Flow-mediated Vasodilation Response Research Articles

The Effect of Conventional and Distal Radial Access Techniques on Radial Artery Structure and Vascular Functions

Introduction: To compare radial artery (RA) diameters, intima-media thickness (IMT), and vascular functions before and after conventional and distal RA cannulation. It has been proposed that distal transradial (DTRA) cannulation can reduce RA complications. However, there has been no comparative study examining the effects of DTR and conventional transradial (CTRA) intervention on RA structure and function. Patients and Methods: Radial artery diameter, IMT, flow-mediated vasodilation (FMD) response were measured using conventional and Doppler RA ultrasonography before, and one day and one month after the procedure in patients who underwent CTRA or DTRA. Results: While baseline and first-day IMT values were similar between the groups, first-month IMT values in the CTRA group were found to be significantly increased compared to those in the DTRA group (CTRA= 0.39 ± 0.10 mm, DTRA= 0.32 ± 0.07 mm, p= 0.016). While proximal RA occlusion developed in three patients who underwent CTRA, it did not develop in any of the patients undergoing DTRA (p= 0.072). Conclusion: In patients who underwent CTRA, RA IMT increased significantly in the first month after the procedure, compared to patients who underwent DTRA. Proximal RAO was not observed in any of the patients who underwent DTRA.

Longer-Term Soy Nut Consumption Improves Vascular Function and Cardiometabolic Risk Markers in Older Adults: Results of a Randomized, Controlled Cross-Over Trial

Abstract Objectives Soy foods may contribute to the beneficial effects of plant-based diets on cardiovascular disease (CVD) risk. However, their effects on vascular function have hardly been investigated. The objective was to investigate if longer-term soy nut consumption improves vascular function and cardiometabolic health in older adults. Methods Twenty-three apparently healthy participants (60–70 years; BMI between 20–30 kg/m2) participated in a randomized, controlled, single-blinded cross-over trial with an intervention (67 g of soy nuts daily providing 25.5 g soy protein) and control period (no nuts) of 16 weeks, separated by eight weeks wash-out. Volunteers followed the Dutch food-based dietary guidelines. At baseline and at 8 and 16 weeks anthropometric measurements and fasting blood samples were collected. Markers of vascular function (i.e., endothelial function, arterial stiffness, and microvascular structure) were assessed at week 16. Results No serious adverse events were reported and the soy nut regime was well tolerated. Body weight remained stable. Serum isoflavone concentrations, a marker of compliance, increased after the intervention period (daidzein: 128.3 ng/mL; 95% CI: 72.6–183.9 ng/mL; P < 0.001 and genistein: 439.8 ng/mL 95% CI: 246.7–632.9 ng/mL; P < 0.001). The brachial artery flow-mediated vasodilation (FMD) response increased by 1.49 pp (95% CI: 0.03–2.95 pp; P = 0.046) following the soy intervention, but no effect was found on the carotid artery reactivity (CAR) response. Arterial stiffness, assessed by carotid-to-femoral pulse wave velocity (PWVc-f), was unchanged. Retinal arteriolar calibers (CRAE), a measure for microvascular structure, tended to improve by 1.42 mm (95% CI: −0.05–2.90 mm; P = 0.059). Soy consumption also lowered serum LDL-cholesterol concentrations by 0.17 mmol/L (95% CI: 0.02–0.32 mmol/L; P = 0.027). HDL-cholesterol and triacylglycerol (TAG) did not change. Finally, office SBP and DBP decreased by 4 mmHg (95% CI: 0–8 mmHg; P = 0.034) and 2 mmHg (95% CI: 1–4 mmHg; P = 0.005), respectively. Conclusions A longer-term daily intake of soy nuts improved endothelial function, office blood pressure, and serum LDL-cholesterol concentrations, suggesting mechanisms by which an increased soy food intake beneficially affects CVD risk in older adults. Funding Sources This study was supported by a grant from the Alpro Foundation.

Effects of Beetroot Powder with or without L-Arginine on Postprandial Vascular Endothelial Function: Results of a Randomized Controlled Trial with Abdominally Obese Men.

