Improvement In Vascular Function Research Articles

Impact of dietary supplementation of glycocalyx precursors on vascular function in type 2 diabetes.

Degradation of the endothelial glycocalyx in type 2 diabetes (T2D) is thought to contribute to impaired shear stress mechanotransduction, leading to endothelial dysfunction and the development of cardiovascular disease. Herein, we tested the hypothesis that restoration of the endothelial glycocalyx with dietary supplementation of glycocalyx precursors (DSGP, containing glucosamine sulfate, fucoidan, superoxide dismutase, and high molecular weight hyaluronan) improves endothelial function and other indices of vascular function in T2D. First, in db/db mice, we showed that treatment with DSGP (100 mg/kg/day) for four weeks restored endothelial glycocalyx length, as assessed via atomic force microscopy in aortic explants. Restoration of the glycocalyx with DSGP was accompanied by improved flow-mediated dilation (FMD) and reduced arterial stiffness in isolated mesenteric arteries. Further corroborating these findings, treatment of cultured endothelial cells with that same mixture of glycocalyx precursors promoted glycocalyx growth. Next, as an initial step to investigate the translatability of these findings, we conducted a pilot (n=22) double-blinded randomized placebo-controlled clinical trial to assess the effects of DSGP (3,712.5 mg/day) for eight weeks on endothelial glycocalyx integrity and indices of vascular function, including FMD, in Veterans with T2D. Contrary to the hypothesis, DSGP neither enhanced endothelial glycocalyx integrity nor improved vascular function indices relative to placebo. Together, these findings conceptually support the notion that restoration of the endothelial glycocalyx can lead to improvements in vascular function in a mouse model of T2D; however, DSGP as a therapeutic strategy to enhance vascular function in individuals with T2D does not appear to be efficacious.

Investigating the Relationship Between Clinical Characteristics, Mental Health, and Vascular Function in Minor Ischemic Stroke or Transient Ischemic Attack Patients.

Over the past decade, there has been extensive research exploring the relationship between vascular health and mental well-being, encompassing aspects such as mood and cognition. However, there is a notable gap in research focusing on the mental and vascular conditions of minor ischemic stroke or transient ischemic attack (TIA) patients, particularly within the Thai population. To investigate the clinical characteristics and mental issues related to vascular functions in patients who have experienced a minor ischemic stroke or TIA. This study, approved by the Buriram Hospital Ethics Committee (IRB: BR0033.102.1/8), adhered to the guidelines of the Helsinki Declaration and obtained informed consent from all participants. A prospective cross-sectional study was conducted at Buriram Hospital, a government regional hospital located in Buriram province, Thailand, involving twenty-three participants diagnosed with minor ischemic stroke or TIA. Measurements included clinical characteristics, Hospital Anxiety and Depression Scale-part Anxiety (HADS-A), Hospital Anxiety and Depression Scale-part Depression (HADS-D), mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), flow-mediated dilation (FMD), and brachial-ankle pulse wave velocity (baPWV). Linear regression analysis was employed to investigate the factors associated with vascular function (FMD and baPWV). The factor related to FMD was HADS-D (β = -0.5, 95% CI -0.33 to -0.04). Factors associated with baPWV included age (β = 0.51, 95% CI 5.05 to 39.50) and the duration of minor ischemic stroke or TIA (β = 0.48, 95% CI 25.41 to 290.99). FMD shows a connection with depressive symptoms in patients with minor ischemic stroke or TIA. Therefore, it is important to detect and provide appropriate treatment for depressive symptoms in these patients, as it may lead to improvements in vascular function and better cerebrovascular outcomes.

Vascular responses during handgrip exercise in healthy postmenopausal females and older males

