Distensibility Coefficient Research Articles

SUBCLINICAL TARGET ORGAN DAMAGE IN PATIENTS WITH TYPE 1 DIABETES MELLITUS. A PROSPECTIVE PRELIMINARY STUDY

Objective: Early atherosclerosis is the main cause of cardiovascular damage and death in patients with type 1 Diabetes Mellitus (T1DM). Some vascular indexes can help to identify and stratify patients before clinical events. This study aims to evaluate the trend over time of some markers of subclinical vascular damage to identify possible associations with anthropometric parameters, blood pressure (BP) and metabolic variables. Design and method: Fifty-six patients with T1DM (mean age: 17.5±2.5 years; mean duration of diabetes: 8.9±4.0 years) were assessed in two occasions (mean follow-up time: 2.7±0.9 years). Peripheral systolic and diastolic BP (pSBP, pDBP), central systolic and diastolic BP (cSBP, cDBP) and Pulse Wave Velocity (PWV) were measured by the SphygmoCorXCEL. Carotid Intima-Media Thickness (cIMT) and the carotid Distensibility Coefficient (cCD) were assessed by ultrasound connected with an image acquisition and analysis system (CardiovascularSuite). Biochemical and anthropometric data were also recorded. Results: At follow-up, PWV and BP values increased significantly while cDC further decreased with the 80.4% of patients that presented a pathological cDC (lower than 40x10 -3 KPa or the 5th percentile). BP values at baseline correlated with all vascular indexes at follow-up: in particular, cSBP was associated with cDC (r = -0.46, p< 0.001), cIMT (r = 0.39, p = 0.004) and PWV (r = 0.32, p = 0.01). These associations remained significant even after adjustment for metabolic (including glycated hemoglobin) and anthropometric parameters. Moreover, baseline arterial stiffness significantly correlated with BP values at follow-up: particularly cDC and PWV were associated with cDBP (r = -0.354, p = 0.009 and r = 0.40, p = 0.002; respectively) even after multiple adjustments. Regarding metabolic parameters, non-HDL-to-HDL-cholesterol ratio correlated with both cDC (r = -0.36, p = 0.007) and PWV (r = 0.30, p = 0.03). Conclusions: The most important finding of this study is the strict and independent association between BP parameters, especially cSBP at baseline, and indexes of vascular damage at follow-up, even after multiple adjustments. Indeed, cDC at baseline is also associated with increased cDBP at follow-up. Our data support the hypothesis of a vicious cycle between BP and arterial stiffness, which may worsen both parameters over time.

SUBCLINICAL TARGET ORGAN DAMAGE IN A SAMPLE OF CHILDREN WITH SOLITARY FUNCTIONING KIDNEY. A PRELIMINARY OBSERVATIONAL STUDY

Objective: Solitary Functioning Kidney (SFK) is a condition characterized by a single-functioning kidney. Children bearing this condition are exposed to an increased risk of subclinical organ damage (SOD) due to the compensatory hyperfiltration in the remaining kidney and increased peripheral blood pressure (pBP) values. The aim of the present study was to assess the impact of traditional (pBP) and novel (central systolic blood pressure, cSBP) cardiovascular risk factors on SOD in children and adolescents with solitary functional kidney. Design and method: Carotid ultrasonography was performed to measure carotid Intima-Media Thickness (cIMT), an index of subclinical atherosclerosis. Arterial stiffness was assessed by measuring carotid Distensibility Coefficient (cDC) and carotid-femoral Pulse Wave Velocity (PWV). Cardiac mass and remodeling were analyzed using transthoracic echocardiography. Central and peripheral (both office and ambulatory) BP measurements, as well as biochemical data from blood and urine samples were collected. Results: Forty-eight SFK children and adolescents were included, of whom 45.5% were hypertensive at the Ambulatory Blood Pressure Monitoring. Twenty-four patients had increased cIMT and RWT while 8.4% and 8.9% demonstrated a reduction of cDC and an increase of PWV. Two patients had a left ventricular mass index (LVMi) above the 95th percentile. cSBP correlated with all vascular indices measured (cIMT r = 0.43; cDC r = -0.33; PWV r = 0.42, p < 0.05) and with LVMi (r = 0.41; p = 0.005). Office pSBP correlated with cDC (r = -0.31; p = 0.03), PWV (r = 0.42 and p = 0.004) and LVMi (r = 0.33; p = 0.02). Regarding ABPM measurements, daytime systolic BP correlated with all vascular indices (cIMT r = 0.34, cDC r = -0.31, PWV r = 0.39 p < 0.005) but not with echocardiographic ones. No correlation was found between cardiovascular parameters and the estimated glomerular filtration rate or the urinary albumin to creatinine ratio. Conclusions: Our data show a high prevalence of subclinical atherosclerosis and cardiac remodeling in children and adolescents with SFK. A lesser proportion of patients presented an increased arterial stiffening. cSBP more than pBP (office or ambulatory) associates with SOD. Children with SFK could bear a greater cardiovascular risk pointing out the importance of early preventive efforts.

