Higher Arterial Stiffness Research Articles

The relationship of macular vessel density and foveal avascular zone with pulse wave velocity and central blood pressure in healthy adults: Persian cohort study

BackgroundTo evaluate the correlation of macular vessel density (VD) and foveal avascular zone (FAZ) parameters measured on optical coherence tomography angiography (OCTA) with systemic arterial stiffness using pulse wave velocity (PWV), pulse wave analysis, arterial age, and central blood pressure (CBP) measurements in healthy subjects.MethodsIn a comparative, cross-sectional, observational study, healthy adults who participated in the PERSIAN Cohort study at Mashhad University of Medical Sciences were included in this study. The study involved using a spectral domain OCTA device to obtain 3 × 3 and 6 × 6 mm scans of the macular superficial capillary plexus (SCP) VD, deep capillary plexus (DCP) VD, and FAZ vascular analysis. Additionally, we used the SphygmoCor XCEL System (AtCor, Itasca, IL) to analyze systemic vascular parameters like CBP and PWV.ResultsThe study included 296 healthy participants with a mean age of 39.2 ± 6.7 years, and 152 subjects (51.3%) were female. Female participants were found to have higher DCP VD and FAZ area values. Age showed a negative correlation with SCP and DCP VDs. PWV showed a negative correlation with parafoveal DCP VDs, but no correlation was observed between macular VDs and aortic diastolic and systolic pressures.ConclusionIn conclusion, age was found to have a negative impact on macular SCP and DCP VDs. In addition, higher arterial stiffness was found to correlate with a lower parafoveal DCP VD value. These findings suggest macular OCTA parameters may be used as early markers of systemic arterial disease.

Abstract MP27: Pregnant Women of Advanced Maternal Age Have Higher Central Artery Stiffness Than Younger Pregnant Women

The frequency of women undergoing pregnancy at advanced maternal age (AMA, ≥35 years) is increasing in developed countries, including the United States. AMA is associated with an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia, and preterm birth. Increased risk for adverse pregnancy outcomes at AMA may be mediated in part by altered arterial structure and function or inadequate maternal arterial adaptations during pregnancy. Therefore, we examined central artery stiffness and endothelial function across healthy pregnancy (i.e. no comorbid maternal or fetal conditions, born at term) in women who had enrolled in a longitudinal study between March 2015 and January 2020. We hypothesized that women at AMA (age ≥35 years, mean±SE: 36±0 years, n=18) would have higher arterial stiffness and lower endothelial function compared with younger women (age 21-30 years, mean±SE: 27±0 years, n=51) across pregnancy. Hemodynamic and arterial function measures were collected in the first (6-13 weeks), second (18-26 weeks), and third (27-37 weeks) trimesters and postpartum (4-14 weeks after the delivery). Brachial artery blood pressure was assessed in the supine position and central artery stiffness was assessed via carotid-femoral (aortic) pulse wave velocity (cfPWV) and carotid β-stiffness index. Endothelial function was determined via brachial artery flow-mediated dilation (FMD). Brachial artery systolic, diastolic, and mean blood pressures were not different between AMA and younger women across pregnancy or postpartum (all P >0.05). The AMA group had higher cfPWV ( P <0.01) and carotid β-stiffness index ( P <0.01) across pregnancy and postpartum compared to the younger group. cfPWV decreased among younger women at the second and third trimesters compared with the first trimester ( P <0.01), while cfPWV among women of AMA did not change ( P =0.07). There were no differences in FMD between AMA and younger women across pregnancy or postpartum ( P =0.96). These results demonstrate that healthy women of AMA have increased central artery stiffness, but no difference in endothelial function, compared to younger pregnant women across pregnancy, and that the normal decrease in aortic stiffness is blunted in pregnant women of AMA compared to younger women. The sustained higher central artery stiffness throughout pregnancy among women of AMA may contribute to increased risk of pregnancy complications and future CVD risk in these women.

