Carotid Distensibility Research Articles

Association of Cross-Sectional and Longitudinal Change in Arterial Stiffness With Gene Expression in the Twins UK Cohort.

We investigated whether expression of genes previously implicated in arterial stiffening associates with cross-sectional and longitudinal measures of arterial stiffness. Women from the Twins UK cohort (n=470, aged 39-81 years) had gene expression in lymphoblastoid cell lines measured using an Illumina microarray. Arterial stiffness was measured by carotid-femoral pulse wave velocity and carotid distensibility. A subsample (n=121) of women had repeat vascular measures after a mean±SD follow-up of 4.3±1.4 years. Associations of arterial phenotypes with gene expression levels were examined for 52 genes identified from previous association studies. The gene transcript most closely associated with pulse wave velocity in cross-sectional analysis was ectonucleotide pyrophosphatase/phosphodiesterase (P=0.012). Pleiotropic genetic effects accounted for 14% of the phenotypic correlation between ectonucleotide pyrophosphatase/phosphodiesterase expression and pulse wave velocity. Progression of pulse wave velocity during the follow-up period best related to expression of ectonucleotide pyrophosphatase/phosphodiesterase (β=0.19, P=0.008) and collagen type IV α 1 (β=0.32, P<0.0001). Gene transcripts most closely related to change in carotid distensibility during the follow-up period were endothelial nitric oxide synthase (β=-0.20, P=0.005), angiotensin-converting enzyme (β=-0.15, P=0.035), and B-cell CLL/lymphoma11B (β=0.18, P=0.010). Expression levels of angiotensin-converting enzyme also related to progression in carotid diameter (β=0.21, P=0.012). Expression levels of ectonucleotide pyrophosphatase/phosphodiesterase, involved in arterial calcification, and collagen type IV α 1, involved in collagen formation, correlate with aortic stiffening. These genes may be functional mediators of arterial stiffening.

Abstract 15619: Childhood Physical Fitness Phenotypes and Adult Carotid Arterial Stiffness

Background: Large artery stiffness is associated with fitness phenotypes in adulthood, but the association of childhood physical fitness with adult arterial stiffness is unknown. Aim: To determine the longitudinal association of childhood physical fitness phenotypes with adult carotid artery stiffness. Methods: Data were from 2,008 participants in the Childhood Determinants of Adult Health Study (52% female) with baseline measurements collected in 1985 when aged 7-15 years and follow-up measurements collected 20 years later. Fitness measures included muscular strength (isometric handgrip, shoulder, and leg strength), power (standing long jump), endurance (number of push-ups in 30 seconds), cardiorespiratory fitness (physical work capacity at heart rate of 170 bpm [PWC170] and time to complete a 1.6km run), and flexibility (sit and reach distance). All predictors were expressed as age- and sex-specific z-scores. Arterial stiffness was measured as carotid distensibility (CD) by ultrasound. Results: In univariable analysis, no association was found between childhood muscular strength (β=-0.029), power (β=-0.013), endurance (β=0.00051), PWC170 (β=0.00045), 1.6km run: (β=-0.0077), and adult CD (all p&gt;0.30). However, an association was present for flexibility in childhood and adult CD (β=-0.038, p=0.028). Following adjustment for relevant adult measures, age and sex, no childhood physical fitness measures were associated with adult CD (muscular strength: β=-0.044; power: β=0.0077, endurance: β=0.017; PWC170: β=-0.0010; 1.6km run: β=0.0058, flexibility: β=-0.035 all p&gt;0.20). Conclusion: Measures of physical fitness in childhood were weakly associated with adult arterial stiffness. Given the reported relationship of adult fitness phenotypes with arterial stiffness, our data suggest current fitness or activities associated with current fitness might play a greater role in determining adult arterial stiffness.

