Markers Of Cardiovascular Health Research Articles

Fibre Intake Is Associated with Cardiovascular Health in European Children.

Background: We aimed at analysing the association between dietary fibre intake during childhood and cardiovascular health markers. Methods: We used observational longitudinal analysis and recorded diet using 3-day diaries at the ages of 3, 4, 5, 6, and 8 years in children from the EU Childhood Obesity Project Trial. At the age of 8, waist circumference, systolic and diastolic blood pressure (SBP and DBP) and biochemical analyses (lipoproteins, triglycerides and homeostasis model for insulin resistance (HOMA-IR)) were evaluated. Those parameters were combined into a cardiometabolic risk score through the sum of their internal z-scores. Results: Four-hundred children (51.8% girls) attended to the 8-year visit with a 3-day diary. Adjusted linear regression models showed that children who repeatedly stayed in the lowest tertile of fibre intake during childhood had higher HOMA-IR (p = 0.004), higher cardiometabolic risk score (p = 0.02) and a nonsignificant trend toward a higher SBP at 8 years. The higher the dietary intake of soluble fibre (from fruits and vegetables) at 8 years, the lower the HOMA-IR and the cardiometabolic risk score (p = 0.002; p = 0.004). SBP was directly associated with fibre from potatoes and inversely with fibre from nuts and pulses. Conclusion: A diet rich in dietary fibre from fruits, vegetables, pulses and nuts from early childhood was associated to a healthier cardiovascular profile, regardless of children’s weight.

Relationship of Indicators of Cardiovascular Health With Change in Cognition in Older Blacks

Older Blacks perform more poorly on cognitive testing than older Whites. Increased prevalence of cardiovascular disease risk factors (CVD-RFs) among Blacks compared to Whites contribute to these disparities. We investigated whether white matter hyperintensities (WMHs) in late-life, a consequence of mid-life CVD-RFs, modify the association between late-life CVD-RFs and cognition in 167 Blacks (age~75yrs; non-demented at baseline). Participants were evaluated for blood pressure (BP) markers of cardiovascular health (systolic/diastolic BP, pulse pressure, mean arterial pressure (MAP) hypertension), WMH volumes adjusted for intracranial volume, and cognition (global and domain-specific at baseline and annually, ~8yrs). Adjusted models revealed differential associations between BP markers and baseline cognition; diastolic BP and MAP predicted faster decline in episodic memory. Hypertension was not significant in any model; however, when adding WMH, the hypertension*WMH interaction was significant for baseline cognition. Cognition among older Blacks is a complex function of BP markers of cardiovascular health and WMH.

The utility of resting pulse rate in defining high blood pressure among adolescents in Mbarara municipality, Uganda.

High resting pulse rate (RPR) is associated with adverse cardiovascular events and could be used as a marker of cardiovascular health. We determined the correlation between RPR and blood pressure (BP); and its accuracy in defining high blood pressure among adolescents attending secondary schools in Mbarara municipality, south-western Uganda. We conducted a cross-sectional study among secondary school adolescents aged 12-19 years in Mbarara municipality, Uganda. We captured demographic characteristics using a structured questionnaire; and measured anthropometric indices and BP. We performed a linear regression analysis to determine the relationship between RPR and blood pressure and plotted receiver operating characteristics curves (ROC) to assess the accuracy of RPR in defining high BP. We enrolled 616 adolescents with a mean age of 15.6 ± 2.0 years and 65.6% (404/616) were female. The RPR was significantly correlated with diastolic blood pressure (DBP) in both boys (Beta = 0.22 [95% CI: 0.10; 0.36]), p < 0.001 and girls (Beta = 0.51 [95% CI: 0.43; 0.60]), p < 0.001. RPR was significantly correlated with systolic blood pressure (SBP) only in the girls (Beta = 0.23 [95% CI: 0.15; 0.30]), p < 0.001. The optimal threshold for RPR in defining prehypertension was RPR ≥ 76 bpm with an area under the curve (AUC) of 0.653 [95% CI: 0.583-0.722], the sensitivity of 0.737 and specificity of 0.577. In defining hypertension, the optimal threshold was RPR ≥ 79 bpm at a sensitivity of 0.737 and specificity of 0.719, with an AUC of 0.728 [95% CI: 0.624-0.831]. Resting pulse rate was positively correlated with BP and was more accurate in defining hypertension compared to prehypertension in the study.

Differential associations between a priori diet quality scores and markers of cardiovascular health in women: cross-sectional analyses from TwinsUK.

