Improvement In Pulse Wave Velocity Research Articles

Effect of Controlled Expiratory Pressures on Cerebrovascular Changes During Valsalva Maneuver

This study aimed to investigate the effects of Valsalva maneuver (VM) with the controlled expiratory pressures on vascular stiffness of common carotid artery (CCA) and cerebral hemodynamic changes using diagnostic ultrasonography. Twenty-seven healthy participants (mean and standard deviation of age = 22.78 ± 1.89) performed 30 and 40 mmHg VM. The right CCA stiffness index and pulse wave velocity (PWV) were measured before (PRE) and after (POST) VM. The peak systolic velocity (PSV), resistance index (RI), and heart rate (HR) were measured before (PRE) and after (POST1 and POST2 during the first and the second 15 s, respectively) VM. Near-infrared spectroscopy (NIRS) was utilized to measure regional oxygen saturation (rSO2) and oxyhemoglobin (HbO) on the left and right prefrontal cortex. Stiffness index decreased by 1.76 (p < 0.001) from PRE to POST only after 30 mmHg VM. PWV decreased by 0.69 m/s (p < 0.001, 30 mmHg) and 0.34 m/s (p = 0.022, 40 mmHg) in POST. Conversely, PSV increased by 5.36 cm/s (p = 0.031, 30 mmHg) and 4.77 cm/s (p = 0.04, 40 mmHg) in POST2. Increase in RI (p = 0.017) and decrease in HR (p = 0.003) occurred only after the 40 mmHg VM. Right HbO decreased after 30 mmHg VM (p = 0.023) from PRE to POST1, and right rSO2 increased after 40 mmHg VM (p = 0.036) from VM (during) to POST1. Both 30 and 40 mmHg VM showed a significant improvement in PWV and an increase in PSV. However, at 30 mmHg VM, a significant decrease in HbO was observed after VM owing to increased cerebral oxygen exchange, and at 40 mmHg VM, an rSO2 increase was observed after VM owing to high vascular pressure. Additionally, the increased pressure and rSO2 at 40 mmHg may have been caused by increased RI. The results indicated that the 30 mmHg VM was more effective on CCA stiffness than the 40 mmHg VM.

Effects of SGLT-2i and GLP-1RA in vascular function parameters: the impact of the weight loss

Abstract Background Arterial stiffness and endothelial function markers flag increased cardiovascular disease risk in patients with type 2 Diabetes Mellitus (T2DM), while weight management plays a crucial role for the management of glycemic control and prevention of complications in these patients. Purpose To investigate the effects of novel antidiabetic agents on arterial stiffness and endothelial function as well as the metabolic parameters of HbA1c and Weight in T2DM patients. Patients and Methods: We enrolled 99 consecutive patients under stable antidiabetic therapy who did not reach therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; glucagon like peptide-1 receptor agonist (GLP-1RA, n=50) or sodium/glucose cotransporter-2 inhibitor (SGLT-2i, n=49). Glycosylated hemoglobin (Hba1c) and weight expressed through Body Mass Index (BMI) along with carotid-femoral pulse wave velocity (PWV) and flow-mediated dilatation (FMD), as biomarkers of arterial stiffness and endothelial function accordingly, were measured at baseline and 3 months after treatment intensification. Results There were no differences between the study groups in traditional risk factors of age and sex or baseline HbA1c, BMI, PWV, and FMD levels (ps=NS for all). In both groups PWV values displayed a statistically significant improvement from 11.2±2.5 to 9.3±2.2 m/sec (p<0.001) in the GLP-1RA group and from 10.7±2.4 to 8.9±2.0 m/sec (p=0.001) in the SGLT-2i group, as presented in Figure 1 through the differences in the values of PWV. FMD values were also significantly improve in both groups from baseline to follow-up; from 6.04±1.22 to 6.50±1.26% (p<0,001) for the GLP-1RA group and from 6.38±1.21 to 6.81±1.29% (p<0.001) for the SGLT-2i group. Moreover, both groups achieved better weight management goals in terms of BMI values between baseline and follow-up; from 33.6±4.9 to 31.5±4.6 kg/m2 for the GLP-1RA group (p<0.001) and from 31.8±5.5 to 30.5±5.6 kg/m2 for the SGLT-2i group (p<0.001), in addition to achieving better glycemic control in terms of HbA1c values, as seen in their paired differences: for GLP-1RA: 1.3±0.7% and for SGLT-2i: 0.8±0.5%. Interestingly, in the SGLT-2i group the magnitude of the PWV improvement was correlated with the weight loss (r=0.368, p=0.007). Conclusion These data provide evidence that the newer antidiabetic drugs, both GLP1-RA and SGLT-2i, have actions that benefit both vascular function, endothelium as well as metabolic parameters. Interestingly, in the patients receiving SGLT-2i the magnitude of the PWV improvement was correlated with the weight loss.delta PWV for SGLT-2i & GLP-1RA groupsCorrelation of deltaWeight & deltaPWV

