Changes In cfPWV Research Articles

P709Improvement in endothelial function and arterial elastic properties facilitates response to cardiac resynchronization therapy

Abstract Background Cardiac resynchronization therapy (CRT) is a well-established therapy in heart failure (HF) patients with prolonged QRS. In HF patients, reduced nitric oxide availability and increased oxidative stress promote endothelial dysfunction (ED) and arterial stiffness. Purpose To investigate the pathophysiologic changes in endothelium and arterial elastic properties in CRT patients and their correlation to therapy. Methods We studied 32 HF patients before and 3 months after CRT implantation. In each visit we performed a 12-lead ECG and assessed markers of endothelial function. Specifically, we examined flow-mediated dilatation of the brachial artery (FMD), carotid to femoral pulse wave velocity (cfPWV), as well as the layer of endothelial glycocalyx using the Perfused Boundary Region (PBR) of the sublingual microvessel range: 5–25 microns. We also evaluated left ventricle ejection fraction (LVEF), left ventricle (LV) global longitudinal strain (GLS) and arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography. Results 32 HF CRT patients, at age 65.5 (±10.9) years, with reduced LVEF (baseline LVEF: 27±7%, LVESV: 151±42 ml, GLS: 6.47±2.89%) were followed-up for a median of 115 days (IQR: 36). During follow up, all markers of ED demonstrated significant change: FMD was increased by 4.37±3.34% (p<0.001), cfPWV and PBR 5–25 were reduced by 1.10±1.56 (p=0.003) and 0.13±0.25 microns (p=0.028) respectively. LVEF was significantly increased (mean change: 7.50±4.77%) and LVESV was significantly reduced (mean change: −26.91±17.20 ml). 16 of 32 patients were responders (LVESV change ≥15% compared to baseline). Among the changes of the examined markers during follow-up, response to CRT correlated with the change of FMD (OR: 3.10, 95% CI: 1.47–15.51, p=0.039) and change of Ea/Ees (OR: 0.000, 95% CI: 0.000–0.061, p=0,0239). Effect of change in measurements during follow-up on response to CRT Measurement OR (95% CI) Main effect p-value FMD change 3.100 (1.470–15.513) 0.0397 cfPWV change 0.669 (0.295–1.354) 0.0622 PBR 5–25 change 1.773 (0.008–455.458) 0.828 Ea/Ees change 0.000 (0.000–0.061) 0.0239 Conclusion Improvement in endothelial function and arterial elastic properties evaluated by FMD and Ea/Ees respectively are related with effective CRT.

Arterial stiffness during whole-body passive heat stress in healthy older adults.

We tested the hypothesis that whole‐body passive heat stress reduces arterial stiffness in older adults. At preheat stress (baseline) and when core temperature was elevated by 0.6 ± 0.2°C (mild) and 1.2 ± 0.3°C (moderate), arterial stiffness was measured in eight healthy younger (26 ± 5 years) and eight healthy older (70 ± 4 years) adults in the supine position. Arterial stiffness was estimated from carotid‐to‐femoral pulse wave velocity (cfPWV, applanation tonometry). cfPWV was higher at baseline in older adults (8.8 ± 2.3 m/sec vs. 5.6 ± 0.9 m/sec, P < 0.01) and this difference was maintained throughout passive heat stress (P < 0.01). cfPWV did not change (P ≥ 0.49) with passive heat stress in either younger (at moderate heat stress: 6.0 ± 1.0 m/sec) or older (at moderate heat stress: 8.5 ± 1.6 m/sec) adults. However, the influence of baseline cfPWV on the change in cfPWV during mild (r = −0.66, P = 0.04) and moderate (r = −0.87, P < 0.01) heat stress were inversely related in older adults, and the strength of these relations was not statistically different (P = 0.08). In younger adults, the influence of baseline cfPWV on the change in cfPWV during mild heat stress was also inversely related (r = −0.79, P = 0.01), while the strength of this relation was attenuated at moderate heat stress (r = −0.24, P = 0.30). Changes in arterial stiffness during passive heat stress in adults aged ≥65 year are likely dependent on the magnitude of baseline arterial stiffness and not necessarily age.

