Independent Determinants Of Pulse Wave Velocity Research Articles

Diabetes Affects the Relationship between Heart Rate Variability and Arterial Stiffness in a Gender-Specific Manner.

Background and Aims: Heart rate variability (HRV), i.e., the beat-by-beat fluctuations in heart rate (HR) reflecting the autonomic nervous system balance, is altered in patients with diabetes. This has been associated with arterial aging (stiffer arteries) and differs in men and women. The present study hypothesized that the impact of HRV on arterial aging, indexed as carotid–femoral pulse wave velocity (PWV), differs in a gender-specific manner and is affected by diabetes mellitus. Method: A total of 422 outpatients (187 women and 235 men) were studied. PWV was measured using the validated SphygmoCor device (AtCor Medical). Time-domain and frequency-domain parameters were measured to assess HRV. Results: The prevalence of diabetes was 30.8% with a slight, but nonsignificant, greater prevalence in men. Both age and SBP were independent determinants of PWV in each of the four groups (men and women with or without diabetes). Low-frequency activity was inversely correlated with PWV. It was greater in women without diabetes, but it was not significant in men regardless of the presence of diabetes. Conclusions: Beyond age, blood pressure, and diabetes, impaired cardiac autonomic function assessed by determination of HRV was significantly associated with arterial aging. The association between lower sympathetic and parasympathetic activity and stiffer arteries was significant in women, but not in men.

RELATIONSHIP BETWEEN ARTERIAL STIFFNESS, PHYSICAL ACTIVITY & SEDENTARY TIME IN A YOUNG MIDDLE-EASTERN POPULATION

Objective: Arterial stiffness (AS) and physical activity are independent cardiovascular(CV) risk factors and predict outcome. We and others have shown that PA is associated with AS; however, the data is largely derived from older, Caucasian populations assessing PA with questionaires. The aim of this study was to explore the relationship between AS and PA using actigraphy in a young Middle-Eastern population, hitherto not studied. Design and method: Four-hundred and two apparently healthy subjects (mean age 20.7 ± 3 years, 52% females) were enrolled in this cross-sectional study. Anthropometric measurements performed included weight, height, waist and hip, total body fat, visceral fat and muscle mass. Participants received an accelerometer (ActiGraph™) to wear on the wrist for 7 consecutive days. The average minutes/day spent at different PA intensities (min/day) was determined according to established cut-points as well as metabolic equivalents (METS). Arterial stiffness was measured using the SphygmoCor™ and Mibilograph® as pulse wave velocity (PWV), central BP and augmentation index(AIx), after fifteen minutes of supine rest. The data was analysed using JMP Pro version 13 (SAS for Windows, NC, USA). Results: 30% of the population met the AHA Guidelines for PA with no gender difference. None of the subjects achieved moderate-vigorous or very vigorous activity with almost 50% of the time spent in being sedentary. There was a significant association between daily step count and body fat and body muscle content (p < 0.001). PWV was associated with age (r = 0.25, p < 0.001), brachial systolic BP(r = 0.57, p < 0.0001), aortic systolic BP(r = 0.65, p < 0.0001), cardiac output(r = 0.39, p < 0.0001), METS achieved(r = -0.42, p < 0.0001), light activity (r = -0.25, p < 0.001), moderate-to-vigorous (r = -0.29, p < 0.001), sedentary time (r = 0.45, P < 0.0001), waist(r = 0.47, p < 0.0001), visceral fat(r = 0.39, p < 0.001) and muscle mass(r = -0.31, p < 0.01). In a stepwise regression model with PWV as the dependent variable, age, MAP, gender, METS achieved and sedentary time emerged as independent determinants of PWV (R2 = 0.39, p < 0.0001). Conclusions: Unhealthy life-style is a strong risk factor for CVD, partly through the development of premature arterial stiffening. Our results highlight the deleterious effects of sedentary time on vascular function, independent of physical activity and energy consumption in a young, healthy population.