Background: Through effects on nitric oxide bioavailability, vascular endothelial function is improved after the intake of a high amount of nitrate or L-arginine, but decreased after the intake of a high-fat meal. Therefore, we compared the effects of beetroot powder with or without L-arginine on postprandial brachial artery flow-mediated vasodilation (FMD) after consumption of a high-fat mixed-meal. Methods: Eighteen abdominally obese men completed this randomized, double-blinded, cross-over trial. The study consisted of five test days, each separated by a wash-out period of at least one week. Participants received in random order, a blended meal with a control or nutritional supplement consisting of beetroot powder providing 200 mg nitrate, beetroot with 0.8 g of L-arginine, beetroot with 1.5 g of L-arginine, or 3.0 g of L-arginine. Participants then fasted and 2 h postprandial FMD measurements were performed. Results: No significant differences between meals were observed for postprandial FMD (p = 0.45) levels. However, there was a non-significant trend towards a more beneficial postprandial FMD response with the beetroot-containing meals as compared with meals without beetroot. Conclusion: This trial could not provide evidence for beneficial additive effects of a single dose of beetroot powder combined with L-arginine on postprandial endothelial function in abdominally obese men.

Dietary macronutrients do not differently affect postprandial vascular endothelial function in apparently healthy overweight and slightly obese men

PurposeWell-designed trials comparing side-by-side effects of macronutrients on postprandial endothelial function are missing. Therefore, we investigated under well-controlled and isocaloric condition effects of fat, carbohydrates, and protein on postprandial endothelial function as assessed by brachial artery flow-mediated vasodilation (FMD), an important non-invasive technique to assess endothelial function.MethodsEighteen apparently healthy overweight and slightly obese men (BMI 26.0–35.0 kg/m2) completed this randomized, double-blinded, cross-over trial. The study consisted of three test days each separated by a wash-out period of at least 1 week. After an overnight fast, men received an isocaloric meal providing 3987 kJ (953 kcal) that was either high in dietary fat (En% fat [F]/carbohydrates [C]/protein [P]: 52.3, 39.2, 8.0), carbohydrates (En% F/C/P: 9.6, 81.5, 8.6), or protein (En% F/C/P: 10.6, 51.5, 36.9). Fasting and 2-h postprandial FMD responses were measured.ResultsA postprandial decrease of 1.2% point in FMD was observed after the high-protein meal (P = 0.015). However, postprandial changes did not differ between meals (P = 0.45). An increase in baseline brachial artery diameters was observed after the high-protein meal (P < 0.001) and changes differed between meals (P = 0.020). A meal*time interaction was found for plasma glucose concentrations, with the most pronounced increases after the high-carbohydrate meal at T15, T30, T60, and T90 (P < 0.05). A significant time and meal (P < 0.001), but no time*meal effect (P = 0.06) was found for serum insulin concentrations. Increases in serum triacylglycerol concentrations did not differ between meals (P = 0.014).ConclusionMacronutrients did not differently affect postprandial endothelial function in apparently healthy overweight and slightly obese men.Trial registrationTrial registration number (ClinicalTrials.gov) NCT03139890 in May 2017

Plant-Based Diet Reverses Vascular Endothelial Dysfunction in Patients with Peripheral Arterial Disease

OBJECtIVE: Peripheral arterial disease (PAD) is characterized by impaired arterial circulation to the extremities caused in part by atherosclerosis. This study examined the effect of a plant-based diet (PBD) on vascular function in PAD patients.METHODs: Patients with PaD were randomized to plant-based dietary intervention (PBD group, n = 24) or no specific dietary advice (control group, n = 28). Biochemical parameters, including lipid profile and inflammatory biomarkers, and nitric oxide were measured at baseline and 4 months after dietary intervention. Vascular function including brachial artery flow-mediated vasodilation (FMD), carotid intima-media thickness(IMT), carotid-femoral pulse wave velocity (PWV), and brachial-ankle PWV were measured at baseline and 4 months after dietary intervention.RESULTS: Biochemical parameters were similar at baseline between the 2 groups. There was no change in any of the biochemical parameters in the control group at 4 months. However, patients in the PBD group had a significant improvement in lipid profile, including total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein a1 (APO-A1) levels. Greater nitric oxide and reduced high-sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL-6) levels were found in the PBD group at 4 months, whereas there were no changes in the control group. at baseline, FMD was similar between the 2 groups. after 4 months, PBD participants showed significant endothelial function improvement in FMD response and arterial stiffness response, with increased carotid-femoral and brachial-ankle PWV compared to the control group.&#x0D; CONCLUSIONS: A plant-based diet improves vascular endothelial function in PaD patients following 4 months of dietary intervention. This dietary intervention can result in decreased serum cholesterol and inflammatory biomarkers, which may further enhance vascular endothelial function.&#x0D; KEYWORDS: Plant-based diet; Vascular endothelial function; Flow-mediated dilation; Brachial artery reactivity test