Pulse wave velocity improvement and lipoprotein(a) change in highly effective triple lipid-lowering therapy

Pulse wave velocity improvement and lipoprotein(a) change in highly effective triple lipid-lowering therapy

Mineralocorticoid receptor antagonist treatment improved arterial stiffness in patients with primary aldosteronism: a cohort study compared with adrenalectomy.

Elevated arterial stiffness in patients with primary aldosteronism (PA) can be reversed after adrenalectomy; however, the effect of medical treatment with mineralocorticoid receptor antagonist (MRAs) is unknown. The aim of this study was to evaluate the effect of MRAs and compare both treatment strategies on arterial stiffness in PA patients. Prospective cohort study. We prospectively enrolled PA patients from 2006 to 2019 who received either adrenalectomy or MRA treatment (spironolactone). We compared their baseline and 1-year post-treatment biochemistry characteristics and arterial pulse wave velocity (PWV) to verify the effects of treatment and related determinant factors. A total 459 PA patients were enrolled. After 1:1 propensity score matching for age, sex and blood pressure (BP), each group had 176 patients. The major determinant factors of baseline PWV were age and baseline BP. The adrenalectomy group had greater improvements in BP, serum potassium level, plasma aldosterone concentration, and aldosterone-to-renin ratio. The MRA group had a significant improvement in PWV after 1 year of treatment (1706.2 ± 340.05 to 1613.6 ± 349.51 cm/s, p < 0.001). There were no significant differences in post-treatment PWV (p = 0.173) and improvement in PWV (p = 0.579) between the adrenalectomy and MRA groups. The determinant factors for an improvement in PWV after treatment were hypertension duration, baseline PWV, and the decrease in BP. The PA patients who received medical treatment with MRAs had a significant improvement in arterial stiffness. There was no significant difference in the improvement in arterial stiffness between the two treatment strategies.

Synergistic effect of albuminuria on atherosclerosis in patients with primary aldosteronism.

Primary aldosteronism (PA) has been associated with atherosclerosis beyond the extent of essential hypertension, but the impact of albuminuria remains unknown. To investigate the effect of concomitant albuminuria on arterial stiffness in PA. Prospective cohort study. A prospective cohort study was conducted to evaluate the association of albuminuria (>30 mg/g in morning spot urine) with arterial stiffness, as measured non-invasively by pulse wave velocity (PWV) in patients with PA. Propensity score matching (PSM) with age, sex, diabetes, systolic and diastolic blood pressure, creatinine, potassium, number of antihypertensive medications, and hypertension history was used to balance baseline characteristics. The effects of albuminuria on PWV before and 1 year after treatment were analyzed. A total of 840 patients with PA were enrolled, of whom 243 had concomitant albuminuria. After PSM, there were no significant differences in baseline demographic parameters except alpha-blocker and spironolactone use. PWV was greater in the presence of albuminuria (p = 0.012) and positively correlated with urine albumin-creatinine ratio. Multivariable regression analysis identified albuminuria, age, body weight, systolic blood pressure, and calcium channel blocker use as independent predictors of PWV. As for treatment response, only PA patients with albuminuria showed significant improvements in PWV after PSM (p = 0.001). The magnitude of improvement in PWV increased with urine albumin-creatinine ratio and reached plateau when it exceeded 100 mg/g according to restricted cubic spline analysis. Concomitant albuminuria in PA was associated with greater arterial stiffness and more substantial improvement after targeted treatment. Both the baseline and the improved extent of PWV increased in correlation with rising urine albumin-creatinine ratio levels, reaching a plateau when the urine albumin-creatinine ratio surpassed 100 mg/g.

