Lower cfPWV Research Articles

Association between leisure-time physical activity and arterial stiffness in adults of the ELSA-Brasil study: a mediation analysis.

We aimed at defining the direct and the mediated pathways for the association between leisure-time physical activity (LTPA) and carotid-to-femoral pulse wave velocity (cf-PWV), and also to identify whether these effects are influenced by sex and age. Cross-sectional data from 13 718 adults (35-74 years) were obtained at the baseline of the ELSA-Brasil study. The cf-PWV was obtained by measuring the pulse transit time and the distance traveled by the pulse between the carotid and the femoral, as well as clinical and anthropometric parameters were measured. The levels of LTPA were determined by applying the long form of the International Physical Activity Questionnaire (IPAQ). Classical cardiovascular risk factors were independently associated with cf-PWV. Path analysis showed that increased levels of LTPA were directly associated with lower cf-PWV in both men and women ( β : -0.123 ± 0.03 vs. 0.065 ± 0.029, P for sex = 0.165), except for diabetes. Also, the mediated effect of LTPA on SBP and DBPs, heart rate, BMI, and fasting glucose, was associated with lower cf-PWV in men and women ( β : -0.113 ± 0.016 vs. -0.104 ± 0.016, P for sex = 0.692), except for diabetes. When age was tested as a moderator, the direct effect did not change significantly according to participants' age, regardless of sex. However, the mediated effect increases in both men and women over 50 years. Our findings support that LTPA in adults reduces cf-PWV by acting in different ways according to age. Physical activity in older individuals improves cardiometabolic risk factors and thus mitigates the stiffening of large arteries.

Mediating effect of fat mass, lean mass, blood pressure and insulin resistance on the associations of accelerometer-based sedentary time and physical activity with arterial stiffness, carotid IMT and carotid elasticity in 1574 adolescents

This study examined the mediating effect of total body fat mass, lean mass, blood pressure (BP) and insulin resistance on the associations of sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous PA (MVPA) with carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT) and carotid elasticity in 1574 adolescents from the Avon Longitudinal Study of Parents and Children birth cohort, UK. ST, LPA and MVPA were assessed with ActiGraph accelerometer. ST and LPA were sex-categorised in tertiles as low (reference), moderate and high, while MVPA was categorised as <40 min/day (reference), 40–<60 min/day and ≥60 min/day. cfPWV, cIMT and carotid elasticity were measured with Vicorder and ultrasound. Fat mass and lean mass were assessed with dual-energy X-ray absorptiometry and homeostatic model assessment of insulin resistance (HOMA-IR) was computed. Mediation analyses structural equation models and linear mixed-effect models adjusted for cardiometabolic and lifestyle factors were conducted. Among 1574 adolescents [56.2% female; mean (SD) age 15.4 (0.24) years], 41% males and 17% females accumulated ≥60 min/day of MVPA. Higher ST was associated with lower cIMT partly mediated by lean mass. Higher LPA (standardized β = −0.057; [95% CI −0.101 to −0.013; p = 0.014]) and the highest LPA tertile were associated with lower cfPWV. BP had no significant mediating effect movement behaviour relations with vascular indices. Lean mass partially mediated associations of higher MVPA with higher cIMT (0.012; [0.007–0.002; p = 0.001], 25.5% mediation) and higher carotid elasticity (0.025; [0.014–0.039; p = 0.001], 28.1% mediation). HOMA-IR mediated the associations of higher MVPA with higher carotid elasticity (7.7% mediation). Engaging in ≥60 min/day of MVPA was associated with higher carotid elasticity. In conclusion, higher LPA was associated with lower arterial stiffness, but higher MVPA was associated with thicker carotid wall explained by higher lean mass.

Factors associated with progression of arterial stiffness in ischemic stroke survivors: the Norwegian Stroke in the Young Study

Background Progressive arterial stiffening may increase the risk of recurrent cardiovascular events in ischemic stroke survivors. Information about factors associated with progressive arterial stiffening during the follow-up of young patients with ischemic stroke is lacking. Methods Arterial stiffness by carotid-femoral pulse wave velocity (cf-PWV) and ambulatory 24-hour blood pressure (24hBP) were assessed in 81 women and 190 men ≤60 years of age included in the Norwegian Stroke in the Young (NOR-SYS) study 3 months and 5.5 years after the incident ischemic stroke, representing baseline and follow-up. Covariables of change in cf-PWV were identified using linear regression analysis. Results At baseline, women had less prevalent hypertension (53% vs. 69%, p < 0.05), and lower clinic and 24hBP than men, whereas age, obesity, and prevalence of smoking and antihypertensive drug treatment did not differ. During follow-up, systolic 24hBP remained unchanged, while diastolic 24hBP fell significantly (p < 0.01). Cf-PWV was lower in women both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p < 0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, an increase in cf-PWV at the 5-year follow-up was associated with the presence of hypertension and lower cf-PWV at baseline, and higher systolic 24hBP and lack of use of antihypertensive treatment at follow-up (all p < 0.05). Conclusion In ischemic stroke survivors participating in the NOR-SYS study, the 5-year increase in cf-PWV did not differ between genders and was associated with higher systolic 24hBP and lack of antihypertensive treatment.

