Elevated Pulse Wave Velocity Research Articles

Effects Of Changes In Obesity, Fitness, And Physical Activity On Aortic Stiffness In Obese Adults

Aortic stiffness, a precursor to adverse cardiovascular outcomes, is worsened in conditions of general and abdominal obesity, low cardiorespiratory fitness (CRF), and physical inactivity. Elevated carotid-femoral pulse wave velocity (cfPWV) is an indicator of aortic stiffness. Behavioral weight loss interventions promote decreased caloric intake and increased moderate-vigorous physical activity (MVPA), but whether increases in MVPA and CRF have independent or additive effects with weight loss on aortic stiffness remains unclear. PURPOSE: To determine the overall and independent effects of changes in general and abdominal obesity, CRF, and MVPA on cfPWV in overweight and obese adults. METHODS: Eighty three (N=83) sedentary, overweight and obese adults (age 44.5 ± 8.1 years; BMI 32.4 ± 4.0 kg/m2) completed 6 months of a standard behavioral weight loss intervention. Assessments included cfPWV (m/s) by applanation tonometry, abdominal obesity by dual X-ray absorptiometry (DXA), MVPA (min/wk, MET-min/wk) by objective activity monitoring and CRF by graded exercise testing. Changes in systolic and diastolic blood pressure (SBP, DBP) were also evaluated. Multiple linear regression was performed to determine the effect of changes in CRF and MVPA on cfPWV with changes in body weight and abdominal fat as covariates. RESULTS: After 6 months, body weight, BMI, waist circumference, and abdominal fat significantly decreased, while CRF and MVPA significantly increased (all p0.1). Reductions in body weight, BMI, waist circumference, and abdominal fat were not associated with the decrease in cfPWV (all p>0.1). The decrease in cfPWV was moderately correlated with decreases in SBP (r=0.379, p<0.001) and DBP (r=0.317, p=0.004). CONCLUSION: These data did not support that changes in fatness were associated with improved aortic stiffness, however, the significant improvements in CRF and cfPWV suggest that targeting fitness in lifestyle interventions for a sedentary, obese population maybe be important for better vascular health. Supported by NIH (HL103646)

Arterial Stiffness in HIV Patients in a Semi Urban Area of South Africa

Introduction: HIV infected patients are said to have increased cardiovascular risk which may result in large arterial wall stiffening. Aortic pulse wave velocity (PWV) provides a measure of this. This study investigated the relationship between aortic pulse wave velocity and the following variables: anthropometry, age, blood pressure and lipid profile. Materials and methods: This was a cross-sectional study comprising 169 participants whose PWV was assessed using the Sphygmocor Vx. Results: In total, 169 participants were examined. There were 63 HIV negatives, 54 HIV positives not on HAART and 52 HIV positives on HAART (62 males, and 107 females). In all the participants, HIV positives not on HAART, HIV positives on HAART, age ≥ 40 years, systolic blood pressure ≥ 130 mmHg, and hip circumference (HC) ≥ 97 cm were significantly and independently associated with elevated PWV ≥ 6.5 m/s (68.5%). In HIV positives not on HAART, only HC ≥ 97 cm was the most independent determinant of elevated PWV. In HIV positives on HAART, only age ≥ 40 years was the most independent determinant of elevated PWV. However, applying multiple linear regression analysis, and using continuous variables, and after adjusting for confounders (WC, TG, HC. and TC), increase in SBP (R2=29.6%), age (R2=9.2%), and decline of CD4 count (R2=10.2 % predicted significantly and independently increasing values of PWV in HIV positives on HAART. PWV t was highest in the HIV positives not on HAART (Treatment naive). Conclusion: Disproportionate rates of increased arterial stiffness, cardiometabolic risk, age, and low CD4 count are associated with HIV positives in these black South Africans.