Introduction: Aerobic exercise interventions improve peripheral endothelial function in healthy older males. However, this effect is not always observed in healthy postmenopausal females and possible mechanisms underlying this sex-related difference remain unknown. Greater vascular shear stress during acute exercise is a key stimulus mediating longer-term improvements in vascular function. It remains unknown if postmenopausal females display a reduced endothelial sensitivity to exercise-induced shear stress relative to males of similar age. Objective and hypothesis: The objective of this study is to test the hypothesis that healthy postmenopausal females exhibit a lower endothelial sensitivity to exercise-induced shear stress relative to males. Methods: Fourteen healthy postmenopausal females (67 ± 8 years) not under hormone replacement therapy and 9 males of similar age (65 ± 7 years) performed handgrip exercise for 4 minutes at 20%, 40%, 60%, and 80% of their maximal voluntary contraction. Each exercise bout was separated by a 10-min recovery period. Brachial artery diameter and blood velocity were continuously measured using high-resolution ultrasound and analyzed using edge-detection software. Endothelial sensitivity to shear rate was quantified as the slope of the linear regression between brachial artery dilation (% change from baseline) and shear stress and compared between groups with an independent t-test. Workload, vascular conductance, diameter dilation, and shear stress were analyzed with mixed-effects models. Results: Males exercised at greater workloads relative to females across all exercise bouts (M: 17 ± 11 vs. F: 9 ± 5 kg, p<0.01). Forearm vascular conductance was greater in males throughout each exercise intensity (M: 2.23 ± 1.70 vs. F: 1.03 ± 0.51 ml/min/mmHg, p=0.02). Despite these differences, arterial dilation (M: 5.32 ± 5.55 vs. F: 5.20 ± 4.80%, p=0.96) and shear stress (M: 142 ± 80 vs. F: 171 ± 86 s−1, p=0.27) did not differ between groups across exercise intensities. Endothelial sensitivity to exercise-induced shear stress did not differ between males (0.02 ± 0.05%/s−1) and females (0.03 ± 0.01%/s−1, p=0.67). Conclusion: These data suggest that a reduced endothelial sensitivity to exercise-induced shear stress may not explain why aerobic exercise interventions do not consistently improve peripheral endothelial function in healthy postmenopausal females. Montreal Heart Institute Foundation. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The Impact of Goode Health LLC Superfood Chocolate Blend Beverage on Peripheral Macro and Microvascular Function

Cardiovascular disease (CVD) is the leading cause of death in the US and world-wide. The are many risk factors associated with elevated risk for and prevalence of CVD; however, it is well documented that reduced macro and microvascular function/health is a major contributing factor. The mechanisms are multifactorial however, reduced vasodilatory reactivity, secondary to elevated oxidative stress and/or inflammation contribute to elevated disease risk. Diets and/or interventions high in antioxidants, polyphenols, and/or anti-inflammatory properties reduce CVD and metabolic disease risk. Furthermore, this is mediated in part through improvements in vascular function. This study tested the hypothesis that 2-weeks of increased daily consumption of a beverage high in antioxidants, polyphenols, and anti-inflammatory properties would improve well-validated indices of peripheral macro and microvascular function in a cohort of Hispanic individuals. METHODS: Six Hispanic individuals (4 males; age: 42±14 yr.; BMI 32±7 kg/m2) participated. All measures were assessed before (pre) and following (post) 14-days of increased daily consumption of the Goode Health LLC Superfood Moroccan Chocolate Blend. During the intervention participants added the chocolate blend powder mix (~28 g) to 8 oz water twice daily. This beverage is high in healthy ingredients including plant-based proteins, prebiotic fiber, antioxidant polyphenols, and anti-inflammatory properties. Peripheral macro and microvascular function/health were assessed pre- and post-intervention as vasodilation in the brachial artery (flow mediated vasodilation; %FMD) and reactive hyperemia (peak mean forearm blood velocity (FBVmean)) in the forearm vasculature respectively following 5-min of forearm ischemia induced by suprasystolic cuff occlusion. RESULTS: Peripheral macrovascular function assessed as %FMD tended to be augmented following Goode Health LLC beverage consumption (Pre: 4.2±2.2 % vs. Post: 5.8±1.6 %, P=0.08). Whereas peripheral microvascular function assessed as peak FBVmean was augmented following the intervention (Pre: 70±17 cm·s−1 vs. Post: 78±20 cm·s−1, P=0.04) CONCLUSION: These preliminary data indicate a positive effect of Goode Health LLC Superfood Moroccan Chocolate Blend consumption on indices of peripheral macro and microvascular function/health. Future studies will continue to expand upon these findings in a larger cohort. Goode Health LLC. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effects of PCSK-9 inhibitors on arterial structure and function: preliminary results

Abstract Background One of the latest chapters in the research for new and stronger lipid lowering therapies has led to the development of PCSK9 inhibitors. In addition to the benefit on lipid profile, a limited number of studies have been published showing a possible improvement in vascular function and structure following their administration. Purpose To evaluate the effects of PCSK9 inhibitors on structural (via carotid Intima Media Thickness – IMT) and functional (carotid-femoral Pulse Wave Velocity – cf-PWV - and brachial artery Flow Mediated Dilatation - FMD) arterial properties. Methods Twenty-two dyslipidemic patients with a clinical indication to PSCK9 inhibitors were prospectively recruited at the cardiology rehabilitation of a hospital. Anthropometric, clinical and therapeutic data were recorded. Each patient underwent instrumental examinations to assess cf-PWV, IMT and FMD at T0 (before the start of therapy), T1 (after 6 months) and T2 (after 12 months). Results In the 22 patients who reached 6 months of follow up there was a significant reduction in LDL cholesterol (from 127.8±31.7 to 47.4±29.1 mg/dl, p<0. 0001) while there was no significant difference in arterial parameters (cf-PWV: from 10.5±3.5 to 9.4±2.3 m/s, p=0.092; FMD: from 11.4±8.1 to 9.8±8.3%, p=0.407; IMT: from 775.6±192.8 to 768.7±144.7, microm, p=0.854). Similar results were also obtained in the 12 patients who reached one year of follow-up: LDL from 129.4±29.1 to 48.8±21.9 mg/dl, p<0.0001; cf-PWV from 10.4±3.3 to 10.5±2.9, p=0.874; FMD from 12.0±9.1 to 11.0±5.6%, p=0.930; IMT from 745.1±203.9 to 770.0±127.3 microm, p=0.710. Conclusion Our study confirm the strong LDL reduction with PCSK9 inhibitors that are needed in order to reach the targets set by the ESC 2019 guidelines. In contrast, they do not show a significant effect on arterial function and structure in terms of cf-PWV, FMD and carotid IMT.

