stiffness index, and pressure-strain elastic modulus were associated with white matter hyperintensity volume. Only compliance was associated with total brain volume in the multivariate models. Sonography measurements of carotid artery stiffness are predictive of white matter hyperintensity volume and total brain volume on MR imaging more than 20 years later. The association is more robust for white matter hyperintensity volume than total brain volume. These findings support the role of arterial stiffness as a method for identifying patients at risk of developing white matter hyperintensity volume and as a potential mechanism leading to small-artery disease of the brain.

Significance of the combination of inter-limb blood pressure differences in the elderly: The Northern Shanghai Study.

Whether the combination of inter-arm and inter-leg systolic blood pressure differences (BPDs) and ankle-brachial index is of clinical significance remains unclear. In this study, we aimed to investigate the association of the combination of inter-limb systolic BPDs with cardiovascular risk factors and hypertension-mediated organ damage (HMOD). A total of 2621 elderly subjects from the Northern Shanghai Study were divided into Group A, B, and C consisting of participants with 0, 1, and ≥2 abnormal inter-limb systolic BPDs, respectively. Comparisons of cardiovascular risk factors and parameters of cardiac, vascular, and renal damage between groups and logistic regression models were conducted. The proportions of subjects presenting 0, 1, and ≥2 abnormal inter-limb systolic BPDs were 60.9%, 25.1%, and 14.0%, respectively. Upward trends, from Group A, through Group B, to Group C, were observed for the level or prevalence of nearly all cardiovascular risk factors and HMOD (P for trend ≤0.007 for all). In multiple logistic regression, Group C showed significantly higher odds for carotid plaque (vs Group A: Odds ratio [OR]=1.88, 95% confidence interval [CI]=1.43-2.48; vs Group B: OR=1.46, 95% CI=1.08-1.97), arterial stiffness (vs Group A: OR=1.26, 95% CI=0.96-1.65; vs Group B: OR=1.36, 95% CI=1.01-1.83), and left ventricular hypertrophy (vs Group A: OR=1.35, 95% CI=1.04-1.76; vs Group B: OR=1.25, 95% CI=0.93-1.67), when compared with Group A and B. In conclusion, the combination of abnormal inter-limb systolic BPDs significantly associates with greater burden of cardiovascular risk factors and higher likelihood for HMOD, especially carotid plaque, arterial stiffness, and left ventricular hypertrophy.

Pulse wave velocity to the global longitudinal strain ratio in survivors of myocardial infarction.

New index of pulse wave velocity to global longitudinal peak systolic strain (PWV/GLPSS) was reported to be associated with cardiovascular damage. We evaluated the prognostic role of this metric in survivors of acute myocardial infarction (AMI). We investigated in 569 patients with AMI, whether PWV/GLPSS was associated with a composite endpoint of death, stroke or new myocardial infarction, in long-term follow-up. Left ventricular longitudinal strain was evaluated by speckle tracking, and carotid arterial stiffness (local PWV) was determined using radiofrequency data technology. During follow-up (median 1316days), 114 subjects reached composite endpoint. These subjects were significantly older (P<0.0001) and were characterized by lower ejection fraction (P<0.0001), lower GLPSS (P<0.0001), higher PWV (P=0.007) and lower PWV/GLPSS index (P<0.0001). Patients with PWV/GLPSS <-0.74 were at a significantly higher risk for the composite endpoint during the follow-up (hazard rate: 1.7; 95% confidence interval: 1.2-2.6; P<0.001). The PWV/GLPSS was additive to the predictive value of EF<35%-patients with PWV/GLPSS <-0.74 and EF<35% had the highest risk for the endpoint events. The current study shows that PWV/GLPSS index has significant, independent and additive value in predicting CV complications, in subjects with myocardial infarction.

Associations between carotid artery longitudinal wall motion and arterial stiffness indicators in young children

