Decrease In Pulse Wave Velocity Research Articles

The effect of breastfeeding during infancy on arterial stiffness in young adults.

Breastfeeding has many benefits for health, also later in life. However, its effects on the cardiovascular system are still unclear. The aim of the present study was to evaluate the effect of exclusive breastfeeding as infants on arterial stiffness in young adults having no cardiovascular risk factors, using aortic pulse wave velocity, and brachial and aortic augmentation index. Eighty-six subjects were included in the study from similar socioeconomic status. 46 subjects who had received exclusive breastfeeding for the first 4-6 months in infancy (26 women, mean age 26.7±4 years) (group 1) and 40 subjects who had received exclusive breastfeeding for less than 3 months or had never been breast-fed (22 women, mean age: 28±3.8 years) (group 2) were recruited. Parameters of arterial stiffness (aortic pulse wave velocity, brachial and aortic augmentation index) were investigated using an arteriograph (TensioMed, Budapest, Hungary), which works on an ossilometric basis. A significant decrease in pulse wave velocity in the breast-fed group was detected compared to the non-breast-fed group (P<0.05) but no significant difference was detected for aortic and brachial augmentation index. In addition there was a significant relationship between breastfeeding duration and aortic pulse wave velocity. Breast milk intake in infancy reduces the risk of cardiovascular disease in young adults, independent of other cardiovascular risk factors. It seems that there is a negative relationship between the duration of breastfeeding and the risk reduction.

Артериальная ригидность у пациентов с острым коронарным синдромом без стойкого подъема сегмента ST в сочетании с хронической болезнью почек и артериальной гипертензией и ее коррекция на фоне антигипертензивной терапии

Objective: to study arterial stiffness in patients with acute coronary syndrome without ST elevation, who have hypertension (AH) and stage 2-3A chronic kidney disease (CKD) and to assess the ability of angiotensin-converting enzyme inhibitor perindopril and angiotensin receptor antagonist losartan to reduce arterial stiffness in these patients. Materials and Methods. We studied 44 patients with ACS without ST elevation combined with CKD stage 2-3A, AH (the 1st group). The comparison groups were the ACS without ST segment elevation, AH patients with normal renal function (the 2nd group, n=27) and the 3rd group (n=44) of patients with chronic CHD, AH and CKD. Group 1 patients were divided into 2 subgroups taking perindopril or losartan. The parameters of vascular wall stiffness (pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), ankle brachial index (ABI), aortic augmentation index (AI), central systolic and pulse aortic pressure, peripheral blood pressure (BP), estimated glomerular filtration rate (GFR) were assessed.) Results. The patients with ACS without ST elevation combined with 2-3A stages of CKD and AH had a significantly higher cPAP, AI, PWV, and CAVI than the patients of the 2nd group. During 3 months of complex therapy with perindopril, a decrease in PWV, cSAP, cPAP, AI was observed. There were no significant differences in the effects of perindopril and losartan on peripheral and central blood pressure, on renal function, on arterial stiffness parameters. Conclusion. Patients with AH and CKD stage 2-3A have more pronounced arterial stiffness compared to similar patients with normal GFR. Antihypertensive therapy with perindopril and losartan allows to reach target levels of peripheral BP, significantly reduce central aortic pressure and improve elastic properties of the arterial vascular wall.

INFLUENCES OF CENTELLA ASIATICA AND CURCUMA LONGA ON ARTERIAL STIFFNESS IN A HYPERTENSIVE ANIMAL MODEL

There is a strong relationship between arterial stiffness and high blood pressure. Arterial stiffness increases the risk of a cardiovascular event and sudden death, especially in hypertensive patients. This study aimed to determine the effective combination of Centella asiatica and Curcuma longa on arterial stiffness in hypertensive animal models. Twenty-five male rats aged 2-3 months were randomly into five groups. The groups comprising the negative control and positive control group (receiving drug carriers), the test drug group receiving captopril 2.5 mg/kg, the combination of Centella asiatica (CA) and Curcuma longa (CL) doses of 50 and 100 mg/kg. Except for the control group, all groups received a high-fat diet and 25% fructose drinking water for 28 days. On day 15, they received test medicines. On days 0, 14, and 28, systolic and diastolic blood pressures, as well as the PWV (pulse wave velocity), were assessed. Nitric oxide levels in serum were measured using Griess reagents on day 28. The results showed that a combination of CA and CL doses of 50 and 100 mg/kg reduced systolic and diastolic blood pressure accompanied by a decrease in PWV and a statistically significant increase in serum NO levels (p &lt;0.05). It concluded that a combination of CA and CL has the potential as antihypertensive, improving arterial elasticity.&#x0D;

Effect of Intensity on Changes in Cardiac Autonomic Control of Heart Rate and Arterial Stiffness After Equated Continuous Running Training Programs.

Background: It is well known that exercise training has positive effects on both cardiac autonomic function and arterial stiffness (AS). However, it is not clear that which exercise training variables, intensity or volume, or both, play a crucial role in this regard. This study investigates the chronic effects of high-volume moderate-intensity training (HVMIT) and low-volume high-intensity training (LVHIT) on heart rate variability (HRV) and AS in sedentary adult men.Materials and Methods: Notably, 45 males (age: 42 ± 5.7 years) were randomly assigned to a control (n = 15), HVMIT (n = 15), or LVHIT (n = 15). The HVMIT group ran three times per week on a treadmill at 50–60% of VO2max for 45–60 min, while the LVHIT trained at 70–85% of VO2max for 25–40 min. Both training protocols were equated by caloric expenditure. HRV, pulse wave velocity (PWV), hemodynamic variables, and body composition were measured before and after 12 weeks.Results: Both protocols (i.e., HVMIT and LVHIT) significantly increased the SD of normal sinus beat intervals (SDNN) and high-frequency (HF) bands (p < 0.05) after 12 weeks. Whereas the low-frequency (LF)-HF ratio decreased significantly in both training protocols (p < 0.05); however, these changes were significantly greater in the LVHIT protocol (p < 0.05). Furthermore, the root mean square of successive RR interval differences (RMSSD) significantly increased only in the LVHIT (p < 0.05). Moreover, a significant decrease in LF and PWV was only observed following the LVHIT protocol (p < 0.05). Some measures of HRV and PWV were significantly correlated (r = 0.275–0.559; p < 0.05).Conclusion: These results show that the LVHIT protocol was more efficient for improving HRV variables and PWV than the HVMIT protocol after 12 weeks of continuous running training. Interestingly, changes in some HRV parameters were related to changes in PWV. Further studies should elaborate on the link between central and peripheral cardiovascular adaptations after continuous and intermittent training regimens differing in intensity.