Research progress on therapeutic effect and mechanism of hydrocortisone on sepsis

Sepsis has remained a high mortality rate worldwide. Endothelial cell dysfunction is closely associated with the development of sepsis. Hydrocortisone has potent immunological and antitoxic effects, and thus it is frequently used in the treatment of septic shock. However, it can also cause respiratory damage and death by anaphylaxis. In recent years, the combination of hydrocortisone and other drugs such as vitamin C and thiamine has achieved promising outcomes in refractory septic shock. The present review focuses on the therapeutic effects of hydrocortisone in sepsis and summarizes the mechanisms by which hydrocortisone acted on the vascular endothelial cells. We highlighted the effect of hydrocortisone on anti-inflammation, anti-apoptosis, improvement of vascular functions, and anti-oxidative stress. We also pointed out that the mechanisms by which the combination therapy with other drugs enhances the effects of hydrocortisone are still unclear and need to be clarified to determine the benefit of the treatment of sepsis.

Preexercise Intermittent Passive Stretching and Vascular Function After Treadmill Exercise.

Acute aerobic exercise stress is associated with decreased endothelial function that may increase the likelihood of an acute cardiovascular event. Passive stretch (PS) elicits improvements in vascular function, but whether PS can be performed before exercise to prevent declines in vascular function remains unknown. This strategy could be directly applicable in populations that may not be able to perform dynamic exercise. We hypothesized that preexercise PS would provide better vascular resilience after treadmill exercise. Sixteen healthy college-aged males and females participated in a single laboratory visit and underwent testing to assess micro- and- macrovascular function. Participants were randomized into either PS or sham-control. Intermittent calf PS was performed by having the foot in a splinting device for a 5-minute stretch, 5-minute relaxation, repeated 4 times. Then, a staged O2 peak test was performed and 65% O2 peak calculated for subjects to run at for 30-minutes. Near-infrared spectroscopy derived microvascular responsiveness was preserved with the PS group (pre: 0.53±0.009%/s), (post: 0.56±0.012%/s; p=0.55). However, there was a significant reduction in the sham control group (pre: 0.67±0.010%/s), (post: 0.51±0.007%/s; p=0.05) after treadmill exercise. Flow mediated vasodilation (FMD) of the popliteal artery showed similar responses. In the PS group, FMD (pre: 7.23±0.74%), (post: 5.86±1.01%; p=0.27) did not significantly decline after exercise. In the sham-control group FMD (pre: 8.69±0.72), (post: 5.24±1.24%; p<0.001) was significantly reduced after treadmill exercise. Vascular function may be more resilient if intermittent PS is performed prior to moderate intensity exercise and, importantly, can be performed by most individuals.

The Effects of Exercise Training on Exercise Capacity and Vascular Function after Transcatheter Aortic Valve Implantation-A Pilot Study.

Transcatheter aortic valve implantation (TAVI) improves event-free survival in patients with severe aortic stenosis, but patients' exercise capacity remains poor after the procedure. Therefore, we sought to compare the effects of a supervised center-based exercise training program and unsupervised exercise routine on exercise capacity and vascular function in patients after TAVI. Patients were randomized to either center-based exercise training (12-24 sessions of combined aerobic and low-weight resistance training twice weekly for 8-12 weeks) or an unsupervised home-based exercise routine (initial appraisal with detailed recommendations and monthly follow-up). Exercise capacity (cardiopulmonary testing) and vascular function (ultrasonographic measurement of flow-mediated vasodilation (FMD) and arterial stiffness) were assessed at the baseline and after the study period. We included 23 patients (mean age of 81 years, 61% women), with higher-than-expected drop-out rates (41%) because of the coronavirus-19 pandemic outbreak. Exercise capacity improved over time, irrespective of the intervention group: 0.09 mL/min/kg increase in peak oxygen uptake (95% CI [0.01-0.16]; p = 0.02), 8.2 Watts increase in workload (95% CI [0.6-15.8]; p = 0.034), and 47 s increase in cumulative exercise time (95% CI [5.0-89.6]; p = 0.029). A between-group difference in change over time (treatment effect) was detected only for FMD (4.49%; 95% CI [2.35; 6.63], p < 0.001), but not for other outcome variables. Both supervised and unsupervised exercise training improve exercise capacity and vascular function in patients after TAVI, with supervised exercise training possibly yielding larger improvements in vascular function, as determined by FMD.