Abstract 13444: Longer Telomere Length is Associated With More Distensible Carotid Arteries in a Healthy Adult Population

Introduction: Chronological age is associated with loss of arterial distensibility leading to greater cardiac afterload and inefficient systemic perfusion. It is not known if cellular aging, marked by a loss of telomeres, underlies vascular aging. We thus examined the association of leukocyte telomere length (LTL) with common carotid distensibility (CD) in a healthy adult population. Methods: We analyzed data from 119 adults free of clinical cardiovascular disease (ages 21-80 years, 39% African American, 60% women, from 99 families) with familial history of early onset coronary artery disease (30x coverage, Illumina HiSeq) for both 4 (LTL4) and 7 (LTL7) contiguous telomere motif repeats (TTAGGG or CCCTAA) using the approach of Ding et al (2014). Mean CD of both carotid arteries was calculated from systolic and diastolic carotid diameters measured using B-mode ultrasound and simultaneous measurement of brachial artery pulse pressure (follow-up time 0-5 years from the LTL visit). We used mixed model regression to account for non-independence of data in families. Results: The mean (SD) of LTL4 was 94851 (16370) and of LTL7 was 80666 (15001) repeats. Adjusting for age at LTL measurement, follow-up time to carotid measurement, sex, race, systolic and diastolic blood pressure, LDL- and HDL-cholesterol levels, current smoking and diabetes, 1 SD higher level of LTL4 was associated with 2.0 х 10 -4 (p = 0.027), and 1 SD higher level of LTL7 with 1.8 х 10 -4 mmHg -1 (p = 0.048) higher CD, which is equivalent to CD at a chronological age that is lower by 4.4 and 4.0 years, respectively. Hypertension is not significantly associated with CD (p = 0.49) when added to this model. Conclusions: Greater LTL is associated with more distensible carotid arteries independent of cardiac risk factors including chronological age and blood pressure. Preserved telomere length represents healthy cellular aging in terms of fewer cell divisions, and thus greater vascular reparative reserve, which may lead to preserved arterial distensibility. This mechanism may partly explain the reported association of greater telomere length with lower risk of vascular events including coronary disease, heart failure and stroke.

Hemodynamic overload and intra-abdominal adiposity in obese children: Relationships with cardiovascular structure and function

Background and aimsChildhood obesity promotes adverse changes in cardiovascular structure and function. This study evaluated whether these changes are related to intra-abdominal adiposity and associated cardiometabolic risk or to body-size induced hemodynamic overload. Methods and results55 obese children/adolescents and 35 healthy-weight controls underwent carotid, cardiac and abdominal ultrasound to assess carotid artery intima-media thickness (IMT), diameter, distension and stiffness, left ventricular (LV) dimension, mass and function and extent of intra-abdominal adiposity.As compared to controls with healthy BMI, obese children had higher systolic blood pressure (BP), stroke volume and lower total peripheral resistance (P < 0.001–0.0001), higher plasma triglycerides, glycated hemoglobin, insulin and HOMA-IR index (P = 0.01–<0.0001), higher carotid IMT, diameter and distension (P < 0.005–0.0005), higher LV diameter, wall thickness and mass (P < 0.001–0.0001), and impaired LV diastolic function assessed by myocardial longitudinal performance (P < 0.005). In entire population, independent determinants of carotid diameter, LV diameter, wall thickness and mass were fat-free mass (or stroke volume, respectively) and BP. Carotid distension was determined by carotid diameter and BP, and carotid IMT by carotid diameter, BP, HDL-cholesterol and glycated hemoglobin. LV diastolic performance was inversely related to preperitoneal fat thickness and plasma insulin levels. ConclusionsObese youths present signs of impaired lipid and glucose metabolism, hyperdynamic circulation and cardiovascular changes. Increase in LV dimensions and mass and in carotid diameter and distension seems to reflect adaptation to body-size induced increase in hemodynamic load, changes in LV diastolic performance a negative impact of intra-abdominal adiposity and associated metabolic risk, and increase in IMT both adaptive remodeling and metabolic risk.

Reference values for local arterial stiffness. Part A: carotid artery.