Impact of Low Birth Weight on Early Vascular Aging and Cardiometabolic Phenotypes in Later Life Among Cameroonian Adults

Background Evidence suggests that low birth weight (LBW) is associated with increased cardiovascular and metabolic risk in adulthood, including increased arterial stiffness, a marker of early vascular aging (EVA) assessable by pulse wave velocity (PWV), obesity and glucose homeostasis abnormalities. The present study aimed to explore the late impact of LBW on PWV and cardiometabolic phenotypes among young adult Cameroonians. Methods The study evaluated 120 subjects (mean age: 26 ± 5 years; 54% male sex) at the Cameroon Heart Institute, Douala, Cameroon, between January and June 2018. Birth weight (BW) and gestational age, sociodemographic, anthropometrics and fasting capillary blood glucose were recorded in all participants. Blood pressure (BP) and PWV were measured using an automatic oscillometric device (Mobil-O-Graph®). Multiple-adjusted linear regression was used to determine predictive factors for PWV. For assessment of potential impact of BW on EVA, PWV was adjusted for age, sex, body mass index (BMI) and mean arterial pressure (MAP). Results 28 participants (23.3%) of the study sample had LBW (<3000g). There was no gender difference between LBW or normal birth weight patients (NBW; controls). Age- and MAP-adjusted PWV (aPWV) were higher in women with LBW compared to NBW (5.6 m/s and 5.3 m/s respectively, P = 0.038). In men, aPWV was similar in LBW and NBW. In this study population, aPWV was higher (on average +15 cm/s) in LBW than in controls, although the difference was not statistically significant (P=0.083). Multivariate regression analysis showed age, male sex, BMI and MAP were independent determinants of PWV, but not LBW. Compared to NBW controls, the prevalence of overweight/obesity, impaired glucose homeostasis and diabetes was higher in LBW: 42.9% vs 37%; 10.7% vs 3.3%, and 3.6 % vs 1.1%, respectively. Moreover, compared with controls, LBW individuals who were overweight/obese in adulthood had a much higher mean fasting capillary glucose (1.54 ±0.17 g/l vs 0.87 ±0.11 g/l in NBW, p=0.003). Conclusion This study suggests that although LBW is associated with increased aortic stiffness in young adulthood, mainly in women, the association was predominantly driven by aging, MAP, BMI and male sex. In adulthood, LBW subjects exhibited higher obesity indices and altered glucose homeostasis.

Arterial Wall Stiffness and the Risk of Atherosclerosis in Egyptian Patients with Overt and Subclinical Hypothyroidism

Objective: Hypothyroidism is associated with an increased risk of atherosclerosis. Pulse wave velocity (PWV) is an index of arterial wall stiffness widely used for noninvasive assessment of early atherosclerosis. We assessed PWV in Egyptian patients with hypothyroidism. Methods: The study included 100 Egyptian females aged 18 to 55 years. They were classified into three groups: group I, 40 women with overt hypothyroidism; group II, 40 women with subclinical hypothyroidism; and group III, 20 euthyroid women as a control group. The three groups were age matched. Doppler ultrasonography was used to calculate the heart-femoral PWV. Results: PWV was significantly higher in women with overt and subclinical hypothyroidism as compared with the control group (9.55 ± 1.81 m/s and 9.30 ± 1.28 m/s, respectively vs. 7.82 ± 2.14 m/s; P<.001 and <.01, respectively). There was a positive correlation between thyroid-stimulating hormone (TSH) and PWV in women with overt hypothyroidism and in those with subclinical hypothyroidism (P<.05 for both). Multivariate regression analysis showed that age and diastolic blood pressure were independent determinants of PWV in women with overt and subclinical hypothyroidism (P<.01 for all). TSH was also an independent determinant of PWV in both groups (P<.05 for both). Conclusion: PWV is significantly higher in Egyptian women with overt and subclinical hypothyroidism as compared with normal control subjects. This denotes early increase in arterial wall stiffness in patients with hypothyroidism, even in the subclinical phase. The positive correlation between PWV and TSH in both groups of patients suggests that the risk of atherosclerosis is proportionate to the severity of hypothyroidism. Abbreviations: ABI = ankle/brachial index; baPWV = brachial-ankle pulse wave velocity; BP = blood pressure; CIMT = carotid intima-media thickness; ECG = electrocardiogram; FT4 = free thyroxine; HDL = high-density lipoprotein; hfPWV = heart-femoral pulse wave velocity; LDL = low-density lipoprotein; PTT = pulse transit time; PWV = pulse wave velocity; SCH = subclinical hypothyroidism; TSH = thyroid-stimulating hormone.