The role of antihypertensive therapy and bariatric surgery in achieving the pulse wave velocity target level in men with arterial hypertension and obesity

Abstract Aim To study the dynamics of pulse wave velocity (PWV) change in men with arterial hypertension (AH) and obesity depending on the treatment tactics of AH and obesity. Materials and methods We examined 61 middle age men with AH stage II-III (atherosclerotic plaque), which were divided into 3 groups depending on body mass index (BMI) and type of therapy: group I – 22 overweight men who received only antihypertensive therapy (AHT); group II – 22 obese men (I–III degree), who took only AHT; group III – 17 obese men (II–III degree) who received AHT and bariatric surgery (BS). The groups didn't differ in age. Combined AHT (2- and 3-component) was prescribed on the principle of preventive chronotherapy. In all groups, after 1, 3 and 6 months of AHT, the effectiveness of treatment was assessed by the dynamics of average level of blood pressure (BP) according to ABPM and the value of PWV (suprasystolic arteriography Tensiomed). We use 3 categories of PWV level: the normal and the intermediate increase levels according to the age and degree of AH (Arterial Stiffness Collaboration, 2010) and the increased level (≥10.0 m/s). Patients in group III at the 2 monthes received BS (sleeve gastrectomy or Hess-Macreau biliopancreatic diversion with duodenal switch, the volume of BS was determined by the surgeons) and continued receiving AHT like other patients. Results The value of BMI in groups I and II didn't change statistically after 6 months, but in group III – it decreased by 9.67 kg/m2 (p&amp;lt;0.01). The average BP level before treatment was equal to AH grade 1 in all groups. After 6 months the target BP level according to ABPM was reached by 68.18% of patients in group I, 54.55% - in group II and 58.82% - in group III. The median of PWV before treatment in all groups was ≥10.0 m/s. (Fig. 1). According to dynamic observations, the level of PWV decreased after 1 and 3 months. After 6 months it decreased by 27.70% in group I (p=0.0001), by 13.33% in group II (p&amp;lt;0.05) and by 29.49% in group III (p&amp;lt;0.ehab724.23781). Evaluation of PWV according to the Arterial Stiffness Collaboration showed that before starting AHT, the number of men with different categories of PWV in the groups was comparable (Fig. 2). After 6 months of treatment in group I all patients achieved a decrease of PWV in &amp;lt;10 m/s, 40.91% of men had an intermediate increase in PWV, and the frequency of normal PWV increased from 13.64% to 59.09%. In group II 9.09% of men still had increased level PWV and the number of men with normal PWV increased more than 4 times. In group III all patients reached the individual norma of PWV according to age and BP at the end of observation. Conclusion Combined AHT in all groups provides a significant decrease of PWV &amp;lt;10 m/s. The combination of AHT and BS showed the greatest positive impact on the decrease of PWV and the achievement of individual norms according to age and BP level in all patients. Funding Acknowledgement Type of funding sources: None.

Evaluation of the effectiveness of statin and spironolactone by the influence on indicators of vascular stiffness in patients with arterial hypertension

Abstract Introduction The possibility of slowing down vascular remodeling in hypertensive patients with the combined effect of antihypertensive drugs and statins has been studied in unitary studies. The effect of spironolactone on vascular stiffness in relation to the severity of the hypotensive effect in combination therapy has also been insufficiently studied. The aim of the research was to study the dynamics vascular stiffness parameters in hypertension patients of high/very high cardiovascular risk in addition rosuvastatin or spironolactone to combined two-component amlodipine and lisinopril therapy. Methods 90 patients (46 men and 44 women aged 51.6±8.5) with hypertension were randomized into groups: the first group received a fixed combination of amlodipine/lisinopril, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin, the third - in addition to the combination of amlodipine / lisinopril received 25 mg of spironolactone. The office and ambulatory blood pressure (BP), central (aortic) BP, augmentation index (AIx), carotid-femoral and carotid-radial pulse wave velocity (PWV) were evaluated before and after a 24-week follow-up period. Results The office and average daily blood pressure decreased against the background of all therapy regimens (all p&amp;lt;0.0001). The degree of decrease in the above parameters was more pronounced under the influence of spironolactone, compared with taking a combination of amlodipine / lisinopril (office systolic BP (SBP) p=0.04 and diastolic BP (DBP) p=0.002, average daily SBP p=0.02 and DBP p=0.014) and office DBP in comparison with the group of additional administration of rosuvastatin (p=0.02). A decrease in central BP and AIx was noted in all groups. A more pronounced decrease in AIx occurred in the statin supplementation group relative to the standard treatment group (−5.8% and −9.0%, respectively, p=0.036). Carotid-femoral PWV significantly decreased in all groups (−0.9±1.5 m/s, −0.7±1.4 m/s, −2.2±2.6 m/s, respectively), in greater degree in the spironolactone addition group compared with the statin supplementation group (p=0.036). Carotid-radial PWV to the same extent significantly decreased only in the second (from 9.5±1.8 to 8.8±1.1 m/s (p=0.034)) and the third (from 9.8±1.3 to 8.4±1.3 m/s (p=0.0002)) groups. Conclusions The addition of a statin to a two-component combination of amlodipine / lisinopril in the treatment of hypertensive patients had an additional effect on the elastic properties of the aorta, in the form of a decrease in the augmentation index, and peripheral arteries, in the form of a decrease in PWV. The addition of spironolactone to standard therapy was accompanied by a significant increase in the antihypertensive effect and a decrease in aortic stiffness in the form of a more pronounced decrease in PWV in the carotid-femoral and carotid-radial areas. Funding Acknowledgement Type of funding sources: None.