CVD is the leading cause of death worldwide and, after dementia, is the second biggest cause of death for women. In England, it accounts for one in four of all deaths. Lifestyle modifications represent the primary route both to reduce CVD risk factors and prevent CVD outcomes. Diet constitutes one of the key modifiable risk factors in the aetiology of CVD. We investigated the relationship between nine main dietary indices and a comprehensive range of CVD risk factors in 2590 women from TwinsUK. After adjustment for multiple testing, we found that the Dietary Approaches to Stop Hypertension (DASH) diet was inversely correlated with some of the most common CVD risk factors (BMI, visceral fat (VF), TAG, insulin, homoeostasis model assessment of insulin resistance (HOMA2-IR) and atherosclerotic CVD (ASCVD) risk) with PFDR ranging from 6·28 × 10-7 to 5·63 × 10-4. Similar association patterns were detected across most of the dietary indices analysed. In our post hoc investigation, to determine if any specific food groups were driving associations between the DASH score and markers of cardiometabolic risk, we found that increased BMI, VF, HOMA2-IR, ASCVD risk, insulin and TAG levels were directly correlated with red meat consumption (PFDR ranging from 4·65 × 10-9 to 7·98 × 10-3) and inversely correlated with whole-grain cereal consumption (PFDR ranging from 1·26 × 10-6 to 8·28 × 10-3). Our findings revealed that the DASH diet is associated with a more favourable CVD risk profile, suggesting that this diet may be a candidate dietary pattern to supplement current UK dietary recommendations for CVD prevention.

Value of baseline clinical and CMR characteristics for the prediction of cancer therapeutics-related cardiac dysfunction: results from the Cardiotoxicity Prevention Research Initiative (CAPRI)

Abstract Background Whether baseline cardiovascular health status significantly influences the risk of Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD) in patients receiving de-novo chemotherapy exposure is an important clinical question for both surveillance and management decisions. The reference standard technique for the serial monitoring of left ventricular (LV) volumes and ejection fraction (EF) is cardiovascular magnetic resonance (CMR). Using this technique, we sought to prospectively evaluate baseline clinical risk factors and CMR-based pre-exposure characteristics for their influence on the incident occurrence of CTRCD. Methods We prospectively enrolled 371 cancer patients referred for baseline (pre-chemotherapy) followed by surveillance CMR imaging as part of the Cardiotoxicity Prevention Research Initiative (CAPRI). We also recruited 62 healthy volunteers to evaluate for referral population differences in CMR-based markers. Study subjects and healthy volunteers underwent identical CMR imaging protocols inclusive of cine imaging, T1 and T2 mapping. CTRCD was defined according to surveillance CMR imaging with criteria established as a drop in LVEF by &amp;gt;5% (meaningful detectable difference for CMR technique) to a value ≤56% (lower limit of normal) at any time point during chemotherapy surveillance. A total of 1474 CMR studies were performed over a median surveillance period of 12.5 months (range 2.3 to 68.9 months). Results The majority of patients were female (77%), being referred for breast cancer (64%) or lymphoma (36%), with a mean age of 54.0±14 years. The baseline prevalence of hypertension, diabetes, hyperlipidemia, and current smoking were 32%, 11%, 46%, and 13%, respectively. Compared to healthy volunteers, cancer patients at baseline showed smaller indexed LV and RV volumes, higher indexed LV mass, and higher native T1 values (mean difference +33 msec; p&amp;lt;0.001). LV and right ventricular (RV) EF and T2 mapping values were not significantly different. CTRCD criteria were met in 22% of patients. Figure 1 shows a forest plot of univariable and multivariable predictors of CTRCD occurrence. Following multivariable adjustment, only combined anthracycline/trastuzumab regimen (OR 4.4, 95% CI 2.0–9.5) and baseline indexed LVEDV (OR 2.3, 95% CI 1.2–4.5) were found to be significant predictors of this outcome. Conclusion Using the reference standard of serial CMR imaging we identified that of all baseline (pre-chemotherapy) clinical and CMR-based markers of cardiovascular health, only indexed LV end-doastolic volume (EDV) was independently associated with future occurrence of CTRCD following adjustment for chemotherapy regimen. We did not observe significant associations with conventional cardiac risk factors in our study population. The observed risk for indexed LVEDV was clinically meaningful (2.3-fold risk per 10 ml/m2) and warrants further investigation as a relevant baseline marker of risk in this referral population. Figure 1. Forest plot of predictors of CTRCD Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Alberta Innovates/Genome Alberta: CAPRI