430-P: Plasma Delta-5 Desaturase Index Is Associated with Arterial Stiffness in Type 2 Diabetes

Decreased plasma n-3 polyunsaturated fatty acid (PUFA) levels or n-3/n-6 PUFA ratio is well known to be associated with the risk of cardiovascular diseases. The n-6 arachidonic acid (AA) to dihomo-γ-linolenic acid (DGLA) ratio in plasma, an indirect measure of delta-5 desaturase activity (D5D index), has been reported to be associated with insulin resistance, diabetes, and cardiovascular diseases. In this cross-sectional study, we investigated the association between plasma D5D index and arterial stiffness in patients with type 2 diabetes (T2D). This study included 382 patients with T2D and 118 healthy controls. Fasting plasma AA, DGLA, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) levels were measured by capillary gas chromatography. Arterial stiffness was assessed by measuring the heart-femoral pulse wave velocity (PWV). In patients with T2D, plasma AA levels (138.1 vs. 101.8 μg/mL, p&amp;lt;0.001) and plasma D5D index (5.85 vs. 4.49, p&amp;lt;0.001) were higher than the controls, while plasma DGLA levels were comparable to the controls (23.8 vs. 22.3 μg/mL, p=0.073). Patients with T2D had greater PWV than the controls (1141 vs. 935 cm/s, p&amp;lt;0.001). In the total population, the presence of T2D was independently associated with increased D5D index after adjusting for age, sex, and other metabolic parameters (β=0.311, p&amp;lt;0.001). Multivariate analysis in patients with T2D showed that D5D index was an independent determinant of PWV after adjusting for age, sex, (EPA+DHA)/AA ratio, and other cardiovascular risk factors (β=0.108, p=0.009). On the other hand, no significant association was found between D5D index and PWV in the controls. These data indicate that plasma n-6 AA/DGLA ratio, an estimate of D5D activity, is increased in patients with T2D and is associated with increased PWV, independently of classical cardiovascular risk factors and n-3 PUFAs. This study suggests that abnormal n-6 PUFA metabolism plays a role in advanced arterial stiffness in T2D. Disclosure T. Morioka: Research Support; Self; Eli Lilly and Company, Merck &amp; Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Roche Diagnostics K.K., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Other Relationship; Self; Ono Pharmaceutical Co., Ltd. M. Emoto: Research Support; Self; Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Taisho Toyama Pharmaceutical CO., Ltd., Takeda Pharmaceutical Company Limited. Y. Kakutani: None. Y. Yamazaki: None. K. Mori: Speaker's Bureau; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd. S. Fukumoto: Research Support; Self; Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Kowa Pharmaceutical Europe Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi K.K. A. Shioi: None. T. Shoji: Research Support; Self; Bayer Yakuhin, Ltd., Chugai Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd. Speaker's Bureau; Self; Kissei Pharmaceutical Co., Ltd., Kowa, Kyowa Hakko Kirin Co., Ltd. M. Inaba: None.

Abstract 19801: Obesity, Insulin Resistance and Loss of Dipping are Associated With Pulse Wave Velocity in Prepubertal Children

Introduction: Arterial stiffness is a dynamic property of the vessels which reflects changes in their structure and function and pulse wave velocity (PWV) is a noninvasive and high-resolution technique to indirectly evaluate it. Childhood obesity is known to be associated with the development of several cardiovascular comorbidities and to the progression of atherosclerosis. Hypothesis: We aimed to compare carotid-femoral PWV between normal weight and overweight/obese prepubertal children and to evaluate its association with other cardiovascular risk factors. Methods: We conducted a cross-sectional study of 315 children aged 8-9 years that have been followed in the population-based birth cohort Generation XXI (Portugal). Anthropometrics, 24-hour ambulatory blood pressure (BP) and PWV were measured. Classification of obesity was according to World Health Organization body mass index (BMI)-for-age reference values. Results: Compared to normal weight children, overweight and obese children presented significantly higher levels of PWV (4.95 (P25-P75: 4.61-5.23), 5.00 (4.71-5.33), 5.10 (4.82-5.50) m/sec, respectively; p for trend&lt;0.001). Significant positive correlations were found between PWV and total cholesterol, LDL cholesterol, triglycerides, fasting insulin and insulin resistance levels (estimated by homeostasis model assessment of insulin resistance - HOMA-IR) and with high-sensitivity C-reactive protein. In a multivariate linear regression model adjusted for sex, age, height and 24-hour systolic BP z-score, the independent determinants of PWV were BMI, HOMA-IR and the absence of dipping pattern. Conclusions: The association between PWV and the loss of dipping and insulin resistance levels, independently of the BMI, reinforces the contribution of these comorbidities to vascular injury in early life. Longitudinal studies are needed to strengthen the role of PWV as a valid tool for risk stratification in children.