The Relationship between Serum Oxalic Acid, Central Hemodynamic Parameters and Colonization by Oxalobacter formigenes in Hemodialysis Patients

Background/Objective: Elevated pulse wave velocity (PWV) and central aortic blood pressures are independent predictors of increased cardiovascular morbidity and mortality in hemodialysis (HD) patients. Oxalic acid is a uremic retention molecule that is extensively studied in the pathogenesis of calcium oxalate stones. Oxalobacter formigenes, a member of the colon microbiota, has important roles in oxalate homeostasis. Data regarding the colonization by and the exact role of O. formigenes in the pathogenesis of oxalic acid metabolism in HD patients are scant. Hence, we aimed to determine the relationship between fecal O. formigenes colonization, serum oxalic acid and hemodynamic parameters in HD patients with regard to the colo-reno-cardiac axis. Methods: Fifty HD patients were enrolled in this study. PWV and central aortic systolic (cASBP) and diastolic blood pressures (cADBP) were measured with a Mobil-O-Graph (I.E.M. GmbH, Stolberg, Germany). Serum oxalic acid levels were assessed by ELISA, and fecal O. formigenes DNA levels were isolated and measured by real-time PCR. Results: Isolation of fecal O. formigenes was found in only 2 HD patients. One of them had 113,609 copies/ml, the other one had 1,056 copies/ml. Serum oxalic acid levels were found to be positively correlated with PWV (r = 0.29, p = 0.03), cASBP (r = 0.33, p = 0.001) and cADBP (r = 0.42, p = 0.002) and negatively correlated with LDL (r = -0.30, p = 0.03). In multivariate linear regression analysis, PWV was independently predicted by oxalic acid, glucose and triglyceride. Conclusions: This is the first study that demonstrates the absence of O. formigenes as well as a relation between serum oxalic acid and cASBP, cADBP and PWV in HD patients. Replacement of O. formigenes with pre- and probiotics might decrease serum oxalic acid levels and improve cardiovascular outcomes in HD patients.

Effects of age and smoking on endothelial function assessed by quantitative cardiovascular magnetic resonance in the peripheral and central vasculature.

BackgroundBoth age and smoking promote endothelial dysfunction and impair vascular reactivity. Here, we tested this hypothesis by quantifying new cardiovascular magnetic resonance (CMR)-based biomarkers in smokers and nonsmokers.MethodsStudy population: young non-smokers (YNS: N = 45, mean age = 30.2 ± 0.7 years), young smokers (YS: N = 39 mean age 32.1 ± 0.7 years), older non-smokers (ONS: N = 45, mean age = 57.8 ± 0.6 years), and older smokers (OS: N = 40, mean age = 56.3 ± 0.6 years), all without overt cardiovascular disease. Vascular reactivity was evaluated following cuff-induced hyperemia via time-resolved blood flow velocity and oxygenation (SvO2) in the femoral artery and vein, respectively. SvO2 dynamics yielded washout time (time to minimum SvO2), resaturation rate (upslope) and maximum change from baseline (overshoot). Arterial parameters included pulse ratio (PR), hyperemic index (HI) and duration of hyperemia (TFF). Pulse-wave velocity (PWV) was assessed in aortic arch, thoracoabdominal aorta and iliofemoral arteries. Ultrasound-based carotid intimal-medial thickness (IMT) and brachial flow-mediated dilation were measured for comparison.ResultsAge and smoking status were independent for all parameters. Smokers had reduced upslope (−28.4%, P < 0.001), increased washout time (+15.3%, P < 0.01), and reduced HI (−19.5%, P < 0.01). Among non-smokers, older subjects had lower upslope (−22.7%, P < 0.01) and overshoot (−29.4%, P < 0.01), elevated baseline pulse ratio (+14.9%, P < 0.01), central and peripheral PWV (all P < 0.05). Relative to YNS, YS had lower upslope (−23.6%, P < 0.01) and longer washout time (13.5%, P < 0.05). Relative to ONS, OS had lower upslope (−33.0%, P < 0.01). IMT was greater in ONS than in YNS (+45.6%, P < 0.001), and also in YS compared to YNS (+14.7%, P < 0.05).ConclusionsResults suggest CMR biomarkers of endothelial function to be sensitive to age and smoking independent of each other.

Low-grade albuminuria associated with brachial-ankle pulse wave velocity in young adults with type 2 diabetes mellitus in China.