SUBCLINICAL TARGET ORGAN DAMAGE IN PATIENTS WITH RESTLESS LEGS SYNDROME. A PRELIMINARY OBSERVATIONAL STUDY

Objective: Restless legs syndrome (RLLS) is a frequent and often underdiagnosed type of insomnia. Since other types of insomnia present a strict association with cardiovascular disease, our study aimed to evaluate the possible association of RLLS with some early markers of cardiovascular organ damage. Design and method: Patients with other types of insomnia and those with central nervous system diseases were excluded. Twenty-eight patients (mean age: 63,1±13,9 years; 28.6% males) participated in the study. Fourteen subjects with diagnosis of RLLS according to International diagnostic criteria (Allen RP et al. 2014 Sleep Medicine) (disease mean duration 9.6±9.2 years; International Restless Legs Scale score 22.9±5.2) were matched for sex, age and major cardiovascular risk factors with 14 controls. In both groups, peripheral Blood Pressure (pBP), central Blood Pressure (cBP) and Pulse Wave Velocity (PWV) were assessed by the SphygmoCorXCEL. Carotid Intima-Media Thickness (cIMT) and the carotid Distensibility Coefficient (cCD) were assessed by ultrasound connected with an image acquisition and analysis system (CardiovascularSuite). Results: We did not find any significant difference between the two groups in the indices of subclinical vascular damage. In the RLS group, blood pressure measurements significantly correlated with all the markers of subclinical vascular damage, particularly pSBP was associated with PWV (r = 0.53, p = 0.009), Pulse Pressure correlated with cIMT (r = 0.58, p = 0.01) and cDBP was inversely related to cDC (r = -0.53; p = 0.03). Conclusions: Our data did not show significant differences in markers of early vascular damage between patients with RLS and matched controls. As expected, the markers of vascular damage were associated with BP. The present is only a pilot study; further studies with a larger sample size are required to confirm our findings.

Comparison of Parameters for Assessment of Carotid Stiffness and Their Association with Carotid Atherosclerosis in Rural Australian Adults: A Pilot Study.

Carotid stiffness has been associated with the development and progression of carotid artery disease and is an independent factor for stroke and dementia. There has also been a lack of comparison of different ultrasound-derived carotid stiffness parameters and their association with carotid atherosclerosis. This pilot study aimed to investigate the associations between carotid stiffness parameters (derived via ultrasound echo tracking) and the presence of carotid plaques in Australian rural adults. In cross-sectional analyses, we assessed forty-six subjects (68 ± 9 years; mean ± SD) who underwent carotid ultrasound examinations. Carotid stiffness was assessed by a noninvasive echo-tracking method, measuring and comparing multiple carotid stiffness parameters, including stroke change in diameter (ΔD), stroke change in lumen area (ΔA), β- stiffness index, pulse wave velocity beta (PWV-β), compliance coefficient (CC), distensibility coefficient (DC), Young's elastic modulus (YEM), Peterson elastic modulus (Ep), and strain. Carotid atherosclerosis was assessed bilaterally by the presence of plaques in the common and internal carotid arteries, while carotid stiffness was assessed at the right common carotid artery. β-stiffness index, PWV-β, and Ep were significantly higher (p = 0.006, p = 0.004, p = 0.02, respectively), whilst ΔD, CC, DC, and strain were lower among subjects with carotid plaques (p = 0.036, p = 0.032, p = 0.01, p = 0.02, respectively) comparing to subjects without carotid plaques. YEM and ΔA did not significantly differ among the groups. Carotid plaques were associated with age, history of stroke, coronary artery disease, and previous coronary interventions. These results suggest that unilateral carotid stiffness is associated with the presence of carotid plaques.

Evaluation of early arterial wall lesions by elastography parameters in spontaneously hypertensive rats