Abstract 13719: Minimal and Delayed Age-Related Increase of Arterial Stiffness Among Tsimane Forager-Horticulturalists

Background: Tsimane forager-farmers of the Bolivian Amazon exhibit a distinct trajectory of vascular aging, characterized by low age-related increases in BP, the lowest levels of coronary calcification ever reported, and robust VO 2 max. However, the prevalence of arterial stiffness (ArSt) in this population and its association with age and other cardiovascular risk factors are unknown. Methods: Large artery elasticity (LAE) and small artery elasticity (SAE) were measured among 491 Tsimane adults (mean age 55.3±13.0 y, 55% female) using HDI CR-2000 (Eagan, MN). Carotid-femoral pulse wave velocity (cfPWV) was assessed among 89 Tsimane (mean age 53.1±15.7 y, 54% female) using the foot-to-foot method with ECG and carotid/femoral pulse wave data. Results: Compared to previous studies from diverse urban populations, Tsimane show lower indices of ArSt: higher LAE (mean 22.79±12.21 ml/mmHg·10) and SAE (mean 7.57±4.04 ml/mmHg·100), and lower cfPWV (mean 6.34±2.1 m/s). LAE and SAE are 73% and 57% higher for Tsimane men, and 70% and 86% higher for Tsimane women, compared to age-matched US MESA adults. Tsimane demonstrate lower LAE and SAE with age, while higher cfPWV was only evident among Tsimane over 70 years (β=2.26±0.71, P =0.001; reference &lt;40 y). Hypertension is rare in this population, but was associated with having higher ArSt. Conclusion: Tsimane forager-farmers have substantially lower levels of ArSt and fewer age-related differences in ArSt compared to more urbanized and sedentary populations. The minimal and delayed age-related increase of arterial stiffness might contribute to the very low observed levels of coronary atherosclerosis and dementia in the Tsimane.

Arterial stiffness and the reallocation of time between device-measured 24-hour movement behaviours: A compositional data analysis

Background and aimsArterial stiffness predicts cardiovascular morbidity and mortality. We aimed to quantify the differences in arterial stiffness associated with reallocating time between 24-h movement behaviours. MethodsThis observational cross-sectional study included Luxembourg residents aged 25-79y who each provided ≥4 valid days of triaxial accelerometry (n = 1001). Covariable adjusted compositional isotemporal substitution models were used to examine if theoretical reallocations of time between device-measured sedentariness, the sleep period, light physical activity (PA), and moderate-to-vigorous PA (MVPA) were associated with the percentage difference in carotid-femoral pulse wave velocity (cfPWV). We further investigated if replacing sedentary time accumulated in prolonged (≥30 min) with non-prolonged (<30 min) bouts was associated with arterial stiffness. The results are presented as 30 min time exchanges (β (95% confidence interval)). ResultsBeneficial associations with lower cfPWV were observed when reallocating time to MVPA from the sleep period (−1.38 (−2.63 to −0.12) %), sedentary time (−1.70 (−2.76 to −0.62) %), and light PA (−2.51 (−4.55 to −0.43) %), respectively. Larger associations in the opposite direction were observed when reallocating MVPA to the same behaviours (for example, replacing MVPA with sedentary time: 2.50 (0.85–4.18) %). Replacing prolonged with non-prolonged sedentary time was not associated with cfPWV (−0.27 (−0.86 to 0.32) %). In short sleepers, reallocating sedentary time to the sleep period was favourable (−1.96 (−3.74 to −0.15) %). ConclusionsIncreasing or at least maintaining MVPA appears to be important for arterial health in adults. Extending sleep in habitually short sleepers, specifically by redistributing sedentary time, may also be important.

Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome.