Taxifolin Reduces Blood Pressure via Improvement of Vascular Function and Mitigating the Vascular Inflammatory Response in Spontaneously Hypertensive Rats.

The effect of a 10-day-long treatment with taxifolin (TAX, 20 mg/kg/day p.o.) was investigated on spontaneously hypertensive rats (SHRs) with a focus on the vascular functions of isolated femoral arteries and thoracic aortas. TAX reduced blood pressure in SHRs. In femoral arteries, TAX increased acetylcholine-induced relaxation, reduced the maximal NA-induced contraction, and reduced acetylcholine-induced endothelium-dependent contraction (EDC); however, TAX had no effect on the vascular reactivity of isolated thoracic aortas. In addition, TAX elevated the total nitric oxide synthase (NOS) activity and iNOS protein expression but reduced cyclooxygenase-2 (COX2) protein expression in the tissue of the abdominal aorta without changes in Nos2 and Ptgs2 gene expressions. TAX also increased the gene expression of the anti-inflammatory interleukin-10 (Il10). In addition, in vitro studies showed that TAX has both electron donor and H atom donor properties. However, TAX failed to reduce superoxide production in the tissue of the abdominal aorta after oral administration. In conclusion, our results show that a decrease in the blood pressure in TAX-treated SHRs might be attributed to improved endothelium-dependent relaxation and reduced endothelium-dependent contraction. In addition, the results suggest that the effect of TAX on blood pressure regulation also involves the attenuation of COX2-mediated pro-inflammation and elevation of anti-inflammatory pathways.

Can yoga show better vascular outcomes than regular exercise among office workers: a scoping review

Background: Isolated systolic hypertension (ISH) in the elderly is mostly brought on by arterial stiffness with ageing, which results in a lack of vascular compliance. The main cardiovascular (CV) hazards for elderly persons are arterial ageing and high blood pressure (BP). The aim of this study was to investigate if endothelial function in young, middle-aged, and older, healthy persons would be improved by Bikram yoga, a heated form of hatha yoga. Methods: Randomised control trials on yoga, vascular function, exercise, and office employees were used in the study, which was done in four databases (Scopus, PubMed, Ovid, and Science Direct). Results: 3 of 103 articles were included. We identified improvement of vascular function, FMD and arterial stiffness using yoga intervention. While exercise does not significantly affect ventricular function, yoga significantly reduces heart rate (p = 0.031) and increases pulse pressure (PD). Yoga also results in a mean increase in left ventricular ejection time (LVET), which was observed in the yoga group. The improvement in myocardial function was more pronounced in the yoga group than in the exercise group, according to the between-group analysis, which revealed a significant difference in post-intervention rate-pressure product (RPP) between the yoga and exercise groups. With a P value of 0.004, the mean% Mean Arterial Pressure (MAP) was significantly lower, demonstrating that yoga was effective in lowering MAP. However, older adults, but not younger ones, experienced a significant increase in brachial artery FMD (Flow Mediated Dilation) following the intervention. Conclusions: Yoga interventions may improve vascular function, arterial stiffness, flow-mediated dilation, heart rate, RRP and MAP, with older adults experiencing a significant increase in brachial artery FMD, suggesting the effectiveness of yoga in improving myocardial function and lowering MAP, particularly in older adults.

Examining changes in vascular function, arterial stiffness and systemic inflammation during hospitalization and recovery from an acute exacerbation of chronic obstructive pulmonary disease

An acute exacerbation of COPD (AECOPD) is associated with increased risk of cardiovascular (CV) events. The elevated risk during an AECOPD may be related to changes in vascular function, arterial stiffness, and systemic inflammation; the time course of these measures and their corresponding recovery are poorly understood. Further, physical activity is reduced during an AECOPD, and physical activity may influence the cardiovascular responses to an AECOPD. The purpose of the study was to examine the acute impact of an AECOPD requiring hospitalization on vascular function, arterial stiffness, and systemic inflammation and examine whether physical activity modulates these variables during recovery. Patients hospitalized for an AECOPD were prospectively recruited and compared to control patients with stable COPD. Vascular function, arterial stiffness, and systemic inflammation (CRP, IL-6) were measured at hospital admission, hospital discharge and within 14 days of discharge. Physical activity was electronically tracked daily while in hospital and for 7 days following discharge using a Fitbit. One hundred and twenty-one patients with an AECOPD requiring hospitalization and 33 control patients with stable COPD were enrolled in the study. Vascular function was significantly lower, and systemic inflammation higher at hospital admission in patients with an AECOPD compared to stable COPD. Significant improvements in vascular function and inflammation were observed within 14 days of hospital discharge; however, vascular function remained lower than stable COPD. Physical activity was low at admission and increased following discharge; however, physical activity was unrelated to measures of vascular function or inflammation at any time point. An AECOPD requiring hospitalization is associated with impaired vascular function that persists during recovery. These findings provide a mechanistic link to help explain the enduring increase in CV risk and mortality following a severe AECOPD event.Clinical trial registration: ClinicalTrials.gov #NCT01949727; Registered: 09/20/2013.