Non-invasive measures of common carotid artery properties, such as diameter and distension, and pulse pressure, have been widely used to determine carotid artery distensibility coefficient - a measure of carotid stiffness (stiffness ∼1/distensibility coefficient). Carotid stiffness has been associated with incident cardiovascular disease (CVD) and may therefore be a useful intermediate marker for CVD. We aimed to establish age and sex-specific reference intervals of carotid stiffness. We combined data on 22 708 individuals (age range 15-99 years, 54% men) from 24 research centres worldwide. Individuals without CVD and established cardiovascular risk factors constituted a healthy sub-population (n = 3601, 48% men) and were used to establish sex-specific equations for percentiles of carotid distensibility coefficient across age. In the sub-population without CVD and treatment (n = 12 906, 52% men), carotid distensibility coefficient Z-scores based on these percentile equations were independently and negatively associated, in men and women, respectively, with diabetes {-0.28 [95% confidence interval (CI) -0.41; -0.15] and -0.27 (-0.43; -0.12)}, mean arterial pressure [-0.26 (-0.29; -0.24) and -0.32 (-0.35; -0.29)], total-to-high-density lipoprotein cholesterol ratio [-0.05 (-0.09; -0.02) and -0.05 (-0.11; 0.01)] and BMI [-0.06 (-0.09; -0.04) and -0.05 (-0.08; -0.02)], whereas these were positively associated with smoking [0.30 (0.24; 0.36) and 0.24 (0.18; 0.31)]. We estimated age and sex-specific percentiles of carotid stiffness in a healthy population and assessed the association between cardiovascular risk factors and carotid distensibility coefficient Z-scores, which enables comparison of carotid stiffness values between (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures.

Comprehensive multi-modality assessment of regional and global arterial structure and function in adults born preterm.

Preterm birth is associated with higher blood pressure, which could be because preterm birth alters early aortic elastin and collagen development to cause increased arterial stiffness. We measured central and conduit artery size and multiple indices of arterial stiffness to define the extent and severity of macrovascular changes in individuals born preterm. A total of 102 young adults born preterm and 102 controls who were born after an uncomplicated pregnancy underwent cardiovascular magnetic resonance on a Siemens 1.5 T scanner to measure the aortic cross-sectional area in multiple locations. Ultrasound imaging with a Philips CX50 and linear array probe was used to measure carotid and brachial artery diameters. Carotid-femoral pulse wave velocity and the augmentation index were measured by SphygmoCor, brachial-femoral pulse wave velocity by Vicorder and aortic pulse wave velocity by cardiovascular magnetic resonance. The cardio-ankle vascular index (CAVI) was used as a measurement of global stiffness, and ultrasound was used to assess peripheral vessel distensibility. Adults born preterm had 20% smaller thoracic and abdominal aortic lumens (2.19±0.44 vs. 2.69±0.60 cm2, P<0.001; 1.25±0.36 vs. 1.94±0.45 cm2, P<0.001, respectively) but similar carotid and brachial diameters to adults born at term. Pulse wave velocity was increased (5.82±0.80 vs. 5.47±0.59 m s−1, P<0.01, 9.06±1.25 vs. 8.33±1.28 m s−1, P=0.01, 5.23±1.19 vs. 4.75±0.91 m s−1, P<0.01) and carotid distensibility was decreased (4.75±1.31 vs. 5.60±1.48 mm Hg−1103, P<0.001) in this group compared with the group born at term. However, the global and peripheral arterial stiffness measured by CAVI and brachial ultrasound did not differ (5.95±0.72 vs. 5.98±0.60, P=0.80 and 1.07±0.48 vs. 1.19±0.54 mm Hg−1103, P=0.12, respectively). Adults who are born preterm have significant differences in their aortic structure from adults born at term, but they have relatively small differences in central arterial stiffness that may be partially explained by blood pressure variations.

Interrelationships between indices of longitudinal movement of the common carotid artery wall and the conventional measures of subclinical arteriosclerosis.

Our objective was to study the interrelationships between longitudinal movement of the wall of the common carotid artery and the conventional measures of arteriosclerosis in a large and well-characterized study population. Successful longitudinal movement analyses were performed on 292 subjects. The peak-to-peak and retrograde amplitudes of the longitudinal movement were directly correlated with carotid artery distensibility (r=0·21, P<0·001 and r=0·23, P<0·001, respectively) and inversely correlated with pulse wave velocity (r=-0·14, P<0·05 and r=-0·17, P<0·01, respectively). All longitudinal motion parameters were independent of brachial flow-mediated dilatation and intima-media thickness. Our findings indicate that arterial stiffening modulates longitudinal movement and, therefore, measurement of longitudinal movement can be of value in the assessment of vascular health.

Carotid arterial stiffness and risk of incident cerebral microbleeds in older people: the Age, Gene/Environment Susceptibility (AGES)-Reykjavik study.