P122 EXPLORING CARDIOVASCULAR RISK ENHANCERS IN WOMEN: EYE-OPENING FINDINGS TO RETHINK ASSESSMENT

Background and Objectives. Traditional cardiovascular risk (CVR) stratification does not consider CVR enhancers (CVRE). Women present under-recognized CVR factors that may lead to developing subclinical vascular lesions such as arterial stiffness (AS). AS is associated with long-term cardiovascular events and can be determined by carotid-femoral pulse wave velocity (cf-PWV). Our objective was to determine cf-PWV in women with low 10-years CVR (10yCVR) with a CVRE and to compare them with a control group. Methods. Multicentric cross-sectional study, carried out in 2023 in Argentina. Group-1: women, 18-59 years-old, office-BP <140/90 mmHg, low (<5%) 10-yCVR using WHO's Calculator for Argentina, with a CVRE: history of gestational hypertension/preeclampsia; previous oncological treatment in current complete remission; autoimmune hematological or rheumatic disease in clinical remission; history of abortions/preterm births; early menopause/menarche; anxiety/depression disorder. Patients with cardiovascular event, chronic renal disease, diabetes, chronic hypertension, target organ lesion, 10-yCVR≥5%, and those on antihypertensive, statins, or aspirin treatment were excluded. Group-2: healthy women who attended routine control. Consecutive sampling. Office-BP were obtained with Omron-M3. cf-PWV was measured non-invasively through Aortic. AS was defined if cf-PWV exceeded 95% confidence interval (95%CI) upper limit for healthy Argentine population. Institutional Research Committee's approval and informed consent were obtained. Data was analyzed using SPSS for Windows. Results. Included 199 women: Group-1 (N=119); Group-2 (N=80). No differences were found between groups concerning age, weight, height, body mass index and heart rate. Group-1 showed higher cf-PWV: 6.89±1.08 vs. 5.56±0.65 (p<0.0001) and higher AS frequency: 57.1% vs. 2.5% (p<0.0001). In multivariate analysis only CVRE maintain related with AS (p<0.0001). A sub-analysis was performed excluding subjects with high-normal office-BP (27.6% of sample): 144 women remained, 77 (53.5%) in Group-1 and 67 (46.5%) in Group-2. Central (aortic) systolic-BP was <121 mmHg in all cases. Group-1 showed higher cf-PWV: 6.62±0.88 vs. 5.59±0.62 (p<0.0001) and AS: 51.9% vs. 1.4% (p<0.0001). Conclusions. Women with CVRE showed greater cf-PWV and higher proportion of AS.

Association between exposure to air pollution and arterial stiffness in participants with and without atherosclerotic cardiovascular disease.

To assess the association of air pollution exposure at different time scales with arterial stiffness in participants with and without atherosclerotic cardiovascular disease (ASCVD). We measured participants' arterial stiffness with brachial-ankle pulse wave velocity (baPWV) from October 2016 to January 2020. Concentrations of air pollutants including fine particles < 2.5μm aerodynamic diameter (PM2.5), inhalable particles < 10μm aerodynamic diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) measured by fixed ambient air monitoring stations were collected for short- (7-day) and long-term (365-day) exposure assessment. We used generalized estimating equations (GEEs) to analyze and further explored the modification effects between ASCVD and air pollutants. Seven hundred sixty-five participants were finally included and four hunderd sixty (60.1%) participants had a history of ASCVD. Based on the partial regression coefficients (β) and 95% confidence intervals (95% CI) calculated from GEEs using linear regression, each 10μg/m3 increase in long-term exposure to PM2.5 and PM10 was associated with 31.85cm/s (95% CI, 17.97 to 45.73) and 35.93cm/s (95% CI, 21.01to50.84) increase in baPWV. There was no association between short-term exposure to air pollution and arterial stiffness. Although no significant interaction effect was observed between air pollution and ASCVD, baPWV showed a greater increment in the subgroup without ASCVD. Long-term exposure to air pollution is closely associated with higher arterial stiffness in participants with and without ASCVD. Reducing air pollution exposure is essential in the primary and secondary prevention of ASCVD.

Greater Adherence to Life's Essential 8 for Cardiovascular Health Is Associated With Lower Arterial Stiffness in Survivors of Cancer.

Survivors of cancer have elevated risk of cardiovascular disease, likely stemming from the negative impact of anticancer therapies on vascular function. Arterial stiffness is a strong indicator of vascular function and independent predictor of cardiovascular disease. The American Heart Association recommends Life's Essential 8 for optimal cardiovascular health. It is currently unknown, however, whether greater adherence to Life's Essential 8 is associated with low arterial stiffness in survivors of cancer. This cross-sectional study included 172 older adult (≥65 years) survivors of cancer (74±6 years; 58% female). Life's Essential 8 100-point cardiovascular health score, with higher scores indicative of better cardiovascular health, was calculated based on 8 components: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. Participants were classified as having low (<60), moderate (60-79), or high (≥80) cardiovascular health. Pulse wave velocity (PWV) was used to assess arterial stiffness; with high arterial stiffness defined as a pulse wave velocity ≥10 m/s. The mean cardiovascular health score was 72±11 and 40 survivors (23%) had high arterial stiffness. Compared with low cardiovascular health, the odds ratio of high arterial stiffness was 0.12 (95% CI, 0.03-0.50) and 0.02 (95% CI, 0.003-0.18) for moderate and high cardiovascular health, respectively. Every 10-point increase in the cardiovascular health score was associated with a 0.43 m/s reduction in pulse wave velocity (P<0.001). Greater adherence to the American Heart Association's Life's Essential 8 was associated with lower prevalence of high arterial stiffness in older adult survivors of cancer. Prospective studies with larger samples are needed.