#6650 SGLT2-INHIBITION IMPROVES VASCULAR FUNCTION IN TYPE 2 DIABETES: A DOUBLE BLIND, RANDOMIZED, PLACEBO CONTROLLED CROSSOVER TRIAL

Abstract Background and Aims Sodium glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular events and protects kidney function in type 2 diabetes (DM2) patients. These benefits may partly be related to improvement of vascular function. In this study we examined the effects of SGLT2i treatment on vasodilatory capacity in patients with DM2. Method Using a double-blind, randomized, placebo-controlled cross-over study design, we included 15 patients with DM2 and preserved kidney function (eGFR &amp;gt; 60 ml/min/1.73 m2). Each participant received four weeks of SGLT2i treatment (empagliflozin 10 mg once daily) or matching placebo. After a two-week wash-out period, each participant was crossed over to four weeks of the opposite treatment. At the end of each treatment period, vascular function was evaluated by venous occlusion plethysmography. Forearm blood flow (FBF) was measured during intra-arterial infusion of increasing concentrations of acetylcholine (ACh) and sodium nitroprusside (SNP), assessing endothelium-dependent and independent vasodilation, respectively. Repeated measures two-way ANOVA was performed to compare absolute FBF between groups. Results 11/15 (73%) of participants were male. Mean age was 68±9 (SD) years (range 49-82), eGFR was 81±10 ml/min/1.73 m2 and duration of diabetes was 15.8±9 years. 11/15 (73%) had hypertension and 9/15 (60%) received treatment with an ACE-inhibitor or Angiotensin-II blocker. 4/15 (27%) had cardiovascular disease. The median albumin-to-creatinine ratio was 29 mg/g (range: 4-1293). Both ACh and SNP dose-dependently increased FBF (Figure 1 and 2). FBF during SNP infusion was significantly higher during empagliflozin treatment as compared to placebo (p = 0.004), whereas there was no difference between empagliflozin and placebo in FBF during ACh infusion (P = 0.399). Conclusion Empagliflozin improves endothelium-independent vasodilatation in patients with DM2, whereas no changes could be observed in endothelium-dependent vasodilation. These results suggest that SGLT2i positively affects vascular function and that the effect is not related to nitric oxide from the endothelium.

EFFECTS OF PCSK-9 INHBITORS ON ARTERIAL STRUCTURE AND FUNCTION: PRELIMINARY RESULTS

Objective: One of the latest chapters in the research for new and stronger lipid lowering therapies has led to the development of PCSK9 inhibitors. In addition to the benefit on lipid profile, a limited number of studies have been published showing a possible improvement in vascular function and structure following their administration. To evaluate the effects of PCSK9 inhibitors on structural (via carotid Intima Media Thickness – IMT) and functional (carotid-femoral Pulse Wave Velocity – cf-PWV - and brachial artery Flow Mediated Dilatation - FMD) arterial properties. Design and method: Twenty-two dyslipidemic patients with a clinical indication to PSCK9 inhibitors were prospectively recruited at the Cardiology Rehabilitation of ASST Grande Ospedale Metropolitano Niguarda Hospital (Milan, Italy). Anthropometric, clinical and therapeutic data were recorded. Each patient underwent instrumental examinations to assess cf-PWV, IMT and FMD at T0 (before the start of therapy), T1 (after 6 months) and T2 (after 12 months). Results: In the 22 patients who reached 6 months of follow up there was a significant reduction in LDL cholesterol (from 127.8±31.7 to 47.4±29.1 mg/dl, p&lt;0. 0001) while there was no significant difference in arterial parameters (cf-PWV: from 10.5±3.5 to 9.4±2.3 m/s, p = 0.092; FMD: from 11.4±8.1 to 9.8±8.3%, p = 0.407; IMT: from 775.6±192.8 to 768.7±144.7, microm, p = 0.854). Similar results were also obtained in the 12 patients who reached one year of follow-up: LDL from 129.4±29.1 to 48.8±21.9 mg/dl, p&lt;0.0001; cf-PWV from 10.4±3.3 to 10.5±2.9, p = 0.874; FMD from 12.0±9.1 to 11.0±5.6%, p = 0.930; IMT from 745.1±203.9 to 770.0±127.3 microm, p = 0.710. Conclusions: Our study confirm the strong LDL reduction with PCSK9 inhibitors that are needed in order to reach the targets set by the ESC 2019 guidelines. In contrast, they do not show a significant effect on arterial function and structure in terms of cf-PWV, FMD and carotid IMT.