THE EFFECT OF PARICALCITOL AND CALCITRIOL WITH OR WITHOUT CALCIMIMETICS ON PULSE WAVE VELOCITY AND SERUM LEVELS FOR PARATHYROID HORMONE, CALCIUM AND PHOSPHORUS IN MAINTENANCE HEMODIALYSIS PATIENTS.

Different vitamin D analogs might have advantages over calcitriol. To evaluate the effects of paricalcitol vs. calcitriol based vitamin D receptor activators on calcium-phosphate metabolism and pulse wave velocity in hemodialysis patients. Observational, cross-sectional and 1 year follow-up study. 181 hemodialysis patients were enrolled in this study as divided in to 5 groups based on vitamin D therapy. Baseline and 12th month data on blood biochemistry, pulse wave velocity and cumulative dose of treatments were compared in each study group as well as in overall paricalcitol vs. calcitriol-based treatment groups. From baseline to 12th month, significant improvement in pulse wave velocity and parathyroid hormone was shown in paricalcitol-based treatment group without a significant change in calcium, phosphate, alkaline phosphatase. A significant increase in pulse wave velocity, serum phosphate levels, calcium x phosphate product and serum alkaline phosphatase levels were noted in calcitriol-based treatment group with no significant change in serum calcium and parathyroid hormone levels. Our findings revealed superiority of paricalcitol than calcitriol based vitamin D receptor activator therapy in terms of serum phosphate levels, CaxP product, dose requirement for vitamin D and the control of pulse wave velocity.

S-11-2: AORTIC PULSE WAVE VELOCITY AND CARDIOVASCULAR RISK

Aortic pulse wave velocity (PWV), which can be non-invasively approached by measuring carotid-femoral (cf) PWV, but also to a certain degree by measuring brachial-ankle (ba) PWV, is currently thought to be the gold standard assessment of aortic / large artery stiffness, an important physical property of the arterial system. The assessment of cfPWV/baPWV can be recommended at several stages in the cardiovascular continuum: + Primordial and primary prevention: cfPWV/baPWV increase the risk of incident hypertension and diabetes mellitus (thus, cardiovascular (CV) risk) in apparently healthy adolescents and young and middle aged adults. + Patients with arterial hypertension: Increased PWV is associated with masked hypertension and is the most prevalent measure of hypertension-mediated organ damage (which is, in turn, an important marker of increased CV risk in patients with hypertension) + Patients with diabetes mellitus: PWV is associated with CV and renal complications in patients with type 1 and type 2 diabetes (and, thus, with very high CV risk in these patients). + Young and middle-aged patients up to their 60ies with intermediate CV risk: Increased cfPWV/baPWV can reclassify CV risk in many of these patients, which was confirmed in a metaanalysis including individual participant data of 17.635 patients of 16 observational studies. Associations stratified by sex, diabetes and hypertension were similar, but decreased with age. Adding cfPWV to the traditional CV risk estimation method resulted in net reclassification indices of 25%, 10%, 13% and 11% for 10-year CV mortality, CHD events, CVD events, and stroke events, respectively. In a large meta-analysis including individual participant data of 14.673 Japanese participants (mean age 59–66 years) from 8 cohort studies without a history of CV disease, similar findings were reported for baPWV. Addition of baPWV to a model incorporating the Framingham risk score (FRS) significantly improved the category-free net reclassification (0.247). Finally, improvement in PWV over a few years is associated with improved prognosis. Although no randomised study so far has proven a reduction of CV events, based on a PWV driven strategy (as compared to a strategy based on traditional CV risk factors), prevention of the normal age-related increase in PWV has been shown recently in the SPARTE study. Furthermore, it is reasonable to treat high and very-high risk patients, detected by measurement of PWV, according to the respective risk category in current prevention guidelines.