Age and high blood pressure are major risk factors for cerebral microbleeds (CMBs). However, the underlying mechanisms remain unclear and arterial stiffness may be important. We investigated whether carotid arterial stiffness is associated with incidence and location of CMBs. In the prospective, population-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik study, 2512 participants aged 66 to 93 years underwent a baseline brain MRI examination and carotid ultrasound in 2002 to 2006 and returned for a repeat brain MRI in 2007 to 2011. Common carotid arterial stiffness was assessed using a standardized protocol and expressed as carotid arterial strain, distensibility coefficient, and Young elastic modulus. Modified Poisson regression was applied to relate carotid arterial stiffness parameters to CMB incidence. During a mean follow-up of 5.2 years, 463 people (18.4%) developed new CMBs, of whom 292 had CMBs restricted to lobar regions and 171 had CMBs in a deep or infratentorial region. After adjusting for age, sex, and follow-up interval, arterial stiffness measures were associated with incident CMBs (risk ratio per SD decrease in carotid arterial strain, 1.11 [95% confidence interval, 1.01-1.21]; per SD decrease in natural log-transformed distensibility coefficient, 1.14 [1.05-1.24]; and per SD increase in natural log-transformed Young elastic modulus, 1.13 [1.04-1.23]). These measures were also significantly associated with incident deep CMBs (1.18 [1.02-1.37]; 1.24 [1.08-1.42]; and 1.23 [1.07-1.42]) but not with lobar CMBs. When further adjusted for blood pressure and other baseline vascular risk factors, carotid plaque, prevalent CMBs, subcortical infarcts, and white matter hyperintensities, the associations persisted. Our findings support the hypothesis that localized increases in carotid arterial stiffness may contribute to the development of CMBs, especially in a deep location attributable to hypertension.

Association between serum uric acid, aortic, carotid and femoral stiffness among adults aged 40-75 years without and with type 2 diabetes mellitus: The Maastricht Study.

Arterial stiffness may be a mechanism to explain the association between uric acid and cardiovascular disease. We aimed to analyse associations between serum uric acid and regional and local arterial stiffness, and assess potential differences related to sex and glucose metabolism status. A cross-sectional study was performed in 614 adults [52.6% men; mean age 58.7 ± 8.5 years; 23.2% type 2 diabetes mellitus (by design)] from The Maastricht Study. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV), distensibility, and compliance coefficient of the carotid and femoral artery, and carotid artery Young's elastic modulus. Higher uric acid (per SD of 74 μmol/l) was associated with greater stiffness indicated by a significantly higher cfPWV [β = 0.216 (95% confidence interval 0.061, 0.372); P = 0.006] and lower carotid distensibility coefficient [β = -0.633 (95% confidence interval -1.099, -0.166); P = 0.008] after adjustment for sex, age, and glucose metabolism status. Associations lost significance after adjusting for mean arterial pressure, BMI, waist, smoking status, heart rate, total : high-density lipoprotein cholesterol ratio, triglycerides, estimated glomerular filtration rate, use of lipid-lowering, antihypertensive, and diabetes medication, and use of secondary uricosurics. No associations were found between uric acid and carotid compliance coefficient, carotid Young's elastic modulus, or stiffness of the femoral artery. A significant interaction (P < 0.10) with glucose metabolism status was found for cfPWV. However, none of the stratified associations were significant. There was no interaction with sex. Uric acid was not significantly associated with stiffness of the aorta, or the carotid or femoral artery among adults aged 40-75 years without and with type 2 diabetes mellitus.

Carotid artery stiffness is related to hyperinsulinemia and insulin-resistance in middle-aged, non-diabetic hypertensive patients