Background and aimsCarotid artery longitudinal wall motion (CALM) is associated with established indicators of arterial stiffness in healthy adults and in adults with cardiovascular disease risk factors. CALM assessment may be more feasible for incorporation into routine clinical examination than traditional assessments of arterial stiffness; however, the relationship between CALM and arterial stiffness in children has not been established. MethodsData were collected from a subset of children participating in the Health Outcomes and Physical activity in Preschoolers study. CALM was characterized by segmental longitudinal wall displacement, velocity, and acceleration. Arterial stiffness was measured using whole-body pulse wave velocity (PWV) and carotid artery β-stiffness index. Associations between CALM and arterial stiffness and the influence of age, sex, and height on those associations were determined. ResultsOne hundred and ninety-one children (ages 5.0–8.0 years) were included in the analyses. Systolic retrograde (r = -0.20, p = 0.01) and maximum (r = -0.15, p = 0.04) CALM displacements were weakly correlated with PWV while systolic anterograde and diastolic CALM displacements and wall velocities and accelerations were not correlated with PWV (r = -0.12 to −0.03, p = 0.10 to 0.64). There were no significant correlations between any CALM outcome and β-stiffness index (r = -0.12 to 0.10; p > 0.05). Associations were attenuated after adjusting for age, sex, and height. ConclusionsHigher arterial stiffness, measured by PWV, but not β-stiffness, is weakly associated with less longitudinal movement of the common carotid artery in young, healthy children indicating CALM measurement is not a strong candidate for clinical assessment of arterial stiffness in children.

580-P: Cardiovascular Autonomic Neuropathy Is Associated with Carotid Intima-Media Thickness and Arterial Stiffness in Patients with Type 2 Diabetes

Cardiac autonomic neuropathy (CAN) is a frequent but underdiagnosed complication of diabetes mellitus. CAN represents a significant cause of morbidity and mortality in patients with diabetes and is associated with a high risk of cardiac arrhythmia and sudden death. The aim of this study is to evaluate the association between CAN and carotid intima-media thickness (CIMT) and arterial stiffness in patients with type 2 diabetes mellitus (T2DM). CAN, CIMT, ankle-brachial index (ABI) and pulse wave velocity (PWV) were evaluated in a cross-sectional sample of 321 patients (147 men and 174 women) with T2DM. CAN was assessed by Ewing’s method which employs five non-invasive tests of autonomic function. Among 321 patients, CAN was found in 87 patients (27%). Compared with the patients without CAN, those with CAN were significantly older and had significantly longer duration of diabetes, lower glomerular filtration rate, higher hs-CRP, mean CIMT, PWV, and ABI. The CAN scores correlated positively with mean CIMT and PWV (P&amp;lt;0.05). Using multivariate regression analysis, CAN score independently predicted mean CIMT in patients with T2DM after adjustment for age and DM duration. In conclusion, CAN was associated CIMT and increased arterial stiffness in patients with T2DM. CAN might be associate with the development of cardiovascular disease through CIMT and arterial stiffness in T2DM. Disclosure T. Sohn: None.

Nonalcoholic Fatty Liver Disease Is Associated With Arterial Distensibility and Carotid Intima-Media Thickness: (from the Multi-Ethnic Study of Atherosclerosis)

Nonalcoholic fatty liver disease (NAFLD) is considered a potential independent risk factor for cardiovascular disease (CVD). The Multi-Ethnic Study of Atherosclerosis cohort enrolled 6,814 adults without previous CVD. We excluded 2,692 participants who had missing variables, were heavy drinkers, or history of steroid use and/or chronic liver disease. NAFLD was defined using noncontrast cardiac CT and a liver/spleen Hounsfield Unit attenuation ratio <1. Ultrasound-measured carotid arterial compliance and stiffness, was expressed as distensibility coefficient and Young's modulus. Common and internal carotid intima-media thickness (CIMT) and coronary artery calcium (CAC) >0 were used as markers of subclinical CVD. A multivariate robust linear regression and logistic regression analysis were done to evaluate the association of NAFLD and this subclinical CVD markers. Our analysis of 4,123 participants showed 55% were female with a mean age of 63 (±10) years, 39% white, 10% Chinese, 28% black, and 23% were Hispanic. The prevalence of NAFLD was 17% (n = 729). Patients with NAFLD had higher distensibility coefficient and higher CIMT. Multivariate linear regression analysis showed the presence of NAFLD was associated with both the common carotid and internal carotid IMT and logCAC. Logistic analysis showed an independent association with CAC > 0 (odds ratio [OR] 1.44 95% confidence interval [CI] 1.18, 1.75) and CIMT > 1 mm (OR 1.30 95% 1.08, 1.56). When stratified by race the association with CIMT > 1 mm was significant in whites (OR 1.37 95% 1.00, 1.90) and Hispanic (OR 1.53 95% 1.08, 2. 17) and CAC > 0 was significant in Hispanics (OR 1.52 95% 1.06, 2.19). In conclusion, NAFLD is modestly associated with carotid IMT and coronary artery calcification in a multiethnic population.