93 EFFECT OF SACUBITRIL/VALSARTAN ON ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN PATIENTS WITH CHRONIC HEART FAILURE

Abstract Aim Heart failure (HF) is associated to endothelial dysfunction, a pathological condition characterized by imbalance between the production of vasoconstrictor and vasodilator factors, increase in the production of cytokines, down-regulation of eNOS, platelets activation and increased oxidative stress. Furthermore, endothelial dysfunction promotes the increase of arterial stiffness, augmenting myocardial damage. Sacubitril/Valsartan (sac/val) is used in the treatment of HF reduced ejection fraction (HFrEF) and has been proven effective in reducing CV disease progression and all-cause mortality in HFrEF patients. The aim of the study was to evaluate the effect of sac/val on endothelial dysfunction and arterial stiffness in patients with HFrEF, at baseline and after 6 months of treatment. Moreover, we evaluated the effects of sac/val on oxidative stress levels and platelets activation. Materials Methods We enrolled 46 Caucasian patients (mean age 70.1±7.1), suffering from HFrEF. Inclusion criteria were LVEF&amp;lt;35, functional class NYHA II or III. All clinical evaluation and laboratory tests were performed at baseline and after 6 months of treatment. The serum values of the markers of oxidative stress (8-isoprostane, NOX-2) and platelets activation (Sp-selectin, GPVI) were assessed with ELISA sandwich. Endothelial function was estimated with the measurement of the reactive hyperemia index (RHI); arterial stiffness (AS) was evaluated with the measurement of carotid-femoral pulse wave velocity (PWV), augmentation pressure (AP) and augmentation index (AI). Results The mean dose of sac/val was 180.5±110 mg without serious adverse events. At 6 months, data showed a significant improvement in in hemodynamic and clinical parameters such as heart rate (HR) (p&amp;lt;0.0001), NT-ProBNP (p&amp;lt;0.0001), fasting plasma glucose (FPG) (p&amp;lt;0.0001). Furthermore, there was a significant reduction in oxidative stress, platelets activation and inflammatory indices. We observed a significant improvement in PWV (p&amp;lt;0.0001), AI (p&amp;lt;0.0001), AP (p&amp;lt;0.0001) and RHI (p&amp;lt;0.0001). A linear correlation analysis was performed to assess the association between vascular parameters and different covariates expressed as Δ variation between baseline and follow-up. ΔPWV was directly correlated with ΔHOMA (p=0.037), ΔIL-6 (p=0.034), ΔTNF-α (p=0.001), Δ8-isoprostane (p=0.016), ΔNox-2 (p=0.01), ΔGP6 (p=0.018), ΔSp-selectin (p=0.023); ΔRHI was inversely correlated with ΔHOMA (p=0.003), ΔIL-6 (p=0.004), ΔTNF-α (p=0.023), ΔCRP (p=0.011), Δ8-isoprostane (p=0.012), ΔNox-2 (p=0.01), ΔGP6 (p=0.014), ΔSp-selectin (p=0.015). From stepwise multivariate linear regression model, ΔTNF-α was the stronger predictor of ΔPWV, justifying 48.5% of its variation and ΔSp-selectin was the major predictor of ΔRHI explaining 23.2% of its variation. Conclusion The treatment with sac/val improved endothelial dysfunction and arterial stiffness, due to reduced levels of oxidative stress, platelet activation and inflammation.

Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism.