Abstract P035: Habitual Aerobic Exercise-Induced Decrease in Circulating C1q Level is Associated With Reduction of Cardiovascular Diseases Risks in the Elderly

Introduction: Habitual aerobic exercise leads to reduction of arterial wall thickness and arterial stiffness with aging. Recently, C1q has been identified as a novel myokine, and the expression of muscle C1q mRNA increases with aging. Additionally, in vivo and in vitro studies, C1q induces proliferation of vascular smooth muscle cells. However, it remains unclear whether the secretion of myokines, C1q, TNF-alpha and IL-6 are related to the changes in cardiovascular disease risk by aging and regular exercise. PURPOSE: This study aimed to clarify whether serum C1q, TNF-alpha and IL-6 levels are associated with the changes in cardiovascular disease risks with aging and regular aerobic exercise. Methods: In a cross-sectional study, 127 healthy male and female subjects (18-81 years) were enrolled in this study. Subjects were divided into two groups; young (&lt;40 year) and middle-aged and older (≥40 year) groups. Serum C1q, TNF-alpha, IL-6 levels were determined by ELISA. Risks of cardiovascular disease were estimated by using carotid-femoral pulse wave velocity (cfPWV) and common carotid intima-media thickness (ccIMT). Additionally, in an intervention study, thirteen older male subjects were randomly divided into two groups: aerobic training group (AT: n=6) and a sedentary control group (Con: n=7). subjects in the AT group completed 8 wk of aerobic exercise training (60-70% peak oxygen uptake for 45 min, 3 days/wk). Results: In the cross-sectional study, serum C1q, TNF-alpha and IL-6 levels, cfPWV and ccIMT were significantly higher in middle-aged and older group as compared with young group (respectively p&lt;0.05). Positive correlations between cfPWV and serum C1q (r=0.41, p&lt;0.05), TNF-alpha (r=0.28, p&lt;0.05) or IL-6 (r=0.26, p&lt;0.05) levels were seen. Additionally, ccIMT was positively correlated with only serum C1q (r=0.67, p&lt;0.05). After adjusting for TNF-alpha and IL-6, the association between the serum C1q and cfPWV (ß=0.44, p&lt;0.05) or ccIMT (ß=0.83, p&lt;0.05) remained statistically significant. Additionally, in the intervention study, cfPWV and serum C1q level significantly decreased after AT intervention (each P&lt;0.05). Furthermore, the AT-induced change in serum C1q level was positively correlated with AT-induced change in cfPWV (r=0.65, P&lt;0.05) and ccIMT (r=0.59, P&lt;0.05). Conclusion: These results suggest that circulating C1q level may reflect the changes of arterial stiffness and thickness with aging and regular exercise, and the reduction of serum C1q level in response to regular aerobic exercise may contribute to the reduction in cardiovascular disease risks in the elderly.

Influence of Exercise Mode on Post-exercise Arterial Stiffness and Pressure Wave Measures in Healthy Adult Males.