BackgroundArterialsclerosis caused by hypertension can lead to many complications, such as heart attack, stroke and so on. Early diagnosis and treatment of arterialsclerosis can prevent cardiovascular and cerebrovascular diseases and improve the prognosis. The present study aimed to explore the value of ultrasonography in evaluating the early lesion of the local arterial wall in hypertensive rats and identify useful elastography parameters.MethodsA total of 24 spontaneously hypertensive rats (SHR), 10-, 20-, 30-, and 40-weeks-old, were used in this study, with 6 rats in each group. Blood pressure was recorded using the Animal Noninvasive Blood Pressure Measurement System (Kent company, model CODA, USA), and the local elasticity of the abdominal aorta of rats was measured using a ultrasound diagnostic instrument (VINNO, Suzhou city, China). According to the histopathological results, SHR were divided into two groups: the normal arterial elasticity and the early arterial wall lesions. Mann–Whitney U test was used to compare the differences in elastic parameters and influencing factors between the above two groups, and receiver operating characteristic curve (ROC) was used to analyze and judge the value of each elastic parameter in evaluating early arterial lesions.ResultsA total of 22 cases were divided into two groups: 14 in the normal arterial elasticity and 8 in the early arterial wall lesions. The differences in age, blood pressure, pulse wave velocity (PWV), compliance coefficient (CC), distensibility coefficient (DC), and elasticity parameter (EP) between the two groups were compared. The differences in PWV, CC, DC and EP were statistically significant. Subsequently, the ROC curve analysis was performed for the above four evaluation indexes of arterial elasticity; the results were as follows: the area under the curve of PWV, CC, DC, and EP was 0.946, 0.781, 0.946, and 0.911, respectively.ConclusionsEarly arterial wall lesions can be evaluated by ultrasound measurement of local PWV. PWV and DC can accurately evaluate the early arterial wall lesions in SHR, and the combined application of the two can improve the sensitivity and specificity of the approach.

Color M-Mode Ultrasound to Assess Carotid Arteries: A Feasibility Study

Introduction: The gradual process of atherosclerosis involves both structural and functional changes that can accumulate over years and contribute to cardiovascular risk. We propose the use of color M-mode ultrasound to evaluate the distensibility of the carotid artery as a quantitative measurement of dynamic function that could evaluate age-related vascular change when considering atherosclerotic cardiovascular disease evaluation and risk. The aim of the study was to assess the feasibility of color M-mode ultrasound to evaluate age-related changes in the carotid arteries. Methods: Color M-mode ultrasound of the distal common carotid artery (CCA) with concurrent electrocardiogram tracing was performed on 62 adults (19 men and 43 women) in 3 age groups: young adult (20-44 years; n = 22), middle age (45-64 years; n = 20), and senior (≥65 years; n = 20). Color M-mode ultrasound images of the CCA were processed offline using ImageJ to quantify total, red, green, and blue (RGB) pixels in systole and diastole. The CCA distensibility was calculated by using the following equation: distensibility coefficient (DC) = (systolic − diastolic diameter)/(diastolic diameter × pulse pressure). The difference in ultrasound parameters among the 3 age groups was analyzed by one-way analysis of variance (ANOVA). Intraobserver and interobserver reliability of offline imaging processing was tested using intraclass correlation coefficient (ICC). Results: We observed a significant difference in CCA distensibility among the 3 age groups ( P < .05). The interobserver reproducibility and intraobserver repeatability in performing offline image processing were excellent (ICC >0.85). Conclusion: These findings suggest that color M-mode ultrasound is feasible in evaluating changes in CCA distensibility and systolic pixel values representing CCA blood flow significantly decreased in seniors.

The Value of RBP4 in Assessing Coronary Artery Elasticity in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus.

Existing research has shown that retinol binding protein (RBP4) has an impairing effect on arterial elasticity and induces insulin resistance, but the clinical value of RBP4 in patients with coronary heart disease (CHD) combined with type 2 diabetes mellitus (T2DM) has not been investigated. This study sought to compare the complexity of coronary artery lesions and coronary artery elasticity between patients with CHD combined with T2DM and those with CHD without T2DM, analyze the risk factors affecting coronary artery elasticity, and investigate the value of RBP4 in assessing coronary artery elasticity in patients with CHD and T2DM. A total of 130 patients with confirmed CHD were consecutively enrolled, including 38 patients with CHD combined with T2DM and 92 patients with CHD without T2DM. Basic clinical data, laboratory findings, coronary angiography and intravascular ultrasound (IVUS) imaging data, and Gensini scores and coronary artery elasticity parameters were calculated in both groups. Elasticity parameters included: stiffness parameter ( ), pressure-strain elastic modulus ( ), distensibility coefficient (DC), and compliance coefficient (CC). Multiple linear regression equations were established with elasticity parameters as dependent variables to explore the factors influencing coronary artery elasticity parameters in patients within the two groups. Compared with patients in the CHD without T2DM group, patients in the CHD combined with T2DM group had higher RBP4 levels, Gensini scores, and values, and lower DC and CC values. Linear regression analysis showed that Gensini score increased with higher and values and decreased with higher DC and CC values. In all patients in the CHD and CHD combined with T2DM groups, RBP4 was an independent risk factor for values after correction for confounders by multiple linear regression analysis, whereas in patients in the CHD without T2DM group, the effect of RBP4 on values was not statistically different. RBP4 was an independent risk factor of coronary artery elasticity in CHD patients with T2DM and in overall CHD patients, but it did not affect coronary artery elasticity in CHD patients without T2DM.