High-resolution CINE MRI allows estimation of 3D regional atrial strains

Abstract Introduction It is increasingly evident that atrial function is an important marker of cardiovascular health. Impaired global left atrial strain has been associated with risk of thromboembolic events, atrial fibrillation and heart failure. When performed at high spatial resolution, CINE MRI allows the estimation of regional atrial strains, which may facilitate earlier identification of atrial disease and improved (non-contrast) characterisation of atrial fibrosis. Nevertheless, to date, high resolution regional atrial strains has not been assessed using CINE MRI. Purpose We introduce a novel rapid 2.2-mm isotropic atrial CINE MRI protocol used to image healthy subjects and patients with cardiovascular disease (CVD). We additionally present a dedicated image analysis pipeline to estimate regional 3D atrial strains from these images. Methods We imaged 10 healthy subjects (5 female, 24–36 years old) and 6 patients referred for cardiac MRI due to known or suspected CVD (2 female, 25–80 years old). All subjects were scanned in a 1.5T Philips Ingenia MRI scanner in a single breath-hold (&amp;lt;25 s), using a short-axis 3D bSSFP protocol (flip angle: 60°, TE/TR: 1.6/3.3 ms) with retrospective cardiac gating, SENSE = 2.3 (along both phase encode directions), typical FOV: 400 x 270 x 70 mm3, isotropic acquisition resolution of 2.2 mm3. Images were reconstructed to 20 cardiac phases with 55% view sharing. The left atrium (LA) was manually segmented in atrial diastole. We tracked the position of evenly spaced points along the LA contour across all phases of the cardiac cycle using the Medical Image Tracking Toolbox. This was used to create a series of deforming smooth triangular meshes, from which Lagrange strain tensors were estimated. Results Figs a-c show 3 orthogonal views of the proposed high-resolution atrial CINE MRI scans for a representative CVD patient, with the LA segmentation overlaid in red. Representative LA principal strain directions (as arrows) with the colour indicating the amount of strain observed along this direction are shown in Fig d for active atrial contraction (posterior view). The calculated strain directions varied smoothly in space and time, as expected, and were largest in amplitude in the regions closest to the mitral valve. Overall, principal strains were larger in healthy subjects (AC strains: 0.12±0.06) than in the CVD cohort (AC strains: 0.04±0.01). This difference was statistically significant during AC (p-value: 0.02), but not during atrial diastole (p-value: 0.06). Conclusions We present a novel high-resolution CINE-MRI protocol for estimating regional atrial strains in 3D, with pilot data from 10 healthy subjects and 6 cardiovascular patients. Future studies will compare regions of abnormal atrial strain with fibrosis identified in late gadolinium enhanced MRI to assess whether regional strains can provide a better characterisation of atrial tissue and improved stratification of patients at risk. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation, EPSRC/Wellcome Trust Centre for Medical Engineering

The effect of olive leaf extract on cardiovascular health markers: a randomized placebo-controlled clinical trial

PurposeOverweight and obesity are associated with many health problems, including cardiovascular disease (CVD). Evidence from previous studies has shown that extracts from olive leaves rich in olive phenolics are able to positively affect CVD risk factors, such as high blood pressure and dyslipidemia. The aim of this study was to investigate the effect of 8-week olive leaf extract (OLE) administration on blood lipid profiles in overweight/obese subjects with mildly elevated cholesterol levels.MethodsIn this randomized, double-blind, placebo-controlled study, 77 healthy adult overweight/obese subjects (aged 56 ± 10 years and BMI 29.0 ± 2.7 kg/m2) with total cholesterol levels of 5.0–8.0 mmol/L (5.9 ± 0.7 mmol/L) were randomly assigned to receive 500 mg of OLE (n = 39) or placebo (n = 38) for 8 weeks. In total, 74 subjects completed the entire study protocol. At baseline, after 4 weeks, and after 8 weeks of supplementation, blood lipid profiles, oxidized low-density lipoprotein (oxLDL), blood pressure, glucose, and insulin levels were assessed. In addition, liver function parameters were measured at baseline and after 8 weeks.ResultsOLE supplementation did not significantly affect blood lipid levels after 4 weeks or after 8 weeks compared to placebo (all p > 0.05). For oxLDL, blood pressure, glucose, and insulin levels and liver function parameters, also no statistically significant differences were found between the two intervention groups (all p > 0.05).ConclusionsBlood lipid profiles were not significantly affected by 8 weeks OLE supplementation in overweight/obese subjects with mildly elevated cholesterol levels.Trial registeredThe trial has been registered at ClinicalTrials.gov (NCT02990637).