Decline of popliteal artery flow-mediated dilation with aging and possible involvement of asymmetric dimethylarginine in healthy men

PurposeWe examined the influences of age and gender on flow-mediated endothelial function and the involvement of the competitive inhibition of l-arginine in endothelial function.MethodsWe measured brachial and popliteal flow-mediated vasodilation (FMD) responses, nitrate/nitrite (NOx) concentrations, and plasma levels of asymmetric dimethylarginine (ADMA) in four healthy, nonsmoking groups: young men (mean 26 ± 2 years, n = 17), middle-aged men (mean 50 ± 3 years, n = 19), young women (mean 27 ± 2 years, n = 16), and middle-aged women (mean 51 ± 2 years, n = 18).ResultsIn young men, we found no significant differences between brachial and popliteal artery FMDs (10.6 ± 1.5 vs 8.7 ± 1.6%, p = 0.06). However, the popliteal artery FMD was significantly lower than the brachial artery FMD in middle-aged men (11.4 ± 1.5 vs 6.4 ± 1.0%, p < 0.001). In women, we found no significant differences between brachial and popliteal artery FMDs in young and middle-aged individuals (young, p = 0.17; middle-aged, p = 0.08). Popliteal artery FMD correlated with plasma NOx and ADMA levels as well as with the NOx/ADMA ratio in men but not in women (r = 0.485, − 0.544, and 0.672, respectively).ConclusionWe concluded that a decrease in flow-mediated endothelial function in arteries of the lower extremities was evident in healthy middle-aged men, but not in middle-aged women. The competitive inhibition of l-arginine may contribute to this decrease in men.

Effects of Resistance Training on Vascular and Hemodynamic Responses in Patients With Coronary Artery Disease

ABSTRACTPurpose: The purpose of this study was to determine the impact of adjunctive resistance training (RT) in aerobically trained patients with coronary artery disease on systolic blood pressure (SBP), heart rate (HR), rating of perceived exertion (RPE; using the traditional 6-to-20 scale), and rate-pressure product (RPP) responses to lifting fixed submaximal workloads. Additionally, pretest and posttest RT measures of brachial artery reactivity were obtained. Method: Fifteen patients with coronary artery disease (Mage = 66.1 ± 5.1 years) who were already performing regular aerobic exercise completed an adjunctive 12-week progressive RT program. Prior to and immediately after the training period, hemodynamic responses and RPE were obtained while participants performed one set of exercises including the bicep curl (BC), shoulder press (SP), and leg press (LP) at individually determined fixed submaximal loads, using ~ 60% to 80% of estimated maximal voluntary contraction. Vascular function was assessed by flow-mediated vasodilation (FMD) testing before and after training. Results: Attenuated hemodynamic and RPE responses for all variables were observed. Meaningful changes were attained for RPP ([HR × SBP] / 100) during BC (106 ± 27 mmHg × beats/min × 10−2 to 91 ± 22 mmHg × beats/min × 10−2, d = 0.6, p < .05) and SP (102 ± 24 mmHg × beats/min × 10−2 to 86 ± 17 mmHg × beats/min × 10−2, d = 0.8, p < .05). Rating of perceived exertion decreased significantly during all exercises (d ranging from 1.8 to 3.1, p < .05): BC (14.3 ± 2.6 to 9.7 ± 1.6), SP (13.9 ± 1.6 to 9.2 ± 1.5), and LP (14.3 ± 1.4 to 10.3 ± 1.6). Peak group FMD responses were 12.8% and 10.3% dilation at pretraining and posttraining, respectively (p > .05). Five of the 15 participants showed modest improvements in their posttraining time to achieve maximum dilation from a mean of 117 s to 81 s, although this change was not statistically significant (p > .05). Conclusion: Among aerobically trained cardiac patients, a supplemental RT program resulted in decreased hemodynamic and RPE responses to lifting fixed submaximal workloads.