Cardiovascular disease is prevalent in type 2 diabetics, and microalbuminuria is associated with cardiovascular disease morbidity. We aimed to investigate the potential association between low-grade albuminuria and arterial stiffness in patients with type 2 diabetes. Between 2009 and 2013, a retrospective study was performed in 578 patients with type 2 diabetes (339 male patients and 239 female patients) with normal urinary albumin-to-creatinine ratios (ACRs; <30 mg/g) from Fuzhou, China. Patients were stratified into tertiles based on urinary ACR levels (lowest tertile, urinary ACR < 4.8 mg/g; highest tertile, urinary ACR ≥ 20.1 mg/g). Arterial stiffness was measured via brachial-ankle pulse wave velocity. Brachial-ankle pulse wave velocity, age, duration of diabetes, systolic blood pressure and pulse wave velocity progressively increased across all urinary albumin-to-creatinine ratio tertiles (p < 0.05). Patients in the second and the highest tertiles had significantly elevated pulse wave velocity [114.6 mm/s (95% CI = 36.8-192.4) and 209.4 mm/s (95% CI = 131.8-286.9)], p = 0.004 and 0.000] compared with those in the lowest ACR tertile. The association between ACR and elevated pulse wave velocity still persisted in patients younger than 65 years of age and those with diabetes <10 years, conferring 45 or 51% greater risk of elevated pulse wave velocity (OR = 1.451; 95% CI = 1.119-1.881; p = 0.005 or OR = 1.515; 95% CI = 1.167-1.966; p = 0.0018) with each ACR tertile increment. Each ACR tertile increment conferred 31.7% higher risk of increased pulse wave velocity (OR = 1.317; 95% CI = 1.004-1.729; p = 0.0468). Patients with type 2 diabetes with urinary albumin excretion in the upper normal range were still at risk for target organ damage. Low-grade albuminuria might be an early marker for the detection of arterial stiffness in patients with type 2 diabetes, especially in younger patients with type 2 diabetes with shorter durations of disease.

Longitudinal Follow-Up of Cardiovascular Comorbidity in Pediatric Renal Transplant Recipients - Results From the 4C-T Study.

Children with chronic kidney disease (CKD) carry an increased cardiovascular risk. Cardiovascular death is the second leading cause of death in children after renal transplantation. The 4C-T (Cardiovascular Comorbidity in Children with CKD and Transplantation) study evaluates cardiovascular target organ damage longitudinally in children prior to and after renal transplantation. The multicenter, prospective, observational 4C study enrolled 736 children aged 6 to 17 years with estimated GFR <40 ml/min/1.73 m2 at 55 Pediatric Nephrology centres from 12 European countries. Of these, 161 have started renal replacement therapy (RRT) and entered the 4C-T study. At annual study visits, the morphology and function of the heart and large arteries were monitored by noninvasive methods. 119 of the 161 patients with RRT had a visit 12 months after RRT start and were included in this analysis. 56 patients had started dialysis and 73 received a transplant. Half of the patients (52 %) were transplanted pre-emptively. Overall patients carried a higher cardiovascular risk compared to the age-matched general population as documented by elevated age-adjusted aortic pulse wave velocity (PWV) and carotid intima-media thickness (IMT). After renal transplantation PWV-SDS decreased from 0.31±1.48 to -0.20±1.21 (p=.007, paired t-test), whereas PWV remained unchanged after initiation of dialysis (0.53±1.75 to 0.43±1.24 (p=.66). No differences were seen for IMT and left ventricular mass index. Our preliminary analyses suggest an improvement of the arteriosclerotic profile in patients undergoing transplantation compared to patients starting dialysis. PWV has been the most sensitive measure for those changes. With more and more patients becoming eligible, the 4C-T study will be one of the largest studies investigating the course of cardiovascular comorbidity in pediatric renal transplant recipients.

Pulse-wave velocity, the ankle-brachial index, and the visceral fat area are highly associated with colorectal adenoma

BackgroundAlthough both colorectal neoplasms and atherosclerosis may be induced by visceral fat accumulation, no association between these factors has yet been elucidated. MethodsAmong Japanese participants in our colonoscopic screening and annual surveillance programs, asymptomatic subjects were investigated. Visceral fat area was measured by computed tomography, and the ankle-brachial index and pulse-wave velocity (markers of systemic atherosclerosis) were also estimated. Colorectal findings during screening were investigated in association with these parameters. ResultsNine hundred and seven subjects (males: 71.9%; mean age: 57.3±8.7 years) were enrolled. Colorectal adenomas were identified during colorectal screening of 407 subjects (44.9%). The prevalence of all colorectal adenoma and advanced neoplasia increased with an elevated pulse-wave velocity from 32.2% (advanced neoplasia, 2.6) to 62.1% (8.4%) in higher quartiles (p<0.001 and p=0.003). The risk of advanced neoplasia was higher in subjects with an abnormal ankle-brachial index (33% vs. 4.6%, p<0.001). Upon multivariate analysis, visceral fat area and pulse-wave velocity were associated with all adenoma, and the ankle-brachial index with advanced neoplasia. ConclusionsThe risk of colorectal adenoma was strongly associated with visceral fat area and markers of atherosclerosis. Colorectal adenoma and atherosclerosis may share a common pathogenesis and the same populations are at high-risk.