Methods of arterial stiffness calculation and cardiovascular disease events: the multiethnic study of atherosclerosis.

A wide variety of different formulae have been used to calculate local arterial stiffness with little external validation in relationship to cardiovascular events. We compared the associations of several arterial stiffness calculations in a large, multiethnic cohort. The multi-ethnic study of atherosclerosis (MESA) is a longitudinal study of 6814 adults without clinical cardiovascular disease (CVD) at enrollment. MESA participants with CVD surveillance through year 2018 and carotid ultrasound ( n = 5873) or aorta MRI ( n = 3175) at the baseline exam (2000-2002) were included. We analyzed 21 different calculations of local arterial stiffness. Cross-sectional and longitudinal statistical analyses were performed in addition to Cox hazard modeling for associations with CVD events (myocardial infarction, resuscitated cardiac arrest, stroke, adjudicated angina, and cardiovascular death). Carotid artery stiffness calculations had variable correlations with each other ( r = 0.56-0.99); aortic stiffness measures were similar ( r = 0.66-0.99). Nevertheless, for CVD events, the hazard ratio (HR) per standard deviation change were similar for all carotid stiffness calculations with HRs in the range of 1.00-1.10 (equivalence P < 0.001). For the aorta, aortic distensibility coefficient had a stronger association with CVD events (HR 1.18 [1.02-1.37]) compared to aorta Peterson's elastic modulus (HR 0.98 [0.89-1.07]) and aorta pulse wave velocity (HR 1.00 [0.90-1.11]). HRs between all other aortic stiffness calculations were equivalent ( P < 0.01). Different methods of calculating local arterial stiffness largely gave equivalent results, indicating that the variety of different arterial stiffness calculations in use do not cause inconsistent findings.

Association between arterial stiffness/remodeling and new-onset type 2 diabetes mellitus in general population

ObjectiveWe studied if large artery stiffness is involved in type 2 diabetes pathogenesis. We also investigated the effect of genetic risk for type 2 diabetes in these associations and the causality. Research design and MethodsIn the prospective population-based Rotterdam Study (n = 3,055; mean age, 67.2 years), markers of aortic and carotid stiffnesses and measures of arterial remodeling were assessed. Cox proportional hazard regression analysis estimated the associations between arterial stiffness measures with incident type 2 diabetes. We used 403 single nucleotide polymorphisms to calculate the genetic risk score (GRS) for type 2 diabetes. We adopted Mendelian randomization (MR) analysis to evaluate the causal associations. ResultsOver a median follow-up of 14.0 years, higher carotid-femoral pulse wave velocity (hazard ratio,1.18; 95 %CI: 1.04–1.35), carotid distensibility coefficient (1.17; 1.04–1.32), and carotid intima-media thickness (1.15; 1.01–1.32) were independently associated with incident diabetes. The associations were stronger among individuals with a higher GRS for type 2 diabetes. MR analysis did not support the causality of the observed associations. ConclusionsElevated arterial stiffness is independently associated with incident type 2 diabetes. For most arterial stiffness markers, the associations with incident type 2 diabetes were more robust in individuals with a higher GRS for diabetes.

Association of statin therapy with progression of carotid arterial stiffness: the Multi-Ethnic Study of Atherosclerosis (MESA).

Arterial stiffness progresses with age and is a predictor of adverse cardiovascular disease events. Studies examining associations of statin therapy with arterial stiffness have yielded mixed results. Associations between the duration and intensity of statin therapy and arterial stiffness have not been studied in a prospective multiethnic cohort. MESA participants (n = 1242) with statin medication use data at each exam (1-5) and who had undergone B-mode carotid ultrasound at baseline and at Exam 5 after (mean ± [SD]) 9.4 ± 0.5 years were analyzed. Carotid arterial stiffness was measured using the distensibility coefficient (DC) and Young's elastic modulus (YEM). Linear regression models were used to evaluate associations between DC and YEM and statin treatment duration and intensity. At baseline, participants were 66.5 ± 8.1 years old, 41% female, 36% White, 30% African American, 14% Chinese American, and 20% Hispanic. The mean baseline low-density lipoprotein cholesterol (LDL-C) was 149.5 ± 14.5 mg/dL. After adjusting for age, sex, race/ethnicity, and CVD risk factors, the percent changes in DC and YEM were found to not be significantly different in individuals on statin therapy at any combination of visits (1-4) compared to participants never on statin therapy (all p > 0.32). There were also no differences in the percent change in DC and YEM based on statin therapy intensity by quartile (all p > 0.14) over the 10-year follow-up period. Based on the aforementioned results, statin therapy was not associated with changes in carotid artery stiffness over nearly a decade of follow-up regardless of therapy duration or intensity.