Effects of Resistance Training on Vascular and Hemodynamic Responses to Standardized Workloads in Coronary Patients

PURPOSE: To determine the impact of superimposed resistance training (RT) in aerobically trained coronary patients on systolic blood pressure (SBP), heart rate (HR), rating of perceived exertion (RPE; 6-20 scale), and rate pressure product (RPP) at fixed submaximal workloads following a 12-week RT intervention. Additionally, pre and post RT measures of brachial artery reactivity, an index of endothelial function, were obtained. METHODS: Fifteen low risk coronary patients (13 men, 2 women; mean ± SD age = 66.1 ± 5.1yrs) completed a progressive 12-week RT program that complemented their regular aerobic training regimen. Prior to training, SBP, HR, RPP, and RPE were obtained while subjects performed 1 set (10 repetitions) of 3 different exercises (bicep curl [BC], shoulder press [SP], leg press [LP]) at an intensity ~ 60-80% of 1-repetition maximum. After the training period, testing was repeated while subjects lifted the identical pre-training loads for each exercise following a standardized protocol. Vascular function was assessed by flow-mediated vasodilation (FMD) testing prior to and immediately following the 12-week RT training intervention. RESULTS: Lifting the same pre-training loads evoked attenuated responses for all variables (HR, SBP, RPE, RPP). A statistically significant decrease was shown for RPP ([HR x SBP]/100) during BC (106 ± 27 to 91 ± 22, P < 0.007) and SP (102 ± 24 to 86 ± 17, P < 0.007), whereas the RPP decrease during LP (116±22 to 109 ± 26) did not achieve statistical significance (P = 0.18). RPE for all 3 exercises decreased significantly (P < 0.0001) following the RT intervention: BC (14.3 ± 2.3 to 9.7 ± 1.6), SP (13.9 ± 1.6 to 9.2 ± 1.5), LP (14.3 ± 1.4 to 10.3 ± 1.6). Pre versus post RT measurements for resting HR and resting SBP were unchanged. Peak FMD responses for the 15 subjects were 12.8% and 10.3% dilation pre- and post-training, respectively (P = 0.332). However, 5 of the 15 subjects showed modest improvements in their post-training time to achieve maximum dilation from a mean of 117 seconds to 81 seconds (P = 0.156). CONCLUSION: Among aerobically trained coronary patients, a superimposed resistance training program resulted in decreased hemodynamic and RPE responses to lifting fixed submaximal workloads and improved FMD responses in 5 of the 15 participants.

Integrated flow-mediated vasodilation response predicts cardiovascular events in elderly patients with cardiovascular risk factors: the Japan Morning Surge–Home Blood Pressure study

The integrated flow-mediated vasodilation (FMD) response has been associated with cardiovascular (CV) risk factors, but the association between the integrated FMD response and subsequent CV events has been unclear. We enrolled 555 patients who had at least one CV risk factor (hypertension, dyslipidemia, diabetes, or smoking). We measured the peak percentage change in diameter (ΔFMD), and integrated FMD response calculated as the area under the dilation curve over a 120-second dilation period (FMD-AUC120). Elderly patients (age ≥ 65 years, N = 270) in the lowest tertile of FMD-AUC120 (FMD-AUC120 < 5.6) had a higher rate of CV events compared with those in the two higher tertiles (FMD-AUC120 ≥ 5.6) (log rank 4.15, P = .041). The association remained significant after adjusting for covariates (hazard ratio 3.84, P = .007). In the 285 middle-aged patients (age < 65 years), the CV event rates were similar between patients in the lowest tertile and those in the two higher tertiles of FMD-AUC120 (log rank 0.39, P = .53). The CV event rates were similar between patients in the lowest tertile and those in the two higher tertiles of ΔFMD in elderly and middle-aged patient groups. In conclusion, integrated flow-mediated vasodilation response, but not ΔFMD, predicted CV events in elderly patients with CV risk factors.