Home blood pressure variability on one occasion is a novel factor associated with arterial stiffness in patients with type 2 diabetes

Recent studies have suggested that not only mean blood pressure but also variability in blood pressure might be related to cardiovascular disease. The aim of this study was to investigate the association between home blood pressure variability on one occasion and markers of arterial stiffness in patients with type 2 diabetes. We investigated the relationship between the s.d. of clinic- or home-measured systolic blood pressure on one occasion and pulse wave velocity (PWV) in 332 patients with type 2 diabetes, and we evaluated whether the SD of clinic- or home-measured systolic blood pressure on one occasion was an independent determinant of PWV by multivariate linear regression analysis, after adjustment for known risk factors for arterial stiffness, including sex, age, duration of diabetes, body mass index, hemoglobin A1c, serum total cholesterol, triglycerides, smoking status, drinking alcohol, presence of antihypertensive medication, average systolic blood pressure and heart rate. Age, average morning home-measured systolic blood pressure, heart rate and PWV (r=0.259, P<0.0001) were positively correlated with the s.d. of morning home blood pressure on one occasion. Multiple regression analysis demonstrated that age, average morning home-measured systolic blood pressure (P=0.0019), heart rate and the s.d. of morning home-measured systolic blood pressure on one occasion (P=0.0159) were independently associated with PWV. In conclusion, home blood pressure variability on one occasion was correlated with PWV, independent of other known risk factors, in Japanese patients with type 2 diabetes.

137 DETERMINANTS OF FUNCTIONAL AND STRUCTURAL PROPERTIES OF LARGE ARTERIES IN APPARENTLY HEALTHY ADULTS

Background: Changes in structural and functional properties of large arteries are correlated with increased cardiovascular risk. The identification of the determinants of these properties and their correlation in healthy subjects is important. Objectives: To evaluate in apparently healthy subjects: 1) distribution of values of structural and functional parameters of large arteries obtained by noninvasive methods. 2) main clinical and demographic determinants of these parameters and their correlations. Methods: We evaluated 210 subjects (54% women, mean age 44±13 years), no history or clinical evidence of cardiovascular disease. Blood pressure(BP) was measured by automatic device Omron(HEM 705CP) at sitting position. Carotid-femoral pulse wave velocity(PWV) was measured by Complior®. Properties of carotid artery (distension, diameter and intima-media thickness-IMT) were assessed by radiofrequency echotracking ultrasound(WTS-2®). All subjetcs underwent biochemical evaluation. Results: The mean values were: PWV=8.71±1.5 m/s, diameter=6617±985 μm, IMT=601.7±132 μm and distension=5.4±2% and no differences according to gender were observed. In univariate analysis, significant determinants(p <0.05) of main vascular parameters were:PWV (Age, Weight, SBP, DBP, Cholesterol, Triglycerides, Glucose), IMT (Age, SBP, PP, Cholesterol, Triglycerides), and Distension (Age, BMI, DBP, PP, HR, Cholesterol, Glucose, Triglycerides). In multivariate analysis, age was independent determinant of PWV and carotid IMT and distension, DBP for distension and creatinine level for diameter. PWV was directly correlated to IMT (R2=0.06,p<0.01) and inversely to distension (R2=0.08,p<0.01). Conclusions: In healthy individuals: a) functional and structural properties of large arteries are most influenced by age, but BP and other biochemical variables can be indirectly related; b)Carotid wall thickness is directly related to aortic stiffness, which in turn is inversely related to the functional capacity of carotid artery.

B-008 N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE COULD BE A MARKER OF SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH TYPE 2 DIABETES