Optimism, pessimism, and health biomarkers in older couples.

Studies have demonstrated the importance of optimism in predicting perceived general health. However, the handful of studies focusing on cardiovascular biomarkers show inconsistent effects. Additionally, no study examined whether spousal levels of optimism and pessimism affect an individual's biological markers of cardiovascular health. Thus, our objectives were to examine whether partners' optimism and pessimism affect individual biological markers, differentiating between between-dyad associations and within-dyad predictive processes. Three waves of the Health and Retirement Study collected in 2006, 2010, and 2014 were used to test actor and partner effects of optimism and pessimism on C-reactive protein (CRP) and high-density lipoprotein. Multilevel longitudinal actor-partner models were used to examine the contribution of a partner's optimism and pessimism to each biomarker, adjusting for respondent's age, sex, depression, body mass index, daily activity levels, and a summary score of respondent's doctor-diagnosed chronic conditions. Partners' pessimism and optimism levels were moderately associated. Results for within-person effects were all non-significant, both within and across waves. Associations at the between-person level were also non-significant, with the exception of a positive association between husbands' pessimism and their own CRP, and husbands' optimism and their wives' CRP. Results suggest that optimism and pessimism may not play a pertinent role in within variability of biomarkers of cardiovascular diseases and have a minor role in predicting to between-person variability of biomarkers of cardiovascular diseases.

The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population-Based Pediatric Studies\u2014A Narrative Review

Stress inducement by physical exercise requires major cardiovascular adaptations in both adults and children to maintain an adequate perfusion of the body. As physical exercise causes a stress situation for the cardiovascular system, cardiovascular exercise stress tests are widely used in clinical practice to reveal subtle cardiovascular pathology in adult and childhood populations with cardiac and cardiovascular diseases. Recently, evidence from small studies suggests that the cardiovascular stress response can also be used within research settings to provide novel insights on subtle differences in cardiovascular health in non-diseased adults and children, as even among healthy populations an abnormal response to physical exercise is associated with an increased risk of cardiovascular diseases. This narrative review is specifically focused on the possibilities of using the cardiovascular stress response to exercise combined with advanced imaging techniques in pediatric population-based studies focused on the early origins of cardiovascular diseases. We discuss the physiology of the cardiovascular stress response to exercise, the type of physical exercise used to induce the cardiovascular stress response in combination with advanced imaging techniques, the obtained measurements with advanced imaging techniques during the cardiovascular exercise stress test and their associations with cardiovascular health outcomes. Finally, we discuss the potential for cardiovascular exercise stress tests to use in pediatric population-based studies focused on the early origins of cardiovascular diseases.

Education, Smoking and CRP Genetics in Relation to C-Reactive Protein Concentrations in Black South Africans.

Because elevated circulating C-reactive protein (CRP) and low socio-economic status (SES), have both been implicated in cardiovascular disease development, we investigated whether SES factors associate with and interact with CRP polymorphisms in relation to the phenotype. Included in the study were 1569 black South Africans for whom CRP concentrations, 12 CRP single nucleotide polymorphisms (SNPs), cardiovascular health markers, and SES factors were known. None of the investigated SES aspects was found to associate with CRP concentrations when measured individually; however, in adjusted analyses, attaining twelve or more years of formal education resulted in a hypothetically predicted 18.9% lower CRP concentration. We also present the first evidence that active smokers with a C-allele at rs3093068 are at an increased risk of presenting with elevated CRP concentrations. Apart from education level, most SES factors on their own are not associated with the elevated CRP phenotype observed in black South Africans. However, these factors may collectively with other environmental, genetic, and behavioral aspects such as smoking, contribute to the elevated inflammation levels observed in this population. The gene-smoking status interaction in relation to inflammation observed here is of interest and if replicated could be used in at-risk individuals to serve as an additional motivation to quit.

Ischemic preconditioning prevents impact of prolonged sitting on glucose tolerance and markers of cardiovascular health but not cerebrovascular responses.