Cardiovascular disease is a major cause of morbidity and mortality in Antiphospholipid syndrome (APS). Arterial stiffness (ArS) has emerged as a predictor of future cardiovascular events in the general population. We aimed to assess ArS in patients with thrombotic APS versus diabetes mellitus (DM) and healthy controls (HC) and identify predictors of increased ArS in APS. ArS was evaluated by carotid-femoral pulse wave velocity (cfPWV) and augmentation index normalized to 75 beats/min (AIx@75) using the SphygmoCor device. Participants also underwent carotid/femoral ultrasound for atherosclerotic plaque detection. We used linear regression to compare ArS measures among groups and assess ArS determinants in the APS group. We included 110 patients with APS (70.9% female, mean age 45.4 years), 110 DM patients and 110 HC, all age/sex matched. After adjustment for age, sex, cardiovascular risk factors and plaque presence, APS patients exhibited similar cfPWV [β = -0.142 (95% CI -0.514, 0.230), p = 0.454] but increased AIx@75 [β = 4.525 (95% CI 1.372, 7.677), p = 0.005] compared with HC and lower cfPWV (p < 0.001) but similar AIx@75 (p = 0.193) versus DM patients. In the APS group, cfPWV was independently associated with age [β = 0.056 (95% CI 0.034, 0.078), p < 0.001], mean arterial pressure (MAP) [β = 0.070 (95% CI 0.043, 0.097), p < 0.001], atherosclerotic femoral plaques [β = 0.732 (95% CI 0.053, 1.411), p = 0.035] and anti-β2-glycoprotein I IgM positivity [β = 0.696 (95% CI 0.201, 1.191), p = 0.006]. AIx@75 was associated with age [β = 0.334 (95% CI 0.117, 0.551), p = 0.003], female sex [β = 7.447 (95% CI 2.312, 12.581), p = 0.005] and MAP [β = 0.425 (95% CI 0.187, 0.663), p = 0.001]. APS patients exhibit elevated AIx@75 vs HC and similar to DM patients, indicating enhanced arterial stiffening in APS. Given its prognostic value, ArS evaluation may help to improve cardiovascular risk stratification in APS.

EFFECTS OF TRIATHLON TRAINING ON HEMODYNAMIC RESPONSES AND VASCULAR FUNCTION: THE ATHLAS STUDY

Objective: Regular and moderate endurance exercise has beneficial effects on the cardiovascular system. Triathlon is a rigorous endurance multisport that requires a higher level of training. Chronic consequences on cardiovascular system of such a high cardiovascular demand have not yet been highlighted. In this study, we assessed the effect of triathlon training and racing on the cardiovascular system in experienced triathletes. Design and method: ATHLAS is a prospective controlled study comparing 34 male recreational long-distance triathletes aged 19 to 39 years (Tri) with 29 healthy insufficiently active of the same age (Ctrl). All volunteers completed three visits throughout an annual sports season: at baseline during the off-season (in winter), at peak of physical performance during races period (in spring/summer), and during active rest in post-season (in autumn). At each visit, peripheral blood pressure was measured, and applanation tonometry was performed to evaluate arterial stiffness by carotid-femoral pulse wave velocity (cfPWV) and myocardial perfusion using the subendocardial viability ratio (SEVR). Results: At baseline, Tri had higher systolic blood pressure (SBP) and pulse pressure (PP) than Ctrl (respectively, 131.1±8.9 vs 125.7±10.4 mmHg; and 56.5±12.8 vs 48.9±6.5 mmHg, p&lt;0.05) but lower cfPWV (6.29 ±0.15 vs 6.95 ±0.16 m/sec, p&lt;0.01). SEVR was increased in Tri indicating better myocardial perfusion (mean difference of 34.42%, p = 0.03). At peak of performance in Tri, SBP and PP were decreased (respectively, mean difference of 3.63 mmHg, and 3.36 mmHg, p&lt;0.05), and returning to baseline levels in active rest. Tri cfPWV and SEVR were not influenced by training phases. In Ctrl group, SBP, PP and cfPWV exhibited seasonal variation with lower levels in spring/summer (p&lt; 0.05). Conclusions: Triathlon training and racing have beneficial effects on arterial stiffness and myocardial perfusion regardless of time of season. In triathletes, increased SBP despite lower arterial stiffness (cfPWV) reflects adaptation of the athlete's heart with a high cardiac output. These results will require further study to determine whether high blood pressure could lead to negative cardiovascular impact in the long term.

Association of socioeconomic status with arterial stiffness in older African American and White adults: The ARIC study cohort

ObjectiveTo examine the cross-sectional associations of individual measures of SES—educational attainment and household income—and the joint effects of SES with PWV, as well as the SES-race interaction, in a cohort of older African American and White adults. MethodsData from the Atherosclerosis Risk in Communities (ARIC) Study were used to evaluate the cross-sectional associations of individual and joint SES [education and income] and carotid femoral pulse wave velocity (cfPWV), a subclinical marker of arterial stiffness, and the interaction of SES and race using adjusted multivariable linear regression models in a cohort of 3342 men and women aged 67–89 years free of CVD in 2011–2013. ResultsParticipants were 64% female, 23% African American, mean cfPWV (12.3±3.5-African American and 11.6±3.9-White participants). Post-graduate education compared to less than high school was significantly associated with lower cfPWV (less stiffness) in African American (β = -1.28 m/s; 95% CI, -1.97, -0.59) but not in White (β = -0.69 m/s; 95% CI, -1.39, 0.01) participants. Income ≥$50K as compared to <$25K, was associated with lower cfPWV both in African American (β = -0.82 m/s; 95% CI, -1.42, -0.22) and White (β = -0.76 m/s; 95% CI, -1.19, -0.32) participants. The interaction of race and individual measures of SES on cfPWV in African American and White adults were not statistically significant (p-value >0.10). ConclusionsHigher SES was cross-sectionally associated with lower arterial stiffness in this cohort; the data did not support differences by race. Prospective studies of SES and cfPWV are needed to efficiently compare larger racially and regionally diverse populations with a wider range of socioeconomic profiles to better identify subgroup CVD risk.