Background Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in patients with type 2 diabetes. N-terminal pro-brain natriuretic peptide (NT-proBNP), which is a useful biomarker of chronic heart failure, has been shown to be a strong predictor of cardiovascular mortality. Furthermore, alterations in vascular structure and function are also recognized increasingly as significant independent predictors of adverse cardiovascularoutcomes. In this study, we investigated the relationships between NT-proBNP and markers of subclinical atherosclerosis in patients with type 2 diabetes. Methods Relationships of NT-proBNP to pulse wave velocity (PWV) or ankle-brachial index (ABI) as wellas to major metabolic risk parameters, including body mass index, blood pressure, serum lipid concentration, serum uric acid concentration,and glycemic control (hemoglobinA1c), age, hemoglobin, serum creatinine concentration, severity of diabetic nephropathy orretinopathy, current treatment of diabetes, smoking status, and presence of CVD were investigated in 323 consecutive patients with type 2 diabetes. Results Log (NT-proBNP) correlated positively with PWV (r = 0.283, p < 0.0001) and correlated negatively with ABI (r = −0.144, p = 0.0094). Multiple regression analysis demonstrated that age (β = 0.267, p < 0.0001), systolic blood pressure (β = 0.249, p < 0.0001), uric acid (β = 0.121, p = 0.0383), creatinine (β = −0.139, p = 0.0239) and log (NT-proBNP) (β = 0.173, p = 0.0043) were independent determinants of PWV and that log triglyceride (β = −0.130, p = 0.0390) andlog (NT-proBNP) (β = −0.153 p = 0.0256) were independent determinants of ABI. Conclusions NT-proBNP was associated with PWV and ABI in patients with type 2 diabetes. NT-proBNP could be a marker of subclinical atherosclerosis in patients with type 2 diabetes.

Relationship between increased arterial stiffness and other markers of target organ damage

The purpose of the present study was to assess the relationship of arterial stiffness with other markers of target organ damage, and the clinical factors related to it. Cross-sectional study that included 208 (115 men) never treated hypertensive, non-diabetic patients (mean age, 49+/-12 years). In addition to a full clinical study, 24h ambulatory blood pressure (BP), and determination of left ventricular hypertrophy (LVH) and microalbuminuria were performed. Clinical arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) obtained with applanation tonometry (SphygmoCor-System). PWV was 8.3 (7.3-9.9)m/s (median, interquartile range). Stepwise regression analysis revealed that age (beta=0.086, p<0.001), 24-h pulse pressure (beta=0.058, p<0.001), and low-density lipoprotein (LDL) cholesterol (beta=0.009, p<0.013) were independent determinants of PWV. PWV>12m/s (indicating target organ lesion) was present in only 16 (7.7%) patients, less frequent than LVH (28% of the patients) and microalbuminuria (16%). However, of the 16 patients with elevated PWV, 10 (62%) had neither LVH or microalbuminuria. In a logistic multivariate regression analysis the factors related to elevated PWV were age > or =45 in man and > or =55 in women (OR: 23.8, 95% CI: 2.7-195.5; p=0.004), LDL cholesterol > or =160mg/dl (OR: 10.6, 95% CI: 2.6-42.7; p=0.001) and increased 24-h pulse pressure > or =55mmHg (OR: 3.9, 95% CI: 1.2-12.9; p=0.03). In untreated middle age hypertensives arterial stiffness assessed by PWV is less frequent than LVH or microalbuminuria. PWV is mainly related to age, LDL cholesterol, and pulse pressure values.

Arterial Stiffness but Not Intima-Media Thickness Is Increased in Euthyroid Patients with Hashimoto's Thyroiditis: The Effect of Menopausal Status

Hashimoto's thyroiditis (HT) is an autoimmune disorder associated with increased cardiovascular risk, mainly as a result of accelerated atherosclerosis. The aim of this study was to determine the effect of HT on carotid atherosclerosis and arterial stiffness, as possible mediators of this vascular impairment. Menopausal status was also considered in this setting since HT is mainly prevalent in women. Fifty-four women with HT and normal thyroid function (thyrotropin [TSH] < 4.5 mU/L) and 72 healthy controls with comparable age and risk factor prevalence were examined in this cross-sectional study. Intima-media thickness (IMT) in the carotid arteries averaged from six sites and carotid-femoral pulse wave velocity (PWV) were measured. Although both groups had TSH levels within normal limits, TSH was higher in HT patients (2.1 +/- 1.16 vs. 1.5 +/- 0.8 mU/L, p = 0.001). PWV (7.95 +/- 2.02 vs. 7.21 +/- 1.24 m/s, p = 0.021), but not IMT (0.644 +/- 0.144 vs. 0.651 +/- 0.169 mm, p = 0.798), was significantly higher in HT patients compared to controls. When the women were divided according to menopausal status, only premenopausal women without HT had significantly lower PWV when compared with the three other subgroups (6.51 +/- 1.09 m/s premenopausal controls vs. 7.64 +/- 2.05 m/s premenopausal HT vs. 7.69 +/- 1.11 m/s postmenopausal controls vs. 8.3 +/- 1.97 m/s postmenopausal HT, p < 0.001). By multivariate analysis PWV independently correlated with age (p = 0.042), the presence of HT (p = 0.002), TSH (p = 0.003), and menopause (p < 0.001) in the whole population while HT was an independent determinant of PWV only in premenopausal women. HT is associated with increased PWV independent of arterial atheromatosis, indicating a direct impact of this disorder on arterial stiffening. This effect may be masked in postmenopausal women possibly due to their heavier cardiovascular risk profile.