Association between albuminuria, atherosclerotic plaques, elevated pulse wave velocity, age, risk category and prognosis in apparently healthy individuals

Two thousand and fifty-nine healthy individuals aged 41, 51, 61 and 71 years examined in 1993, were divided in age, SCORE and Framingham risk score (FRS) groups. Subclinical vascular damage (SVD) was defined as carotid-femoral pulse wave velocity (cfPWV) at least 12 m/s, carotid atherosclerotic plaques or albuminuria defined as urine albumin/creatinine ratio at least 90th percentile of 0.73/1.06 mg/mmol men/women. In 2006, the composite endpoint (CEP) of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and hospitalization for ischemic heart disease was recorded (n = 229). With increasing age, SCORE or FRS risk group, prevalence of cfPWV at least 12 m/s (5.2, 14.5, 35.3, 53.5% or 4.4, 15.6, 50.9, 66.1% or 4.0, 9.5, 32.1, 56.1%), atherosclerotic plaque (4.0, 19.0, 35.3, 53.5% or 3.5, 16.8, 43.7, 55.9%, or 6.6, 7.6, 9.8, 20.0%) and albuminuria (7.9, 8.7, 11.4, 20.6% or 7.9, 8.2, 16.6, 19.5% or 6.6, 7.6, 9.8, 20.0%) increased, all P < 0.001.CEP was associated with albuminuria in individuals aged 61 or 71 years, with moderate or very high SCORE or intermediate or high FRS (all P < 0.05), with atherosclerotic plaques in individuals aged 41, 51 or 61 years, with moderate SCORE or with high-intermediate or high FRS (all P < 0.01), and with cfPWV at least 12 m/s in individuals aged 51 years (P < 0.001) or high FRS (P < 0.05). Presence of at least one SVD was significantly associated with an increased risk in individuals aged 51 [hazard ratio 2.7 (1.6-4.8)] and 61 years [hazard ratio 2.7 (1.5-4.7)], moderate [hazard ratio 2.4 (1.6-3.7)] or high SCORE risk group [hazard ratio 2.3 (1.2-4.7)] and low-intermediate [hazard ratio 3.3 (1.5-7.0)], high-intermediate [hazard ratio 2.3 (1.5-3.5)] and high FRS risk group [hazard ratio 2.0 (1.4-3.0)]. SVD and especially atherosclerotic plaques or urine albumin/creatinine ratio (UACR) at least 0.73/1.06 mg/mmol (men/women) added prognostic information in individuals aged 51 or 61 years or with moderate or intermediate risk.

Elevated brachial-ankle pulse wave velocity is independently associated with microalbuminuria in a rural population.

Microalbuminuria is a marker of generalized endothelial dysfunction resulting from arterial stiffness or insulin resistance, and brachial-ankle pulse wave velocity (baPWV) is a good measure of arterial stiffness. We aimed to investigate whether elevated baPWV is independently associated with microalbuminuria. This study included 1,648 individuals aged over 40 who participated in the baseline Multi-Rural Cohort Study conducted in Korean rural communities between 2005 and 2006. Participants were classified into less than 30 mg/g as normoalbuminuria or 30-300 mg/g as microalbuminuriausing urinary albumin creatinine ratio (UACR). The median and Q1-Q3 baPWV values were significantly higher in the microalbuminuric group both in men (1,538, 1,370-1,777 cm/s vs. 1,776, 1,552-2,027 cm/s, P < 0.001) and women (1,461, 1,271-1,687 cm/s vs. 1,645, 1,473-1,915 cm/s, P < 0.001). BaPWV was independently associated with microalbuminuria in both genders after adjusting for pulse rate; fasting blood glucose; triglyceride; homeostatic model assessment insulin resistance (HOMAIR) and, history of hypertension and diabetes. Fasting blood sugar and HOMAIR were judged as having nothing to do with multicolinearity (r = 0.532, P < 0.001). Elevated baPWV was independently associated with microalbuminuria regardless of insulin resistance among rural subjects over 40 yr.Graphical