Aortic diameter, pulse wave velocity, central aortic pulse pressure, left ventricular parameters, and diastolic dysfunction in patients with aortic aneurysm

Abstract Background The enlargement of aortic aneurysm can alters pulse wave propagation and reflection, which may influence to left ventricular (LV) afterload changes. The relevance of pulse wave velocity (PWV) and central blood pressure depending on the locus of the aneurysm for LV structure and diastolic function (DF) are not clearly unknown. Purpose Assess the relationship between central pulse pressure (CPP), PWV and LV structure and DF in patients with ascending aortic aneurysm (AA) and abdominal aortic aneurysm (AAA). Methods 121 patients (95 male, 63±12 years) with aortic aneurysms and preserved LV systolic function were enrolled before aortic repair. 51 patients (37 male, 54±13 years) had AA and 70 patients (58 male, 69±7 years) had AAA. CPP and PWV were measured using applanation tonometry. A echocardiographic exam was performed with a Vivid 7 GE (USA). LV mass index (LVMI) and relative wall thickness (RWT) were calculated according to standard formulas. LV filling pressure (E/Em) was estimated by Doppler-derived ratio of mitral inflow velocity (E) to septal (Em) by tissue Doppler. Transmitral flow patterns (E/A ratio of E to late (A) ventricular filling velocities) were measured with the pulsed doppler method. Results Concentric LV hypertrophy (LVH) was observed in 51 (42%), eccentric LVH – in 35 (29%) patients. CPP was positively related with LVMI (r=0.362, P=0.001), but PWV was inversely associated with LVMI (r=−0.244, P=0.029). CPP was not associated with RWT (P≥0.5), whereas PWV was positively related (r=0.223, P=0.004). PWV decreased with increasing aortic diameter in AA and AAA (r=−0.360, P=0.029 and r=−0.315, P=0.019, respectively). 12 (23%) patients with AA and 36 (56%) patients with AAA had grade I diastolic dysfunction, 20 (40%) patients with AA and 12 (18%) patients with AAA had grade II diastolic dysfunction (P&amp;lt;0.001). Consequently, the E/A ratio was higher in patients with AA than in patients with AAA (1.21±0.39 vs 0.83±0.33; P=0.007). CPP and PWV was inversely associated with LV DF (E/A: r=−0.352 and −0.238; E/Em: r=−0.292 and −0.279, respectively; both P&amp;lt;0.05). E/A and E/Em increased with the expansion of the maximum aortic diameter at the level of the AA and AAA (E/A: r=0.612 and 0.416; E/Em: r=0.719 and 0.339, respectively; both P&amp;lt;0.005). RWT and LVMI were correlated with the aortic diameter at the level of the AA (r=−0.439, P=0.008 and r=0.286, P=0.05, respectively), but bore no relation with the aortic diameter at the level of the AAA. Conclusions In patients with aortic aneurysm CPP and PWV were conjointly but differently related to LV structure. Eccentric LV hypertrophy was accompanied by a significant decrease of PWV. Reduced PWV and decreased CPP exhibited association with more severe LV diastolic dysfunction, possibly due to the apparent effect of increased aortic aneurysm diameter. LV DF was severely reduced in the patients with AA compared by patients with AAA. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Almazov National Medical Research Centre

Effect ofglucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on left atrial strain and arterial function

Abstract Background We investigated the effects of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on left atrial function of patients with type 2 diabetes mellitus and we searched for a relation with arterial function. Methods A total of 213 patients (59,5±9,1 year old, 161 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n=46 served as controls), liraglutide (n=40), empagliflozin (n=46) or their combination (GLP-1RA + SGLT-2i) (n=50) as add-on. We measured at baseline and 6 months posttreatment: (a) perfused boundary region of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness), (b) pulse wave velocity (PWV) and central systolic blood pressure, (c) global left ventricular Longitudinal strain, (d) left atrial strain. Results Six months after intervention, all patients improved left atrial reservoir strain (GLP1RA 30,7±9,3 vs 33,9±9,7%, p=0,011 / SGLT2i 30±8,3 vs 32,3±7,3%, p=0,04 / GLP1 &amp; SGLT2i 29,1±8,7 vs 31,3±8,2, p=0,007) in comparison with controls (33±8,3% vs 32,8±7,4, p=0,829). Also, patients treated with GLP1RA and their combination improved left atrial conduction strain (p&amp;lt;0.05). GLP-1RA or GLP-1RA + SGLT-2i provided a greater improvement in GLS compared with insulin or SGLT-2i (controls −18,5±3,9% vs −19,1±3%, p=0,202 / GLP1RA −18,2±4,1% vs −19,1±3,5%, p=0,03 / SGLT2i −19±4,1% vs −19,1±3,8%, p=0,764 / GLP1 &amp; SGLT2i −16,7±3,9% vs −17,5±4,3%, p=0,026). SGLT-2i or GLP-1RA and SGLT-2i showed a greater decrease of PWV (Controls 12,06±3,02 vs 11,62±2,79 m/sec, p=0,142 / GLP1 11,54±2,91 vs 11,45±2,52 m/sec, p=0,822 / SGLT2 11,86±2,51 vs 11,33±2,28 m/sec, p=0,047 / GLP1 &amp; SGLT2 12,01±2,46 vs 10,85±1,79 m/sec, p=0,021) and central and brachial systolic blood pressure than insulin or GLP-1RA. At baseline, there was a correlation of LA reservoir strain with PWV (r=−0,209, p=0,008), central SBP (r=−0,151, p=0,030), EF (r=0,214, p=0,004), GLS (r=−0,279, p=0,009). At 6 months follow up, there was a correlation of LA reservoir strain with PWV (r=0,217, p=0,003), central SBP (r=0,214, p=0,004), EF (r=−0,221, p=0,049), GLS (r=0,275, p=0,014). Conclusions Treatment with GLP-1RA, SGLT-2i, and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with improvement arterial and myocardial function. Funding Acknowledgement Type of funding sources: None.