Background and aimsGlycometabolic abnormalities are frequently found in hypertension and could affect the mechanical properties of carotid arteries. The aim of the study was to investigate the relationship of glucose tolerance, plasma insulin, and insulin sensitivity with carotid distensibility in middle-aged, non-diabetic hypertensive patients free of cardiac and vascular complications. Method and resultsIn 93 patients with grade 1–2, uncomplicated, primary hypertension and 68 matched normotensive controls we measured plasma glucose and insulin at fast and after an oral glucose load (OGTT), calculated the HOMA-index as a marker of insulin sensitivity, and assessed distensibility of common carotid arteries by B-mode ultrasonography. Hypertensive patients were hyperinsulinemic and insulin-resistant as compared to normotensive controls. Hypertensive patients with impaired fasting glucose and/or impaired glucose tolerance had comparable distensibility of carotid arteries. Patients with decreased carotid distensibility were older and had higher body mass, fasting and post-OGTT plasma insulin, HOMA-index, and carotid IMT than the remaining patients, but no differences in glycated hemoglobin, and fasting or post-OGTT plasma glucose. Carotid coefficient of distensibility was inversely related and β-stiffness directly related with fasting and post-OGTT plasma insulin, and HOMA-index. Multivariate logistic regression showed that age and post-OGTT plasma insulin levels predicted carotid artery stiffening independent of body mass index, sex, blood pressure, and plasma glucose levels. ConclusionsThe study demonstrates that decreased insulin sensitivity and the related hyperinsulinemia but not hyperglycemia could contribute to carotid artery stiffening in middle-aged, non-diabetic hypertensive patients free of cardiovascular complications.

Following the Physical Activity Guidelines for Adults With Spinal Cord Injury for 16 Weeks Does Not Improve Vascular Health: A Randomized Controlled Trial

ObjectiveTo evaluate the effects of following the physical activity guidelines (PAG) for adults with spinal cord injury (SCI) for 16 weeks. DesignRandomized controlled trial. SettingCommunity exercise program. ParticipantsIndividuals with SCI (N=23; neurological level of injury, C3–T11; American Spinal Injury Association Impairment Scale A–C; time postinjury, 12.0±9.9y; age, 41.4±11.6y). InterventionsParticipants were randomly assigned to PAG training (n=12) or active control (n=11) groups. PAG training involved ≥20 minutes of moderate-vigorous aerobic exercise (rating of perceived exertion 3–6 on 10-point scale) and 3×10 repetitions of upper-body strengthening exercises (50%–70% 1 repetition maximum) 2 times per week. The control group maintained existing physical activity levels with no guidance on training intensity. Main Outcome MeasuresOutcome measures were obtained pre- and postintervention. Vascular health indicators included arterial stiffness via carotid distensibility and pulse wave velocity, and endothelial function via flow-mediated-dilation. Fasted blood samples were analyzed for markers of cardiovascular disease (CVD) risk. Body composition was assessed via anthropometrics and with dual-energy x-ray absorptiometry. ResultsTwenty-one individuals completed the intervention (PAG=12, control=9). Group-by-time interactions were observed for whole-body mass (P=.03), whole-body fat (P=.04), visceral adipose tissue (P=.04), and carotid artery distensibility (P=.05), suggesting maintained body composition and carotid stiffness in the PAG group concurrent with declines in the control group. No changes were found in any other outcome measure. ConclusionsWhile 16 weeks of adherence to the PAG in adults with SCI is insufficient to improve many markers of CVD risk, it may prevent declines in others. The PAG should continue to be promoted as a means to increase physical fitness and maintain body composition in individuals with SCI, but changes may be needed to achieve other health outcomes.

PP.20.21

Objective: The functional and structural properties of large arteries in patients with severe hypertension, more suitable for cardiovascular complications, have not been studied. The aim of our study was to evaluate modifications of large arteries obtained by noninvasive methods (pulse wave velocity-PWV and carotid ultrasound), its major determinants and the correlations with inflammatory markers in patients with severe hypertension. Design and method: We evaluated 48 patients (age 53,6 ± 8 years; 75% white; 71% women), with stage 3 arterial hypertension, under the same antihypertensive treatment for one month. Carotid parameters (diameter, wall thickness, distension) were evaluated by radiofrequency ultrasound and arterial stiffness by PWV measurements. All patients were submitted to 24-hs ambulatory blood pressure monitoring and blood samples were collected to analyze inflammatory markers and biochemical profile. Results: The office mean arterial pressure (MAP) was 117,1 ± 17 mmHg, mean PWV 12,21 ± 2,7 m/s, intima media thickness(IMT) 0,76 ± 0,12 mm, carotid diameter 7,38 ± 1,1 mm and carotid distension 5,27 ± 2 %. We observed a significative correlation between PWV and MAP (r = 0.38, p < 0.05) while carotid distension did not correlate to MAP. PWV measurements significantly correlated to SBP during sleep period (r = 0.356, p = 0.01), the lowest SBP during sleep (0.402, p < 0.01), and morning surge (r = 0.309, p < 0.05). Carotid distension was negatively correlated to glycemia (r = -0.32, p = 0.026). Concerning inflammatory markers, PWV was inversely correlated to adiponectin levels (r = -0.306, p = 0.03). Also PWV and IMT values were significantly correlated (r = 0,32, p < 0.05). Conclusions: In patients with stage 3 hypertension arterial stiffness is correlated to nocturnal blood pressure and morning surge, and is associated to elevated glycemia and a decreased adiponectin production. The data suggests an integrative role of metabolic, inflammatory and hemodynamic changes in large arteries impairment linked to hypertension.