Abstract P054: Endogenous Sex Hormone Levels and Endothelial Function Among Men and Post-Menopausal Women in the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Sex is a major determinant of cardiovascular disease (CVD). Endogenous sex hormones exert a variety of effects on the vascular endothelium, and changes in sex hormone levels after menopause may play a role in CVD risk in women. We hypothesized that a more androgenic sex hormone profile among post-menopausal women, but not among men, would be associated with reduced blood flow-mediated vasodilation (FMD) of the brachial artery, a marker of worse endothelial function. Methods: We examined 1396 post-menopausal women and 1707 men participating in MESA, who were free of clinical CVD at baseline. Sex hormone levels [total testosterone (T), sex hormone binding globulin (SHBG), estradiol (E2)] were measured at Exam 1 (2000-02); free T and T/E2 ratio were calculated. FMD was measured by high-resolution ultrasound. Using multivariable adjusted Poisson and linear regression methods, we tested the cross-sectional associations of sex hormones (log transformed) with FMD. Results: The mean age of men and women was 61 and 64 years, respectively. Of women, 34% were using hormone therapy (HT). Among women, after adjusting for demographics, CVD risk factors, and HT use, higher SHBG was associated with higher FMD, whereas higher free T was associated with lower FMD (Table, Model 2). In women, when examining the “best FMD response” (top decile vs. bottom 9 deciles), higher E2 was positively associated with a prevalent best response, whereas higher free T was inversely associated. Among men, a higher T/E2 ratio was marginally associated with lower FMD. Conclusion: The association between sex hormones and FMD differs in men and women. Higher E2 and SHBG and lower free T levels were associated with better FMD in post-menopausal women but not in men. Higher T/E2 ratio was associated with lower FMD in men. Further studies are needed to assess longitudinal changes in sex hormone levels and their association with vascular aging. Sex hormone levels may help identify individuals at increased CVD risk who may benefit from other risk reduction strategies.

Postoperative Vasoplegic Syndrome Is Associated With Impaired Endothelial Vasomotor Response in Cardiac Surgery: A Prospective, Observational Study

Vasoplegic syndrome (VS) affects up to 30% of cardiac surgery patients. Onset of VS may be associated with overproduction of nitric oxide (NO). The response of the brachial artery to NO can be assessed using flow-mediated vasodilation (FMD). The aim of this study was to assess brachial artery diameter and FMD response immediately after cardiac surgery. Prospective, observational study. Single-center study in a tertiary teaching hospital. Patients older than 18 years undergoing elective cardiac surgery with cardiopulmonary bypass who provided informed consent. Brachial artery diameter and FMD response were measured before cardiac surgery and just after surgery on admission to the intensive care unit. Patients were screened for VS for the following 48 hours. Eleven (39%) of the 28 patients included in the study developed VS. Brachial artery diameter and FMD differed between VS and non-VS patients. On intensive care unit admission, mean (± standard deviation) brachial artery diameter was greater in VS patients than in non-VS patients (3.9 ± 0.7 mm v 3.0 ± 0.8 mm, respectively; p = 0.002). Similarly, the FMD response after surgery was greater in VS patients than in non-VS patients (42% ± 8% v 31% ± 1%, respectively; p = 0.014). Brachial artery diameter and FMD response after surgery were both predictive of VS, with an area under the curve (95% confidence interval) of 0.850 (0.705-0.995) (p = 0.002) and 0.755 (0.56-0.95) (p = 0.047), respectively. Cardiac surgery with cardiopulmonary bypass appears to alter the NO-mediated endothelial vasomotor response.

Comparison Of The Brachial And Popliteal Artery Vascular Responses To The Consumption Of A High Fat Meal

Results from earlier studies indicate that the consumption of a high fat meal (HFM) significantly reduces the vascular reactivity (i.e. decreased vasodilatory response) in the brachial artery. Given the prevalence of vascular disease in the lower extremities, it is interesting that there is little data to date comparing the effect of consuming a HFM on the vascular responses of the upper and lower limbs. PURPOSE: To compare the vascular response of the brachial (BA) and popliteal (PA) arteries following the consumption of a HFM. It is hypothesized that endothelial dysfunction induced by the consumption of a HFM will be greater in the PA than in the BA, consistent with the findings that the lower extremities are more susceptible to endothelial dysfunction and vascular disease compared to the upper extremities. METHODS: Eight healthy (23.8 ± 1.8 yrs (±SD)) men (n=3) and women (n=5) reported to the facility following a 12 h fast. Each subject rested in either the supine (BA) or prone position (PA) to obtain baseline measurements of the artery of interest. Endothelial-dependent vascular function was assesses using the flow-mediated vasodilation (FMD) technique. Each subject consumed a high fat meal consisting of 90g total fat (63 g saturated fat), 364 mg cholesterol, 17 g carbohydrate and 139 mg sodium. BA and PA FMD responses were obtained 60 min following ingestion of the HFM. Longitudinal images of the BA and PA were obtained in B-mode using a linear array probe with an operating frequency of 7.0 MHz. Images were captured (10 fps) and analyzed using a commercially available system that incorporates an automated wall detection program. FMD (%) was calculated as the difference between baseline diameter and the maximal diameter measured following release of the occlusion cuff (250 mmHg) placed around the forearm for 5 min. RESULTS: Compared to baseline, consumption of a HFM resulted in a decrease (p<0.05) in vascular reactivity for both the BA (pre, 10.6 ± 3.7 vs. post, 6.2 ± 2.2 %FMD) and the PA (pre, 4.8 ± 2.1 vs. post, 2.1 ± 1.2 %FMD). When expressed as relative to the change in FMD within a limb, the decrease in the PA (55.3%) was greater (p<0.05) than for the BA (42.4%). CONCLUSIONS: While the differences in the FMD response to a HFM between the BA and PA artery are apparent, the mechanism behind this difference warrants further investigation