Effect of alpha-lipoic acid on arterial stiffness parameters in type 2 diabetes mellitus patients with cardiac autonomic neuropathy.

Objective. Significantly underdiagnosed, diabetes-associated cardiac autonomic neuropathy (CAN) causes a wide range of cardiac disorders that may cause life-threatening outcomes. This study investigated the effects of alpha-lipoic acid (ALA) on arterial stiffness and insulin resistance (IR) parameters in type 2 diabetes mellitus (T2D) patients and definite CAN. Methods. A total of 36 patients with T2D and a definite stage of CAN were recruited. This investigation was carried out on two separate arms: traditional hypoglycemic therapy (n=18, control) and ALA (n=18) 600 mg in film-coated tablets/q.d. in addition to traditional hypoglycemic therapy. The duration of the study was three months. Results. In subjects with T2D and definite stage of СAN, treatment with ALA resulted in a significant decrease of glucose, immunoreactive insulin concentration, and Homeostasis Model Assessment (HOMA)-IR (HOMA-IR) parameters; pulse wave velocity (PWV), aorta augmentation index (AIxao) during the active period of the day and decrease of PWV, AIxao, and brachial augmentation index during the passive period of the day compared with the results, obtained in the control group. Therefore, the administration of ALA to patients with T2D for three months promotes the improvement of glucose metabolism and arterial stiffness parameters. Conclusions. In patients with T2D and definite stage of СAN treatment with ALA improved HOMA-IR and arterial stiffness parameters. These findings can be of clinical significance for the complex treatment of diabetes-associated CAN.

Артеріальна жорсткість та синдром обструктивного апное сну в пацієнтів з артеріальною гіпертензією на фоні терапії постійним позитивним тиском у дихальних шляхах

Актуальність. Синдром обструктивного апное сну (СОАС), особливо тяжкого ступеня, пов’язаний із фатальними та нефатальними серцево-судинними подіями. СОАС та артеріальна гіпертензія (АГ) мають достовірні взаємозв’язки, і дана супутня патологія є дуже поширеною та пов’язана зі збільшеним ризиком серцево-судинних захворювань. Однією з причин є підвищена жорсткість артерій. Неінвазивним показником жорсткості артерій є швидкість поширення пульсової хвилі в аорті, що рекомендована сучасними настановами для оцінки серцево-судинного ризику. Метою дослідження було оцінити зміни жорсткості артерій у пацієнтів з АГ та СОАС та можливості її корекції при лікуванні постійним позитивним тиском у дихальних шляхах (СРАР-терапія). Матеріали та методи. У дослідження були включені 185 пацієнтів із легкою та середньою АГ (49,8 ± 0,8 року), які були розподілені на групи: 1-ша — пацієнти, у яких був СОАС (n = 148), 2-га — пацієнти без СОАС (контрольна група, n = 37). Вони пройшли клінічне та спеціальне обстеження: сомнологічне дослідження за допомогою двоканального портативного монітора, оцінку денної сонливості за опитувальною шкалою Епворта, вимірювання офісного артеріального тиску та добове моніторування артеріального тиску, ехокардіографію, вимірювання швидкості поширення пульсової хвилі. За 10 місяців подальшого дослідження були включені 105 пацієнтів, які були розподілені на 4 підгрупи: А — пацієнти із середнім та тяжким ступенями СОАС на СРАР-терапії (n = 23), В — пацієнти із середнім та тяжким ступенями СОАС без СРАР-терапії (n=29), С— пацієнти з легким ступенем СОАС (n = 29), D — пацієнти без СОАС (контрольна група, n =24). Усі пацієнти отримували подібну антигіпертензивну терапію відповідно до Рекомендацій ESC/ESC 2013 року. Результати. У пацієнтів з АГ та СОАС (середній індекс апное/гіпопное — 38,10±2,51 події/год) порівняно з пацієнтами без СОАС (середній рівень AГI — 3,02 ± 0,25 події/год) був значно вищий індекс маси тіла (35,20 ± 0,57 проти 30,60 ± 0,79 кг/м2, Р &lt; 0,001), а також рівень глюкози в крові (107,2 ±2,2 проти 98,0 ± 2,5 мг/дл, Р = 0,045), рівень сечової кислоти (6,17 ± 0,10 проти 5,5 ± 0,3мг/дл, Р = 0,048) та індекс маси міокарда лівого шлуночка (115,80 ± 2,39 проти 104,60 ± 4,56 г/м2, Р = 0,035). Протягом 10 місяців спостереження в пацієнтів з АГ та СОАС на фоні CPAP-терапії спостерігалося достовірне зниження швидкості поширення пульсової хвилі по артеріях еластичного типу (із 12,20±0,63 до 10,05±0,43м/с, Р = 0,009), офісного систолічного артеріального тиску (від 143,80±132,70 до 132,70±2,33 мм рт.ст., Р= 0,021) та офісного діастолічного артеріального тиску (від 93,80 ± 3,31 до 86,00 ± 3,19 мм рт.ст., Р=0,012). У пацієнтів центральний систолічний артеріальний тиск зменшився з 130,30 ± 3,97 до 119,70± 2,97 мм рт.ст., Р = 0,012). Висновки. Поєднання терапії постійним позитивним тиском у дихальних шляхах та антигіпертензивної терапії покращує еластичність артерій та допомагає досягти цільового рівня артеріального тиску в пацієнтів з артеріальною гіпертензією та синдромом обструктивного апное сну середнього та тяжкого ступенів.

Effects of Exercise and Weight Loss on Proximal Aortic Stiffness in Older Adults With Obesity.