Association between eating behaviour and 13-year cardiovascular damages in the initially healthy STANISLAS cohort.

Several dimensions of eating behaviour (EB), such as restrained eating (RE), appear to be cross-sectionally associated with certain cardiovascular (CV) diseases and metabolic risk factors although little is known regarding longitudinal associations. This study aimed to assess the associations between EB and CV damage or metabolic syndrome after 13 years, in initially healthy individuals. This study included 1109 participants from the familial STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux) cohort study. Emotional eating (EmE), RE, and external eating were assessed using the Dutch Eating Behaviour Questionnaire. Metabolic syndrome and CV damages such as carotid-femoral pulse-wave velocity (cfPWV), left ventricular mass, carotid intima-media thickness, and diastolic dysfunction (DD) were measured after a period of 13 years. Mixed model analysis with a family random effect and adjustment for age, sex, education, temporal gap, physical activity, metabolic factors at baseline, and the onset of CV disease during follow-up, and mediation analysis were performed in adults and adolescents separately. Among adults, EmE was associated with a 38% increased risk of DD 13 years later [odds ratio = 1.38 (1.05; 1.83)]. Stress level mediated 31.9% of this association (P = 0.01). Emotional eating was positively associated with cfPWV (β=0.02 [0.01; 0.04]). External eating was slightly associated with lower cfPWV (β=-0.03 [-0.05; -0.01]). No associations were observed between EB dimensions and metabolic syndrome. Energy intake was not found to be a mediator of any associations. Our results suggest that CV prevention should also take into account EB and include emotion regulation skills teaching.

Abstract 14102: The Joint Effect of Arterial Stiffness and High Central Blood Pressure on Risk of Stroke Among Hypertensive Adults

Introduction: The increases in arterial stiffness and central blood pressure (cBP) suggest significant status of vascular damages with different physio-pathological progress. However, the joint effect of them on risk of first stroke have remained uncertain. And the predictive value of CAP over peripheral blood pressure (bBP) is controversial. Hypothesis: This study aims to test the hypothesis that the combination of elevated arterial stiffness and central systolic blood pressure (cSBP) can predict first stroke and is associated with highest risks among hypertensive adults. Methods: A total of 7531 hypertensive adults without prior history of stroke were analyzed. cSBP was measured noninvasively using A-Pulse CASPro device. Arterial stiffness was measured by carotid-femoral pulse wave velocity using the noninvasive PulsePen device (WPP001-ET, DiaTecne s.r.l). Whole data was collected from July 2016 to December 2019. Increased arterial stiffness was defined as cfPWV ≥10 m/s. The primary outcome was first all-cause stroke. Results: Of the 7531 participants, mean age was 61.3 ± 9.3 years, 37.2% were male, the mean brachial blood pressure is the mean cfPWV was 9.4 ± 2.2 m/s, the mean cSBP is 131.3 ± 12.8 mmHg. During a mean follow-up time of 3.3 years, 432 (5.2%) participants developed stroke, of which 380 were ischemic strokes. Compared with the reference group (low cfPWV and cSBP), only the group with both high cfPWV and cSBP was significantly associated with risk of stroke after adjusted for covariates (HR: 1.51, 95% CI 1.10, 2.07). Similar result was found in Kaplan Meier Curve. Such association appears robust in different sub-group analysis. Conclusion: The combination of higher arterial stiffness and central systolic blood pressure is associated with highest risk of first stroke compared to other groups. The combined control of arterial stiffness and central blood pressure serves the purpose of primary prevention of first all-cause stroke among hypertensive population.

Abstract 9225: The Role of Leucine/Alpha-KIC/HMB Metabolism Pathway in Vascular Aging