P197 EFFECTS OF PCSK–9 INHBITORS ON ARTERIAL STRUCTURE AND FUNCTION: PRELIMINARY RESULTS

Abstract Background One of the latest chapters in the research for new and stronger lipid lowering therapies has led to the development of PCSK9 inhibitors. In addition to the benefit on lipid profile, a limited number of studies have been published showing a possible improvement in vascular function and structure following their administration. Purpose: To evaluate the effects of PCSK9 inhibitors on structural (via carotid Intima Media Thickness – IMT) and functional (carotid–femoral Pulse Wave Velocity – cf–PWV – and brachial artery Flow Mediated Dilatation – FMD) arterial properties. Methods Twenty–two dyslipidemic patients with a clinical indication to PSCK9 inhibitors were prospectively recruited at the Cardiology Rehabilitation of ASST Grande Ospedale Metropolitano Niguarda Hospital (Milan, Italy). Anthropometric, clinical and therapeutic data were recorded. Each patient underwent instrumental examinations to assess cf–PWV, IMT and FMD at T0 (before the start of therapy), T1 (after 6 months) and T2 (after 12 months). Results In the 22 patients who reached 6 months of follow up there was a significant reduction in LDL cholesterol (from 127.8±31.7 to 47.4±29.1 mg/dl, p&amp;lt;0. 0001) while there was no significant difference in arterial parameters (cf–PWV: from 10.5±3.5 to 9.4±2.3 m/s, p=0.092; FMD: from 11.4±8.1 to 9.8±8.3%, p=0.407; IMT: from 775.6±192.8 to 768.7±144.7, microm, p=0.854). Similar results were also obtained in the 12 patients who reached one year of follow–up: LDL from 129.4±29.1 to 48.8±21.9 mg/dl, p&amp;lt;0.0001; cf–PWV from 10.4±3.3 to 10.5±2.9, p=0.874; FMD from 12.0±9.1 to 11.0±5.6%, p=0.930; IMT from 745.1±203.9 to 770.0±127.3 microm, p=0.710. Conclusion Our study confirm the strong LDL reduction with PCSK9 inhibitors that are needed in order to reach the targets set by the ESC 2019 guidelines. In contrast, they do not show a significant effect on arterial function and structure in terms of cf–PWV, FMD and carotid IMT.

Wild blueberry (poly)phenols can improve vascular function and cognitive performance in healthy older individuals: a double-blind randomized controlled trial

BackgroundEvidence suggests that the intake of blueberry (poly)phenols is associated with improvements in vascular function and cognitive performance. Whether these cognitive effects are linked to increases in cerebral and vascular blood flow or changes in the gut microbiota is currently unknown. MethodsA double-blind, parallel randomized controlled trial was conducted in 61 healthy older individuals aged 65–80 y. Participants received either 26 g of freeze-dried wild blueberry (WBB) powder (302 mg anthocyanins) or a matched placebo (0 mg anthocyanins). Endothelial function measured by flow-mediated dilation (FMD), cognitive function, arterial stiffness, blood pressure (BP), cerebral blood flow (CBF), gut microbiome, and blood parameters were measured at baseline and 12 wk following daily consumption. Plasma and urinary (poly)phenol metabolites were analyzed using microelution solid-phase extraction coupled with liquid chromatography–mass spectrometry. ResultsA significant increase in FMD and reduction in 24 h ambulatory systolic BP were found in the WBB group compared with the placebo group (0.86%; 95% CI: 0.56, 1.17, P < 0.001; −3.59 mmHg; 95% CI: −6.95, −0.23, P = 0.037; respectively). Enhanced immediate recall on the auditory verbal learning task, alongside better accuracy on a task-switch task was also found following WBB treatment compared with placebo (P < 0.05). Total 24 h urinary (poly)phenol excretion increased significantly in the WBB group compared with placebo. No changes in the CBF or gut microbiota composition were found. ConclusionsDaily intake of WBB powder, equivalent to 178 g fresh weight, improves vascular and cognitive function and decreases 24 h ambulatory systolic BP in healthy older individuals. This suggests that WBB (poly)phenols may reduce future CVD risk in an older population and may improve episodic memory processes and executive functioning in older adults at risk for cognitive decline.Clinical Trial Registration number in clinicaltrials.gov: NCT04084457.