Obesity may accelerate age-related increases in aortic stiffness. Although aerobic exercise training generally has favorable effects on aortic structure and function, exercise alone may not be sufficient to improve aortic stiffness in older adults with obesity. We determined the effects of aerobic exercise training with and without moderate- to high-caloric restriction (CR) on the structure and function of the proximal aorta in 160 older (65-79 years) men and women with obesity (body mass index=30-45 kg/m2). Participants were randomly assigned to 1 of 3 groups: aerobic exercise training only (treadmill 4 days/week for 30 minutes at 65% to 70% of heart rate reserve; n=56), aerobic exercise training plus moderate CR (n=55), or aerobic exercise training plus more intensive CR (n=49) for 20 weeks. Aortic pulse wave velocity, aortic distensibility, and other measures of aortic structure and function were assessed by cardiovascular magnetic resonance imaging. Pearson correlation coefficients were examined to assess associations between changes in proximal aortic stiffness and changes in fitness, fatness, and other potential confounders. Weight loss in the aerobic exercise training plus moderate CR (-8.0 kg [95% CI, -9.17 to -6.87]) and aerobic exercise training plus more intensive CR (-8.98 kg [95% CI, -10.23 to -7.73) groups was significantly greater compared with the aerobic exercise training-only group (-1.66 kg [95% CI, -2.94 to -0.38]; P<0.017 for both). There were significant treatment effects for descending aorta distensibility (P=0.008) and strain (P=0.004) and aortic arch pulse wave velocity (P=0.01) with the aerobic exercise training plus moderate CR group having a 21% increase in distensibility (P=0.016) and an 8% decrease in pulse wave velocity (P=0.058). None of the aortic stiffness measures changed significantly in the aerobic exercise training-only or aerobic exercise training plus more intensive CR groups, and there were no significant changes in any other measure of aortic structure or function in these groups. Overall, increases in aortic distensibility were correlated with improvements in body weight and body fat distribution, but these associations were not statistically significant after adjustment for multiple comparisons. In older adults with obesity, combining aerobic exercise with moderate CR leads to greater improvements in proximal aortic stiffness than exercise alone. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT01048736.

Plasma expression of microRNA-425-5p and microRNA-451a as biomarkers of cardiovascular disease in rheumatoid arthritis patients

To validate in a cohort of 214 rheumatoid arthritis patients a panel of 10 plasmatic microRNAs, which we previously identified and that can facilitate earlier diagnosis of cardiovascular disease in rheumatoid arthritis patients. We identified 10 plasma miRs that were downregulated in male rheumatoid arthritis patients and in patients with acute myocardial infarction compared to controls suggesting that these microRNAs could be epigenetic biomarkers for cardiovascular disease in rheumatoid arthritis patients. Six of those microRNAs were validated in independent plasma samples from 214 rheumatoid arthritis patients and levels of expression were associated with surrogate markers of cardiovascular disease (carotid intima-media thickness, plaque formation, pulse wave velocity and distensibility) and with prior cardiovascular disease. Multivariate analyses adjusted for traditional confounders and treatments showed that decreased expression of microRNA-425-5p in men and decreased expression of microRNA-451 in women were significantly associated with increased (β = 0.072; p = 0.017) and decreased carotid intima-media thickness (β = −0.05; p = 0.013), respectively. MicroRNA-425-5p and microRNA-451 also increased the accuracy to discriminate patients with pathological carotid intima-media thickness by 1.8% (p = 0.036) in men and 3.5% (p = 0.027) in women, respectively. In addition, microRNA-425-5p increased the accuracy to discriminate male patients with prior cardiovascular disease by 3% (p = 0.008). Additionally, decreased expression of microRNA-451 was significantly associated with decreased pulse wave velocity (β = −0.72; p = 0.035) in overall rheumatoid arthritis population. Distensibility showed no significant association with expression levels of the microRNAs studied. We provide evidence of a possible role of microRNA-425-5p and microRNA-451 as useful epigenetic biomarkers to assess cardiovascular disease risk in patients with rheumatoid arthritis.

Impact of Bariatric Surgery on Pulse Wave Velocity as a Measure of Arterial Stiffness: a Systematic Review and Meta-analysis.

Weight loss during post-bariatric surgery period has been linked to both reduced ASCVD mortality and overall mortality. Atherosclerosis causes arteries to lose their elasticity and become more stiff resulting in increased pulse wave velocity (PWV). It has been revealed that PWV favorably predicts subsequent ASCVDs. The goal of this systematic review and meta-analysis was to see how bariatric surgery affected PWV, an index of arterial stiffness. A systematic literature search in four databases was performed. Also, Cochrane guidelines were reviewed to determine bias possibility in the related studies. Comprehensive Meta-Analysis (CMA) V2 software is used to conduct the meta-analysis. Studies were evaluated regarding heterogeneity in design, populations under investigation, and treatment duration using random-effects model and the generic inverse variance weighting approach. A random-effect meta-regression approach was used to investigate the association with the estimated effect size. Evaluation of funnel plot, Egger's weighted regression, and Begg's rank correlation tests were utilized to estimate the presence of publication bias in the meta-analysis. The results of meta-analysis on 13 trials including 1426 individuals demonstrated a remarkable decline of PWV after bariatric surgery (WMD: -0.652, 95% CI: -1.004, -0.301, p<0.001). The random-effects meta-regression revealed no evidence of significant correlation between the changes in PWV and initial BMI, BMI changes, or duration of follow-up. The decrease of PWV might be utilized as an independent surrogate marker of improvement of ASCVD risk after bariatric surgery.