Primary aldosteronism (PA) patients have a higher degree of arterial stiffness, which can be reversed after adrenalectomy. We aimed to compare the reversal of arterial stiffness between surgically and medically treated PA patients and to identify the predictors of effective medical treatment. We prospectively enrolled 445 PA patients and collected data on baseline clinical characteristics, biochemistry, blood pressure, and pulse wave velocity (PWV) before treatment and 12 months after treatment. In the mineralocorticoid receptor antagonist (MRA)-treated patients, the relationship between the change in PWV after 1 year (ΔPWV) and posttreatment renin activity was explored using the restricted cubic spline (RCS) method. Of the 445 enrolled PA patients, 255 received adrenalectomy (group 1) and 190 received MRAs. In the RCS model, posttreatment plasma renin activity (PRA) 1.5 ng/mL/h was the best cutoff value. Therefore, we divided the MRA-treated patients into 2 groups: those with suppressed PRA (< 1.5 ng/mL/h, group 2), and those with unsuppressed PRA (≥ 1.5 ng/mL/h, group 3). Only group 1 and group 3 patients had a statistically significant improvement in PWV after treatment (both P < .001), whereas no significant improvement was noted in group 2 after treatment (P = .151). In analysis of variance and post hoc analysis, group 2 had a significantly lower ΔPWV than group 1 (P = .007) and group 3 (P = .031). Multivariable regression analysis of the MRA-treated PA patients identified log-transformed posttreatment PRA, age, and baseline PWV as independent factors correlated with ΔPWV. The reversal of arterial stiffness was found in PA patients receiving adrenalectomy and in medically treated PA patients with unsuppressed PRA.

Effect of sacubitril/valsartan on endothelial dysfunction and arterial stiffness in patients with chronic heart failure

Abstract Background Heart failure (HF) is associated to endothelial dysfunction, a pathological condition characterized by imbalance between the production of vasoconstrictor and vasodilator factors, increase in the production of cytokines, down-regulation of eNOS, platelets activation and increased oxidative stress. Furthermore, endothelial dysfunction promotes the increase of arterial stiffness, augmenting myocardial damage. Sacubitril/Valsartan (sac/val) is used in the treatment of HF reduced ejection fraction (HFrEF) and has been proven effective in reducing CV disease progression and all-cause mortality in HFrEF patients. Purpose The aim of the study was to evaluate the effect of sac/val on endothelial dysfunction and arterial stiffness in patients with HFrEF, at baseline and after 6 months of treatment. Moreover, we evaluated the effects of sac/val on oxidative stress levels and platelets activation. Methods We enrolled 46 Caucasian patients (mean age 70.1±7.1), suffering from HFrEF. Inclusion criteria were EF&amp;lt;35, functional class NYHA II or III. All clinical evaluation and laboratory tests were performed at baseline and after 6 months of treatment. The serum values of the markers of oxidative stress (8-isoprostane, NOX-2) and platelets activation (Sp-selectin, GPVI) were assessed with ELISA sandwich. Endothelial function was estimated with the measurement of the reactive hyperemia index (RHI); arterial stiffness (AS) was evaluated with the measurement of carotid-femoral pulse wave velocity (PWV), augmentation pressure (AP) and augmentation index (AI). Results The mean dose of sac/val was 180.5±110 mg without serious adverse events. At 6 months, data showed a significant improvement in in hemodynamic and clinical parameters such as heart rate (HR) (p&amp;lt;0.0001), NT-ProBNP (p&amp;lt;0.0001), fasting plasma glucose (FPG) (p&amp;lt;0.0001). Furthermore, there was a significant reduction in oxidative stress, platelets activation and inflammatory indices. We observed a significant improvement in PWV (p&amp;lt;0.0001), AI (p&amp;lt;0.0001), AP (p&amp;lt;0.0001) and RHI (p&amp;lt;0.0001). A linear correlation analysis was performed to assess the association between vascular parameters and different covariates expressed as Δ variation between baseline and follow-up. ΔPWV was directly correlated with ΔHOMA (p=0.037), ΔIL-6 (p=0.034), ΔTNF-α (p=0.001), Δ8-isoprostane (p=0.016), ΔNox-2 (p=0.01), ΔGP6 (p=0.018), ΔSp-selectin (p=0.023); ΔRHI was inversely correlated with ΔHOMA (p=0.003), ΔIL-6 (p=0.004), ΔTNF-α (p=0.023), ΔCRP (p=0.011), Δ8-isoprostane (p=0.012), ΔNox-2 (p=0.01), ΔGP6 (p=0.014), ΔSp-selectin (p=0.015). From stepwise multivariate linear regression model, ΔTNF-α was the stronger predictor of ΔPWV, justifying 48.5% of its variation and ΔSp-selectin was the major predictor of ΔRHI explaining 23.2% of its variation. Conclusion The treatment with sac/val improved endothelial dysfunction and arterial stiffness, due to reduced levels of oxidative stress, platelet activation and inflammation. Funding Acknowledgement Type of funding sources: None.