Hypertension in individuals working in the Arctic on a rotating basis: relationship of arterial stiffness with inflammatory markers and some metabolic risk factors

Aim. To assess the relationship of arterial stiffness, inflammatory markers, some metabolic risk factors, including gender-specific aspects, in hypertensive (HTN) patients working in the Arctic on a rotating basis.Material and methods. In the polar settlement of Yamburg (68 21’ 40" northern latitude), on the basis of the medical unit of OOO YaGD, 99 men (M) and 81 women (F) with grade 1-2 HTN (61 M and 44 F) and normotensive individuals (HTN0) were examined. Patients with HTN were comparable in terms of age (p=0,68), number of rotation work years (p=0,7701), office systolic BP (p=0,473), diastolic BP (p=0,6992), and body mass index (p=0,465). We carried out 24-hour BP monitoring, common carotid artery ultrasound with the calculation of local stiffness parameters (distensibility coefficient, stiffness index, Peterson’s elastic modulus (Ep), Young’s elastic modulus (Eу)); pulse wave velocity (PWV) was studied. In addition, biochemical blood tests with the determination of high-sensitivity C-reactive protein, homocysteine, C-peptide, insulin, cortisol, atrial natriuretic peptide, interleukins (IL-1β, IL-6, IL-8, IL-10), tumor necrosis factor (TNF-α).Results. In groups M and F with HTN, in comparison with HTN0, higher values of following vascular stiffness parameters were revealed: group F — pulse pressure (p=0,018), intima-media thickness (p=0,0077), PWV (p&lt;0,00001), Eу (p=0,0314); group M — PWV (p=0,0004), Eу (p=0,0024) and reduced common carotid artery strain (p=0,0131). In M with HTN, in comparison with F with HTN, intima-media thickness (p=0,0008), stiffness index (p=0,0368), Ep (p=0,051) were higher. PWV in M and F with HTN was determined significantly higher than in persons with normal BP (p=0,0007; p=0,0001). Correlation analysis revealed the relationship between PWV and 24-hour blood pressure monitoring in hypertensive men and women. An increase in PWV per unit of measurement in women increases the HTN probability by 1,7 times, in men — by 1,4 times. Compared with HTN0 group, the levels of C-peptide (p=0,032), insulin (p=0,035), IL-1β (p=0,025), cortisol (p=0,031) in M group were significantly higher, while significantly higher levels of C-peptide (p=0,015), insulin (p=0,012), IL-6 (p=0,021), TNF-α (p=0,047) were revealed in F group. Stepwise logistic regression analysis revealed following independent parameters affecting the HTN probability: M group — PWV (odds ratio (OR) 1,554 (95% confidence interval (CI): 1,058-2,281, p=0,025)), C-peptide (OR 1,186 (95% CI: 1,004-1,588, p=0,022)), IL-1β (OR 1,464 (95% CI: 0,936-2,291, p=0,099)); F group — PWV (OR 2,015 (95% CI: 1,319-3,078, p=0,001)), C-peptide (OR 2,133 (95% CI: 1,236-3,680, p=0,006)), IL-6 (OR 2,101 (95% CI: 1,003-4,400, p=0,049)) and reduced TNF-α level (OR 0,801 (95% CI: 0,668-0,959, p=0,016)).Conclusion. Under the rotation work conditions in the Arctic, high vascular stiffness values, regardless of sex, are associated with HTN. In men, regardless of BP level, vascular stiffness parameters were higher. However, a stronger association of vascular stiffness with the HTN risk was observed in women. In hyper­tensive patients in the Arctic, an association of vascular stiffness with nonspecific immune inflammation factors was found, which was more pronounced in women. In addition to vascular stiffness and pro-inflammatory cytokines, the "northern" HTN model includes C-peptide, which is an atherosclerosis modulator.

Effects of three-months folate supplementation on early vascular abnormalities in hyperhomocysteinemic patients with epilepsy