Prolonged, uninterrupted sitting is demonstrated to acutely impair glucose homeostasis, but it also leads to detrimental cardiovascular health effects. We examined whether ischemic preconditioning (IPC) prevents the impact of prolonged sitting-induced glucose intolerance and measured related influencing factors such as (para)sympathetic nerve activity [assessed by heart rate variability (HRV)] and blood pressure during 2 h of prolonged sitting. In this randomized, controlled crossover study, 15 healthy participants (80% men) with a mean age of 21 ± 1 yr (means ± SD) and body mass index of 25.0 ± 2.4 kg/m2 performed IPC (IPC, 4 × 5-min 220-mmHg unilateral occlusion at the thigh muscle) or a sham intervention (sham, 4 × 5 min 20-mmHg), followed by 2 h of sitting. After IPC or sham intervention, fingertip blood glucose was measured before and after 30, 60, 90, and 120 min of 75 g of glucose ingestions. Blood glucose responses during an oral glucose tolerance test were significantly attenuated, resulting in a lower area under the curve when sitting was preceded by a bout of IPC than sham (P < 0.05). IPC increased high-frequency oscillations and decreased the ratio of low-frequency-to-high-frequency oscillations at 120 min in HRV (P < 0.05). Moreover, a lower blood pressure was observed with IPC compared with sham (P < 0.05). Prolonged sitting or IPC did not affect cerebrovascular responses (P > 0.05). Collectively, these results indicate that the application of IPC before prolonged, uninterrupted sitting bout was associated with a better glucose tolerance and prevented impairment in (para)sympathetic nerve activity and blood pressure in healthy young men and women.

Daily supplementation with aronia melanocarpa (chokeberry) reduces blood pressure and cholesterol: a meta analysis of controlled clinical trials

Background & Objectives Cardiovascular disease is a leading cause of morbidity and mortality in the United States. Dietary supplements, such as those rich in antioxidants, have the potential to improve markers of cardiovascular health, but little is known about the total effect of these supplements. The purpose of this analysis is to identify the effect size of supplementation with aronia berry extracts and to evaluate how age may influence these effects. Methods This analysis included a literature review of controlled trials evaluating the effects of daily aronia berry supplementation for an average of 6-8 weeks on the outcomes of total cholesterol and blood pressure. Three distinct analyses were conducted: systolic blood pressure, diastolic blood pressure, and total cholesterol. The moderator of age was evaluated for each of the three outcome measures. Results & Conclusion Daily supplementation with aronia berry extracts for 6-8 weeks significantly reduces systolic blood pressure, which is a key risk factor for cardiovascular disease, as well as total cholesterol. These effects are most significant in adults over the age of 50 years. Supplementation with aronia berry is a safe and effective way to reduce total cholesterol and systolic blood pressure, with even larger effects among adults over the age of 50 years.

Late-onset hypogonadism: Reductio ad absurdum of the cardiovascular risk-benefit of testosterone replacement therapy.

Low testosterone (T) level is considered a marker of poor cardiovascular health. Ten years ago, the Testosterone in Older Men with Mobility Limitations (TOM) trial was discontinued due to a higher number of adverse events in men receiving T compared with placebo. Since then, several studies have investigated the risks of T replacement therapy (TRT) in late-onset hypogonadism (LOH). To review the mechanism by which TRT could damage the cardiovascular system. Comprehensive literature search of recent clinical and experimental studies. The mechanisms of T-mediated coronary vasodilation were reviewed with emphasis on calcium-activated and ATP-sensitive potassium ion channels. We showed how T regulates endothelial nitric oxide synthase (eNOS) and phosphoinositide 3-kinase/protein kinase B/eNOS signaling pathways in vessel walls and its direct effects on cardiomyocytes via β1-adrenergic and ryanodine receptors and provided data on myocardial infarction and heart failure. Vascular smooth muscle senescence could be explained by the modulation of growth factors, matrix metalloproteinase-2, and angiotensin II by T. Furthermore, leukocyte trafficking, facilitated by changes in TNF-α, could explain some of the effects of T on atheromatous plaques. Conflicting data on prothrombotic risk linked to platelet aggregation inhibition via NO-triggered arachidonate synthesis or increased aggregability due to enhanced thromboxane A in human platelets provide evidence regarding the hypotheses on plaque maturation and rupture risk. The effects of T on cardiac electrophysiology and oxygen delivery were also reviewed. The effects of TRT on the cardiovascular system are complex. Although molecular studies suggest a potential benefit, several clinical observations reveal neutral or occasionally detrimental effects, mostly due to confounding factors. Attempts to demonstrate that TRT damages the cardiovascular system via systematic analysis of the putative mechanisms led to the contradiction of the initial hypothesis. Current evidence indicates that TRT is safe once other comorbidities are addressed.