Helicobacter pylori infection and arterial stiffness in patients with type 2 diabetes mellitus

Epidemiologic studies have suggested possible atherogenic roles for such pathogens as Chlamydia pneumoniae, Helicobacter pylori (Hp), cytomegalovirus, and herpes simplex virus. The aim of the present study was to examine the relationship between seropositivity of antibodies to Hp (Hp infection) and arterial stiffness determined by pulse wave velocity (PWV) in 130 patients (73 men and 57 women) with type 2 diabetes mellitus without a history of cardiovascular disease. The prevalence of Hp infection in patients with type 2 diabetes mellitus was 53.8%. Age (66.7 ± 11.3 vs 60.0 ± 12.2 years, P = .0014) and systolic blood pressure (138 ± 19 vs 131 ± 22 mm Hg, P = .0420) were significantly higher in patients with Hp infection than in those without. Serum C-reactive protein was higher in patients with Hp infection than in those without, although it did not reach statistical significance (0.23 ± 0.27 vs 0.18 ± 0.20 mg/dL, P = .2205). Pulse wave velocity was significantly higher in patients with Hp infection than in those without (1877 ± 550 vs 1585 ± 331 cm/s, P = .0005). Multiple regression analysis demonstrated that age ( β = .388, P < .0001), mean arterial pressure ( β = .289, P = .0006), hypertensive treatment ( β = .185, P = .0282), and presence of Hp infection ( β = .169, P = .0220) were independent determinants of PWV. In conclusion, Hp infection is associated with arterial stiffness determined by PWV in patients with type 2 diabetes mellitus.

Abstract 3002: Long Term Oral Contraceptive Use is an Independent Risk Factor for Arterial Stiffening

Oral contraceptives (OC) are among the most frequently used drugs in the world with approximately 100 million women worldwide taking OC. In contrast to the active controversy surrounding hormone replacement therapy, little attention has been focused on OC, a drug therapy taken by far more women for far longer time periods. We describe the population effects of current and long-term OC exposure on a prognostically well validated marker of arterial stiffness: carotid-femoral pulse wave velocity (PWV). The Asklepios study is a representative sample (2524 apparently healthy M/F volunteers, aged 35–55 years, 1301 women) from the Belgian general population, free from overt cardiovascular disease. The subjects were extensively screened (biochemistry, lifestyle, cardiac and vascular echography, arterial tonometry). PWV was measured from flow patterns registered by Doppler echography in the femoral and carotid arteries. Of 1301 women (median age 45.7 y), 27.4% were actively taking OC. In contrast past use of OC is far more prevalent with 81% of women having taken OC for at least 1 year. The median duration of exposition in these women was 13 years. Age-adjusted PWV was higher in women currently taking OC: 6.75 versus 6.55 m/s (difference 0.19 ± 0.09 m/s; p = 0.034). However, current OC users also had higher blood pressures (BP): systolic BP (+4.4 ± 0.9 mmHg; p &lt; 0.001), diastolic BP (+2.3 ± 0.6 mmHg; p &lt; 0.001). After adjustement for BP, the difference in PWV between current OC users and non-users became non-significant: 6.60 versus 6.62 m/s (difference 0.02 ± 0.09 m/s; p = 0.814). In contrast, duration of OC use is a significant determinant of PWV, even after adjustement for age, BP, lipid levels, body size, heart rate, drug therapy (lipid-lowering, antihypertensive), glycemic status and smoking: F = 6.1; p = 0.013. Per 10 years of OC exposure PWV increased by 0.1 m/s (0.02– 0.18; p = 0.013). Use of OC is associated with increased vascular stiffness in women. Current use is associated with increased PWV because OC’s increase blood pressure, long-term use (probably through structural remodelling of the vessels) is an independent determinant of PWV, increasing PWV by 0.10 m/s per 10 years exposure.