Relationship between aortic pulse wave velocity, selected proinflammatory cytokines, and vascular calcification parameters in peritoneal dialysis patients

Vascular calcification and arterial stiffening are cardiovascular risk factors among chronic kidney disease patients. Elevated aortic pulse wave velocity (AoPWV) is an independent predictor of increased cardiovascular morbidity and mortality. The aim of the study was to analyze the relationships between inflammatory and vascular calcification parameters and arterial wall stiffness in chronic kidney disease (CKD) patients treated by peritoneal dialysis. The study included 57 patients (27 women and 30 men) aged from 19 to 75 years (mean age 53 ± 13), treated by peritoneal dialysis during 4-100 months (mean 30.4 months). The concentrations of albumin, lipids, interleukin-6 (IL-6), IL-18, high-sensitive C-reactive protein, transforming growth factor-β1 (TGF-β1), osteocalcin, osteoprotegerin (OPG), fibroblast growth factor 23, fetuin A, parathyroid hormone (iPTH), total calcium (Ca), and phosphates (Pi) were measured. AoPWV was performed using a tonometric method, common carotid artery intima-media thickness (CCA-IMT) by ultrasonography evaluation, and calcium scoring (CaSc) with multirow spiral computed tomography (MSCT). In univariate analysis, AoPWV correlated negatively with osteocalcin (R = -0.37; P = 0.005) and positively with OPG (R = 0.41; P = 0.002). Additionally, AoPWV was significantly positively associated with inflammatory parameters: IL-6 (R = 0.35; P = 0.009), TGF-β1 (R = 0.27; P = 0.047), and white blood cell (WBC) count (R = 0.33; P = 0.01). There were also positive correlations between AoPWV and imaging data: CCA-IMT (R = 0.32; P = 0.02) and CaSc (R = 0.38; P = 0.004). AoPWV did not correlate with calcium, phosphate, Ca × Pi index, or iPTH concentration. After multiple adjustments, osteocalcin was the only significant predictor of AoPWV. In logistic regression adjusted for age, hypertension, and mean arterial pressure at AoPWV evaluation, only osteocalcin was significantly associated with high (above median) AoPWV values [odds ratio 0.96 (0.92-0.99) per unit increase in osteocalcin]. OPG concentration and some inflammatory markers (WBC count, IL-6, TGF-β1) influenced the severity of arterial wall stiffness in CKD patients. Measurement of osteocalcin seems to be the best predictor of AoPWV.

Interaction of hyperalbuminuria, artherosclerotic plaques and elevated pulse wave velocity with age and risk category in apparently healthy subjects

Interaction of hyperalbuminuria, artherosclerotic plaques and elevated pulse wave velocity with age and risk category in apparently healthy subjects

Changes in Aortic Pulse Wave Velocity of Patients Undergoing Endovascular Repair of Abdominal Aortic Aneurysms

To assess changes in pulse wave velocity (PWV), a valid index of arterial stiffness, in patients undergoing endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). Arterial stiffness is an independent marker of all-cause mortality and cardiovascular morbidity and mortality. Forty-eight consecutive male patients (mean age 71±4 years) underwent elective EVAR (AAA group) after exclusion of patients with Marfan syndrome or other collagen-related disorders. Thirty-one age-matched men (mean age 69±5 years) without overt cardiovascular disease served as controls. PWV and clinical parameters were determined at baseline in both groups and after 6 months in the AAA group. At baseline, the groups did not differ in demographic characteristics, lipid profile, or blood pressure levels (p>0.05). PWV was considerably higher in AAA than controls (p<0.001). PWV positively correlated with mean blood pressure, AAA diameter, and age in univariate and multivariate analysis (R(2)=0.498, p=0.008). At 6 months after EVAR, PWV significantly increased from 13.11±3.57 m/s to 16.41±2.33 m/s (p<0.001) in the AAA group. Patients with AAA present with significantly elevated PWV levels compared to controls, and stent-graft repair is associated with a significant increase in the PWV. Whether those changes contribute to the cardiovascular risk in AAA patients needs further investigation.