A 28-Day Carbohydrate-Restricted Diet Improves Markers of Cardiovascular Disease in Professional Firefighters

Waldman, HS, Smith, JW, Lamberth, J, Fountain, BJ, Bloomer, RJ, Butawan, MB, and McAllister, MJ. A 28-day carbohydrate-restricted diet improves markers of cardiovascular disease in professional firefighters. J Strength Cond Res 34(10): 2785-2792, 2020-This study compared the effects of a 4-week, nonketogenic, carbohydrate-restricted (<25% of calories) diet (CRD) on markers of inflammation and oxidative stress in professional firefighters (FF). Subjects (n = 15) reported to the laboratory for 2 sessions (i.e., baseline and post-CRD) where blood was drawn from an antecubital vein after a 10-hour overnight fast. Dependent variables measured at baseline and post-CRD included adiponectin, insulin, human growth hormone, cortisol, C-reactive protein, albumin, lipids, glucose, amylase, creatine kinase, malondialdehyde (MDA), advance oxidation protein products (AOPP), total nitrate + nitrite, and soluble intracellular adhesion molecule-1. Compared with baseline, the CRD resulted in dramatic improvements to subjects' cardiometabolic profiles, including decreases in AOPP (51.3 ± 27.3 vs. 32.9 ± 7.9 ng·ml), MDA (1.6 ± 0.6 vs. 1.1 ± 0.5 µmol·L), and triglycerides (84.4 ± 34.4 vs. 64.2 ± 14.4 mg·dl), respectively. In addition, the CRD increased total cholesterol (151.5 ± 23.0 vs. 167.7 ± 38.2 mg·dl) and high-density lipoprotein cholesterol (46.3 ± 12.7 vs. 50.6 ± 15.5 mg·dl), but no differences were found with low-density lipoprotein cholesterol. Overall, our results show a 4-week CRD can favorably improve some markers of cardiovascular health in male FF.

A Group-Based Community Reinforcement Approach of Cognitive Behavioral Therapy Program to Improve Self-Care Behavior of Patients With Type 2 Diabetes.

IntroductionThis study evaluated a cognitive behavioral-based self-care intervention program on diabetes management in individuals with type 2 diabetes in Jiangsu Province, China. People with type 2 diabetes were recruited to a 6-month, prospective, intervention study.MethodsThe intervention group (n = 296) received an intensive cognitive behavioral-based self-care intervention, including group activities, frequent blood glucose monitoring, nutritional counseling, diabetes-specific meal and a weekly progress report. The control group (n = 110) received diabetes education, including diet and physical activity instruction only. Assessment data was obtained at baseline, and after 12 and/or 24 weeks of intervention. The intention to treat method was used to assess the effectiveness of the intervention program.ResultsThe intervention group showed improved fasting blood glucose, HbA1c, systolic and diastolic blood pressures compared to the control group. The intervention group also had significantly improved knowledge and self-care behavior, and general health.ConclusionThis study demonstrates that significant improvement in glycemic control and markers of cardiovascular health can occur in Chinese people with type 2 diabetes following a CBT-based intervention program that includes diabetes education, frequent blood glucose monitoring and daily use of a diabetes-specific meal plan, suggesting CBT is beneficial to improve health outcome in patients with type 2 diabetes.

Social Integration, Daily Discrimination, and Biological Markers of Health in Mid- and Later Life: Does Self-Esteem Play an Intermediary Role?

Background and ObjectivesThis cross-sectional study examines associations of social integration and daily discrimination with 4 biological markers of inflammation and cardiovascular health and tests whether self-esteem may mediate any of these effects.Research Design and MethodsData came from 746 participants of the National Survey of Midlife Development in the United States (MIDUS) Refresher (2011–2014) and MIDUS Refresher Biomarker Project (2012–2016). Structural equation modeling estimated direct and indirect associations of social integration and daily discrimination with glycosylated hemoglobin (HbA1c), high-density lipoprotein (HDL), C-reactive protein, and interleukin-6.ResultsSocial integration and daily discrimination were both significantly associated with self-esteem, which was in turn associated with HbA1c, HDL, and interleukin-6 levels. Social integration was indirectly associated with HbA1c, HDL, and interleukin-6 via self-esteem. Daily discrimination was directly associated with HbA1c, C-reactive protein, and interleukin-6 and was indirectly associated with HDL and interleukin-6 via self-esteem.Discussion and ImplicationsFindings identify social correlates of inflammation and cardiovascular risk and suggest that self-esteem may serve as a pathway for effects. Overall, results were somewhat mixed: Daily discrimination was directly associated with both self-esteem and 3 of the 4 biological markers of health; however, although social integration was strongly associated with self-esteem, it was only weakly and indirectly associated with biological health markers. Moreover, the indirect effects of daily discrimination on the biomarker outcomes—while significant—were notably smaller than its direct effects. Implications for theory, practice, and future research are discussed, including the need for further study of self-esteem and physical health across mid- and later life.