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

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

The Acute Effect of Exercise on Arterial Stiffness in Healthy Subjects: A Meta-Analysis

Arterial stiffness has been shown to be a subclinical marker associated with cardiovascular disease. Meanwhile, long-term exercise has been demonstrated to reduce arterial stiffness, providing a decrease in cardiovascular risk. However, the acute effect of exercise on arterial stiffness is unclear. This systematic review and meta-analysis aimed to assess the acute effect of exercise interventions on arterial stiffness in healthy adults. We searched the Cochrane Central Register of Controlled Trials, MEDLINE (via Pubmed), Scopus, and Web of Science databases, from their inception to 30 June 2020. A meta-analysis was performed to evaluate the acute effect of exercise on arterial stiffness using random-effects models to calculate pooled effect size estimates and their corresponding 95% CI. Pulse wave velocity was measured as an arterial stiffness index. The 30 studies included in the meta-analysis showed that pulse wave velocity was not modified immediately after exercise (0 min post) (ES: 0.02; 95% CI: −0.22, 0.26), but subsequently decreased 30 min after exercise (ES: −0.27; 95% CI: −0.43, −0.12). Thereafter, pulse wave velocity increased to its initial value 24 h after exercise (ES: −0.07; 95% CI: −0.21, 0.07). Our results show that, although there is a significant reduction in pulse wave velocity 30 min after exercise, the levels of arterial stiffness return to their basal levels after 24 h. These findings could imply that, in order to achieve improvements in pulse wave velocity, exercise should be performed on a daily basis.

Improvement in Pulse Wave Velocity and Baroreflex Sensitivity Three-and Six-Month Postrenal Transplantation.

Cardiovascular diseases are an important cause of mortality in end-stage renal disease (ESRD) and increased arterial stiffness and autonomic dysfunction have been proposed to explain part of this excess cardiovascular risk. This prospective study was designed with the aim of noninvasive assessment of the vascular function, i.e., arterial stiffness in the form of pulse wave velocity (PWV) and autonomic function in the form of baroreflex sensitivity (BRS) in ESRD patients before renal transplantation (RT) and three and six months after RT. The study was conducted in 64 patients of ESRD slated for RT in the Department of Nephrology and was being followed up during all three visits (pretransplant, three-, and six-month posttransplant). The period of patient recruitment and data collection lasted for approximately 1½ years. Although PWV did not show a significant change, the change in PWV was negatively correlated with baseline PWV, and it was statistically significant. The BRS after RT had a significant improvement as early as three months. The correlation between change in PWV and change in BRS postrenal transplant was not seen. RT improves BRS, but it is still unknown that it is through amelioration of arterial properties or neural components or/and a relative contribution of both. We suggest that the improvement in BRS postrenal transplant is probably because of the improvement in autonomic neural functions rather than the improvement in compliance of barosensitive regions of large arteries.

Pulse Wave Velocity Assessment for Cardiovascular Risk Prognostication in ESKD: Weighting Recent Evidence.