Serum phosphate varies with degree of proteinuria in nephrotic syndrome and is associated with elevated pulse wave velocity

The occurrence of vascular stiffness in the setting of the nephrotic syndrome and the influence of serum phosphate on this association is unknown. A retrospective study of 42 prevalent, adult nephrotic patients who underwent carotid-femoral pulse wave velocity (PWV) measurement, a median of 24 months after kidney biopsy. Elevated PWV was determined using published age-specific reference ranges. The association, statistical significance and independence of serum phosphate with spot urine protein-creatinine ratio (PCR) and the association of phosphate with PWV was examined. Mean PCR was 5.5 g/g and mean eGFR (CKD-EPI) was 70 mL/min/1.73 m2. Serum phosphate was statistically significantly associated with severity of nephrotic syndrome independently of eGFR and age. Median (intra-quartile range) PWV was 7 m/s (4-11), with a linear trend for higher PWV across tertile of average serum phosphate over follow-up, P<.001. Twenty subjects (48%) had elevated age-specific PWV, which on logistic regression was statistically significantly associated with mean serum phosphate, OR (95% CI) per 0.1 mmol/L: 2.7 (1.5, 4.9), P = .001, which in separate analyses was independent of eGFR and other laboratory data. In this cohort of patients with the nephrotic syndrome serum phosphate was commonly elevated, despite well preserved eGFR, which was significantly and independently associated with elevated PWV over follow-up.

Abstract 206: PPARγ Deficiency Causes Aortic Stiffness and Dysregulated Elastin Turnover

PPARγ, a nuclear receptor that regulates adipocyte development and glucose homeostasis, is the molecular target of a class of insulin-sensitizing drugs. Loss-of-function mutations in PPARG gene are implicated in human hypertension and PPARγ agonists decrease blood pressure both in animal models and human patients. We have previously generated mice with varying Pparg expression created by modifying its 3′-UTR sequence, and concluded an inverse relationship between PPARγ expression level and blood pressure. Interestingly, mice with extremely low PPARγ expression exhibited an increase in systolic blood pressure without significant change in diastolic blood pressure, ultimately causing a significant increase in pulse pressure. Thus, we hypothesized that PPARγ deficiency impairs aortic elasticity, resulting in the increase in pulse pressure. Aortic pulse wave velocity (PWV) was significantly increased in PPARγ hypomorphic mice, suggesting that aortas of PPARγ hypomorphic mice were stiffer than those of wild-type mice. The measurement of mechanical property by atomic force microscope (AFM) showed higher tissue rigidity in the aorta of PPARγ hypomorphic mice. Expression of elastin in aortas was significantly decreased, and negatively correlated with aortic PWV in PPARγ hypomorphic mice. This was accompanied by increased elastin fiber breaks, elastolytic activity, and expressions of MMP-9 in aortas of PPARγ hypomorphic mice. The elevated PWV in PPARγ hypomorphic mice was ameliorated after treatment of PPARγ agonist. Together, our results suggest that PPARγ deficiency impairs elasticity in aorta and underscore the importance of PPARγ in the regulation of blood pressure and vascular reactivity.

Abstracts

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Usefulness of Physical Fitness and the Metabolic Syndrome to Predict Vascular Disease Risk in Older Chinese (from the Guangzhou Biobank Cohort Study-Cardiovascular Disease Subcohort [GBCS-CVD

Physical fitness can independently lower the risk of cardiovascular disease (CVD). We explored the independent and combined associations of physical fitness, measured using the seated at rest heart rate (RHR), and the metabolic syndrome (MS), with CVD risk, as described by an elevated pulse wave velocity (PWV) in older Chinese. Data from 1,996 participants were drawn from the Guangzhou Biobank Cohort Study-Cardiovascular Disease Subcohort. Analysis of variance and logistic regression analysis were used to establish the independent and combined associations of the RHR and the MS with PWV. The RHR was independently associated with an elevated PWV (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.22 to 2.18), as was the MS (OR 2.36, 95% CI 1.76 to 3.17). The participants with a high RHR, but without the MS, had an adjusted OR of 1.63 (95% CI 1.15 to 2.30) for the presence of the CVD proxy. Those with a low RHR and the MS had an adjusted OR of 2.35 (95% CI 1.66 to 3.33). The risk of an elevated PWV increased almost fourfold with both a high RHR and a diagnosis of the MS (OR 3.87, 95% CI 2.39 to 6.28, p = 0.52 for interaction). In conclusion, physical fitness, measured using the RHR, and the MS are independently associated with an elevated PWV, a surrogate marker for CVD. The strength of this association was further increased in the presence of both. These findings confirm the beneficial effects of physical fitness on attenuating the risk of CVD among older Chinese.