The association between orthostatic blood pressure changes and subclinical target organ damage in subjects over 60 years old.

BackgroundAlthough recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events, the underlying mechanisms are still controversial. The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old.MethodsThis is a prospective observational cohort study. One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled. Participants were grouped according to whether they had a drop ≥ 20 mmHg in systolic or ≥ 10 mmHg in diastolic BP (orthostatic hypotension), an increase in mean orthostatic systolic blood pressure ≥ 20 mm Hg (orthostatic hypertension), or normal changes within 3 min of orthostatism. Multiple regression modeling was used to investigate the relationship between orthostatic hypotension, orthostatic hypertension and subclinical organ damage with adjustment for confounders.ResultsOrthostatic hypotension and orthostatic hypertension were found in 461 (23.1%) and 189 (9.5%) participants, respectively. Measurement of carotid intima-media thickness (IMT), brachial-ankle pulse wave velocity (baPWV), clearance of creatinine, and microalbuminuria were associated with orthostatic hypotension; measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model. After adjustment, IMT [odds ratio (OR), 95% confidence interval (CI) per one-SD increment: 1.385, 1.052–1.823; P = 0.02], baPWV (OR = 1.627, 95% CI: 1.041–2.544; P = 0.033) and microalbuminuria (OR = 1.401, 95% CI: 1.002–1.958; P = 0.049) were still associated with orthostatic hypotension, while orthostatic hypertension was only associated with IMT (OR = 1.730, 95% CI: 1.143–2.618; P = 0.009).ConclusionsOrthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis, arterial stiffness and renal damage in subjects over 60 years old. Orthostatic hypertension correlates with carotid atherosclerosis only.

Evaluation of subclinical atherosclerosis by ultrasound radiofrequency data technology in patients with Behçet's disease.

We aimed to evaluate subclinical atherosclerosis based on carotid intima-media thickness (CIMT) and arterial stiffness measurements in patients with Behçet's disease (BD), using ultrasound (US) radiofrequency (RF) data technology. We included 33 BD patients and 33 healthy controls in this study. The participants did not have any primary cardiovascular risk factors, such as diabetes mellitus, hypertension, hyperlipidemia and obesity. All participants were evaluated using Doppler ultrasonography. Arterial stiffness and CIMT measurements were performed in bilateral common carotid arteries using the US RF data technology. The right, left and mean CIMT values were similar between the patient and control groups (P >0.05). There was also no statistically significant difference in the right side α and β stiffness indices despite higher values in the patient group (P> 0.05). The right, left and mean distensibility coefficient (DC) and compliance coefficient (CC) values of the patient group were significantly lower than the control group (P< 0.05). The left and mean α- and β-stiffness indices, and the right, left and mean pulse wave velocity (PWV) values were significantly higher in the patient group (P< 0.05). We found higher mean CIMT and PWV values, and α- and β-stiffness indices in patients with mucocutaneous involvement compared with those with major organ involvement, while the mean DC and CC values were lower in the former. However, these results did not reach a statistically significant level. This study demonstrated evidence of subclinical atherosclerosis in BD in the absence of major atherosclerotic risk factors.

SUN-086 Effect of Growth Hormone Daily Replacement in the Vascular System of Adult Patients with Childhood Onset Hypopituitarism

Introduction: Adult with Childhood onset hypopituitarism (CHO), include growth hormone deficiency is characterized by abnormal body composition, impaired lipid and glycemic metabolism, impairment of physical capacity and increase in cardiovascular risk factors (CVR), besides being associated with the presence of atheromatous plaques in the carotid and femoral arteries, increased mean intimal thickness, and increased arterial stiffness. There is evidence of the role of GH replacement in the atherogenic profile and CVR, however they are limited and controversial. Objective: To evaluate the human recombinant growth hormone replacement (hrGHr) daily in the metabolic parameters and vascular system in adult patients with COH. Patients and Methods: Fifty-one adult with COH were selected for the study. They were divided into 2 groups: 1- hrGHr: 13 male, 14 female with median age 33.2 yrs, hrGHr in adult life with 7.38 yrs median time in the dose of approximately 1U per day in order to keep IGF1 in the normal range for age and sex; 2- Without hrGHr: 13 male, 11 female with 36.9 yrs median age and without hrGHr in adult life of 10.4 yrs median time. Anthropometric parameters, dual-energy X-ray absorptiometry (DEXA), lipid and glycemic profile, and structural and functional parameters of the arterial vessels (carotid intima media thickness, arterial stiffness and flow mediated dilation) were evaluated. Results: The diagnosis of obesity and overweight was higher in patients without hrGHr. Among the anthropometric characteristics, the waist-to-height ratio and diastolic blood pressure were higher in patients without replacement (p=0.03 and p=0.019, respectively). In the evaluation of body composition through DEXA, the Fat Mass Index among patients under hrGHr was significantly lower than in patients without hrGHr (p=0.029). Although no statistical difference in the vascular parameters between patients with and without hrGHr, it was observed a trend towards a higher arterial stiffness in the group without replacement (p=0.051). In the group of patients without hrGHr, arterial stiffness had a significant and positive correlation with the time without hrGHr (p=0.038). Conclusions: These data suggest that the hrGHr in adults with COH may have protective effects on cardiovascular system.