Introduction: Vascular aging, starting from youth, encompasses arterial degeneration and hardening that impairs vascular function, and ultimately causes end-organ damage, predominantly in the heart, brain, and kidney. Leucine (Leu) is an essential amino acid in the biosynthesis of proteins. It is initially catalyzed to α-ketoisocaproate (α-KIC), and then further metabolized to β-hydroxy-β-methylbutyrate (HMB). Our prior work showed a significant decrease in circulating HMB in response to additional sodium intake, a key risk factor for accelerated vascular aging. Hypothesis: We aimed to test the hypotheses that Leu/α-KIC/HMB metabolic activity declines with chronological aging, and that Leu/α-KIC/HMB metabolism is inversely associated with vascular aging in a young population. Methods: Global metabolomic profiling was performed in blood samples from 65 black adolescents and young adults, aged 25.9 ± 9.4 yrs and 85% were female. Blood levels of leucine, α-KIC, and HMB were extracted and log-transformed. Associations of leucine, α-KIC, and HMB with age, carotid-femoral pulse wave velocity (cfPWV), and intima-media thickness (IMT) were determined by pairwise correlations. A p -value smaller than 0.05 was considered significant. Results: Among 65 subjects with an age range of 13 to 45 yrs, older age was associated with lower levels of HMB (r=-0.37, P =0.002) and α-KIC (r=-0.30, P =0.016), but not leucine (r=-0.22, P =0.078). Higher levels of HMB and α-KIC, but not leucine, were associated with lower cfPWV (HMB: r=-0.33, P =0.010; α-KIC r=-0.31, P =0.018). Metabolites in the Leu/α-KIC/HMB metabolism pathway were also inversely associated with IMT, but only HMB showed a borderline statistical significance (r=-0.23, P =0.072). Conclusions: Our findings indicated a potential role of Leu/α-KIC/HMB metabolism in vascular aging, even in a young black population.

Determining Underlying Mechanisms of Early Vascular Ageing by Clustered Analysis: The African-PREDICT Study.

Identifying individuals at increased risk of early vascular ageing (EVA) is paramount to inform intervention and prevention strategies and curb the increasing burden of cardiovascular disease. We stratified and phenotyped pre-screened young apparently healthy South African adults (20-30 yrs) (n=1,041) into vascular ageing profile groups based on carotid femoral pulse wave velocity (cfPWV) percentiles (healthy vascular ageing [HVA]; average vascular ageing [AVA] and EVA). We further compared various anthropometric, cardiovascular (CV), oxidative stress and lifestyle risk factors and determined factor scores to explore associations between CV measures and factor clusters to explore associations in those at risk of EVA. Young adults in the EVA group displayed marked phenotypic characteristics in terms of anthropometry, CV, and lifestyle risk factors, even though cfPWV were within healthy ranges. Blood pressure (brachial and central) and cfPWV were all incrementally higher across all three vascular ageing groups (p-trend ≤0.011). Hypertension, lifestyle risk factors such as self-reported smoking and alcohol consumption were all highest in the EVA group (p-trend ≤0.046). Additionally, in the EVA group only, cfPWV (adj. R2=0.028; β=0.171; p=0.042) associated positively with Factor 2 (oxidative stress and antioxidant capacity). No associations existed between Factor 1 (basic lipids) and any anthropometric or CV measures (p>0.050). Young adults with higher cfPWV presented with a less favourable vascular profile and more unhealthy lifestyle behaviours compared to groups with lower cfPWV. In the EVA group, cfPWV positively associated with a cluster of oxidative stress and antioxidant capacity. Early lifestyle behaviours may have the ability to modify the balance between oxidants and antioxidants, potentially contributing to early onset arterial stiffness.

Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial

BackgroundPeripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes.MethodsBetween 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015–2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate.ResultsRandomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI − 1.09 to − 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were − 1.25% (95% CI: − 3.28 to 0.78), central pulse pressure − 1.74 mmHg (95% CI − 4.79 to 1.31), central systolic blood pressure − 3.06 mmHg (− 7.08 to 0.96), and central diastolic blood pressure − 1.70 mmHg (− 3.74 to 0.34).ConclusionsIntensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.

The acute effect of maximal exercise on arterial stiffness in adults with and without intellectual and developmental disabilities.

We compared central and peripheral arterial stiffness response patterns between persons with and without intellectual and developmental disabilities (IDD) of different age groups at rest and following a cardiopulmonary exercise test (CPET). Fifteen young adults with and without IDD, and 15 middle-aged adults without IDD performed a CPET. Central and peripheral arterial stiffness were measured at rest and following CPET using estimates of carotid-femoral (cfPWV), carotid-radial (crPWV), and carotid-ankle (cdPWV) pulse wave velocity derived from piezoelectric mechano-transducers. cfPWV remained unchanged following CPET in adults with and without IDD but increased in middle-aged adults (d=0.85; 95% CI: 0.27-1.42m·s-1, p=0.005), whereas cdPWV was similarly reduced (d= -0.77; 95% CI: -1.06 to -0.48m·s-1, p<0.001) in all groups. crPWV remained unchanged in all groups. These results were independent of exercise-related changes in mean arterial pressure. Overall group differences suggested that persons with IDD (d = -1.78; 95% CI: -3.20 to -0.37m·s-1, p=0.009) and without IDD (d = -1.84; 95% CI: -3.26 to -0.43m·s-1, p=0.007) had lower cfPWV than middle-aged adults. We found no evidence of early vascular aging and diminished vascular reserve following CPET in adults with IDD.