5B.03

Objective: The present study was designed to investigate the relationship between left ventricular elastance (ELV), arterial elastance (EA), parameters of vascular stiffness and the influence of gender in a population of hypertensive individuals at high cardiovascular (CV) risk. Design and method: Seventy eight subjects participated in the study. Trans-thoracic cardiac ultrasound exam and parameters of aortic stiffness (carotid-femoral pulse wave velocity, PWV) wave reflection (augmentation index, AIx), aortic and carotid pulse pressure (PP) were obtained. Ultrasound images of the common carotid artery were acquired for the assessment of intima-media thickness (IMT) as well as carotid compliance (CC) and distensibility coefficient (DC). Results: The mean age of subjects was 62,5 years old, 37,2% had diabetes, 48,7% dyslipidemia, 7,7% previous CV events. Women (43%) and men were superimposable for CV risk factors except for older age (63.3 ± 9.2 vs 57.5 ± 10.4 years, p < 0.001) and greater prevalence of dyslipidemia (66% vs 35%, p = 0.04). In the overall population ELV was significantly correlated with EA (r = 0.79,p < 0.001), age, gender and BMI (r = 0.30,p = 0.07,r = -0.64,p < 0.001,r = -0.32,p = 0.004 respectively), AIx (r = 0.53,p < 0.001), aortic PP (r = 0.39,p < 0.001) CC (r = -0.44, p < 0.001) and DC (r = -0.27, p = 0.02), but not with PWV (r = 0.13,p = 0.28). In the multiple regression model including EA, ELV was still significantly correlated with EA, BMI, gender (all p < 0.001) and aortic PP (p = 0.004). Conversely, DC and PWV were not. DC, CC, PWV and IMT were similar in men and women. ELV (p < 0.0001) and EA (p = 0.0002) were higher in women than in men, while EA/ELV was lower (p = 0.0003). While EA and BMI were significantly correlated with ELV both in men (r = 0.74,p < 0.0001) and women (r = 0.77,p < 0.0001), DC was correlated with ELV only in women (women r = 0.04,p = 0.03, men r = -0.21,p = 0.17), and aortic PP (men r = 0.44,p = 0.002, women r = 0.44, p = 0.01) and AIX (men r = 0.37,p = 0.002, women r = 0.33, p = 0.06) only in men. Conclusions: In hypertensive individuals, main determinants of ventricular elastance are arterial elastance as an integrated index of arterial vascular load, central PP, gender and BMI. However, large artery stiffness in women and pressure augmentation in men might play an additional role.

7C.10

Objective: A prothrombotic state is associated with presence and severity of organ damage in hypertensive patients. In these patients, evidence of subclinical carotid damage anticipates major cardiovascular events. The aim of this study was to investigate the association of prothrombotic markers with carotid stiffness in hypertension. Design and method: In 116 hypertensive patients (age 49 ± 13 years; 54 males) we assessed common carotid artery stiffness by B-mode ultrasonography and measured plasma fibrinogen, D-dimer, plasminogen-activator inhibitor-1 (PAI-1), homocysteine, lipoprotein(a), and C-reactive protein. Results: No significant differences were observed in fibrinogen, D-dimer, lipoprotein(a), homocysteine, and C-reactive protein levels between patients with values below or above the median of the distribution of carotid distensibility, compliance, coefficient of distensibility, coefficient of compliance, Young elastic modulus, and beta-stiffness. Only PAI-1 levels were borderline higher in patients with high values of the Young elastic modulus than in patients with low values (P = 0.042). The Young elastic modulus was significantly correlated with age and PAI-1 levels (r = 0.286, P = 0.036), whereas no further significant correlation between non-traditional cardiovascular risk factors and indices of carotid stiffness was observed. Stepwise multivariate regression analysis indicated that Young elastic modulus was independently associated with age and PAI-1 (B = 0.289, P = 0.028). Conclusions: The findings of this study do not support the involvement of a prothrombotic state and other non-traditional cardiovascular risk factors related to the hemostatic system in carotid artery stiffening of hypertensive patients.