BackgroundEpilepsy has been associated with an increased risk of cardiovascular events. Anti-seizure medication (ASM) may contribute to vascular risk by several mechanisms, including increased homocysteine levels. This study aims to assess the global vascular burden in hyperhomocysteinemic people with epilepsy (PWE) on long‐term ASM before and after folic acid supplementation and in subgroups of PWE treated with single enzyme-inducing or single non-enzyme inducing ASM. MethodsOne hundred and seventy-four hyperhomocysteinemic (HHcy) PWE who met the inclusion criteria were enrolled. Carotid Doppler ultrasonography, FMD and ultrasound assessment of the brachial artery properties at the baseline and after 90 days of folic acid supplementation were performed. The vascular biomarkers MMP-9 and TIMP-1 were also detected. ResultsAfter folic acid supplementation, in HHcy patients homocysteine levels reduced from 26.8 ± 10.5 to 20.2 ± 5.3 μmol/L, carotid Intima-Media-Thickness reduced from 0.83+0.06 mm to 0.79±0.05 mm, and FMD, distensibility coefficient and β-stiffness improved (p < 0.05). Moreover, MMP-9 and TIMP-1 reduced after supplementation (p < 0.05). PWE treated with a single enzyme-inducing ASM showed an impairment of vascular parameters compared to patients treated with non-enzyme inducing ASM. ConclusionsThe results highlight the importance of assessing homocysteine levels and estimating the cardiovascular risk of PWE, preferring non-enzyme inducing ASM in high cardiovascular-risk patients. An adequate correction of homocysteine levels with folate supplementation should be considered to improve the cardiovascular profile.

Morbid obesity is associated with hypertrophic outward remodeling and increased stiffness of small conduit arteries: An ultra-high frequency ultrasound study

Background and aimsAlthough many studies have been published on the effect of obesity on large and small arteries, there are no data in the literature regarding the effect of obesity on medium-sized arteries, and in particular of small conduit arteries. The aim of the present study was to investigate whether patients with severe obesity presented structural or functional alterations in different arterial segments. Methods and results34 patients with severe obesity (BMI≥35 kg/m2) and 34 age-and sex-matched normal weight patients were recruited as controls. Aortic stiffness (carotid-femoral pulse wave velocity) and wave reflection (augmentation index) were recorded. Ultrasound images of common carotid, radial and interdigital arteries were acquired for the assessment of wall-to-lumen ratio, wall cross-sectional area (WCSA), compliance, distensibility coefficient (DC) and Young's elastic modulus (Einc). Insulin sensitivity was calculated by oral glucose sensitivity index (OGIS). No differences between groups in carotid artery remodeling were found, while WCSA of the radial and interdigital arteries were higher in obese group than in controls. As regard the parameters of vascular elasticity, the DC of radial and interdigital arteries were lower (p = 0.025 and p = 0.001, respectively), as well as the Einc of radial arteries was higher (p = 0.021), in subject with obesity compared to controls. All these correlations were consistent after adjustment for the main covariates. Finally, in a multiple regression analysis OGIS was and independent determinant of interdigital artery DC (R2 = 0.29, p = 0.001). ConclusionsFor the first time, we describe an outward remodeling and increased stiffness in small conduit arteries in severe obesity.

RF34 | PMON276 The Effect of Gender Affirming Hormone Therapy (GAHT) on Non-Conventional Cardiovascular Risk Markers in Transgender Men: A Systematic Review

Abstract The process of gender transitioning includes the employment of gender-affirming hormone therapy (GAHT) to attenuate gender dysphoria. Although considered relatively safe, there is still debate whether GAHT may increase the risk of cardiovascular disease (CVD) in transgender men (TM). Non-conventional subclinical cardiovascular (CV) risk markers, such as inflammation or coagulation markers, endothelial activity-related substances, and the use of ultrasound-assisted vascular function evaluation, may improve CV risk prediction in specific populations. Therefore, we conducted a systematic review to summarize the available findings regarding GAHT and its effects on these non-conventional cardiovascular risk markers in TM. Medline, LILACS, SCOPUS, and Embase databases were searched for cross-sectional, case-control, cohort, or randomized clinical trial studies published until July 2020. The selection criteria for the studies were as follows: ≥ 18 years old transgender male, no established CVD, using GAHT (androgens) for at least 2 months and compared with cis women or untreated transmen or before and during/after treatment for cohort studies. From 152 studies initially identified, 7 studies (3 cohorts and 4 case-control) were included in the systematic review. Some of these studies assessed different CV risk markers in the same group of participants. No changes were found in t-PA PAI-1, ICAMs, and PCR-us after 4 and 12 months of GAHT. Fibrinogen did not differ either in TM with or with no GAHT. Three studies evaluated flow-mediated-vasodilation (FMD) of the brachial artery. The only cohort study found no changes in FMD after 12 months of GAHT. One case-control study observed significant impaired FMD, and another one showed impaired FMD- after-nitroglycerin in transmen compared with cis women. One study reported increased homocysteine and higher carotid intima-media thickness (C-MIT) after 12 months of hormone use. Further, one study observed testosterone did not affect distensibility (DC) or compliance (CC) coefficient after 12 months, but the changes in fasting insulin levels were negatively associated with changes in the CC and DC. One study assessed the vascular function using brachial-ankle pulse wave velocity (baPWV) and observed a higher risk in TM with GAHT versus the untreated group. The results of the present systematic review suggest that GAHT may be associated with worse subclinical cardiovascular markers in TM. Further studies assessing long-term clinical follow-up of transgender men using GAHT could positively impact the prevention of CVD and management strategies for this population. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 1:00 p.m. - 1:05 p.m.

Ideal Life’s Simple 7 Score Relates to Macrovascular Structure and Function in the Healthy Population

Background: Cardiovascular health scores, such as Life’s Simple 7 from the American Heart Association, and the assessment of arterial properties are independently used to determine cardiovascular risk. However, evidence of their association remains scarce, especially in healthy, middle-aged to older populations. Methods: A healthy sample of the Swiss population aged 50–91 years as part of the COmPLETE cohort study was included. Carotid intima–media thickness (cIMT), carotid lumen diameter (cLD), carotid distensibility coefficient (DC), flow-mediated dilation (FMD), and brachial–ankle pulse wave velocity (baPWV) were used to determine arterial properties. The Life’s Simple 7 cardiovascular health score was calculated using seven categories (body-mass index, cholesterol, systolic blood pressure, hemoglobin A1c, smoking status, physical activity, and diet). In accordance with the American Heart Association, for each category, two points were given for an ideal health metric level, intermediate scores one point, and poor scores zero points. Intermediate and ideal health scores corresponded to a total of 5–9 and 10–14 points, respectively. Results: A total of 280 participants (50.7% male) were included. After adjusting for age and sex, an ideal health score was associated with lower cIMT (−0.038 mm, 95% CI: −0.069 mm–−0.007 mm, p = 0.017), lower cLD (−0.28 mm, 95% CI: −0.46 mm–−0.11 mm, p = 0.002), and lower baPWV (−0.05 m/s, 95% CI: −0.08 m/s–−0.02 m/s, p = 0.003). No differences were found for FMD and DC. Conclusions: Even in a healthy sample of middle-aged and older adults, individuals with an ideal cardiovascular health score showed more favorable biomarkers of vascular aging than those with an intermediate score. This stresses the relevance of promoting an optimal lifestyle, even among the healthy population.

Association of Blood Pressure-Related Increase in Vascular Stiffness on Other Measures of Target Organ Damage in Youth.

Hypertension-related increased arterial stiffness predicts development of target organ damage (TOD) and cardiovascular disease. We hypothesized that blood pressure (BP)-related increased arterial stiffness is present in youth with elevated BP and is associated with TOD. Participants were stratified by systolic BP into low- (systolic BP <75th percentile, n=155), mid- (systolic BP ≥80th and <90th percentile, n=88), and high-risk BP categories (≥90th percentile, n=139), based on age-, sex- and height-specific pediatric BP cut points. Clinic BP, 24-hour ambulatory BP monitoring, anthropometrics, and laboratory data were obtained. Arterial stiffness measures included carotid-femoral pulse wave velocity and aortic stiffness. Left ventricular mass index, left ventricular systolic and diastolic function, and urine albumin/creatinine were collected. ANOVA with Bonferroni correction was used to evaluate differences in cardiovascular risk factors, pulse wave velocity, and cardiac function across groups. General linear models were used to examine factors associated with arterial stiffness and to determine whether arterial stiffness is associated with TOD after accounting for BP. Pulse wave velocity increased across groups. Aortic distensibility, distensibility coefficient, and compliance were greater in low than in the mid or high group. Significant determinants of arterial stiffness were sex, age, adiposity, BP, and LDL (low-density lipoprotein) cholesterol. Pulse wave velocity and aortic compliance were significantly associated with TOD (systolic and diastolic cardiac function and urine albumin/creatinine ratio) after controlling for BP. Higher arterial stiffness is associated with elevated BP and TOD in youth emphasizing the need for primary prevention of cardiovascular disease.

Comparison between Carotid Distensibility-Based Vascular Age and Risk-Based Vascular Age in Middle-Aged Population Free of Cardiovascular Disease.