Effects of Maximal Exercise on Central and Peripheral Arterial Stiffness in Adults with and without Intellectual and Developmental Disabilities

Adults with Down‐Syndrome seem to be protected from early aging‐associated increases in arterial stiffness and to present blunted responses to maximal aerobic exercise in comparison to age‐matched controls, possibly underlying diminished vascular reserve. However, whether these arterial stiffness responses apply to adults with intellectual and developmental disabilities (IDD) in general remains unknown. We compared central and peripheral arterial stiffness response patterns between persons with and without IDD of different age groups following maximal aerobic exercise. We hypothesized that adults with IDD would show an attenuated arterial stiffness response to maximal aerobic exercise in comparison to young and middle‐aged adults without IDD. Thirty young adults with (n=15, age= 30 ± 7 years) and without (n=15, age= 27 ± 7 years) IDD, and 15 middle‐aged adults (age= 51 ± 4 years) without IDD performed a bout of maximal aerobic exercise. Central and peripheral arterial stiffness were measured at rest and following maximal aerobic exercise using applanation tonometry estimates of carotid‐femoral (cfPWV), carotid‐distal (cdPWV), and carotid‐radial (crPWV) pulse wave velocity, respectively. cfPWV was unchanged following maximal aerobic exercise in young adults with and without IDD (figure) but increased in middle‐aged adults (d= 0.85; 95% CI: 0.27 to 1.42 m.s‐1, p= 0.005), whereas cdPWV was reduced (d= ‐0.77; 95% CI: ‐1.06 to ‐0.48 m.s‐1, p&lt; 0.001) and crPWV unchanged in all three groups, independent of changes in mean arterial pressure. Overall group differences suggest that young adults with (d= ‐1.78; 95% CI: ‐3.20 to ‐0.37 m.s‐1, p= 0.009) and without(d= ‐1.84; 95% CI: ‐3.26 to ‐0.43 m.s‐1, p= 0.007) IDD had lower cfPWV than middle‐aged adults. We found no evidence of early vascular aging and or a diminished vascular reserve following maximal aerobic exercise in adults with IDD.

The Functional Polymorphism of DDAH2 rs9267551 Is an Independent Determinant of Arterial Stiffness.

Background: The association of circulating asymmetric dimethylarginine (ADMA) levels with cardiovascular risk and arterial stiffness has been reportedly demonstrated, although the causal involvement of ADMA in the pathogenesis of these conditions is still debated. Dimethylaminohydrolase 2 (DDAH2) is the enzyme responsible for ADMA hydrolysis in the vasculature, and carriers of the polymorphism rs9267551 C in the 5′-UTR of DDAH2 have been reported to have higher DDAH2 expression and reduced levels of serum ADMA.Approach and Results: We genotyped rs9267551 in 633 adults of European ancestry and measured their carotid–femoral pulse wave velocity (cfPWV), the gold-standard method to estimate arterial stiffness. cfPWV resulted significantly lower in rs9267551 C allele carriers (Δ = −1.12 m/s, P < 0.01) after correction for age, sex and BMI, and a univariate regression showed that the presence of rs9267551 C variant was negatively associated with cfPWV (β = −0.110, P < 0.01). In a multivariable regression model, subjects carrying the rs9267551 C allele manifested significantly lower cfPWV than GG carriers (β = −0.098, P = 0.01) independently from several potential confounders. We measured circulating ADMA levels in a subset of 344 subjects. A mediation analysis revealed that the effect of DDAH2 rs9267551 genotype on cfPWV was mediated by the variation in ADMA levels.Conclusions: These evidences hint that the presence of rs9267551 C allele may explain, at least in part, a reduction in vessel rigidity as measured by cfPWV, and support the attribution of a causative role to ADMA in the pathogenesis of arterial stiffness.

Association of Estimated Cardiorespiratory Fitness in Midlife With Cardiometabolic Outcomes and Mortality