MO754THE INTERRELATIONSHIP BETWEEN FLUID OVERLOAD AND VASCULAR STIFFNESS IN HEMODIALYSIS PATIENTS: A SCOPING REVIEW

Abstract Background and Aims Fluid overload and vascular stiffness are two independent predictors of cardiovascular events in hemodialysis (HD) patients. To date, observational and interventional studies that investigated the effect of inter- and intradialytic fluid overload changes on vascular stiffness in HD patients are very limited. We performed a scoping review to explore existing reports about effects of fluid overload on vascular stiffness in adults receiving HD treatment and to identify knowledge gaps for future research. Method We followed the framework originally developed by Arksey and O’Malley. We searched Medline, Embase, CINAHL, and Cochrane Database of systematic reviews from inception to October 29, 2019. References of review papers were screened for relevant studies not identified from the initial search until saturation is achieved. Results Of 666 eligible studies, nineteen studies met the inclusion criteria. These included clinical observational studies (n=16) and randomized controlled trials (n=3). In general, most of the identified studies had small sample size and short term of follow up. Studies use different definitions of fluid overload and vascular stiffness. Measures of relative fluid overload like the ratio of extracellular fluid/intracellular fluid, fluid overload/extracellular fluid, and/or extracellular fluid/total body fluid were used as a representative of fluid status. Pulse wave velocity and augmentation index were used interchangeably as vascular stiffness measures. The accumulated findings were inconsistent and inconclusive. There was no consensus whether intradialytic fluid volume changes affected vascular stiffness. In the majority of the observational studies, a decrease in pulse wave velocity or augmentation index correlated with a decrease in blood pressure after fluid correction by HD treatment. The randomized clinical trials used different methods and technologies for the correction of fluid overload, thereby, results were conflicting. Conclusion Current literature is insufficient to justify whether fluid overload changes have a direct effect on vascular stiffness in HD patients. The findings were conflicting which limits the comparisons of studies and generalization of findings. These knowledge gaps urge the need for further clinical studies to enhance the understanding and to improve the quality of research in this topic. This includes standardized definitions and methodologies as well as longer term of follow up.

The influence of plant saponins on the elasticity parameters of the great arteries in patients with multifocal atherosclerosis

Background. Among the goals of pathogenetic therapy in patients with multifocal atherosclerosis, not only control of the intensity of atherogenesis, but also the elastic properties of the arterial system is becoming increasingly important, which opens up additional ways to reduce overall and cardiovascular mortality in this category of patients.&#x0D; Aim. To evaluate effectiveness of medication Vazosponin (ZAO Vifitekh, Russia), which is a source of plant saponins in a dosage 400 mg per day, on the indicators of the elasticity of the great arteries.&#x0D; Materials and methods. The study included 100 patients with multifocal atherosclerosis: those who had had myocardial infarction or percutaneous coronary intervention during the previous 2 1 2 months and who had stenosing atherosclerosis of peripheral arteries brachiocephalic arteries and/or arteries of the lower extremities. The main group MG (n=50) consisted of patients who received combined hypolipidemic treatment: atorvastatin in dosage 40 mg/day + Vazosponin 400 mg/day along with baseline treatment. The control group (CG) included 50 patients who received only atorvastatin in dosage 40 mg/day along with baseline treatment. The observation period for each patient was 90 days with 3 control points (on the 1st, 10th and 90th days of therapy), in which were evaluated the elasticity indicators of the main arteries pulse wave velocity, linear blood flow velocity, total peripheral vascular resistance, actual specific vascular resistance.&#x0D; Results. There was a decrease in pulse wave velocity in both groups by the 90th day of the study, with a significant advantage in the group of patients who received Vazosponin: in the CG the indicator decreased by 7.3% (p0.05), in the MG by 19.3% (p0.05). The decrease in linear blood flow velocity was 14.3% (p0.05), in the CG the indicator decreased by 5.7% (p0.05). The dynamics of peripheral vascular resistance indicators showed an obvious advantage in the group of patients who received plant saponins: in the MG of patients, a decrease in total peripheral vascular resistance was detected by an average of 11.0% (p=0.006) and actual specific vascular resistance by 39.3% (p=0.0008), while in the CG by 4.5% and 5.0%, respectively.&#x0D; Conclusion. The addition of Vazosponin to the basic therapy of patients with multifocal atherosclerosis made it possible to achieve an additional increase in the elasticity of the arterial system, a significant decrease in peripheral vascular resistance, and the elimination of the escape effect of basic therapy. The data presented make it possible to consider the possibility of using preparations of plant saponins in combination therapy of patients with multifocal atherosclerosis who have instrumentally verified violations of the elastic properties of the arterial system.

Assessment of the effectiveness of antihypertensive therapy in the early post-stroke period of ischemic stroke based on indicators of arterial stiffness

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Globally, stroke is the second leading cause of death, leading to a reduction in life expectancy and disability of patients. It seems important to study and introduce into practical health care both new approaches to stroke prevention and measures aimed at full recovery in the post-stroke period. Purpose To assess the antihypertensive therapy (AHT) in patients with arterial hypertension (AH) in the early post-stroke period of ischemic stroke (IS), based on indicators of arterial stiffness. Methods The study included 180 patients with hypertension (mean age 64 years) in the acute period of ischemic stroke (IS). Inclusion criteria in this trial: AH, age over 40 years, time from the onset of stroke no more than 48 hours. Arterial stiffness was assessed by an oscillometric method with an assessment of the 24-hour reflected wave transit time (RWTT), aortic augmentation index (AIxao)), arterial stiffness index (ASI), and pulse wave velocity (PWV). The indicators were assessed at the time of admission, at the time of discharge from the hospital (14-21 days) and 2 months after discharge. We determined endothelin-1 (ET-1) levels by ELISA at admission and 2 months after discharge. Retrospectively, patients were divided into 5 groups depending on the prescribed AHT: group 1 (48 patients) - ACEIs/ARBs, thiazide-like diuretics (TLDs), group 2 (46 people) - ACEIs/ARBs, nondihydropyridine calcium antagonists (ACs) and beta-blockers (BBs), group 3 (39 people) - ACEIs/ARBs and ACs, group 4 (26 patients) - ACEIs/ARBs and BBs, group 5 (21 people) - ACEIs/ARBs, TLDs and BBs. Results AHT showed a positive trend in terms of arterial stiffness in all 5 groups. Compared with the baseline values, the significant decrease in PWV (12.4 ± 1.7m/s vs 10.9 ± 1.8m/s, p &amp;lt; 0.01), AIxao (39.8 ± 6.3% vs 36.8 ± 5,2%, p &amp;lt; 0.001), ASI (167.9(127.0;174.5) vs 158.8(115.0;168.7)), p &amp;lt; 0.05), increased RWTT (98.0 ± 9.8ms vs 105.3 ± 7.5ms) in group 2 of patients were found. After 2 months, when comparing indicators between groups the significant decrease in PWV to 9.1(8.7; 11.6)m/s, p &amp;lt; 0.01), AIxao to 31.7(29.8;41.9)%, p &amp;lt; 0.01, an increase in RWTT to 107.7(102.4; 110.2)ms, p &amp;lt; 0.01 in the group of patients taking ACEIs/ARBs, ACs and BBs were detected. After 2 months after discharge, a significant decrease of ET-1 was also observed in group 2 (5.8 ± 2.2ng/ml vs 4.2 ± 1.8ng/ml). The combination of ACEs/ARBs and BBs showed the least effectiveness in reducing arterial stiffness. Conclusions The combination of ACEIs/ARBs, ACs and BBs showed the greatest efficiency in reducing the stiffness in patients with hypertension in the early post-stroke period of IS. It seems important for the functional recovery of patients in the post-stroke period to use the drug therapy aimed not only at lowering blood pressure, but also favorably affecting the arterial stiffness.