Effects of traditional Chinese exercise on vascular function in patients with Alzheimer's disease: A protocol for systematic review and network meta-analysis of randomized controlled trials.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder with an insidious onset, usually characterized by memory impairment, visual-spatial skill impairment, executive dysfunction and personality behavioral changes. Studies have confirmed that vascular dysfunction may precede AD pathological changes and can present as vascular malformations, atherosclerosis, and impaired self-regulation, and can affect oxidative stress and amyloidosis. Therefore, it is important to improve or prevent vascular dysfunction in AD patients. Regular exercise can effectively inhibit the production of reactive oxygen species during the occurrence of AD and can improve the reduction of cerebral blood flow due to AD. Previous studies have shown that exercise can achieve superior clinical results in improving vascular function in AD patients. Therefore, we hypothesize that traditional Chinese exercises (TCEs) may have a good clinical effect in improving vascular function in patients with AD. We will search "PubMed," "the Cochrane Library," "Embase," "Web of Science," "CINAHL," "ProQuest Dissertations and Theses," and "ProQuest-Health & Medical Collection," "CNKI," "SinoMed," "VIP," and "Wanfang Data" to find randomized controlled trials of the effects of TCEs on AD vascular function from the creation of the database to the present, including at least 1 indicator in carotid intima-media thickness (cIMT), middle cerebral artery mean flow velocity (MFV), blood indicators [Heme Oxidase-1 (HO-1), angiopoietin I (Ang I), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor, matrix metalloproteinase-9 (MMP-9)], and arterial stiffness [(Ankle Brachial Index (ABI), pulse wave velocity (PWV)]. For the included literature, Excel 2019 will be used for data extraction and collection. For the indicators that can be netted for network meta-analysis, Surface Under the Cumulative Ranking for each exercise modality will be calculated with the help of Stata 16.0 and rank, where the higher the SUCRA score, the higher the ranking. For the indicators that cannot be netted, Review Manager 5.4 will be used for meta-analysis will be performed to evaluate the improvement effect of TCEs on AD patients. This meta-analysis will further determine the efficacy and safety of TCEs on vascular function in AD patients. In this study, randomized controlled trials of the effects of TCEs on vascular function in AD patients will be selected to provide evidence-based medical evidence for promoting the application of TCEs by observing the order of advantages and disadvantages of various exercise modalities through network meta-analysis.

Effect of menopause and age on vascular impairment

AimsThe prevalence of cardiovascular diseases increases in women after menopause. The aim of the study was to determine the impact of conventional cardiovascular risk factors such as age, blood pressure, smoking, cholesterol, obesity, and glucose balance, but also menopausal state and sleep-disordered breathing on vascular impairment during menopausal transition. Methods89 women initiated the study and 74 of them participated in the 10-year follow-up. Cardiovascular disease risk factor assessments, ultrasound measurements of brachial artery function, including nitroglycerin-mediated vasodilatation and flow-mediated endothelium-dependent vasodilation, and sleep studies were repeated at baseline and at 5-year and 10-year follow-ups. ResultsOver the study period, all the cardiovascular disease risk estimates increased. Both flow-mediated endothelium-dependent vasodilatation (decline 55 %) and nitroglycerin-mediated vasodilatation (decline 18 %) worsened over the 10 years (p < 0.001). Vascular function was not associated with menopausal state (determined with follicle stimulating hormone). Systolic blood pressure (p = 0.009) and smoking (p = 0.006) at baseline were negatively associated with nitroglycerin-mediated vasodilatation at 5-year follow-up and the use of hormonal therapy at 5-year follow-up was positively associated with concurrent nitroglycerin-mediated vasodilatation (p = 0.041). Intermittent nocturnal hypoxemia at baseline was associated with flow-mediated endothelium-dependent vasodilatation at 10-year follow-up (p = 0.043). High body mass index and impaired glucose balance at 5-year follow-up were associated with nitroglycerin-mediated vasodilatation decline at 10-year follow-up (p = 0.022 and p = 0.037, respectively). ConclusionsWe demonstrate how cardiovascular risk factors and vascular function evolve during menopausal transition. Although menopause was not associated with vascular impairment, short-term improvement in vascular function was observed in those using menopausal hormonal therapy. Intermittent nocturnal hypoxemia, obesity and impaired glucose control are early predictors of vascular decline during postmenopause.

Exploring mechanisms of blood pressure regulation in response to device-guided and non-device-guided slow breathing: A mini review.