Carotid intima-media thickness and elastic properties of aortas in normotensive children of hypertensive parents.

A significant correlation between hypertension history and high blood pressure has been observed with regard to age, race and gender. Investigating carotid intima-media thickness and aortic stiffness prior to the development of hypertension in children of hypertensive parents enabled us to evaluate these patients for subclinical atherosclerosis. We compared carotid intima-media thickness, aortic strain, distensibility, stiffness indices and elastic modulus in 67 normotensive children whose parents had a diagnosis of essential hypertension and 39 normotensive children with no parental history of hypertension. Although there were no significant differences between the two groups in terms of systolic blood pressure, diastolic blood pressure, average blood pressure and pulse pressure (P>0.05), systolic blood pressures were higher among patients 15 years and older in the study group. No significant differences were noted between the control and study groups regarding interventricular septal thickness, left-ventricular posterior wall thickness, left-ventricular systolic and diastolic diameter and aortic annulus diameter (P>0.05). The left atrium diameter was larger in the study group compared with that in the control group, mainly because of the values of the 15-year-old and older children (P=0.01). The mean, maximum and minimum values of carotid intima-media thickness were significantly different in the study group compared with the control group among all age groups (P<0.001, P<0.001, P=0.006, respectively). Aortic systolic and diastolic diameters were larger in normotensive children of hypertensive parents compared with the control group (P=0.014, P=0.001, respectively). Although there were no differences between the study and control groups regarding aortic strain, aortic distensibility, elastic modulus and stiffness indices (P>0.05), aortic distensibility was lower, and aortic stiffness indices were higher among children 15 years and older in the study group. An increase in the carotid intima-media thickness in all age groups and a decrease in aortic elastic properties in 15-year-old and older children of hypertensive parents may indicate subclinical atherosclerosis in these apparently healthy children.

Aortic Pulse Wave Velocity in Healthy Children and Adolescents: Reference Values for the Vicorder Device and Modifying Factors.

Aortic pulse wave velocity (PWV), an indicator of arterial stiffness, independently predicts cardiovascular mortality risk in adults. Arterial stiffening advances with age and seems accelerated in children with certain disease conditions such as chronic kidney disease or diabetes. The Vicorder, an oscillometric device to measure PWV, has been validated in children, but reference values in a large pediatric cohort, association to carotid stiffness and influence of individual and family risk factors have not been determined. Pulse waves were captured in 1,003 healthy children (aged 6-18 years) in 6 centers and gender-specific reference data normalized to age/height were constructed. In 589 children carotid distensibility and intima media thickness were measured. Gestational and family history was reported. PWV correlated with age (r = 0.57, P < 0.0001) with significant gender-related differences starting at age 9. Further significant correlations were seen for height, weight, body mass index, blood pressure, pulse pressure, and heart rate. Independent predictors for PWV in a multivariate regression analysis were gender, age, height, weight, mean arterial pressure, and heart rate. Risk factors for higher PWV included small for gestational age at birth, secondhand smoking, parental hypertension, and obesity. PWV showed weak correlations with 2 of the carotid distensibility measures, but not with intima media thickness. This study defines reference values for PWV captured by the Vicorder device in children and adolescents and reveals associations with potential cardiovascular risk factors in a healthy population. Gender-specific percentiles for age/height will allow for the assessment of pediatric cohorts using this oscillometric method.

Association of sex hormones with carotid artery distensibility in men and postmenopausal women: multi-ethnic study of atherosclerosis.