Evidence for improved systemic and local vascular function after long-term passive static stretching training of the musculoskeletal system.

Vascular function and arterial stiffness are important markers of cardiovascular health and cardiovascular co-morbidity. Transitional phases of hypoemia and hypermia, with consequent fluctuations in shear rate, occuring during repetitive passive stretching adminstration (passive stretching training) may constitute an effective stimulus to induce an amelioration in vascular function, arterial stiffness and vascular remodelling by improving central and local blood flow control mechanisms. Vascular function, arterial stiffness and vascular remodelling were evaluated before and after 12weeks of passive stretching training and after 6weeks from training cessation, in the femoral, popliteal (treated with stretching), and brachial arteries (untreated) of both sides. After passive stretching training, vascular function and arterial remodelling improved, and arterial stiffness decreased in all the arteries, suggesting modifications of both central and local blood flow control mechanisms. Passive stretching-induced improvements related to central mechanisms seemed to have a short duration, as they returned to pre-training baseline within 6weeks from training cessation, whereas those more related to a local mechanism persisted in the follow-up. Acute passive stretching (PS) effects on blood flow ( ), shear rate ( ), and vascular function in the feeding arteries of the stretched muscle have been extensively investigated; however, few data are available on vascular adjustments induced by long-term PS training. We investigated the effects of PS training on vascular function and stiffness of the involved (femoral and popliteal) and uninvolved (brachial) arteries. Our hypothesis was that PS-induced changes in and would improve central and local mechanisms of control. Thirty-nine participants were randomly assigned to bilateral PS (n=14), monolateral PS (n=13) or no PS training (n=12). Vascular function was measured before and after 12weeks of knee extensor and plantar flexor muscles' PS training by single passive limb movement and flow-mediated dilatation (FMD). Central (carotid-femoral artery PWV, PWVCF ) and peripheral (carotid-radial artery PWV, PWVCR ) arterial stiffness was measured by pulse-wave velocity (PWV), together with systolic (SBP) and diastolic (DBP) blood pressure. After PS training, increases of 30%, 25% and 8% (P<0.05) in femoral Δ , popliteal and brachial artery FMD%, respectively, occurred in both PS training groups. A decrease in PWVCF , PWVCR , SBP and DBP (-25%, -17%, -4% and -8%, respectively; P<0.05) was noted. No changes occurred in controls. Vascular function improved and arterial stiffness reduced in the arteries involved and uninvolved with PS training, suggesting modifications in both central and local control mechanisms. PS-induced improvements had a short duration in some of vascular function parameters, as they returned to baseline within 6weeks of PS training cessation.