Association of Carotid Arterial Atherosclerosis, Dilation, and Stiffness with Cerebral Small Vessel Disease (S35.008)

Association of Carotid Arterial Atherosclerosis, Dilation, and Stiffness with Cerebral Small Vessel Disease (S35.008)

Carotid arterial stiffness and intima-media thickness: A little impact of uric acid

Accurate assessment of cardiovascular (CV) risk is essential for clinical decision making. Serum uric acid has been proposed as a novel additional CV risk.

Individuals with Overlap Syndrome have Lower Cognitive Performance than Individuals with COPD or Obstructive Sleep Apnea Alone: Role of Carotid Artery Stiffness

BackgroundChronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are two of the most prevalent respiratory disorders in adults and are both independently associated with impaired cognitive function. The coexistence of OSA in individuals with COPD is termed ‘overlap syndrome’ and occurs in up to 65% of all COPD patients. However, it is unknown if individuals with overlap syndrome have lower cognitive function than individuals with COPD or OSA alone. Carotid artery stiffness is associated with cognitive dysfunction among individuals with and without known cardiovascular disease (CVD). Both COPD and OSA are independently associated with greater carotid artery stiffness compared with controls. It is not known if carotid artery stiffness is exacerbated in overlap syndrome patients and if greater carotid artery stiffness is associated with lower cognitive function in this group. We hypothesized that a) individuals with overlap syndrome would have reduced cognitive performance and greater carotid artery stiffness than individuals with either COPD or OSA alone and b) greater carotid artery stiffness would be associated with reduced cognitive performance among individuals with overlap syndrome.MethodsNinety former smokers (n=12 with overlap syndrome, n= 45 with COPD only, n= 12 with OSA only and n=21 controls; age 69 ± 7 yrs; 53M/37F) completed measurements of pulmonary function, common carotid artery stiffness and neuropsychological testing. OSA status was determined by self‐report of previous clinical diagnosis with OSA.ResultsIndividuals with overlap syndrome performed lower in the executive functioning domain after adjusting for age, sex, body mass index (BMI) and FEV1/FVC than individuals in the other groups (overlap 43.5 ± 4.8 vs. COPD 48.3 ± 5.1 vs. OSA 51.8 ± 5.2 vs. controls 50.2 ± 5.4 norm‐based age‐adjusted t‐scores; P=0.019). Individuals with overlap syndrome also had greater carotid β‐stiffness index compared with individuals in the other groups after adjusting for age, BMI, sex and FEV1/FVC (overlap 5.9 ± 2.5 vs. COPD 3.92 ± 1.4 vs. OSA 3.5 ± 1.1 vs. controls 3.5 ± 1.1U; P=0.015). There were no differences in blood pressure, heart rate, resting oxygen saturation (SpO2) or nocturnal mean SpO2 in overlap syndrome patients vs. the other groups. Higher carotid β‐stiffness index was associated with lower executive function performance in the entire cohort (r=−0.32, P=0.002) and in individuals with overlap syndrome (r=−0.58, P = 0.048). There was no relation between carotid β‐stiffness index and executive function in individuals with COPD alone, OSA alone or former smoker controls (all P&gt;0.05).ConclusionThese data suggest that cognitive performance is lower in individuals with overlap syndrome than in individuals with either COPD or OSA alone and that exacerbated carotid artery stiffening may be an underlying mechanism for the lower cognitive performance observed in this group.Support or Funding InformationNIH K23 HL095658; R01 HL089897 NIH/NCATS Colorado CTSI; UL1 TR001082This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.