The decline in carotid distensibility with age is steeper in women than in men, however, the correlates of this sex difference are not known. We examined the association of bioavailable testosterone, estradiol, dehydroepiandrosterone, and sex hormone-binding globulin, in 2783 postmenopausal women and 2987 men aged 45 to 84 years at the Multi-Ethnic Study of Atherosclerosis baseline examination. Carotid artery lumen diameters by ultrasound and brachial artery blood pressures were measured at systole and diastole. Regression models to determine the association of carotid distensibility coefficient and lumen diameter with sex-specific quartiles of sex hormones were adjusted for age, race, height, weight, diabetes mellitus, current smoking, antihypertensive medication use, total and high-density lipoprotein cholesterol levels, and hormone replacement therapy in women. A higher DC indicates a more distensible vessel. In women, higher dehydroepiandrosterone (P=0.008) and lower sex hormone-binding globulin (P=0.039) were associated with lower distensibility; higher dehydroepiandrosterone and lower estradiol were associated with smaller carotid diameters. In men, higher Bio-T (P=0.009) and lower estradiol (P=0.007) were associated with greater distensibility and also with smaller diameters (P=0.012 and 0.002, respectively). An androgenic internal milieu is associated with lesser carotid distensibility and diameter remodeling in women, but the opposite is true for men. Higher levels of estradiol are associated with smaller carotid diameters in both the sexes. Future longitudinal and experimental studies are needed to reveal the mechanism and clinical consequences of these associations.

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Coronary heart disease risk factors, coronary artery calcification and epicardial fat volume in the Young Finns Study.

We investigated associations of pre-clinical coronary heart disease (CHD), adolescence and adulthood CHD risk factors, and epicardial fat volume (EFV), which is thought to influence CHD pathology. EFV and coronary calcium scores were quantified using computed tomography imaging for 557 subjects from the Cardiovascular Risk in Young Finns Study in 2007. CHD risk marker levels were assessed repeatedly from 1980 to 2007. Carotid intima-media thickness (cIMT), carotid distensibility, and brachial flow-mediated dilatation were measured by vascular ultrasound in 2007. Increased EFV was cross-sectionally associated with male sex, increased waist circumference, body-mass index (BMI), cIMT, metabolic syndrome prevalence, levels of apolipoprotein B, total cholesterol, low-density lipoprotein cholesterol, triglycerides, C-reactive protein, blood pressure, insulin, and fasting glucose, as well as ever smoking, alcoholic intake, and lower high-density lipoprotein cholesterol (HDL-C), carotid distensibility and physical activity in adulthood. In BMI-adjusted analyses, only apolipoprotein B, ever smoking, alcohol intake and metabolic syndrome prevalence were independently associated with EFV. In adolescence, skinfold thickness, BMI, and insulin levels were higher and HDL-C lower with increasing EFV. Subjects in the lowest vs. highest quarter of EFV had consistently lower BMI across the early life-course. Associations of CHD risk markers with EFV were attenuated after multivariable adjustment. We found no evidence of increased EFV being independently associated with pre-clinical atherosclerosis. EFV was most strongly associated with BMI and waist circumference. Subjects with higher EFV had consistently higher BMI from age 12 suggesting that life-long exposure to higher BMI influences the development of EFV.

The effect of physical activity on cardiometabolic health and inflammation in treated HIV infection.

In HIV-uninfected populations, physical activity decreases mortality and inflammation. Inflammation is a potential cause of comorbidities in HIV+ adults, the evidence examining the effect of physical activity on cardiometabolic health is limited. This analysis examines the relationship between physical activity, cardiometabolic health and inflammation. We conducted a nested study within the SATURN-HIV trial in which 147 HIV+ adults were randomized to 10 mg daily rosuvastatin or placebo. Measures of physical activity, cardiometabolic health, inflammation and vascular disease (carotid artery intima media thickness and computed tomography-acquired measures pericardial fat volume) were assessed at baseline and through 96 weeks. Spearman correlations and multivariable analyses were used to explore relationships between physical activity, cardiometabolic health and inflammation. Median age (Q1, Q3) was 46 (40.4, 52.7) years, 80% were male, 69% were African American and 46% were on protease inhibitors. Baseline median physical activity was 44 min per week (0, 150), 24% of participants performed greater than 150 min per week. At baseline, physical activity correlated with several markers of cardiometabolic health and inflammation (all P≤0.05). Over all time points median physical activity was independently associated with carotid distensibility (β=2.53; P=0.008), pericardial fat volume (β=-6.13; P=0.001) and interleukin-6 (β=-0.468; P<0.001). Physical activity is associated with vascular disease, endothelial function, and may be an adjuvant to decreasing comorbidities in HIV+ adults. Further studies should examine long-term effects of physical activity on cardiometabolic health and inflammation in this population. Clinicaltrials.gov NCT01218802.