P0263A NEPHROLOGIST'S LOOK AT HYPERTENSIVE DISORDERS OF PREGNANCY

Abstract Background and Aims Preeclampsia (PE) is a pregnancy-related syndrome of variable severity that falls under the broad category of hypertensive disorders of pregnancy (HDP). The relationship between PE and chronic kidney disease (CKD) is not entirely understood. Once considered a self-limited disease healed by delivery, it is now acknowledged that PE is a marker of cardiovascular and kidney health in the long term. The aim of this study was to review the data of women with hypertensive disorders of pregnancy at our institution, to identify need and to organize a conjoint nephrology and obstetrical activity in our setting Method We retrospectively reviewed all the medical charts of the patients hospitalized in the last two years for hypertensive disorders of pregnancy and who delivered in our Hospital. The cohort was divided into two groups: gestational hypertension (GH) and PE. A descriptive analysis of the clinical-laboratoristic was performed (t-test for continuous data with normal distribution). Results We identified 93 cases of hypertensive disorders of pregnancy on a total of 3279 deliveries (2.8%), 47 GH and 46 PE [2 cases of HELLP syndrome and 1 of eclampsia included in the PE group]. These two groups showed similar mean age: 33.5±6 vs 34.9±6 years (p value= 0.25); serum creatinine (sCr) and uric acid at admission were statistically different, and higher in the PE group (sCr 0.57±0.15 and 0.66±0.2 – p=0.01 and uric acid 4.5±1.38 and 5.6±1.47 – p=0.01). Comorbidities were frequent in the PE group: thyroid disfunction was found in 17% of cases (7 hypothyroidism and 1 hyperthyroidism, all under treatment), coagulation abnormalities were present in 15% of cases (4 MTHFR mutation, 1 protein S deficiency, 1 prothrombin-gene mutation, 1 patient was positive for LLAC); gestational diabetes was diagnosed in 13% of the cases. We identified 1 renal transplant recipient, 1 IgA-vasculitis patient, 1 patient with family medical history positive for PE (in her twin sister); none of these patients had been identified as at high risk for PE. At hospital admission, 54% of the patients were on antihypertensive treatment, 7 of them for chronic hypertension and 18 for gestational hypertension (12 of these patients underwent a previous hospitalization during the same pregnancy, diagnosed with gestational hypertension); at admission only 24% of PE patients were treated with anticoagulant or antiplatelet prophylaxis. Caesarean section was performed in 36 cases (78%). All but one children live-born, the exception being a child from a multiple pregnancy (quadruplets). Conclusion A multidisciplinary approach and a nephrological follow-up are increasingly indicated in PE. Our series underlines a high prevalence of comorbidity or risk factors, including thyroid disfunction, gestational diabetes and coagulation abnormalities. The high prevalence (7/46) of chronic hypertension and the fact that the two patients with kidney disease were not identified as at risk for PE underlines the potential role for developing a synergic approach between nephrologist and obstetricians.

Nonlinear Dynamic Modeling of Blood Pressure Waveform: Towards an Accurate Cuffless Monitoring System

The objective is to develop a cuffless modelling approach to accurately estimate the blood pressure (BP) waveform and extract important BP features, such as the systolic BP (SBP), diastolic BP (DBP), and mean BP (MAP). Access to the full waveform has significant advantages over previous cuffless BP estimation tools in terms of accuracy and access to additional cardiovascular health markers (e.g., cardiac output), as well as potentially providing arterial stiffness and identifying different cardiovascular diseases. Nonlinear autoregressive models with exogenous input (NARX) are implemented using an artificial neural network to predict the BP waveforms using electrocardiography (ECG), and/or photoplethysmography (PPG) signals as inputs. The efficacy of the model is compared with a pulse arrival time (PAT) model using 15 subjects from the MIMIC II database. Two training modes are considered: training on the first eight minutes of data for each subject (Predictive training) and testing on the rest (up to 5.2 hours); and training on the first and the last eight minutes (Interval training) and testing the model in between. Predictive training and Interval training exhibited similar results initially, while Interval training resulted in higher accuracy over longer periods. The proposed method models the BP as a dynamical system leading to better accuracy in the estimation of SBP, DBP and MAP when compared to the PAT model. Moreover, the NARX model, with its ability to provide the BP waveform, yields more insight into patient health.

Body Composition Changes During Traditional Versus Intensive Cardiac Rehabilitation in Coronary Artery Disease.

Intensive cardiac rehabilitation (CR) was recently approved by Medicare and includes more hours and more focus on nutrition, stress management, and group support than a traditional, exercise-focused CR. The purpose of this study was to compare changes in body composition and cardiovascular (CV) risk factors after intensive versus traditional CR programs in patients with coronary artery disease (CAD). We studied 715 patients with CAD who completed a traditional versus intensive CR program at UCLA Medical Center between 2014 and 2018. Markers of CV health, including body composition using bioelectrical impedance analysis, were assessed pre- and post-program participation. In both types of CR programs, body mass index, body fat percentage, blood pressure, and cholesterol levels (total cholesterol and low-density lipoprotein cholesterol) were significantly lower post- compared with pre-program. Exercise capacity was increased in both groups. Intensive CR patients had greater reductions in body mass index, body fat percentage, visceral adipose tissue, and diastolic blood pressure. Traditional CR patients demonstrated greater increases in high-density lipoprotein cholesterol and estimated lean mass. In patients with CAD, both traditional and intensive CR programs led to improvements in CV risk factors, though the magnitude of the effects of the program differed between the programs. Further studies, including studies analyzing CV outcomes, are needed to help determine optimal CR program choice for CAD patients based on their risk factor and body composition profile.