The Effects of Moderate‐to‐Vigorous Physical Activity on Arterial Stiffness during Pregnancy

Moderate-to-vigorous physical activity (MVPA) is associated with lower arterial stiffness in the general population. The objective of the present study was to investigate the relationship between MVPA and arterial stiffness in pregnancy. Thirty-nine women participated in this study resulting in 68 measurements in non-pregnant (NP; n=21), first (TM1; n=8), second (TM2; n=20), and third trimesters (TM3; n=19). Carotid to femoral (central) and carotid to finger (peripheral) pulse wave velocity (PWV) were assessed using finometer (proper digital artery), tonometer (carotid artery), and ultrasound (femoral artery). Carotid artery distensibility, compliance, elasticity, and ß-stiffness were calculated from carotid artery diameters at diastole and systole from three ultrasound images of the right carotid artery assessed using manual digital calipers. MVPA was measured during the waking hours of 7-consecutive days using accelerometry (Actigraph; model wGT3X-BT). Freedson accelerometer counts for MVPA were ≥ 1,952 cmp. Comparisons between pregnant and non-pregnant participants and according to gestational age (in pregnant participants only) were performed using multilevel linear regression models adjusted for multiple tests per participant during the study period (NP, TM1, TM2, or TM3) using random effects for modelling intra-cluster correlation to generate β coefficients and 95% confidence intervals (CI). Carotid artery distensibility, elasticity, and β-stiffness were not statistically different between the NP, TM1, TM2, and TM3 phases. However, carotid compliance was higher in TM2 compared to NP. Central and peripheral PWV did not differ between pregnant and non-pregnant participants. Though, meeting the MVPA guidelines (≥150minutes per week) was associated with a decrease in both central PWV (Adj. β coef.: -0.30; 95% CI: -0.58, -0.02, p=0.04) and peripheral PWV (Adj. β coef.: -0.54; 95% CI: -0.91, -0.16, p=0.005) in pregnant and non-pregnant assessments. Central PWV (β Coef: -0.14, 95% CI: -0.27, -0.02, p=0.024; n=42), varied according to gestational age with a decrease in mid-pregnancy and subsequent increase to late pregnancy while gestational age was not significantly associated with peripheral PWV. Adjustment for meeting the MVPA guidelines (β Coef: -0.34, 95% CI: -0.62, -0.06, p=0.016) reduced the association between gestational age and central-PWV (Figure 1). These results suggest that there is a relationship between MVPA and arterial stiffness throughout pregnancy. This may explain a proportion of the correlation between increased physical activity and a reduced risk of hypertension-related disorders in pregnancy.

ARTERIAL STIFFNESS IMPROVEMENT IN HYPERTENSIVE TYPE 2 DIABETIC PATIENTS: DISSIMILAR EFFECTS OF CANAGLIFLOZIN AND PERINDOPRIL

Objective: We have shown in hypertensive type 2 diabetic patients (DM) a strong correlation between serum uric acid (SUA) and pulse wave velocity (PWV). Additionally, after 6 months treatment, we found a significant PWV improvement either with perindopril or canagliflozin that, when adjusted for office BP values, the PWV improvement was blunted in the perindopril treated patients while in those receiving canagliflozin a significant effect still remains. Thus, the aim of the present work was to evaluate in normoglycemic diabetic hypertensive patients with normal renal function, the effects and relationships of canagliflozin and perindopril on SUA, 24hs AMBP and carotid femoral PWV. Design and method: For 6 month, 40 hypertensive DM patients, under metformin 2000 mg and amlodipine, received canagliflozin 100–300 mg 10 mg daily (n = 20, 10 females, 59 ± 4y) while other 20 patients (8 females, 62 ± 4y) received perindopril 10 mg on top. Laboratory parameters determined at baseline and after a 6-month treatment were: HbA1C, fasting blood glucose level, glomerular filtration rate, SUA, urine acid uric, 24 h ambulatory blood pressure monitoring (ABPM) and PWV. Results: After 6 months treatment with canagliflozin, a decrease in PWV, (12.29 ± 0.16 to 8.49 ± 0.09m/sec; p &lt; 0.001), HbA1C (8.1 to 7.0%; p &lt; 0.05), SUA (7.87 ± 0.06 to 6.83 ± 0.06 mg/%; p &lt; 0.05), and 24 h ABPM (154 ± 6/96 ± 5 to 141 ± 3/86 ± 4mmHg; p &lt; 0.01) was observed. Similarly, after Perindopril, a decrease in 24hs ABPM (152 ± 7/98 ± 7 to 139 ± 6/84 ± 5mmHg; p &lt; 0.05), PWV (12.53 ± 0.15 to 8.92 ± 0.19m/sec; p &lt; 0.001) and SUA (7.77 ± 0.18 to 7.35 ± 0.11mg%; p &lt; 0.05) was observed. Nevertheless, the SUA reduction induced by canagliflozin (-13.20 ± 0.71%) was greater (p &lt; 0.001) than the induced by Perindopril (-4.98 ± 1.30%). A significant correlation between delta SUA and delta PWV was only observed with canagliflozin (r: 0.82, p &lt; 0.001). Urine uric acid increased from 350 ± 20 to 580 ± 30 mg/24hs (p &lt; 0.05) with canagliflozin, whereas no changes were observed with perindopril. Conclusions: In patients with type 2 DM and hypertension, both canagliflozin and perindopril were able to ameliorate blood pressure and arterial stiffness values. Moreover, canagliflozin improved PWV associated to uric acid reduction. It is suggested that the reduction in SUA and the increase in UA urine excretion seems to have an intrinsic vascular wall effect therefore, it may reduce cardiovascular risk.