Arterial stiffness is associated with prehypertension in both non-hypertensives and treated hypertensives–A matched case control study

BackgroundPrehypertension (PHT) is a cardiovascular health risk defined by blood pressure (BP). Arterial stiffness (AS) provides beyond brachial BP inference on vascular ageing and pulse wave analysis (PWA) can measure it non-invasively.We compared association between AS and PHT using age and gender matched case-controls. MethodsThis is a sub analysis of previous PWA studies of hypertensives and non-hypertensives. Using oscillometric PWA by Mobil-o-Graph (IEM, Stolberg, Germany), parameters of AS (augmentation pressure and index, reflection magnitude, aortic pulse wave velocity, pulse pressure amplification), brachial hemodynamics (BH), and central hemodynamics (CH; aortic BP, cardiac output related parameters, stroke work) were derived. Age and gender matched case controls were compared as: 1) Nonhypertensives with BP at prehypertensive level (PHT) versus normotensives (NT) (n = 217 each), 2) Under treatment hypertensives with BP at prehypertensive level (PHT-T) versus untreated, nonhypertensives with BP at prehypertensive level (PHT-UT) (n = 74 each). ResultsPHTs had higher AS, BH and CH than NTs, with statistical significance for all but few parameters. PHT-T had comparable BH but higher AS, CH than PHT-UT with significance for few parameters. ConclusionPulse wave analysis derived arterial stiffness is associated with prehypertension compared to normal, after age and gender matching. In hypertensives, arterial stiffness is significantly higher despite being treated to prehypertension level as compared to control. It hints arterial stiffness to be better parameter than brachial BP to study prehypertension.

Hippocampal volume mediates the association of arterial stiffness with cognitive impairment in adult population.

To investigate the association of arterial stiffness with brain perfusion, brain tissue volume and cognitive impairment in the general adult population. This prospective study included 1488 adult participants (age range: 22.8-83.9 years) from the Kailuan study. All participants underwent brachial-ankle pulse wave velocity (PWV) measurement, brain MRI, and Montreal Cognitive Assessment (MoCA). The association of PWV with cerebral blood flow (CBF), brain tissue volume and MoCA score was investigated. Mediation analysis was used to determine whether CBF and brain tissue volume changes mediated the associations between PWV and MoCA score. A 1 standard deviation (SD) increase in PWV was associated with lower total brain CBF [ β (95% CI) -0.67 (-1.2 to -0.14)], total gray matter CBF [β (95% CI) -0.7 [-1.27 to -0.13)], frontal lobe CBF [ β (95% CI) -0.59 (-1.17 to -0.01)], parietal lobe CBF [ β (95% CI) -0.8 (-1.43 to -0.18)], and temporal lobe CBF [ β (95% CI) -0.68 (-1.24 to -0.12)]. Negative associations were found for PWV and total brain volume [ β (95% CI) -4.8 (-7.61 to -1.99)] and hippocampus volume [ β (95% CI) -0.08 (-0.13 to -0.04)]. A 1 SD increase PWV was significantly associated with elevated odds of developing cognitive impairment [odds ratio (95% CI) 1.21 (1.01-1.45)]. Mediation analysis showed that hippocampal volume partially mediated the negative association between PWV and MoCA scores (proportion: 14.173%). High arterial stiffness was associated with decreased total and regional CBF, brain tissue volume, and cognitive impairment. Hippocampal volume partially mediated the effects of arterial stiffness on cognitive impairment.

Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study.

Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47% hypertension), 1 SD increment in FWA was associated with 0.16 (95% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span.

Higher arterial stiffness and blunted vagal control of the heart in young women with compared to without a clinical diagnosis of PTSD.