Cumulative Hypoxemia During Sleep Predicts Vascular Endothelial Dysfunction in Patients With Sleep-Disordered Breathing.

Sleep-disordered breathing (SDB) is associated with repeated intermittent hypoxemia, and it is known as one of the risk factors for cardiovascular diseases. Previous studies assessing the effects of frequency and depth of hypoxemia on cardiovascular diseases have shown conflicting results. The aim of the current study was to clarify what SDB-related parameters most predict endothelial dysfunction to better understand the pathogenesis of endothelial dysfunction in patients with SDB. We conducted polysomnography (PSG) and measured flow-mediated vasodilation response (%FMD) in 50 outpatients suspected of SDB. Evaluated indices included: apnea-hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), averaged arterial oxygen saturation (averaged SpO2), lowest arterial oxygen saturation (lowest SpO2), ratio of arterial oxygen saturation <90% (<SpO2 90%), and averaged time desaturation summation index (TDS: [100%-averaged SpO2] × total sleep time). Significant differences were observed only in the TDS between the first and third (P = 0.03) and between the first and forth (P = 0.04) quartile groups, stratified by %FMD. The %FMD showed a significant relationship with TDS (β = -0.47, P = 0.001), even after adjusting for confounding factors (β = -0.33, P = 0.02). In contrast, AHI, 3%ODI, averaged SpO2, lowest SpO2, and <SpO2 90% showed no significant relationships. This study shows the validity of TDS in predicting endothelial damage in patients with SDB. Cumulative hypoxemia, rather than the frequency of hypoxemic events presented as AHI, may be a greater contributing factor in causing endothelial dysfunction. A simple index like TDS may be a useful and novel indicator of the influence of SDB on the vasculature.

Abstract 12127: Integrated Flow-Mediated Vasodilation Response Predicts Cardiovascular Events in Elderly Patients at Cardiovascular Risk Factor

Introduction: The integrated flow-mediated vasodilation (FMD) response was shown to be associated with cardiovascular risk factors, but the association between the integrated FMD response and consequent cardiovascular events has been unclear. Hypothesis: We assessed the hypothesis that the integrated FMD response predicts consequent cardiovascular events. Methods: We enrolled 575 patients who had at least one cardiovascular risk factor (hypertension, dyslipidemia, diabetes, or smoking). We measured the FMD magnitude of the percentage change in peak diameter (ΔFMD), and we measured the integrated FMD response calculated as the area under the dilation curve during a 120-sec dilation period (FMD-AUC 120 ) using a semiautomatic edge-detection algorithm. The primary outcome was defined as any cardiovascular event (a composite of cardiovascular death, and hospitalization for myocardial infarction, stroke, or heart failure). Results: The mean duration of follow-up was 35±22 months (range: 1-74 months). During the follow-up period, 34 cardiovascular events were recorded. Among the elderly patients (age[[Unable to Display Character: &amp;#8201;]]≥[[Unable to Display Character: &amp;#8201;]]65 yrs, n[[Unable to Display Character: &amp;#8201;]]=[[Unable to Display Character: &amp;#8201;]]281), the patients with the lowest tertile of FMD-AUC 120 (FMD-AUC 120 &lt;[[Unable to Display Character: &amp;#8201;]]5.6) suffered a higher incidence of cardiovascular events compared with the patients with the higher two tertiles (FMD-AUC 120 ≥[[Unable to Display Character: &amp;#8201;]]5.6) (log rank 4.16, p=0.041). The association remained significant after adjusting for age, gender and office systolic blood pressure (hazard ratio 1.25, p=0.039). In the younger patients (age[[Unable to Display Character: &amp;#8201;]]&lt;[[Unable to Display Character: &amp;#8201;]]65 yrs, n[[Unable to Display Character: &amp;#8201;]]=[[Unable to Display Character: &amp;#8201;]]294), cardiovascular events were similar among the patients with the lowest tertile and those with the higher two tertiles of FMD-AUC 120 . Cardiovascular events were also similar in the patients with the lowest tertile and the higher two tertiles of ΔFMD in both the elderly and younger patients. Conclusions: The integrated FMD response, but not ΔFMD, predicted cardiovascular events in elderly patients with a cardiovascular risk factor.