Background: Exercise mode has been reported to be an important determinant of arterial stiffness and wave reflection changes following a brief bout of exercise with inconsistent results to date. This study examined the impact of exercise mode on arterial stiffness and pressure wave measures following acute aerobic exercise (AER), resistance exercise (RES), and a control (CON) condition with no exercise.Methods: In a randomized, cross-over, repeated measures design, 21 healthy adult males (26.7 ± 7.2 years) undertook three experimental intervention sessions: AER (30-min cycle ergometry at 70–75% maximum heart rate), RES (3 × 10 repetitions of six upper and lower body exercises at 80–90% of 10-repetition maximum) and CON (30-min seated rest). Measures of arterial stiffness and pressure waves, such as carotid-femoral pulse wave velocity (cf-PWV), augmentation index (AIx), AIx corrected for heart rate of 75 (AIx75), and forward wave (Pf), backward wave (Pb) and reflection magnitude, were assessed at Rest and at 10-min intervals for 60 min after the intervention sessions. Comparisons between interventions and over time were assessed via repeated measures ANOVA and post-hoc Tukey's tests.Results: No significant differences in cf-PWV were noted between the three interventions at rest or post-intervention. However, RES led to significantly greater post-intervention AIx, AIx75, Pf, and Pb compared to AER and CON with AIx75 also remaining significantly elevated throughout the post-intervention period. In contrast, AER resulted in a brief, significant elevation of AIx75 and no change in cf-PWV, Pf, Pb, and reflection magnitude.Conclusions: Exercise mode, specifically RES and AER, significantly influenced the time course of pressure wave reflection responses following a brief bout of exercise in healthy adult males. Distinct adjustments during exercise including changes in blood pressure and vasomotor tone may be key modulators of post-exercise arterial function. Identification of modal differences may assist in understanding the impact of exercise on cardiovascular function and the mechanisms by which exercise benefits vascular health.

Acute Effect of Interval Walking on Arterial Stiffness in Healthy Young Adults.

The purpose of this study was to determine the acute effects of interval walking (IW) on arterial stiffness. The participants in this study were 14 healthy men and women (age 27.5±3.8 y). Carotid-femoral pulse wave velocity (cfPWV) was measured using an automatic oscillometric device at 30 min before (baseline) and at 30 and 60 min after walking. Participants repeated five sets of 3-min walks at 30% and 70% of maximum aerobic capacity for a total of 6 min per set in the IW trial. The participants also walked for 30 min at 50% (moderate intensity) of maximum aerobic capacity in a continuous walking (CW) trial. cfPWV was significantly decreased from baseline at 30 min (P=0.02) after the IW trial, and this reduction in cfPWV persisted for 60 min (P=0.01). In contrast, cfPWV was significantly decreased from baseline at 30 min (P=0.03) after the CW trial, but the reduction did not persist for 60 min. Moreover, changes in cfPWV in the IW trial after 30 and 60 min were significantly lower than in the CW trial (P<0.05). These results suggest that IW acutely reduces central arterial stiffness more than CW in healthy young adults.

Abstract P364: Baseline and Change in Blood Pressure Are Associated With Central Arterial Stiffening and Pressure Pulsatility in Older Adults: The Atherosclerosis Risk in Communities Study - Neurocognitive Study (ARIC-NCS)

Background: Greater central arterial stiffness and pulsatility predict target organ small vessel disease and all-cause mortality. Understanding change in artery stiffness and pulsatility and their determinants has implications for prevention. Reports of the temporal association of blood pressure with arterial stiffness and pulsatility are conflicting. Objective: Characterize the prospective association of blood pressure with changes in arterial stiffness and pulsatility in a population of older black and white adults. Methods: This is a preliminary analysis of 864 adults (508 women; 164 black; mean age 74 years) examined in both visits 5 (2011-2013) and 6 (2016-2018; n=4,215 expected) of the population-based ARIC-NCS. At both visits, certified staff measured arterial stiffness (carotid-femoral PWV (cfPWV), brachial-ankle PWV (baPWV)) and pulsatility (central pulse pressure (cPP)). Associations of baseline (visit 5) and annual change in SBP, diastolic blood pressure (DBP), and central SBP (cSBP) with the annual change in PWV and cPP were evaluated by multivariable linear regression. We adjusted for age, sex, race-center, and visit 5 heart rate, body mass index, smoking status, hypertension medication, and type 2 diabetes. Results: Over the 5 years between visits, cfPWV increased by 28 cm/s/y, baPWV increased by 28 cm/s/y, and cPP increased by 0.62 mmHg/y. Higher baseline SBP, DBP, and cSBP were associated with lower annual change in cfPWV, baPWV, and cPP (Table). Higher annual changes in SBP, DBP, and cSBP were associated with greater annual change in cfPWV, baPWV, and cPP. Their effect on annual change in cfPWV, baPWV, and cPP were ~double that of the baseline measures. Conversely, baseline PWV was not associated with annual changes in blood pressure. Conclusion: Annual changes in SBP, DBP, and cSBP are modifiable traits that were positively associated with change in arterial stiffness and pulsatility. Lowering blood pressure, therefore, may reduce the progression of arterial stiffness among older adults.