Young women are typically thought to be protected from cardiovascular disease (CVD) before menopause. However, posttraumatic stress disorder (PTSD) increases CVD risk in women by up to threefold. Data in predominantly male cohorts point to physiological mechanisms such as vascular and autonomic derangements as contributing to increased CVD risk. The purpose of the study reported here was to determine whether young women diagnosed with PTSD, compared to those without, present with arterial stiffness and impaired autonomic control of the heart. A total of 73 healthy young women, ranging in age from 18 to 40years, with a history of trauma exposure were included in this study, 32 with and 41 without a clinical PTSD diagnosis. We measured resting pulse wave velocity (PWV), central hemodynamics, augmentation pressure and augmentation index (AI) via pulse wave analysis using applanation tonometry. Heart rate variability was also assessed via peripheral arterial tone. In comparison to controls, women with PTSD showed higher central arterial pressure (mean ± standard deviation: systolic blood pressure 104 ± 8 vs. 97 ± 8mmHg, p < 0.001; diastolic blood pressure 72 ± 7 vs. 67 ± 7mmHg, p = 0.003), PWV (6 ± 0.3 vs. 5 ± 0.6m/s, p < 0.001) and AI (22 ± 13 vs. 15 ± 12%, p = 0.007) but lower standard deviation of normal-to-normal intervals (SDNN; 44 ± 17 vs. 54 ± 18ms, p = 0.005) and root mean square of successive differences between normal heartbeats (RMSSD; 37 ± 17 vs. 51 ± 22ms, p = 0.002). PTSD in young women is associated with higher brachial and central pressures, increased arterial stiffness and blunted parasympathetic control of the heart. These findings illustrate potential mechanisms underlying high risk for CVD in young women with PTSD, suggesting possible treatment targets for this at-risk group.

Associations Between Arterial Stiffness and Metabolic Target in Children and Adolescents With Type 1 Diabetes Treated in a Modern Setting

Objective: To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in a modern European technology‐based cohort of children and adolescents with type 1 diabetes.Research Design and Methods: Cross‐sectional study, including 127 children recruited from Pediatric Diabetes Departments across Eastern Denmark between May 2022 and January 2024. Arterial stiffness was assessed as carotid–femoral pulse‐wave‐velocity (cfPWV) using the Sphygmocor XCEL system. Unadjusted and adjusted linear regression models explored associations between cfPWV and other risk factors. Adjustments included age, sex, diabetes duration, time‐in‐range, hemoglobin A1c (HbA1c), body mass index (BMI) z‐score, low‐density lipoprotein (LDL)‐cholesterol, and mean arterial pressure (MAP).Results: Median (interquartile range [IQR]) age was 14.2 years (12.0, 16.4), diabetes duration was 4.7 years (2.7, 8.4), HbA1c level was 7.0% (6.5, 7.9), (53 mmol/l: 48–63), time‐in‐range was 63% (53–75), and 52% were male. The majority were treated with continuous‐subcutaneous‐insulin‐infusion (82%), and all (except two) used continuous‐glucose‐monitors. The prevalence of elevated arterial stiffness (cfPWV z‐score over the 90th percentile) was 16%. Unadjusted analyses demonstrated higher cfPWV was associated with longer diabetes duration, higher age, HbA1c, MAP, and liver stiffness, and lower time‐in‐range and insulin sensitivity. Higher cfPWV remained associated with higher age (standardized β (confidence interval (CI) 95%): 0.38 (0.27, 0.48); p &lt; 0.001) and lower time‐in‐range (−0.15 ((−0.26), (−0.03)); p &lt; 0.011) after adjustment.Conclusions: Despite modern treatment technology and better overall metabolic control, children and adolescents with type 1 diabetes present with a high prevalence of elevated arterial stiffness. Higher arterial stiffness was associated with higher age and lower time‐in‐range, independent of other risk factors, including HbA1c.

Abstract 17170: Association of Plasma Homocysteine Levels in Cancer Survivors - Data From Framingham Heart Study Offspring Cohort

Introduction: Cancer survivors experience a high prevalence of vascular remodeling from their anti-cancer therapies, which can lead to arterial stiffness. High plasma homocysteine (Hcy) is associated with increased cardiovascular disease risk via its role in decreasing nitric oxide bioavailability and impairing vascular function. However, there is limited work on its role in cancer survivorship. We, therefore, hypothesized that survivors of breast, gastrointestinal, and prostate cancer with elevated plasma Hcy values have higher arterial stiffness and lower endothelial function compared to those with low plasma Hcy. Methods: We evaluated cardiovascular disease-free cancer survivors in the Framingham Heart Study Offspring Cohort (n=196, 66±8 years old, 55.1% women, 26.4±1.2 years from cancer diagnosis, Range: [23.8 - 29.6 years]) with plasma Hcy measurements. The cohort median plasma Hcy was used to define low (&lt;8.16 μmol/L) and high Hcy (≥8.16 μmol/L) groups. Arterial stiffness was assessed via carotid-femoral pulse wave velocity (cfPWV). Peripheral vascular endothelial function was assessed via endothelium-dependent brachial artery flow-mediated dilation (FMD). Differences in cfPWV, FMD, and cardiovascular risk factors were assessed via independent sample t-test or chi-square test. Differences in cfPWV and FMD were further assessed via one-way ANCOVA with age, sex, and cardiovascular medications included as covariates. Results: cfPWV was significantly higher in the high Hcy (9.9±1.5m/s) vs. low Hcy group (8.5±1.9m/s, p=0.005); however, there were no differences in FMD between groups (2.4±1.7 vs. 2.7±2.0%, p=0.42). After controlling for our covariates, cfPWV was still significantly higher in the high Hcy group (Mean[95% CI]): (9.8[9.0-10.61]) compared to the low Hcy group (8.5[8-9.1]) (p=0.015). Conclusions: Our findings suggest an association between elevated Hcy and an increase in arterial stiffness in cancer survivors. This supports the potential adverse consequences of vascular stiffening following cancer diagnosis and treatment which could have long-term cardiovascular health implications.

Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness

BackgroundPreeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. ObjectiveTo analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. MethodsSixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n=30) and PE group with severe features or severe PE (n=35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student’s t-test or the Mann–Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman’s correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. ResultsWomen with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5–34.3) vs. 19.0% (14–29) and 24.0 (14.0–30.0) vs. 20.0% (12.3–26.8), respectively). Carotid-femoral pulse wave velocity (cfPWV) was significantly higher at both 1 and 6 months postpartum in the severe PE group compared to the non-severe PE group (10.2 (8.8−10.7) vs. 8.8m/s (8.3−9.6) and 10.0 (8.8−10.6) vs. 8.8m/s (8.3−9.3), respectively). Central systolic pressure and central pulse pressure amplification were also higher, although not significantly, in the severe PE group in comparison with the non-severe PE group. ConclusionsWomen who have had severe PE have more pronounced arterial stiffness parameters than those in whom PE was not particularly severe. The determination of cAIx and cfPWV, as a strategy for the assessment of cardiovascular risk, should be evaluated among women who have had PE.

OR18-03 Peripheral But Not Hepatic Insulin Resistance Associates With Adverse Vascular And Metabolic Health In Type 1 Diabetes: A Possible Target For Adjunctive Therapy

Abstract Disclosure: J.R. Snaith: None. N. Olsen: None. G. Kowalski: None. C. Bruce: None. J. Holmes-Walker: None. J.R. Greenfield: None. Insulin resistance in type 1 diabetes (T1D) is a cardiometabolic risk factor that is potentially targetable with adjunctive therapy. Prior studies of metformin in T1D have yielded mixed results. Whether liver and/or muscle insulin resistance is a prerequisite for metformin’s action in adults with T1D is unknown. The INTIMET study recruited 40 adults with T1D (age 37.4±8.8 years, HbA1c 7.5±0.9%, diabetes duration 22.9±8.8 years, BMI 26.4±0.9 kg/m2) and 20 age- and BMI-matched controls without diabetes. Subjects with T1D were randomized to metformin extended-release 1500mg daily or placebo for 26 weeks. Two-step hyperinsulinemic euglycemic clamps (low-dose 20 mU/m2/min, high-dose 60 mU/m2/min insulin) using 6,6-2H2-glucose tracers assessed liver (basal glucose rate of appearance [B-Ra] and low-dose endogenous glucose production [L-EGP]; primary outcomes) and muscle (high-dose glucose infusion rate [GIR]; secondary outcome) insulin resistance at t=0 in all subjects and at t=26 weeks in T1D. Dual-energy x-ray absorptiometry was used to measure fat free mass and visceral adipose tissue (VAT). Applanation tonometry was used to measure arterial stiffness (AIx, augmentation index). Adults with T1D and controls had similar B-Ra (18.2±5.1 vs 18.3±2.2 mmol/kgFFM/min; p=0.87). However, T1D were insulin-resistant at the liver (L-EGP 5.9±2.2 vs 3.6±1.7 mmol/kgFFM/min; p&amp;lt;0.001) and at muscle (GIR 62±20 vs 88±18 µmol/min·kgFFM; p&amp;lt;0.001). Despite these differences, VAT was comparable. In all subjects, baseline GIR correlated with L-EGP (r=-0.343; p=0.008), VAT (r=-0.269; p=0.039) and BMI (r=-0.304; p=0.019). In contrast, baseline L-EGP did not relate to VAT (r=0.060; p=0.653) or BMI (r=0.173; p=0.189). Adults with T1D had borderline higher AIx than controls (11.2±11.4 vs 4.7±13.1%, p=0.05). In the whole group, GIR was associated with LogAIx (r=-0.258, p=0.048), but L-EGP was not (r=0.154; p=0.246). In T1D, HbA1c correlated with GIR (r=-0.329; p=0.041) but L-EGP did not (r=0.307; p=0.057). After 26 weeks, there was no difference between metformin vs placebo-treated T1D subjects in HbA1c and weight, or B-Ra, L-EGP or GIR using generalised linear regression adjusted for age and baseline B-Ra, L-EGP and GIR. In these models, baseline GIR inversely predicted L-EGP (p=0.027) and directly predicted GIR (p&amp;lt;0.001) at 26 weeks. Adults with T1D exhibited greater liver and muscle insulin resistance, and higher arterial stiffness, which was not improved with metformin. Muscle but not liver insulin resistance related to BMI, VAT, HbA1c and AIx. Baseline muscle insulin resistance predicted muscle and hepatic insulin resistance at 26 weeks, irrespective of metformin treatment. This study highlights 1) the importance of muscle but not liver insulin resistance in T1D and 2) the need to identify muscle insulin resistant T1D individuals to enable interventions that improve vascular and metabolic outcomes. Presentation: Saturday, June 17, 2023

A possible mechanism and predictors of forming looped guidewire between the right subclavian and brachiocephalic artery during coronary angiography with right radial artery access: An original paper.

Guidewire occasionally creates a loop-like appearance between the right subclavian artery and brachiocephalic artery when performing coronary angiography (CAG) with right radial artery (RtRA) access. We called this occurrence a looped guidewire at the brachiocephalic artery (looped GW at BA). It is associated with difficulties in catheter manipulation. This study aimed to assess the predictors of forming a looped GW at the BA. We examined 175 (mean age, 71.3 ± 9.5 years; 74.9% men) consecutive patients who underwent elective CAG with the RtRA access. Looped GW at the BA was defined as a loop-like appearance of the 0.035-inch GW between the right subclavian and brachiocephalic artery on a frontal view or left anterior oblique. To identify the predictors of looped GW at BA, patient characteristics and examination data obtained before CAG were compared between patients with and without looped GW at the BA. The prevalence of looped GW at BA was 10.9%. The cardio-ankle vascular index (CAVI), which reflects arterial stiffness, was significantly different in patients with or without looped GW at BA (9.8 ± 1.0 vs. 8.9 ± 1.5, p = 0.0092). The area under the receiver-operating characteristic curve of CAVI to predict looped GW at BA was 0.745, with 0.94 sensitivity and 0.57 specificity in a cutoff point of CAVI ≥9.0. Looped GW at BA can be ruled out by CAVI and is associated with high arterial stiffness.

Relationship of body mass index and visceral fat area combination with arterial stiffness and cardiovascular risk in cardiovascular disease-free people: NHANES (2011-2018).

Obesity and arterial stiffness are strongly associated with cardiovascular disease; however, their relationship remains controversial. Body mass index was measured using anthropometric evaluation, and visceral fat area was calculated using an absorptiometry scan. The data of 5309 participants were collected from NHANES (National Health and Nutrition Examination Survey) (2011-2018). Based on the normal-weight normal visceral fat group that was considered as a reference, ePWV increased in all other groups, with the obese grade 2 visceral obesity group increasing the most by 26.35 cm/s (95% CI: 13.52, 39.18, P < 0.001), followed by normal-weight visceral obesity group 24.43 cm/s (95% CI: 1.88, 46.98, P = 0.035), which was even higher than obese grade 1 visceral obesity (β: 21.16, 95% CI: 9.24, 33.07, P = 0.001), obese grade 2 normal visceral fat group (β: 13.8; 95% CI: 0.10, 27.5, P = 0.048) and overweight visceral obesity group (β: 10.23; 95% CI: 1.89, 18.57, P = 0.018). For the 10-year cardiovascular risk, the obese grade 2 visceral obesity group had a 9.56-fold increase in compared with the control (OR: 10.56, 95% CI: 4.06, 27.51, P < 0.0001). Normal-weight visceral obesity, obese grade 1 visceral obesity, and overweight visceral obesity groups increased by 8.03-fold (OR: 9.03, 95% CI: 2.66, 30.69; P < 0.001), 7.91-fold (OR: 8.91, 95% CI: 3.82, 20.79, P < 0.001), and 7.28-fold (OR: 8.28, 95% CI: 3.19, 21.46, P < 0.001). The risk was lower in the normal visceral fat group. Except for the obese grade 2 normal visceral fat group, there was no significant difference in other groups. Normal-weight visceral obesity was associated with higher arterial stiffness and 10-year cardiovascular risk.

Evaluation of arterial stiffness between peritoneal dialysis and hemodialysis in patients with renal replacement therapy

Objectives: The aortic stiffness index beta (ASI-β), calculated noninvasively with the pressure change caused by arterial strain and volume changes on echocardiography, shows a strong correlation with invasive measurements of arterial stiffness. This study aimed to compare arterial stiffness and distensibility between peritoneal dialysis (PD) and hemodialysis (HD) and patients in renal replacement therapy. Methods: This cross-sectional and observational study analyzed 108 patients under renal replacement therapy (PD and HD). The aortic stiffness index beta (ASI-β) was calculated for each group. Results: The mean age of the patients in the study was 58.2±11.1 years, and 49 (45.4%) of the patients were female and 59 (54.6%) were male. Age, gender, comorbid rates, and levels of blood pressure and heart rate did not differ between the PD and HD groups. Blood pressure levels and heart rate. Mean aortic strain (5.6±1.9 vs. 9.4±2.8, p &amp;lt; 0.001) and median distensibility (1.5 vs. 2.9 cm, p &amp;lt; 0.001) were lower in the PD group than the HD group, while median ASI-β (11.6 vs. 6.2, p &amp;lt; 0.001) and mean E/e’ (10.6±2.9 vs. 9.2±2.3, p = 0.006) were higher in the PD group. The rate of concentric hypertrophy was higher in the PD group (47.5% vs. 23.5%, p = 0.005). Conclusion: PD patients have higher arterial stiffness and lower distensibility levels compared to HD patients. Therefore, patients with PD may be more prone to diastolic dysfunction, cardiovascular disease, and events.

Abstract P201: First Trimester Anxiety Is Associated With Increased Arterial Stiffness In High-risk Pregnant Women

Preeclampsia is a leading pregnancy complication characterized by vascular dysfunction, leading to hypertension and organ damage. Evidence suggests positive associations between higher arterial stiffness and preeclampsia, as well as anxiety and preeclampsia. Anxiety, a transdiagnostic factor, is also associated with increased arterial stiffness in the general population, but no reports exist in pregnant women. Moreover, the association between anxiety and arterial stiffness in pregnancy and the risk of developing preeclampsia has not yet been explored. To address this gap, we aimed to evaluate the role of anxiety in arterial stiffness measurements and the development of preeclampsia in high-risk pregnant women. In this prospective study, women with high-risk singleton pregnancies before 14 weeks gestation were recruited at two tertiary care obstetric clinics in Montreal, Canada, and followed throughout pregnancy. Arterial stiffness parameters (carotid-femoral pulse wave velocity [cfPWV]) were measured at baseline (10-13 weeks gestation) and at four-week intervals throughout pregnancy. Self-reported anxiety symptoms were recorded using the Beck Anxiety Inventory, and participants’ scores were ranked as having minimal, mild, moderate, or severe anxiety. After excluding incomplete questionnaires, the total study sample comprised 156 women, of whom 10 (6.4%) developed preeclampsia. There was no difference in anxiety scores between groups based on baseline characteristics (i.e., age, BMI, and race). First trimester anxiety scores were associated with increased cfPWV in the early and late second trimester time points (p=0.02, p= 0.04, respectively). Higher baseline anxiety was also associated with a greater increase in cfPWV from baseline to 18 weeks gestation (p=0.04). A trend was also observed between baseline anxiety scores and the development of preeclampsia (p=0.07). Anxiety in the first trimester of pregnancy is associated with higher cfPWV values and a greater increase from the first to the second trimester, as well as potentially a higher risk for preeclampsia. Our ongoing study will further explore these findings as they can have important implications for patient prenatal care.

Association between psychosocial work-related factors at midlife and arterial stiffness at older age in a prospective cohort of 1736 white-collar workers

ObjectiveArterial stiffness and exposure to psychosocial work-related factors increase the risk of developing cardiovascular disease. However, little is known about the relationship between psychosocial work-related factors and arterial stiffness. We...