RELATIONS OF THE AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE WITH FEATURES OF THE LEFT VENTRICLE IN ASCENDING AORTIC ANEURYSM

Objective: To reveal relations of the arterial stiffness, central blood pressure (BP) with left ventricular (LV) structure and function in patients with ascending aortic aneurysms (AAA). Design and method: We examined 44 patients with AAA (30 (68%) males; 55 ± 13 years old) before AAA surgical repair. Office brachial BP (BBP) was measured by OMRON (Japan). Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV). Central BP (CBP) and PWV were measured with the SphygmoCor (Australia). Ambulatory BP monitoring was performed with the BPLab (Russia) with 24-hour measuring of BBP and CBP. A transthoracic echocardiographic examination was performed with a Vivid 7 GE (USA). Results: Hypertension was observed in 40 (91%) patients. LV hypertrophy (LVH) was found in 41 (94%) patients (mean LV mass index (LVMI) 163 ± 48 g/m2). Diastolic dysfunction presented in 39 (89%) patients. PWV was inversely related to the AAA diameter (r = - 0.389, P = 0.03): PWV decreased with an increase of the aortic diameter at the level of the aortic root. A decrease of PWV correlated with a decline of relative wall thickness (RWT) (r = 0.365, P = 0.040), but eccentric LVH occurred only in 17 (38%) patients with AAA. PWV correlated directly with LV ejection fraction (r = 0.464, P = 0.048), but PWV was inversely related to LV end-diastolic size (LVED) (r = -0.533, P = 0.003). Rigid type diastolic disturbances (E/A ratio&gt;2) were negatively correlated with PWV (r = -0.652, P = 0.041). Office pulse BBP and CBP correlated with the LVMI (r = 0.428, P = 0.019 and r = 0.508, P = 0.002, respectively). 24-hour pulse BBP and CBP were correlated with LVMI (r = 0.660, P = 0.018 and r = 0.721, P = 0.008, respectively). The increase of LVED had a closer association with office pulse CBP (r = 0.459, P = 0.007) than with office pulse BBP (r = 0.410, P = 0.017). Conclusions: Eccentric LV hypertrophy was accompanied by a significant reduction of PWV in patients with AAA. The severity of the diastolic dysfunction increased with a decline of PWV. PWV is probably not suitable for accurate assessment of the arterial stiffness in AAA due to the apparent confounding effect of aortic diameter. In AAA central pulse BP had a closer association with LVMI and LVED than brachial pulse BP.

IMPACT OF REDUCTION IN AIRCRAFT NOISE EXPOSURE ON BLOOD PRESSURE AND ARTERIAL STIFFNESS DURING COVID-19 PANDEMIC: CROSS-SECTIONAL AND LONGITUDINAL STUDY

Objective: The COVID-19 lockdown caused unprecedented decline in environmental noise pollution. We aimed to evaluate the impact of aircraft noise exposure decrease during lockdown on blood pressure (BP) and selected hypertension-mediated organ damages. Design and method: As previously reported (J Hypertens. 2019; 37) in 2015 (1st observation) we examined group of inhabitants exposed to high (&gt;60 dB) aircraft noise living near Cracow Airport (n = 101), and compared them to unexposed group (&lt;55 dB) (n = 100). In June 2020, 4 months after COVID-19 pandemic restrictions introduction, we reassessed (2nd observation) 74 and 75 participants from previously exposed and unexposed groups, respectively, using the same study protocol. We collected medical history, office and ambulatory BP, echocardiographic and arterial stiffness data. Results: In exposed to aircraft noise group the prevalence of arterial hypertension increased from 1st to 2nd observation (P &lt; 0.05). During lockdown in the noise exposed group office and 24 hour diastolic BP (DBP, P &lt; 0.022) decreased significantly, which was accompanied by a significant drop in annoyance (P = 0.006). In this group in 2nd observation DBP was significantly lower than estimated DBP (i.e. calculated as a sum of DBP at 1st observation and parameter estimates of cross-sectional association of DBP and age multiplied by 5.5 year – time period between observations) (P = 0.047). The obtained decline in DBP from 1st to 2nd observation was grater in noise exposed than unexposed participants, even after adjustment for covariates. The carotid-femoral pulse wave velocity (PWV), initially higher in noise exposed group, decreased from 1st to 2nd observation in both groups, however this was more pronounced in the exposed than unexposed group (P = 0.003). In 1st observation PWV in noise exposed participants did not show any relationship with age (Parameter Estimate (PE)=0.01 m/s/year; P = 0.71), while in 2nd observation, during aircraft noise decline caused by COVID-19 lockdown, the expected positive relation of PWV with age was reinstituted (PE = 0.15 m/s/year; P &lt; 0.001). Conclusions: As our previous study indicated, aircraft noise exposure may increase BP and accelerate arterial stiffening. The decrease in BP and PWV due to noise intensity diminution, observed during COVID-19 lockdown, in fact provides evidence for this observation.