Long term oral contraceptive use is an independent risk factor for arterial stiffening

Background Oral contraceptives (OC) are among the most frequently used drugs in the world. We describe the population effects of current and long-term OC exposure on carotid-femoral pulse wave velocity (PWV). Methods The Asklepios study is a representative sample (n=2524, aged 35-55 years, 1301 women) from the Belgian general population, free from overt cardiovascular disease. The subjects were extensively screened; carotid-femoral PWV was measured using Doppler echography. Results Of 1301 women (median age 45.7 years), 27.4% were actively taking OC. However, past use of OC is far more prevalent with 81% having taken OC (median exposure 13 years). Age-adjusted PWV was higher in women currently taking OC: 6.75 versus 6.55 m/s (difference 0.19±0.09 m/s; p=0.034). However, current OC users also had higher blood pressures (BP): systolic +4.4±0.9 mmHg, p<0.001; diastolic +2.3±0.6 mmHg, p<0.001. After adjustment for BP, the difference in PWV between current OC users and non-users became non-significant: 6.60 versus 6.62 m/s (difference 0.02±0.09 m/s; p=0.814). Duration of OC use, in contrast, remained a significant determinant of PWV, even after adjustment for age, BP, lipids, body size, heart rate, drug therapy (lipid-lowering, antihypertensive), glycemic status and smoking: F=6.1; p=0.013. Per 10 years of OC exposure PWV increased by 0.10 m/s (0.02–0.18; p=0.013). Interpretation: Use of OC is associated with increased vascular stiffness. Current use is associated with increased PWV because OC's increase BP, long-term use (probably through structural remodelling of the vessels) is an independent determinant of PWV, increasing PWV by 0.1 m/s per 10 years of exposure.

Relationship between serum albumin and pulse wave velocity in patients on continuous ambulatory peritoneal dialysis

Hypoalbuminemia is a risk factor for cardiovascular events and mortality in dialysis patients, but the underlying mechanism remains unclear. Meanwhile, increased pulse wave velocity (PWV), the marker of arterial stiffness, has been proved to be an independent predictor of cardiovascular disease. The relationship between serum albumin and PWV in continuous ambulatory peritoneal dialysis patients (CAPD) was studied. Sixty-two CAPD patients were studied. The average age was 63 +/- 12 years and dialysis duration was 23 +/- 22 months. Serum albumin, C-reactive protein (CRP), and carotidfemoral PWV were measured. Among these patients, 43.5% were men. The mean serum albumin concentration was 37 +/- 4 g/L and PWV was 11.9 +/- 2.3 m/s. PWV positively correlated with age (r = 0.35, P < 0.01), diabetes (yes=1, no=0; r = 0.292, P < 0.05), systolic blood pressure (SBP; r = 0.493, P < 0.001) and CRP (r = 0.295, P < 0.05), but negatively correlated with serum albumin (r = -0.357, P < 0.01). In multiple regression analysis, SBP (beta = 0.615, P < 0.001), age (beta = 0.414, P < 0.01), albumin (beta = -0.315, P < 0.05) and total cholesterol (beta = 0.275, P < 0.05) were independent determinants of PWV. In a non-inflamed subgroup (CRP < 3 mg/L, n=30), albumin still negatively correlated with PWV (r = -0.66, P < 0.001). Serum albumin inversely correlated with increased PWV in CAPD patients, suggesting that increased arterial stiffness might be the link between hypoalbuminemia and increased cardiovascular mortality in dialysis patients.

Association of adiponectin with procollagen type I carboxyterminal propeptide in non‐diabetic essential hypertension