Does treatment modality affect measures of arterial stiffness in women with gestational diabetes?

To investigate whether arterial stiffness (AS) differs between healthy women and women with gestational diabetes mellitus (GDM) managed by different treatment modalities. This was a prospective longitudinal cohort study comparing AS in pregnancies complicated by GDM and low-risk controls. AS was assessed by recording aortic pulse-wave velocity (AoPWV), brachial augmentation index (BrAIx) and aortic augmentation index (AoAIx) using the Arteriograph® at four gestational-age windows: 24 + 0 to 27 + 6 weeks (W1); 28 + 0 to 31 + 6 weeks (W2); 32 + 0 to 35 + 6 weeks (W3) and ≥ 36 + 0 weeks (W4). Women with GDM were considered both as a single group and as subgroups stratified by treatment modality. Data were analyzed using a linear mixed model on each AS variable (log-transformed) with group, gestational-age window, maternal age, ethnicity, parity, body mass index, mean arterial pressure and heart rate as fixed effects and individual as a random effect. We compared the group means including relevant contrasts and adjusted the P-values using Bonferroni correction. The study population comprised 155 low-risk controls and 127 women with GDM, of whom 59 were treated with dietary intervention, 47 were treated with metformin only and 21 were treated with metformin + insulin. The two-way interaction term of study group and gestational age was significant for BrAIx and AoAIx (P < 0.001), but there was no evidence that mean AoPWV was different between the study groups (P = 0.729). Women in the control group demonstrated significantly lower BrAIx and AoAIx compared with the combined GDM group at W1-W3, but not at W4. The mean difference in log-transformed BrAIx was -0.37 (95% CI, -0.52 to -0.22), -0.23 (95% CI, -0.35 to -0.12) and -0.29 (95% CI, -0.40 to -0.18) at W1, W2 and W3, respectively. The mean difference in log-transformed AoAIx was -0.49 (95% CI, -0.69 to -0.30), -0.32 (95% CI, -0.47 to -0.18) and -0.38 (95% CI -0.52 to -0.24) at W1, W2 and W3, respectively. Similarly, women in the control group also demonstrated significantly lower BrAIx and AoAIx compared with each of the GDM treatment subgroups (diet, metformin only and metformin + insulin) at W1-W3. The increase in mean BrAIx and AoAIx seen between W2 and W3 in women with GDM treated with dietary management was attenuated in the metformin-only and metformin + insulin groups. However, the mean differences in BrAIx and AoAIx between these treatment groups were not statistically significant at any gestational-age window. Pregnancies complicated by GDM demonstrate significantly higher AS compared with low-risk pregnancies regardless of treatment modality. Our data provide the basis for further investigation into the association of metformin therapy with changes in AS and risk of placenta-mediated diseases. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Efficacy of γ-linolenic acid, Vitis vinifera extract, and acetyl-L-carnitine combination therapy for improving arterial stiffness in Korean adults: Real-world evidence.

Atherosclerosis is associated with various cardiovascular diseases (CVDs). Measurement of arterial stiffness using pulse wave velocity (PWV) enables assessment of atherosclerosis progression in individuals. The authors screened patients with asymptomatic atherosclerosis, based on the PWV findings, to evaluate appropriate early interventions and assess the efficacy of γ-linolenic acid, Vitis vinifera extract, and acetyl-L-carnitine triple combination therapy in atherosclerosis prevention. This retrospective study analyzed the medical records of adult patients between March 2007 and April 2019, with presenting complaints of fatigue and lethargy. Among patients with vascular stiffness beyond their biological age on brachial-ankle PWV (baPWV) testing, those with ≥80% compliance for three drugs were allocated to the experimental group. Those with compliance of <80% for any one drug were allocated to the control group to assess changes in arterial stiffness, fasting plasma glucose (FPG), lipid level, and blood pressure (BP). After 1year of triple-combination therapy, there were significant decreases in right and left baPWV (1537.16±274.84 and 1519.00±289.32cm/s, respectively) as compared to baseline (1633.15±271. 20 and 1598.64±267.95cm/s, respectively; p<.001). There was no difference in baPWV between sexes. Moreover, neither group showed significant changes in FPG and lipid levels. When triple-combination therapy combining γ-linolenic acid, V. vinifera extract, and acetyl-L-carnitine was administered to patients with high arterial stiffness relative to their age, as assessed by baPWV, the experimental group showed a decrease in arterial stiffness in both sexes.