The associations of estimated cardiorespiratory fitness (eCRF) during midlife with subclinical atherosclerosis, arterial stiffness, incident cardiometabolic disease, and mortality are not well understood. To examine associations of midlife eCRF with subclinical atherosclerosis, arterial stiffness, incident cardiometabolic disease, and mortality. This cohort study included 2962 participants in the Framingham Study Second Generation (conducted between 1979 and 2001). Data were analyzed from January 2020 to June 2020. eCRF was calculated using sex-specific algorithms (including age, body mass index, waist circumference, physical activity, resting heart rate, and smoking) and was categorized as: (1) tertiles of standardized eCRF at examination cycle 7 (1998 to 2001); (2) tertiles of standardized average eCRF between examination cycles 2 and 7 (1979 to 2001); and (3) eCRF trajectories between examination cycles 2 and 7, with the lowest tertile or trajectory (ie, low eCRF) as referent group. Subclinical atherosclerosis (carotid intima-media thickness [CIMT], coronary artery calcium [CAC] score); arterial stiffness (carotid-femoral pulse wave velocity [-1000/CFPWV]); incident hypertension, diabetes, chronic kidney disease (CKD), cardiovascular disease (CVD), and mortality after examination cycle 7. A total of 2962 participants were included in this cohort study (mean [SD] age, 61.5 [9.2] years; 1562 [52.7%] women). The number of events or participants at risk after examination cycle 7 (at a mean follow-up of 15 years) was 728 of 1506 for hypertension, 214 of 2268 for diabetes, 439 of 2343 for CKD, 500 of 2608 for CVD, and 770 of 2962 for mortality. Compared with the low eCRF reference value, high single examination eCRF was associated with lower CFPWV (β [SE], -11.13 [1.33] ms/m) and CIMT (β [SE], -0.12 [0.05] mm), and lower risk of hypertension (hazard ratio [HR], 0.63; 95% CI, 0.46-0.85), diabetes (HR, 0.38; 95% CI, 0.23-0.62), and CVD (HR, 0.71; 95% CI, 0.53-0.95), although it was not associated with CKD or mortality. Similarly, compared with the low eCRF reference, high eCRF trajectories and mean eCRF were associated with lower CFPWV (β [SE], -11.85 [1.89] ms/m and -10.36 [1.54] ms/m), CIMT (β [SE], -0.19 [0.06] mm and -0.15 [0.05] mm), CAC scores (β [SE], -0.67 [0.25] AU and -0.63 [0.20] AU), and lower risk of hypertension (HR, 0.54; 95% CI, 0.34-0.87 and HR, 0.48; 95% CI, 0.34-0.68), diabetes (HR, 0.27; 95% CI, 0.15-0.48 and HR, 0.31; 95% CI, 0.18-0.54), CKD (HR, 0.63; 95% CI, 0.40-0.97 and HR, 0.64; 95% CI, 0.44-0.94), and CVD (HR, 0.46; 95% CI, 0.31-0.68 and HR, 0.43; 95% CI, 0.30-0.60). Compared with the reference value, a high eCRF trajectory was associated with lower risk of mortality (HR, 0.69; 95% CI, 0.50-0.95). In this cohort study, higher midlife eCRF was associated with lower burdens of subclinical atherosclerosis and vascular stiffness, and with a lower risk of hypertension, diabetes, chronic kidney disease, cardiovascular disease, and mortality. These findings suggest that midlife eCRF may serve as a prognostic marker for subclinical atherosclerosis, arterial stiffness, cardiometabolic health, and mortality in later life.

Associations of Walking Activity With Hypertensive Mediated Organ Damage in Community-Dwelling Elderly Chinese: The Northern Shanghai Study.

Background: Walking, as the most common campaign in older people, is recommended to improve their cardiovascular health. However, the direct association between weekly walking activity and asymptomatic hypertensive mediated organ damage (HMOD) remains unclear.Methods: 2,830 community-dwelling elderly subjects (over 65 years) in northern Shanghai were recruited from 2014 to 2018. Weekly walking activity was assessed by International Physical Activity Questionnaires (IPAQ). Within the framework of comprehensive cardiovascular examinations, HMOD, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity, creatinine clearance rate, urinary albumin–creatinine ratio, carotid-femoral pulse wave velocity (cf-PWV), carotid intima–media thickness (CIMT), arterial plaque, and ankle-brachial index (ABI), were all evaluated.Results: 1,862 (65.8%) participants with weekly walking activity showed lower CIMT, lower cf-PWV, fewer abnormal ABI, and lower prevalence of hypertension and coronary heart disease (p < 0.05). Walking activity was negatively correlated with age and smokers (correlation coefficient: −0.066, −0.042; both p < 0.05). After adjusting for cardiovascular risk factors and concomitant diseases, walking activity was significantly associated with better indicator of most vascular HMOD in multivariate logistic regressions, including arterial stiffness [odds ratio (OR) = 0.75, p = 0.01], increased CIMT (OR = 0.70, p = 0.03), and peripheral artery disease (OR = 0.72, p = 0.005), but not cardiac or renal HMOD. Subgroup analysis further showed that walking duration ≥1 h/day was significantly associated with decreased risk of most vascular HMOD after adjustment for confounders and moderate-to-vigorous physical activity based on IPAQ (all p < 0.05).Conclusions: In the community-dwelling elderly Chinese, there was a significant negative association of weekly walking activity with vascular HMOD, but not cardiac or renal HMOD. Increased daily walking duration, but not walking frequency, was significantly associated with improved vascular HMOD. Hence, increasing daily walking duration seems to encourage a healthy lifestyle in terms of vascular protection.Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02368938.