Cellular Senescence, Vascular Disease, and Aging

> You must remember this, > > A kiss is just a kiss, > > A sigh is just a sigh, > > The fundamental things apply, > > As time goes by. “As Time Goes By,” by Herman Hupfeld, Casablanca (1942)1 The increasing prevalence of older-age people in our society represents the culmination of centuries of medical, scientific, and social endeavors. At least in Western society, now relatively freed from pestilence, abject poverty, gross malnutrition, and polluted water and food sources, an increasing proportion of the population can expect to make it to old age. However, although US age-adjusted death rates from cardiovascular disease, coronary heart disease, and stroke continue to fall, a disproportionate number of people who reach old age (≈80% of people aged ≥80 years) suffer from these diseases.1a In this 2-part review, we consider important pathobiological changes that occur with aging in the cardiovascular system, exploring promising areas of recent scientific progress and novel insights that may be translatable into targeted clinical strategies to help to alleviate the excess morbidity and mortality imposed by cardiovascular disease in the elderly. In this second installment, we focus specifically on vascular disease states of the elderly, including systolic hypertension, vascular calcification, and dementia, and we review relevant basic and clinical discoveries that further elucidate these conditions. ### The Elderly Vascular Phenotype Aging is associated with various changes in the vascular system at differing structural and functional levels. At the macroscopic level, an increase in arterial lumen size and arterial wall thickening, mainly of the intima, are observed.2 In addition, increased vascular calcification and a generalized stiffening of the arterial tree lead to increased arterial wave reflectance, increased systolic blood pressure, decreased diastolic blood pressure, and a widened pulse pressure. An interesting aspect of vascular biology in which significant inroads have been made is our understanding of pulse wave velocity, which …

Letter: The Prevalence of Peripheral Arterial Disease in Korean Patients with Type 2 Diabetes Mellitus Attending a University Hospital (Diabetes Metab J 2011;35:543-50)

Letter: The Prevalence of Peripheral Arterial Disease in Korean Patients with Type 2 Diabetes Mellitus Attending a University Hospital (Diabetes Metab J 2011;35:543-50)

Non-triggered quantification of central and peripheral pulse-wave velocity.

PurposeStiffening of the arteries results in increased pulse-wave velocity (PWV), the propagation velocity of the blood. Elevated aortic PWV has been shown to correlate with aging and atherosclerotic alterations. We extended a previous non-triggered projection-based cardiovascular MR method and demonstrate its feasibility by mapping the PWV of the aortic arch, thoraco-abdominal aorta and iliofemoral arteries in a cohort of healthy adults.Materials and MethodsThe proposed method "simultaneously" excites and collects a series of velocity-encoded projections at two arterial segments to estimate the wave-front velocity, which inherently probes the high-frequency component of the dynamic vessel wall modulus in response to oscillatory pressure waves. The regional PWVs were quantified in a small pilot study in healthy subjects (N = 10, age range 23 to 68 yrs) at 3T.ResultsThe projection-based method successfully time-resolved regional PWVs for 8-10 cardiac cycles without gating and demonstrated the feasibility of monitoring beat-to-beat changes in PWV resulting from heart rate irregularities. For dul-slice excitation the aliasing was negligible and did not interfere with PWV quantification. The aortic arch and thoracoabdominal aorta PWV were positively correlated with age (p < 0.05), consistent with previous reports. On the other hand, the PWV of the iliofemoral arteries showed decreasing trend with age, which has been associated with the weakening of muscular arteries, a natural aging process.ConclusionThe PWV map of the arterial tree from ascending aorta to femoral arteries may provide additional insight into pathophysiology of vascular aging and atherosclerosis.

Clinical Summaries

Clinical Summaries