Aerobic exercise training-induced changes in serum C1q/TNF-related protein levels are associated with reduced arterial stiffness in middle-aged and older adults

Adiponectin regulates endothelial nitric oxide synthase in endothelial cells, and body fat loss by aerobic exercise training promotes adiponectin secretion. Recently, C1q/tumor necrosis factor-related proteins (CTRPs) have been identified as novel adipokines and are paralogs of adiponectin, but the association between exercise training-induced reduction of arterial stiffness and circulating CTRPs levels remains unclear. This study aimed to clarify whether the reduction of arterial stiffness in middle-aged and older adults is associated with the change in serum levels of CTRPs induced by exercise training. A total of 52 middle-aged and older participants were randomly divided into two groups: a training group ( n = 26) and a sedentary control group ( n = 26). Participants in the training group completed 8 wk of aerobic exercise training (60-70% peak oxygen uptake for 45 min, 3 days/wk). The reduction of percent whole body fat, abdominal visceral fat area, and carotid-femoral pulse-wave velocity (cfPWV) was significantly greater in the training group than in the control group ( P < 0.05). Moreover, the increase in serum adiponectin, CTRP3, and CTRP5 from baseline to 8 wk was significantly higher in the training group compared with the control group ( P < 0.05). Additionally, the training-induced change in cfPWV was negatively correlated with the training-induced change in serum adiponectin, CTRP3, and CTRP5 levels ( r = -0.51, r = -0.48, r = -0.42, respectively, P < 0.05), and increased plasma nitrite/nitrate level by exercise training was correlated only with adiponectin levels ( r = 0.41, P < 0.05). These results suggest that the exercise training-induced increase in serum CTRPs levels may be associated with the reduction of arterial stiffness in middle-aged and older adults.

ARTERIAL STIFFNESS IS ASSOCIATED WITH LOWER CEREBRAL BLOOD PERFUSION IN OLDER ADULTS

Arterial stiffness is an emerging risk factor for Alzheimer's disease and related dementias, partly through its novel associations with both cerebrovascular disease and β-amyloid deposition. Initial reports suggest that greater aortic stiffness may be related to lower cerebral perfusion in the brain. This study included participants from a randomized controlled clinical trial of exercise who received brain MRIs and cognitive testing before and after 6 months of aerobic training or stretching exercise. MRI included multi-phase pseudo-continuous arterial spin labeling to define cerebral blood flow in the whole brain gray matter (CBFgm). A subset of participants received baseline (n=17) and/or post-intervention (n=22) measures of central arterial stiffness using the AtCor SphygmoCor XCEL to obtain carotid-femoral pulse wave velocity (cfPWV). General linear models were used to assess associations between cfPWV and (global and voxel wise) cerebral blood flow with and without adjustment for age, gender, education, intracranial volume and APOE-4 status. Participants in this sample had a mean(SD) age of 67(9) years [range 51–89], 60% women, 19% were APOE-ε4 positive and all had at least an 12th grade education. Baseline cfPWV was negatively correlated with CBFgm (figure), showed regional specificity, and remained significant adjustment for covariates (beta = -4.3(1.8), p=0.04). Baseline and post intervention measures of cfPWV were highly correlated (rho=0.62, P<0.01) and showed similar negative associations with global CBFgm; however, change in cfPWV was not associated with changes global CBFgm (p=0.35). Correlations between global CBF and arterial stiffness by gender.

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

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

High-Intensity Interval Cycling Exercise on Wave Reflection and Pulse Wave Velocity.