Effect of treatment on the hemodynamics system in systemic lupus erythematosus patients

Abstract Systemic lupus erythematosus (SLE) is a rare autoimmune disease which is associated with inflammation and accelerated atherogenesis, as it's related to the endothelium activation process. Measurements of arterial stiffness and IMTc are a repeatable and noninvasive methods to estimate a CVD risk. We could assume that the outcome of the correct therapy, if applied in the early stage of the SLE, could prevent the consequences of vessel inflammation and retract endothelium lesions. Purpose The main objective of this study was to assess the common carotid artery thickness of the intima-media complex (IMTc), ankle-brachial index (ABI), and pulse wave velocity (PWV) in patients with SLE and compare the studied parameters between individuals treated with corticosteroids with patients with other medications or without treatment. Methods Consecutive patients with SLE were included prospectively to the study between X 2016 and XII 20120 in the 2nd Department of Cardiology of our Medical University. Patients with other connective tissue diseases and chronic inflammation were excluded from this study. Activity of SLE was measured by The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K), with cut-off point at 6 points for active disease. Basic clinical data and cardiovascular (CVS) risk factors were gathered, each patient underwent the measurement of IMTc, ABI and cfPWV. All data were compared between groups treated or not treated with glicocorticosteroids (GCS). Results The study group consisted of 43 patients with SLE. Mean age was 57.4 years, 39 of the studied subjects were women, and 21 patients (48.84%) were treated with GCS. Mean duration of SLE time was 12.3 years, mean time of treatment with GCS was 5.3 years. On average the mean SLEDAI-2K value was 6.35±5.83 points and 18 patients (41.86%) had above 6 points. New-onset CV disease occurred in 6 patients (33.33%) treated with CGS and in 3 pts (25%) not treated with GCS (p=0.2546) Patients treated with GCS had lower values of ABI when compared to patients not treated with GCS (right ankle: 1.76 vs 1.86, p=0.047, left ankle: 1.63 vs 1.81, p=0.041) although the values were in the scope of standards. Similar situation occurred with the carotid femoral artery (cfPWV) (8.00 vs 8.83 m/s, p=0.032). However, the carotid radial artery PWV values were not significantly altered between groups (8.89 vs 9.61 m/s, p=0.12). The IMTc values were significantly higher in the GCS group (1.51 vs 1.13 mm, p&amp;lt;0.001). Statistically significant correlation with CVS risk factors was found for cfPWV (r=0.812, p=0.021). Conclusions Patients treated with GCS had lower cfPWV and ABI when compared to the group not treated with GCS. Further studies to establish the prognostic value of PWV among SLE patients are justified, as it could be superior to the IMTc measures at the early stage of vascular impairment, because PWV explores a greater range of vessels. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Silesia in Katowice, Poland

Abstract P218: The Association Of Mid-life Cumulative Exposure To Systolic Blood Pressure, Myocardial Oxygen Demand, And Hypertension With Later-life Central Arterial Stiffness And Its 5-year Change: The Atherosclerosis Risk In Communities Study - Neurocognitive Study (ARIC-NCS)

Background: Greater central artery stiffness predicts cardiovascular disease and all-cause mortality, thus understanding arterial stiffness determinants has prevention implications. Reports of the temporal association of blood pressure with arterial stiffness are conflicting and the association with myocardial oxygen demand has not been evaluated. Objective: Characterize the association of mid- to later-life cumulative exposure to systolic blood pressure (SBP), myocardial oxygen demand, and hypertension (HTN) with arterial stiffness and its 5-year change in older adults. Methods: We included 1,975 adults (1151 women; 359 Black; visit 5 mean age 74 years) examined in visits 5 (2011-13) and 6 or 7 (2016-19) of the population-based ARIC-NCS with measures of arterial stiffness (carotid-femoral pulse wave velocity (cfPWV)). Higher cfPWV indicates greater arterial stiffness. We calculated cumulative exposures as the sum of averages from four consecutive visits from 1987-89 to 1996-98 divided by total time. Myocardial oxygen demand was calculated as the rate pressure product (RPP): (SBP x heart rate)/1,000. We derived HTN duration as the time since first HTN detection. Associations of cumulative exposures with visit 5 cfPWV and the 5-year cfPWV change were evaluated by multivariable linear regression adjusted for demographics and cardiometabolic factors. Results: Over the mean 5.7 years between visits 5 and 6 or 7, cfPWV increased by 144.9 cm/s (SD: 276.0; range -680.0, 961.5 cm/s). HTN at any visit, duration, and the time-weighted cumulative measures were associated with higher visit 5 cfPWV (Table). Prevalent HTN was inversely associated with cfPWV change. No statistically significant associations were observed for the other exposures and cfPWV change. Conclusion: Cumulative exposure to SBP, RPP, and HTN are modifiable traits associated with higher cfPWV at later-life, but not with rate of cfPWV change in older adulthood. HTN at visit 5 was associated with lower cfPWV change, albeit the change is of small magnitude.