The concept of vascular age (VA) was proposed to provide patients with an understandable explanation of cardiovascular (CV) risk and to improve the performance of prediction models. The present study compared risk-based VA derived from Framingham Risk Score (FRS) and Systematic Coronary Risk Estimation (SCORE) models with value-based VA derived from the measurement of the common carotid artery (CCA) distensibility coefficient (DC), and it assessed the impact of DC-based VA on risk reclassification. In 528 middle-aged individuals apparently free of CV disease, DC was measured by radiofrequency-based arterial wall tracking that was previously utilised to establish sex- and age-specific reference values in a healthy population. DC-based VA represented the median value (50th percentile) for given sex in the reference population. FRS-based and SCORE-based VA was calculated as recommended. We observed a good agreement between DC-based and FRS-based VA, with a mean difference of 0.46 ± 12.2 years (p = 0.29), while the mean difference between DC-based and SCORE-based VA was higher (3.07 ± 12.7 years, p < 0.0001). When only nondiabetic individuals free of antihypertensive therapy were considered (n = 341), the mean difference dropped to 0.70 ± 12.8 years (p = 0.24). Substitution of chronological age with DC-based VA in FRS and SCORE models led to a reclassification of 28% and 49% of individuals, respectively, to the higher risk category. Our data suggest that the SCORE prediction model, in which diabetes and antihypertensive treatment are not considered, should be used as a screening tool only in healthy individuals. The use of VA derived from CCA distensibility measurements could improve the performance of risk prediction models, even that of the FRS model, as it might integrate risk prediction with additional risk factors participating in vascular ageing, unique to each individual. Prospective studies are needed to validate the role of DC-based VA in risk prediction.

Markers of subclinical vascular damage in young adults with type 1 diabetes mellitus: the role of central blood pressure.

Type 1 diabetes mellitus (T1D) is a chronic disease leading to cardiovascular complications that can be diagnosed early as subclinical vascular damage. To prevent such damage, it is important to increase knowledge of the effects of the different cardiovascular risk factors in patients with T1D. The aim of our study was to assess possible associations between markers of subclinical arterial damage and traditional cardiovascular risk factors, with a special focus on peripheral blood pressure and central blood pressure (cBP), in a sample of young adults with T1D. The study included 172 T1D patients (mean age 24.7 ± 8.7 years, duration of T1D 13.5 ± 9.6 years). Pulse wave velocity (PWV), pulse wave analysis and cBP were assessed by tonometry (SphygmoCor Xcel). Carotid intima-media thickness (cIMT) and carotid distensibility coefficient (cDC) were assessed by high-resolution echo-Doppler analysis and further examined with dedicated hardware. Seventeen patients (10.1%) were classified as hypertensive by office peripheral blood pressure, and 48 patients (27.9%) were classified as hypertensive by cBP. One hundred sixteen patients (68.8%) had cDC under the range of normality, one patient had a PWV (0.6%) above 10 m/s, and no patients had a cIMT above 0.9 mm. In multivariable analysis, central SBP, but not metabolic parameters, remained associated with all the markers of subclinical arterial damage [cIMT ( β = 0.288 ± 0.001; P < 0.001), PWV ( β = 0.374 ± 0.007; P < 0.001), cDC ( β = -0.149 ± 0.055; P = 0.029)]. The independent association between cBP and markers of subclinical vascular damage underlines the importance of haemodynamic factors in the development of early signs of macrovascular disease in T1D patients. Further studies are warranted to better define the role of cBP to stratify cardiovascular risk, to individualize the need for follow-up and to tailor preventive strategies in T1D patients.

Complement factors D and C3 cross-sectionally associate with arterial stiffness, but not independently of metabolic risk factors: The Maastricht Study.

Arterial stiffness predicts cardiovascular outcomes. The complement system, particularly the alternative complement pathway, has been implicated in cardiovascular diseases. We herein investigated the associations of factor D, the rate-limiting protease of the alternative pathway, and C3, the central complement component, with arterial stiffness. In 3019 population-based participants (51.9% men, 60.1 ± 8.2 years, 27.7% type 2 diabetes [T2D], oversampled]), we measured carotid-femoral pulse wave velocity (cfPWV), carotid distensibility coefficient (DC) and carotid Young's elastic modulus (YEM), and plasma concentrations of factors D and C3. We conducted multiple linear regression to investigate the association of factors D and C3 (main independent variables, standardized) with cfPWV (primary outcome) and DC and YEM (secondary outcomes), adjusted for potential confounders. Per SD higher factors D and C3, cfPWV was 0.41 m/s [95% confidence interval: 0.34; 0.49] and 0.33 m/s [0.25; 0.41] greater, respectively. These associations were substantially attenuated when adjusted for age, sex, education, mean arterial pressure, and heart rate (0.08 m/s [0.02; 0.15] and 0.11 m/s [0.05; 0.18], respectively), and were not significant when additionally adjusted for T2D, waist circumference and additional cardiovascular risk factors (0.06 m/s [-0.01; 0.13] and 0.01 m/s [-0.06; 0.09], respectively). Results were comparable for carotid YEM and DC. In persons with T2D, but not in those without, the association between factors D and cfPWV was significant in the fully adjusted model (0.14 m/s, [0.01; 0.27], P = 0.038, Pinteraction < 0.05). The strong association of plasma factors D and C3 with arterial stiffness in this population-based cohort was not independent of T2D and other metabolic risk factors. Our data suggest that a possible causal pathway starting from alternative complement activation may via hypertension and T2D contribute to greater arterial stiffness.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.