Objective. The serum concentration of procollagen type I carboxyterminal propeptide (PICP) is a good marker for collagen deposition in hypertension. Increased collagen deposition was associated with myocardial fibrosis and increased arterial stiffness. A decreased adiponectin level is associated with increased atherosclerosis. The role of adiponectin and its relation to PICP in essential hypertension have rarely been studied before. Methods. We recruited 188 non‐diabetic uncomplicated hypertensive patients (mean age: 41±7 years; 128 men). No patient had vascular complications or renal or liver diseases. Overnight fasting blood samples were collected to assess patient lipid profiles, blood sugar, insulin, high‐sensitivity C‐reactive protein (hsCRP), PICP and adiponectin. Carotid to radial pulse wave velocity (PWV) measured using tonometry was used as an index of arterial stiffness. Results. Adiponectin (r = −0.216, p = 0.003) and male gender (p<0.001) were independent determinants of PICP. Diastolic blood pressure (r = 0.422, p<0.001) and current smoking (p = 0.005) were independent determinants of PWV. PWV was significantly correlated with PICP (r = 0.156, p = 0.034). Adiponectin was significantly correlated with triglyceride (r = −0.276, p<0.001), high‐density lipoprotein (r = 0.262, p<0.001), the homeostasis model assessment (HOMA) index (r = −0.220, p = 0.002), hsCRP (r = −0.207, p = 0.004) and the body mass index (BMI) (r = −0.202, p = 0.005). After compensation with possible confounding factors, adiponectin was still significantly correlated with PICP (beta = −0.196, p = 0.006). Conclusion. Serum adiponectin may be a marker for metabolic syndrome in essential hypertension. Adiponectin was significantly negatively correlated with PICP. Metabolic syndrome probably plays an important role in increased collagen synthesis and arterial stiffness through the effects of decreased adiponectin in non‐diabetic essential hypertension.

Relationship between low serum endogenous androgen concentrations and arterial stiffness in men with type 2 diabetes mellitus

The aim of this study was to evaluate the relationship between arterial stiffness determined by pulse wave velocity (PWV) and serum endogenous androgen concentrations as well as major cardiovascular risk factors in men with type 2 diabetes mellitus. Serum free testosterone and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured in 268 men with type 2 diabetes mellitus. Relationships between PWV and serum endogenous androgen concentrations as well as major cardiovascular risk factors, including age, blood pressure, serum lipid concentration, glycemic control (hemoglobin A 1c), body mass index, and degree of albuminuria, were evaluated. Positive correlations were found between PWV and age ( r = 0.491, P < .0001), duration of diabetes ( r = 0.320, P < .0001), systolic blood pressure ( r = 0.292, P < .0001), and log (urinary albumin excretion) ( r = 0.269, P < .0001). Inverse correlations were found between serum free testosterone concentration and PWV ( r = −0.228, P = .0003) and between serum DHEA-S concentration and PWV ( r = −0.252, P = .0002) in men with type 2 diabetes mellitus. Pulse wave velocity was significantly greater in patients with lower concentrations of free testosterone (<10 pg/mL) than in patients with higher concentrations of free testosterone (1864 ± 359 vs 1736 ± 327 cm/s; P = .0053). Pulse wave velocity also was significantly greater in patients with lower concentrations of DHEA-S (<1000 ng/mL) than in patients with higher concentrations of DHEA-S (1843 ± 371 vs 1686 ± 298 cm/s; P = .0008). Multiple regression analysis identified both serum free testosterone concentration ( β = −.151, P = .0150) and serum DHEA-S concentration ( β = −.200, P = .0017) as independent determinants of PWV. In conclusion, serum endogenous androgen concentrations are inversely associated with arterial stiffness determined by PWV in men with type 2 diabetes mellitus, which is true for men in general based on other works.

Relations of cardiovascular risk factors to aortic pulse wave velocity in asymptomatic middle-aged women.

Cross-sectional associations between aortic elasticity assessed by carotid to femoral pulse wave velocity (PWV) and cardiovascular risk factors were examined in 429 apparently healthy middle-aged women. PWV was strongly and positively related to blood pressure and hypertension. Weak but significant positive associations were also found between PWV and age, heart rate, some lipids and lipoproteins, blood glucose (either as a continuous or dichotomous variable), body mass index, haematocrit, leucocyte count and family history of diabetes. No associations were observed between PWV and high density lipoprotein cholesterol, apolipoprotein A1, fibrinogen, cigarette smoking, menopausal status and a family history of hypertension or myocardial infarction. After adjustment for systolic blood pressure, PWV remained significantly related to heart rate, leucocyte count, blood glucose (as a dichotomous variable) and a family history of diabetes. Multiple regression analysis showed that systolic blood pressure and, to a lesser extent, heart rate, leucocyte count and a family history of diabetes were all independent determinants of PWV. This pattern of associations suggests that arterial stiffness measured by PWV reflects the sclerotic rather than the atherotic component of atherosclerosis. The potential influence of a family history of diabetes on the elastic properties of the aorta needs to be ascertained in further studies.