Kingsley, JD, Tai, YL, Vaughan, J, and Mayo, X. High-intensity interval cycling exercise on wave reflection and pulse wave velocity. J Strength Cond Res 31(5): 1313-1320, 2017-The purpose of this study was to assess the effects of high-intensity exercise on wave reflection and aortic stiffness. Nine young, healthy men (mean ± SD: age: 22 ± 2 years) participated in the study. The high-intensity interval cycling exercise consisted of 3 sets of Wingate Anaerobic Tests (WATs) with 7.5% of bodyweight as resistance and 2 minutes of rest between each set. Measurements were taken at rest and 1 minute after completion of the WATs. Brachial and aortic blood pressures, as well as wave reflection characteristics, were measured through pulse wave analysis. Aortic stiffness was assessed through carotid-femoral pulse wave velocity (cfPWV). A repeated-measures analysis of variance was used to investigate the effects of the WATs on blood pressure and vascular function across time. There was no change in brachial or aortic systolic pressure from rest to recovery. There was a significant (p ≤ 0.05) decrease in brachial diastolic pressure (rest: 73 ± 6 mm Hg; recovery: 67 ± 9 mm Hg) and aortic diastolic pressure (rest: 75 ± 6 mm Hg; recovery: 70 ± 9 mm Hg) from rest to recovery. In addition, there was no significant change in the augmentation index (rest: 111.4 ± 6.5%; recovery: 109.8 ± 5.8%, p = 0.65) from rest to recovery. However, there was a significant (p ≤ 0.05) increase in the augmentation index normalized at 75 b·min (rest: 3.29 ± 9.82; recovery 21.21 ± 10.87) during recovery compared with rest. There was no change in cfPWV (rest: 5.3 ± 0.8 m·s; recovery: 5.7 ± 0.5m·s; p = 0.09) in response to the WAT. These data demonstrate that high-intensity interval cycling exercise with short rest periods has a nonsignificant effect on vascular function.

Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension.

AimsThere are few proven strategies to enhance physical activity and cardiometabolic profiles in patients with type 2 diabetes and hypertension. We examined the effects of physician‐delivered step count prescriptions and monitoring.MethodsParticipants randomized to the active arm were provided with pedometers and they recorded step counts. Over a 1‐year period, their physicians reviewed their records and provided a written step count prescription at each clinic visit. The overall goal was a 3000 steps/day increase over 1 year (individualized rate of increase). Control arm participants were advised to engage in physical activity 30 to 60 min/day. We evaluated effects on step counts, carotid femoral pulse wave velocity (cfPWV, primary) and other cardiometabolic indicators including haemoglobin A1c in diabetes (henceforth abbreviated as A1c) and Homeostasis Model Assessment‐Insulin Resistance (HOMA‐IR) in participants not receiving insulin therapy.ResultsA total of 79% completed final evaluations (275/347; mean age, 60 years; SD, 11). Over 66% of participants had type 2 diabetes and over 90% had hypertension. There was a net 20% increase in steps/day in active vs control arm participants (1190; 95% CI, 550‐1840). Changes in cfPWV were inconclusive; active vs control arm participants with type 2 diabetes experienced a decrease in A1c (−0.38%; 95% CI, −0.69 to −0.06). HOMA‐IR also declined in the active arm vs the control arm (ie, assessed in all participants not treated with insulin; −0.96; 95% CI, −1.72 to −0.21).ConclusionsA simple physician‐delivered step count prescription strategy incorporated into routine clinical practice led to a net 20% increase in step counts; however, this was below the 3000 steps/day targeted increment. While conclusive effects on cfPWV were not observed, there were improvements in both A1c and insulin sensitivity. Future studies will evaluate an amplified intervention to increase impact.

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

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

Change in Pulse Wave Velocity and Short-Term Development of Cardiovascular Events in the Hemodialysis Population.