Hypertension is a widespread disease that, if persistent, increases the risks of coronary heart disease mortality and morbidity. Slow breathing is a recommended blood pressure-lowering strategy though the mechanisms mediating its effects are unknown. This review aims to evaluate autonomic and vascular function as potential mediators driving BP adaptive responses with slow breathing. We searched EBSCO host, Web of Science, Cochrane Central Register of Controlled Trials, and PubMed using key words for optimized search results. Nineteen studies were included in this review (11 device-guided; 8 non-device-guided breathing). Though some studies showed increased vagally mediated components of heart rate variability during slow breathing, results from acute and long-term studies were incongruent. Increases in baroreflex sensitivity (BRS) following a single device-guided slow breathing bout were noted in normotensive and hypertensive adults. Long-term (4weeks to 3months) effects of slow breathing on BRS were absent. Device-guided breathing resulted in immediate reductions in muscle sympathetic nerve activity (MSNA) in normo- and hyper-tensive adults though results from long-term studies yielded inconsistent findings. Non-device-guided slow breathing posed acute and chronic effects on vascular function with reductions in arterial stiffness in adults with type I diabetes and increases in microvascular endothelial function in adults with irritable bowel syndrome. Non-device guided breathing also reduced pro-inflammatory cytokines in healthy and hypertensive adults in acute and chronic studies. No adverse effects or non-adherence to treatment were noted in these trials. Device-guided slow breathing is a feasible and effective modality in improving BRS, HRV, and arterial stiffness though its long-term effects are obscure. Though less evidence exists supporting the efficacy of non-device-guided slow breathing, acute and chronic studies demonstrate improvements in vascular function and inflammatory cytokines. More studies are needed to further explore the long-term effects of slow breathing in general and non-device-guided breathing in particular.

Abstract 15285: Exercise Adherence Among Older Persons With Hiv: Characteristics and Performance

Introduction: Despite optimal treatment adherence, the inflammatory response associated with HIV remains, which leads to premature vascular aging and a heightened risk for cardiovascular disease (CVD). Persons with HIV (PWH) are twice as likely to develop CVD at an average of 8 years earlier than non-HIV infected persons. Routine aerobic exercise as recommended by the AHA guidelines has been shown to lower inflammation, reduce cardiovascular risk factors and to benefit overall health. AHA guidelines recommend moderate to vigorous physical activity (MVPA) of at least 150 minutes per week, but less than 50% of the general population meets this standard and little is known about these parameters in older PWH (OPWH). Hypothesis: The purpose of this study was to examine adherence to a moderate intensity exercise regimen among OPWH (n=76). Methods: All participants (mean age 55 +/- 5.2, 65% male, 82% Black) were evaluated at baseline (BL) for cardiorespiratory fitness and target HR using the modified Balke VO2 test. Participants were provided an exercise prescription based on their individual target HR at 60 - 70 % max for at least 240 minutes per week and provided with activity trackers to monitor exercise adherence. Each participant was remotely monitored at regular intervals using MI techniques to determine exercise intensity and adherence to exercise prescription. Results: Mean exercise adherence at 3-, 6-, and 12-months was 63%, 60% and 61% respectively. Higher adherence was associated with higher baseline VO 2 max and reported lower sleep disturbance, perceived stress, fatigue, and pain as well as greater emotional support throughout the study. Persons with higher adherence to exercise were also associated with greater improvement in vascular function measured by flow-mediated dilation at 6-months. Conclusions: OPLWH participating in an aerobic exercise program for 1 year consistently exceeded the recommended 150 minutes/week of moderate intensity exercise by 10+% more than the general population. Exercise adherent participants achieved a high degree of cardiovascular activity and a reduction in physical/emotional deterrents to exercise which may lead to reduced CVD risk.

Swimming Exercise Alleviates Endothelial Mitochondrial Fragmentation via Inhibiting Dynamin-Related Protein-1 to Improve Vascular Function in Hypertension.

Regular exercise has been recommended clinically for all individuals to protect against hypertension but the underlying mechanisms are not fully elucidated. We recently found a significant mitochondrial fragmentation in the vascular endothelium of hypertensive human subjects. In this study, we investigated whether exercise could restore endothelial mitochondrial dynamics and thus improve vascular function in hypertension. Vascular endothelial mitochondrial morphological alterations were examined in patients with hypertension and hypertensive animal models. Furthermore, swimming exercise-induced endothelial mitochondrial dynamics and vascular function changes were investigated in spontaneously hypertensive rats (SHRs). Mitochondrial fragmentation with an elevated mitochondrial fission mediator Drp1 (dynamin-related protein-1) was observed in the mesenteric artery endothelium from hypertensive patients. A similar mitochondrial fragmentation with increased Drp1 expression were exhibited in the aortic endothelium of angiotensin II-induced hypertensive mice and SHRs. Interestingly, swimming exercise significantly reduced vascular Drp1 expression and alleviated endothelial mitochondrial fragmentation, thus improving blood pressure in SHRs. In cultured endothelial cells, angiotensin II exposure induced Drp1 upregulation, mitochondrial fragmentation and dysfunction, and reduced nitric oxide production, which was blunted by Drp1 genetic reduction or its inhibitor Mdivi-1. Mdivi-1 administration also ameliorated endothelial mitochondrial fragmentation, vascular dysfunction and blood pressure elevation in SHRs while swimming exercise plus Mdivi-1 treatment provided no additional benefits, suggesting that Drp1 inhibition may partially contribute to swimming exercise-conferred anti-hypertensive effects. These findings suggest that swimming exercise alleviates endothelial mitochondrial fragmentation via inhibiting Drp1, which may contribute to exercise-induced improvement of vascular function and blood pressure in hypertension.