Among patients with end-stage kidney disease (ESKD), arterial stiffness is considered as a powerful predictor of cardiovascular (CV) morbidity and mortality. However, the relevance of aortic pulse wave velocity (PWV) as a prognostic biomarker for CV risk estimation is not yet fully clear. We performed a systematic search of Medline/PubMed database from inception through August 21, 2019 to identify observational cohort studies conducted in ESKD patients and exploring the association of PWV with CV events and mortality. Whereas "historical" cohort studies showed aortic PWV to be associated with higher risk of CV and all-cause mortality, recent studies failed to reproduce the independent predictive value of aortic PWV in older ESKD patients. Studies using state-of-the-art prognostic tests showed that the addition of aortic PWV to standard clinical risk scores could only modestly improve CV risk reclassification. Studies associating improvement in PWV in response to blood pressure (BP)-lowering with improvement in survival cannot demonstrate direct cause-and-effect associations due to their observational design and absence of accurate methodology to assess the BP burden. Despite the strong pathophysiological relevance of arterial stiffness as a mediator of CV disease in ESKD, the assessment of aortic PWV for CV risk stratification in this population appears to be of limited value. Whether aortic PWV assessment is valuable in guiding CV risk factor management and whether such a therapeutic approach is translated into improvement in clinical outcomes, is an issue of clinical relevance that warrants investigation in properly-designed randomized trials.

Clapping jumping jacks to improve endothelial function in obese adults: if you're happy and you NO it, clap your hands.

Clapping jumping jacks to improve endothelial function in obese adults: if you're happy and you NO it, clap your hands.

Red Yeast Rice for Hypercholesterolemia.

The extract of red yeast rice (RYR) is the most effective cholesterol-lowering nutraceutical on the market. In particular, its effectiveness is directly related to the amount of monacolin K within the extract (up to 10 mg/day). Consuming monacolin K on a daily basis reduces low-density lipoprotein (LDL) cholesterol plasma levels between 15% and 25% within 6 to 8 weeks. Certainly, the decrease in LDL-cholesterol is accompanied by a similar reduction in total cholesterol, non-high-density lipoprotein cholesterol, plasma apolipoprotein B, matrix metalloproteinases 2 and 9, and high-sensitivity C-reactive protein. Furthermore, the RYR lipid-lowering effect is associated with significant improvements in pulse wave velocity and endothelial function, which are validated and reliable biomarker tools able to detect vascular aging. Although it has a mechanism of action similar to statins, a daily consumption of between 3 and 10 mg monacolin K has only minimal associated risks, and mild myalgias are seen only in the frailest patients (those who also cannot tolerate minimal dosages of statin). The monacolin K found in RYR is a safe and effective supplement for managing mild to moderate hypercholesterolemia in people with no additional cardiovascular risk factors.

Short-Duration High-Intensity Interval Exercise Training Is More Effective Than Long Duration for Blood Pressure and Arterial Stiffness But Not for Inflammatory Markers and Lipid Profiles in Patients With Stage 1 Hypertension.

The present study compared the effects of 2 different high-intensity interval training (HIIT) protocols on arterial stiffness, lipid profiles, and inflammatory markers in hypertensive patients. Thirty hypertensive (stage 1) patients, aged 48.0 ± 3.2 yr, were randomly allocated to the short-duration HIIT (SDHIIT, n = 10), long-duration HIIT (LDHIIT, n = 10), and control (n = 10) groups. After a 2-wk preparatory phase of continuous mild training, patients in the SDHIIT group performed 8 wk of HIIT including 27 repetitions of 30-sec activity at 80% to 100% of (Equation is included in full-text article.)O2peak interspersed with 30-sec passive/active (10%-20% of (Equation is included in full-text article.)O2peak) recovery. Patients in the LDHIIT group performed 8 wk of HIIT, 32 min/session including 4 repetitions of 4-min activity at 75% to 90% of (Equation is included in full-text article.)O2peak interspersed with 4-min passive/active (15%-30% of (Equation is included in full-text article.)O2peak) recovery. Blood pressure (BP), pulse wave velocity (PWV), inflammatory markers, and lipid profiles were measured before and after training. Significant (P < .05) reductions in systolic blood pressure and PWV were found following 2 training protocols, though, only the changes in PWV following the SDHIIT were significantly different than those in the LDHIIT and control groups. Interleukin-6 and triglycerides decreased and interleukin-10 increased significantly (P < .01) following both HIIT programs, whereas the differences between the 2 training protocols were not statistically significant. C-reactive protein and lipids did not change significantly following HIIT. Performing HIIT improves systolic blood pressure and inflammatory markers in patients with stage 1 hypertension irrespective of the HIIT intensity and duration, and PWV improvement is intensity related.