The association between single measurements of carotid-femoral pulse wave velocity (cfPWV) and cardiovascular (CV) events is driven by late events beyond 12 months of follow-up. This prospective study compares single measurements of cfPWV vs the 2-year delta cfPWV and the association with short-term development of CV events in hemodialysis patients. cfPWV was performed at t=0 and t=1 two years later, and patients were followed-up for development of CV events through 12 months (n=66). In Cox regression models adjusted for CV risk factors, history of CV events and delta cfPWV remained associated with the development of CV events (hazard ratio for prior CV events=8.9, P=.03; hazard ratio for delta cfPWV=1.14; P=.002). When delta cfPWV was substituted for single cfPWV measurement, none of the single measures were associated with new CV events. The change in cfPWV, but not single measurements of cfPWV, was associated with the development of CV events through 12 months.

Abstract P250: Changes in Glycemia and Blood Lipids Following a 4 Month Mhealth Walking Intervention

Introduction: Walking interventions focused on increasing step counts are typically associated with salutary effects on glycemia, fasting insulin, insulin resistance and blood lipids which may be in turn associated with improvements in cardiorespiratory fitness (peak oxygen uptake [[Unable to Display Character: &amp;#8211;]] VO 2peak ) and vascular stiffness. We hypothesized that a novel 4-month, behavioral economics-based walking intervention would have favorable effects on glucose homeostasis and blood lipids and that these in turn would be related to VO 2peak and vascular stiffness (carotid femoral pulse wave velocity [[Unable to Display Character: &amp;#8211;]] cfPWV). Methods: We carried out secondary analyses on a subsample of sedentary, overweight/obese adults who participated in a 4-month, 2x2, randomized-controlled walking intervention examining the effects of goal setting (static v. adaptive goals) and rewards (immediate v. delayed) on steps/day (N=96). Fasting blood samples (n=58) were collected from participants before and after the intervention. Premenopausal females were in the follicular phase of their menstrual cycles. Lipid and glucose levels were measured using an automated chemistry analyzer, while insulin was measured using radio-immunoassay. Homeostatic model of insulin resistance (HOMA-IR) was calculated using the following formula (HOMA-IR=glucose x insulin / 405). We examined associations [partial correlations (adjusted for age)] between changes in blood biomarkers and VO 2peak and cfPWV, irrespective of group, and we used linear mixed models to examine between-group differences in levels of and change in biomarker outcomes. Results: Groups did not differ in overall levels of, or degree of change in, biomarker outcomes (all p&gt;0.05). Mean changes, irrespective of group, in biomarkers were as follows: glucose Δ= 0.74± 4.5mg/dl; insulin Δ= 0.09 ± 4.1 μU/ml; total cholesterol Δ= 0.24 ± 20.6 mg/dl; HDL-C Δ= 0.27 ± 5.1 mg/dl; LDL-C Δ= 1.3 ± 19.9 mg/dl; triglycerides Δ= 1.7 ± 27.2 mg/dl; HOMA-IR Δ = -.0548 ± 1.05). We found no significant associations between change in biomarker levels and change in VO 2peak or change in cfPWV (all correlation coefficients &lt; 0.15; p &gt; 0.05). Conclusion: A 4-month, behavioral economics-based mHealth intervention focused on increasing steps/day did not bring about favorable changes on markers of glycemia, insulin resistance and blood lipids.

Acute benefits of the microbial-derived isoflavone metabolite equol on arterial stiffness in men prospectively recruited according to equol producer phenotype: a double-blind randomized controlled trial

Background: There is much speculation with regard to the potential cardioprotective benefits of equol, a microbial-derived metabolite of the isoflavone daidzein, which is produced in the large intestine after soy intake in 30% of Western populations. Although cross-sectional and retrospective data support favorable associations between the equol producer (EP) phenotype and cardiometabolic health, few studies have prospectively recruited EPs to confirm this association.Objective: The aim was to determine whether the acute vascular benefits of isoflavones differ according to EP phenotype and subsequently investigate the effect of providing commercially produced S-(–)equol to non-EPs.Design: We prospectively recruited male EPs and non-EPs (n = 14/group) at moderate cardiovascular risk into a double-blind, placebo-controlled crossover study to examine the acute effects of soy isoflavones (80-mg aglycone equivalents) on arterial stiffness [carotid-femoral pulse-wave velocity (cfPWV)], blood pressure, endothelial function (measured by using the EndoPAT 2000; Itamar Medical), and nitric oxide at baseline (0 h) and 6 and 24 h after intake. In a separate assessment, non-EPs consumed 40 mg S-(–)equol with identical vascular measurements performed 2 h after intake.Results: After soy intake, cfPWV significantly improved in EPs at 24 h (cfPWV change from 0 h: isoflavone, −0.2 ± 0.2 m/s; placebo, 0.6 ± 0.2 m/s; P < 0.01), which was significantly associated with plasma equol concentrations (R = −0.36, P = 0.01). No vascular effects were observed in EPs at 6 h or in non-EPs at any time point. Similarly, no benefit of commercially produced S-(–)equol was observed in non-EPs despite mean plasma equol concentrations reaching 3.2 μmol/L.Conclusions: Acute soy intake improved cfPWV in EPs, equating to an 11–12% reduced risk of cardiovascular disease if sustained. However, a single dose of commercially produced equol had no cardiovascular benefits in non-EPs. These data suggest that the EP phenotype is critical in unlocking the vascular benefits of equol in men, and long-term trials should focus on confirming the implications of EP phenotype on cardiovascular health. This trial was registered at clinicaltrials.gov as NCT01530893.

Effects on carotid-femoral pulse wave velocity 24 h post exercise in young healthy adults.

Arterial stiffness, often measured by carotid-femoral pulse wave velocity (cfPWV), is a subclinical marker of cardiovascular disease that is known to be reduced by exercise training. Exercise is also known to have acute vascular effects, yet it is unclear whether exercise 24 h before cfPWV testing influences this outcome. Thirty healthy, young adults completed a supervised, 30-min bout of moderate-to-vigorous intensity treadmill running. cfPWV, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured both before (after 48 h of abstaining from exercise) and 24 h after (with no additional exercise) the exercise session. From pre-exercise to 24 h post exercise, cfPWV decreased from 6.05±0.82 to 5.84±0.87 m s(-1) (P=0.02), SBP from 119.7±13.8 to 116.8±11.4 mm Hg (P=0.03) and DBP from 65.1±5.7 to 63.2±5.4 mm Hg (P=0.02), with no significant changes in HR. cfPWV was positively correlated with SBP pre-exercise (r=0.54, P<0.01) and post exercise (r=0.53, P<0.01). Changes in blood pressure explained 4-5% of the variability in cfPWV change; adjustments slightly attenuated the 24-h effects of exercise on cfPWV. Some evidence of gender differences was observed with higher cfPWV in males across assessments (P<0.05) and statistically significant reductions in cfPWV in males (-0.36±0.54 m s(-1) (P=0.02)) but not in females (-0.07±0.31 m s(-1) (P=0.41)). In conclusion, cfPWV decreased 24 h after an exercise bout, suggesting that exercise completed in the past 24 h should be considered before cfPWV testing.

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

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

Investigating the effect of glucose on aortic pulse wave velocity using pancreatic clamping methodology.

Aortic stiffness, determined by carotid-femoral pulse wave velocity (cfPWV), independently predicts cardiovascular outcomes. Recent studies suggest that glucose levels influence arterial stiffness indices. It is not clear, however, whether glucose affects cfPWV independently of glucoregulatory hormones. The aim of this study was to utilize a pancreatic clamping approach to determine whether plasma glucose independently predicts cfPWV. Healthy participants (N = 10) underwent pancreatic clamping to control glucose at varying concentrations using a 20% dextrose infusion while suppressing endogenous glucagon, insulin, and growth hormone by octreotide and replacing the hormones intravenously to achieve basal concentrations. Tonometric cfPWV, blood pressure, heart rate, plasma glucose, glucagon, insulin, growth hormone, and vasoactive biomarkers were measured. Plasma glucose levels of 150 mg/dl at 1 hr and 200 mg/dl at 2 hr postbaseline were achieved. There were no significant changes in cfPWV (5.8 m/s at 0 hr, 5.9 m/s at 1 hr, and 5.9 m/s at 2 hr) with increased glucose levels. There were small increases in insulin secretion. A definitive role for glucose in cfPWV modulation was not determined; there is a potential role for insulin as a cfPWV modulator. Continued efforts in clarifying the independent roles of glucose and insulin can elucidate novel vessel-related targets for cardiovascular disease prevention and management in patients with impaired glucose tolerance and diabetes.

Correlates of aortic stiffness progression in patients with type 2 diabetes: importance of glycemic control: the Rio de Janeiro type 2 diabetes cohort study.

The correlates of serial changes in aortic stiffness in patients with diabetes have never been investigated. We aimed to examine the importance of glycemic control on progression/regression of carotid-femoral pulse wave velocity (cf-PWV) in type 2 diabetes. In a prospective study, two cf-PWV measurements were performed with the Complior equipment in 417 patients with type 2 diabetes over a mean follow-up of 4.2 years. Clinical laboratory data were obtained at baseline and throughout follow-up. Multivariable linear/logistic regressions assessed the independent correlates of changes in cf-PWV. Median cf-PWV increase was 0.11 m/s per year (1.1% per year). Overall, 212 patients (51%) increased/persisted with high cf-PWV, while 205 (49%) reduced/persisted with low cf-PWV. Multivariate linear regression demonstrated direct associations between cf-PWV changes and mean HbA1c during follow-up (partial correlation 0.14, P = 0.005). On logistic regression, a mean HbA1c ≥7.5% (58 mmol/mol) was associated with twofold higher odds of having increased/persistently high cf-PWV during follow-up. Furthermore, the rate of HbA1c reduction relative to baseline levels was inversely associated with cf-PWV changes (partial correlation -0.11, P = 0.011) and associated with reduced risk of having increased/persistently high aortic stiffness (odds ratio 0.82 [95% CI 0.69-0.96]; P = 0.017). Other independent correlates of progression in aortic stiffness were increases in systolic blood pressure and heart rate between the two cf-PWV measurements, older age, female sex, and presence of dyslipidemia and retinopathy. Better glycemic control, together with reductions in blood pressure and heart rate, was the most important correlate to attenuate/prevent progression of aortic stiffness in patients with type 2 diabetes.

A novel device for measuring arterial stiffness using finger-toe pulse wave velocity: Validation study of the pOpmètre®

The finger-toe pathway could be a good alternative for assessing arterial stiffness conveniently. To evaluate the accuracy of the pOpmètre®--a new device that measures finger-toe pulse wave velocity (ft-PWV). The pOpmètre has two photodiode sensors, positioned on the finger and the toe. Pulse waves are recorded continuously for 20 seconds, and the difference in pulse wave transit time between toe and finger (ft-TT) is calculated. The travelled distance is estimated using subject height. Study 1 compared ft-PWV with carotid-femoral PWV (cf-PWV) obtained by the reference method (SphygmoCor®) in 86 subjects (mean age 53±20 years), including 69 patients with various pathologies and 17 healthy normotensives. Study 2 compared changes in ft-PWV and cf-PWV during a cold pressor test in 10 healthy subjects. Study 3 assessed repeatability in 45 patients. ft-PWV correlated significantly with cf-PWV (R2=0.43; P<0.0001). A better correlation was found in terms of transit time (R2=0.61; P<0.0001). The discrepancy between transit times was related to age. The cold pressor test induced parallel changes in cf-PWV and ft-PWV, with increased aortic stiffness that was reversible during recovery. Intra-session repeatability was very good, with a coefficient of variation of 4.52%. The pOpmètre® allows measurement of arterial stiffness in routine clinical practice. The greatest advantages of ft-PWV are simplicity, rapidity, feasibility, acceptability by patients and correct agreement with the reference technique. Further studies are needed to adjust for bias and to validate the pOpmètre in larger populations.