Genistein and endothelial function in postmenopausal women with metabolic syndrome

Previous data have suggested that genistein could exert beneficial effects on endothelial function and on predictors of cardiovascular risk in healthy postmenopausal women. In a randomized clinical trial, we studied the effects of genistein on endothelial function in postmenopausal women with metabolic syndrome (MS). Twenty postmenopausal women with MS, according to modified NCEP-ATP III criteria were randomly assigned to receive placebo or genistein (54 mg/day) for 6 months, along with a Mediterranean-style diet. Postmenopausal women without MS (n = 15), served as controls. The primary goal was the assessment of endothelial function by flow-mediated vasodilation (FMD) of brachial artery; moreover, time-to-peak dilation in the FMD response has been evaluated. Secondary outcomes were fasting glucose, fasting insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, visfatin, adiponectin and homocysteine blood levels. Data on adverse events were also recorded. After 6 months of treatment, FMD at 50s and peak FMD significantly increased in genistein recipients compared with placebo. Moreover, genistein significantly decreased the blood levels of total cholesterol, triglycerides, homocysteine and visfatin compared with placebo, while blood adiponectin levels were increased. Genistein recipients neither experienced more side-adverse effects than placebo nor discontinued the study. Six months of treatment with genistein effectively improves brachial artery flow-mediated vasodilation in postmenopausal women with metabolic syndrome.

Masked Hypertension Defined by Home Blood Pressure Monitoring Is Associated With Impaired Flow‐Mediated Vasodilatation in Patients With Cardiovascular Risk Factors

The relationships between home blood pressure (BP), masked hypertension defined by home BP, and integrated flow-mediated vasodilation (FMD) response remain unclear. The authors enrolled 257 patients (mean age, 63.5 years; 51% men) who had at least one cardiovascular risk factor. FMD of the brachial artery was measured with a semiautomatic edge-detection algorithm. The integrated FMD response was calculated as the area under the dilation curve during 120 seconds after deflation (FMD-AUC120) and the FMD magnitude as the percentage change in peak diameter (ΔFMD). Masked hypertension was defined by office BP <140/90 mm Hg and home BP ≥135 mm Hg and/or 85 mm Hg. Home systolic BP was inversely correlated with FMD-AUC120 and ΔFMD (FMD-AUC120: r=-.23, P<.001; ΔFMD: r=-.13, P=.041), and office systolic BP was inversely associated with FMD-AUC120 (r=-.16, P=.011), but not with ΔFMD. After adjusting for covariates, home systolic BP (β=-.27, P=.003), but not office BP, was inversely associated with FMD-AUC120, whereas ΔFMD was not associated with office or home systolic BP. FMD-AUC120 was significantly lower in patients with masked hypertension compared with those with normotension (7.7±6.7 vs 11.5±8.8 mm × s, P=.048). Home systolic BP and masked hypertension defined by home BP were associated with a decrease in FMD-AUC120.

Chronic Intake of Onion Extract Containing Quercetin Improved Postprandial Endothelial Dysfunction in Healthy Men

Background: Epidemiologic studies have shown that dietary flavonoids reduce the risk of cardiovascular events. Onion is rich in quercetin, a strong antioxidant flavonoid. In some in vitro studies, quercetin improved endothelial function associated with atherosclerosis, a leading cause of cardiovascular events. Objective: The aim of this study was to determine whether chronic onion extract intake would improve postprandial endothelial dysfunction induced by an oral maltose load in healthy men. Methods: Healthy men (44 ± 10 years, n = 23) received 4.3 g of onion extract (containing 51 mg of quercetin) once a day for 30 days. Before and after the chronic onion extract intake, fasting and postprandial flow-mediated vasodilation (FMD) responses were measured. Results: Maltose loading significantly decreased FMD both before and after chronic onion extract intake (p = 0.000037 and p = 0.0035, respectively). The chronic onion extract intake did not significantly affect fasting FMD (p = 0.069) but improved the postprandial FMD significantly from 5.1% ± 2.2% to 6.7% ± 2.6% (p = 0.00015). The chronic onion extract intake did not alter systemic and forearm hemodynamics. Conclusion: These findings suggest that chronic onion extract intake ameliorates postprandial endothelial dysfunction in healthy men and may be beneficial for improving cardiovascular health.

Effect of Transradial Coronary Angiography Procedure on Vascular Diameter and Vasodilator Functions in the Access Site

The present study aimed to investigate the long-term effects of transradial procedures on the radial artery diameter and vasodilator properties. The study included a total of 35 patients (28 males and 7 females) who underwent left transradial coronary angiography with an appropriate indication. The radial artery diameters were measured before and after flow-mediated vasodilation (FMD) and nitrate-mediated vasodilation (NMD). The nonintervened right radial artery served as the control. A marked narrowing in the diameter of the intervened radial artery and impaired FMD response indicating endothelial dysfunction were observed at a mean of 9 months after transradial intervention. Structural and functional changes should be taken into consideration if previously intervened radial artery would be used for interventions, such as arterial bypass graft or dialysis fistula.

Grape Polyphenols Reduce Blood Pressure and Increase Flow-Mediated Vasodilation in Men with Metabolic Syndrome

AbstractWe evaluated the effects of grape polyphenols in individuals classified with metabolic syndrome (MetS). Men (n = 24)aged 30–70 y were randomly assigned to consume either a freeze-dried grape polyphenol powder (GRAPE) or a placebo for 30 d in a double-blind, crossover design, separated by a 3-wk washout period. Participants were asked to maintain their usual diet and physical activity during the study and abstain from consuming polyphenol-rich foods. MetS criteria including blood pressure (BP) and markers of vascular endothelial function including brachial artery flow-mediated vasodilation (FMD), plasma total nitrite + nitrate (NOx) to estimate NO production, plasma soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1) were measured at the end of each dietary period.Systolic BP (P < 0.0025) and plasma sICAM-1 concentrations (P < 0.025) were lower, whereas the FMD response was higher (P < 0.0001), during the GRAPE compared with the placebo period. In addition, changes in sVCAM-1 concentrations between periods were positively correlated with changes in systolic BP (r = 0.45; P < 0.05). Although NOx concentrations did not differ between periods, changes in systolic BP were negatively correlated with changes in NOx concentrations (r =–0.44; P < 0.05), indicating the vasodilating properties of NO. Other MetS variables did not differ between the GRAPE and placebo periods. These results suggest that GRAPE polyphenols may potentiate vasorelaxation and reduce BP and circulating cell adhesion molecules, resulting in improvements in vascular function.

The Increase in Flow‐Mediated Vasodilation Induced by Grape Polyphenols is Positively Correlated with Increased Expression of Inducible Nitric Oxide (iNOS)

Twenty four men (30–70 y) with metabolic syndrome (MetS) participated in a double blind study and were randomly allocated to either a freeze‐dried grape polyphenol powder (GRAPE) or a placebo for 30 d. After a 3‐wk washout, they followed the alternate treatment. Participants abstained from consuming polyphenol‐rich foods. Flow‐mediated vasodilation (FMD), Inflammatory markers tumor necrosis factor (TNF)‐a, interleukin 6 (IL‐6), IL‐8, and the anti‐inflammatory IL‐10 were measured in plasma as well as 8‐ isoprostanes in urine. Additionally, mRNA expression of IL‐6, IL‐ 1b, IL‐10, the antioxidant enzymes (SOD1&amp;2, GPx1&amp;4), the endothelial (eNOS) and inducible (iNOS) isoforms of nitric oxide synthase, and NADPH oxidase (NOX2) were measured in peripheral blood mononuclear cells isolated at both periods. FDM was increased during the GRAPE period (p&lt;0.0001) while inflammatory or antioxidant markers were not different (p&gt;0.05) between periods. However, iNOS expression changes were correlated with changes in absolute (mm) FMD response (r=0.514, p&lt; 0.025) and with changes in SOD2 expression (r=0.642, p&lt;0.01). These results suggest that the beneficial effects of GRAPE on FMD are positively associated with NO production in men with MetS. However, 4 wk of GRAPE supplementation were not enough to detect changes in anti‐inflammatory or anti‐oxidant gene expression [Supported by The California Table Commission]