Improvement of pulse wave velocity and metabolic cardiovascular risk parameters through egg protein hydrolysate intake: A randomized trial in overweight or obese subjects with impaired glucose tolerance or type 2 diabetes

It was shown in animals that the egg protein-hydrolysate NWT-03 improves endothelial function. We designed a human crossover study to assess acute (2 h) and short-term (2 days) effects of 5 g/d NWT-03 in 40 overweight and obese subjects with impaired glucose-tolerance or type-2 diabetes.At day 1, both fasting (time point 0;t0) and 120 min after intake (t120), and day 3 (t120), pulse-wave velocity, augmentation index, heart rate and blood pressure were measured and blood was sampled for analysis of metabolic parameters (serum lipids, glucose and insulin). Acute and short-term effects were calculated.Carotid-radial PWV (short-term), AIx (acute), triacylglycerol (short-term), glucose (acute), and insulin (acute) decreased, while HDL cholesterol (short-term) increased significantly during NWT-03 consumption.The egg protein-hydrolysate NWT-03 is a potential functional food ingredient in IGT and T2DM. Whether the improvement in cr-PWV is mediated through effects on metabolism as well as long-term benefits warrants further study.

Effect of Treat-to-target Strategies Aiming at Remission of Arterial Stiffness in Early Rheumatoid Arthritis: A Randomized Controlled Study.

To determine the efficacy of 2 tight control treatment strategies aiming at Simplified Disease Activity Score (SDAI) remission (SDAI ≤ 3.3) compared to 28-joint count Disease Activity Score (DAS28) remission (DAS28 < 2.6) in the prevention of arterial stiffness in patients with early rheumatoid arthritis (RA). This was an open-label study in which 120 patients with early RA were randomized to receive 1 year of tight control treatment. Group 1 (n = 60) aimed to achieve SDAI ≤ 3.3 and Group 2 (n = 60), DAS28 < 2.6. Pulse wave velocity (PWV) and augmentation index (AIx) were measured at baseline and 12 months. A posthoc analysis was also performed to ascertain whether achieving sustained remission could prevent progression in arterial stiffness. The proportions of patients receiving methotrexate monotherapy were significantly lower in Group 1 throughout the study period. At 12 months, the proportions of patients achieving DAS28 and SDAI remission, and the change in PWV and AIx, were comparable between the 2 groups. In view of the lack of differences between the 2 groups, a posthoc analysis was performed at Month 12, including all 110 patients with PWV, to elucidate the independent predictors associated with the change in PWV. Multivariate analysis revealed that achieving sustained DAS28 remission at months 6, 9, and 12 and a shorter disease duration were independent explanatory variables associated with less progression of PWV. With limited access to biologic disease-modifying antirheumatic drugs, treatment efforts toward DAS28 and SDAI remission had similar effects in preventing the progression of arterial stiffness at 1 year. However, achieving sustained DAS28 remission was associated with a significantly greater improvement in PWV. [Clinical Trial registration: Clinicaltrial.gov NCT01768923.].

Changes in Aortic Pulse Wave Velocity and the Predictors of Improvement in Arterial Stiffness Following Aortic Valve Replacement.

The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm² /m² . Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = -0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005-1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023-1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients' characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients.