Marker Of Arterial Stiffness Research Articles

Cardio Ankle Vascular Index (CAVI) as arterial stiffness marker in subjects with ankylosing spondylitis

BackgroundAnkylosing spondylitis (AS) is a chronic, inflammatory disease of the axial spine that can manifest with various clinical signs and symptoms1.Cardio-ankle vascular index (CAVI), which is calculated based on the stiffness parameter thus obtained, is theoretically independent of changes in blood pressure. With this distinct advantage, CAVI has been widely applied clinically to assess arterial stiffness in subjects with or without known cardiovascular diseases2.ObjectivesThe aim of this study was to evaluate the Cardio Ankle Vascular Index (CAVI) in subjects with ankylosing spondylitis pared with controls free of morbidities.MethodsWe enrolled 41 participants in this study. Eighteen patients with diagnosed AS and 23 controls free of comorbidities. CAVI was measured by VaSera VS-1000 (Fukuda- Denshi Company, Ltd, Tokyo, Japan).ResultsThe results are expressed as mean ± standard deviation for continuous variables. The data were analyzed using SPSS v. 24 (SPSS Inc., Chicago, IL). The normality of the data was evaluated with Shapiro-Wilk test. A two-tailed p < 0.05 was considered statistically significant. Individuals with AS exhibited greater pSBP (p < 0.01), DBP (p < 0.05), and MBP (p < 0.01) compared to controls. Moreover, in the AS group we observed a higher CAVI with a mean difference of 1.14 (p < 0.01, 95% CI of .41 to 1.8) (Figure 1).ConclusionAS is a chronic inflammatory disease that primarily affects the articular joints of the spine. Individuals with ankylosing spondylitis showed increased CAVI, this contributes to explain the higher risk of cardiovascular disease in this pathological condition.Figure 1Cardio-anlde vascular index: (CAVI) in patients with ankylosing spondylitis (AS) compared to Controls

Relationship between Aortic Arch Calcification, Detected by Chest X-Ray, and Renal Resistive Index in Patients with Hypertension

Objective: Aortic arch calcification (AAC) is a surrogate marker for arterial stiffness and hypertension-related vascular damage. Renal resistive index (RRI), a renal Doppler ultrasonography parameter, is used to assess renal hemodynamics. In this study, we aimed to evaluate the relationship between RRI and AAC in patients with hypertension. Methods: Patients with hypertension underwent a chest X-ray and re nal Doppler ultrasonography. They were divided into two groups according to RRI (group 1: RRI ≥0.70; group 2: RRI < 0.70). Two examiners, blinded to the findings of RRI, reviewed the AAC in these patients. The kappa value was detected to be 0.781 and a p value < 0.001 was considered significant. Results: The study included 289 hypertensive patients (mean age 63.87 ± 11.38 years). In 53.6% (n = 155) of the study subjects, RRI was observed to be ≥0.70. Patients with RRI ≥70 were older and had more prevalent AAC as well as left ventricular hypertrophy. A multiple linear regression analysis was carried out to test whether presence of AAC significantly predicted RRI. The results of the regression analysis indicated that presence of AAC significantly predicted RRI (β = 0.053; p < 0.001). Conclusions: A strong and independent relationship was found between AAC on chest X-ray and RRI in patients with hypertension.

Association of galectin-3 with markers of myocardial function, atherosclerosis, and vascular fibrosis in patients with rheumatoid arthritis.

Galectin-3 has emerged as a promising novel biomarker of cardiovascular fibrosis in patients with cardiovascular diseases. We investigated whether galectin-3 correlates with markers of vascular fibrosis, subclinical atherosclerosis, and cardiac function in patients with rheumatoid arthritis (RA), a disease accompanied by high cardiovascular risk. RA and non-RA individuals underwent applanation tonometry, carotid ultrasound, and impedance cardiography, to obtain markers of arterial stiffness, subclinical atherosclerosis, and myocardial function, respectively. Cardiovascular risk was estimated from the Framingham Heart Study. Serum levels of galectin-3 were determined by enzyme-linked immunosorbent assay. Galectin-3 was elevated in RA patients (n = 85) compared to controls (n = 39), but this difference was no longer significant after adjustment for the presence of cardiovascular comorbidities. In the univariate analysis, galectin-3 significantly correlated with markers of vascular stiffness (including pulse wave velocity, central blood pressure, central and peripheral pulse pressure, and total arterial compliance); atherosclerosis (carotid intima-media thickness); myocardial blood flow (cardiac output, stroke volume) and contractibility (acceleration and velocity index); systemic vascular resistance, and estimated cardiovascular risk. Multivariate analysis models revealed an independent association between galectin-3 and both cardiac output (β = -0.274, P = 0.039), as well as systemic vascular resistance (β = 0.266, P = 0.039). In a relatively well-controlled cohort of RA patients with low-grade systemic inflammation and long-standing disease, serum galectin-3 might be useful as a marker of cardiac function and cardiovascular fibrosis.

Diets high in n-3 fatty acids are associated with lower arterial stiffness in patients with rheumatoid arthritis: a latent profile analysis.

Supplementation with n-3 fatty acids can influence inflammation and markers of arterial stiffness that are increased in patients with rheumatoid arthritis (RA). However, it is unknown whether specific patterns of dietary fatty acid intake are similarly associated. In a longitudinal study, eighty-six RA patients reported their dietary intake and had arterial stiffness measured using the augmentation index (AIx) at baseline and 8 months. Latent profile analysis (LPA) was performed to characterise patterns of fatty acid intake using sixteen major fatty acids. Models for two to six profiles were compared using the Akaike and Bayesian information criteria. Associations between AIx and the profiles were adjusted for age, sex, disease activity, fish oil supplementation, medications, physical activity and socio-economic status. LPA identified five distinct profiles. Profile 1 subjects (n 7) reported significantly higher intake of palmitoleic acid (16 : 1), arachidonic acid (20 : 4n-6), EPA (20 : 5n-3), DHA (22 : 6n-3) and docosapentaenoic acid (22 : 5n-3) (P&lt;0·001 for each) than profiles 2 (n 14), 3 (n 19), 4 (n 23) and 5 (n 23) and significantly higher grilled and tinned fish consumption. The AIx varied significantly across the five profiles (P=0·023); subjects in profile 1 had a significantly lower AIx than those in profile 3 (β=-7·2 %; 95 % CI -11·5, -2·9; P=0·001) who had the lowest reported intake of n-3 fatty acids. Fish oil supplementation was also independently associated with lower AIx (β=-4·15 %; 95 % CI -6·73, -1·56; P=0·002). A diet characterised by a higher reported intake of n-3 fatty acids, palmitoleic acid (16 : 1) and arachidonic acid (20 : 4n-6) is associated with a lower AIx in RA patients.

A3963 Prevalence of isolated systolic hypertension in middle-aged Chinese

Objectives: To investigate the prevalence and risk factors of isolated systolic hypertension in untreated middle-aged Chinese. Methods: All employees and retired workers at a factory in Dali were invited to take part in our study in May to July, 2010, and participants without antihypertensive treatment and younger than 60 years were included in the present analyses. Standard questionnaire was used to collect information on smoking and drinking habits, family history of hypertension, and diabetes mellitus. Isolated systolic hypertension was diagnosed as office systolic blood pressure ≥140 mmHg and diastolic blood pressure < 90 mmHg in untreated participants. Results: One thousand two hundred and eight participants included 490 women and 905 normotensive participants. The prevalence of isolated systolic hypertension, isolated diastolic hypertension, and systolic diastolic hypertension were 3.4%, 3.0%, and 18.7%, respectively. Isolated systolic hypertension was prevalent in participants with older age and short stature. In logistic analysis, old age and short stature were significant risk factors for isolated hypertension. Indeed, a 10 years increase of age and a decrease of 5 cm of body height was associated with a 2.56 (1.62, 4.03) and then 1.46 (1.05, 2.04) times higher risk of isolated systolic hypertension. In further analyses, we found a significant interaction between age and body height in relation to pulse pressure. Only in those aged 50 to 60 years participants, lower body height was associated with a higher pulse pressure, a marker of arterial stiffness. Conclusion: Isolated systolic hypertension was prevalent in middle-aged Chinese and associated with older age and lower stature. More attention is needed to pay for this special subtype of hypertension in Chinese.

A17970 Ambulatory pulse pressure components

Objectives: Ambulatory pulse pressure (PP) a known predictor of mortality, believed to be an arterial stiffness marker. However stiffness is pressure-dependent. We developed a method for splitting PP into two components expressing the contribution of a pressure-independent stiffness (‘elastic’, elPP) and the pressure-dependence of stiffness (‘stiffening’, stPP), and investigating their predictive power for all-cause mortality. Methods: Deriving quantitative expressions for elPP and stPP assuming an exponential pressure–volume relationship in arteries, calculated from ambulatory BP (ABP) data and estimate standardized hazard ratios with Cox proportional hazards regression in selected patient groups. Results: ABP records of 1,999 consecutive hypertensive patients, of whom 103 died from all causes within 5 years, were analyzed. PP, elPP, stPP and stPP/elPP (‘PP variables’) (mean ± SD) were 60 ± 14, 50 ± 10, 10 ± 8 mmHg, and 0.20 ± 0.14, respectively. elPP and stPP were weak correlated (r = 0.21). Predictive power was found for patients with heart rate < 70: Mean[95%CI](P-value) hazard-ratio of PP, stPP and stPP/elPP (adjusted) were 1.48[1.13–1.95](P = 0.005), 1.58[1.20–2.09](P = 0.001), and 1.78 (1.25–2.52](P = 0.001), respectively The elPP (83%of PP) did not show predictive power. None of the PP variables displayed predictive power for the higher-heart-rate subgroup. Conclusion: Ambulatory PP components provide a novel and clinically valuable tool bridging between PP and arterial properties. Replacing PP by its components, taken as independent variables, may improve predictive power. The prognostic significance of the PP for all-cause mortality in elderly hypertensive patients with lower heart rates is dominated by its smaller component that quantifies arterial stiffening with pressure.

A1340 Elevated circulating Homocysteine and High Sensitivity C-Reactive Protein jointly as Useful Predictive Factors for Arterial Stiffness

Objectives: Elevated plasma total homocysteine (tHcy) and high sensitivity C-reactive protein (hsCRP) levels are independent risk factors for cardiovascular disease. This study aimed to evaluate the effectiveness of tHcy and hsCRP as potential markers for arterial stiffness in Chinese adults. Methods: we conducted a 12-year longitudinal study in 220 individuals in Hanzhong, China from 2005 to 2017. The average age at follow-up was 41.83 ± 3.10 years old. Demographic information, medical history, blood pressure, and anthropometric measurements as well as fasting blood and urine samples, including tHcy, hsCRP and brachial-ankle pause wave velocity (baPWV) were measured and analyzed. Results: We found that subjects whose baseline tHcy and hsCRP levels were above 75th percentile were prone to be at the highest quartile at follow-up (tHcy: RR:9.649; 95% CI, 4.206–22.137; P < 0.01; hsCRP: RR:3.601; 95% CI, 1.599–8.109; P < 0.01). The risk of developing arterial stiffness was significantly increased in the highest quartile of baseline hsCRP, while the associations were not found between baseline tHcy and follow-up baPWV. Besides when tHcy and hsCRP were combined, compared with low tHcy/low hsCRP (tHcy < 12.3 μmol/L and hsCRP < 0.36 μmol/L), high tHcy or/and high hsCRP was/were significantly associated with elevated risk for developing arterial stiffness (baPWV≥12 m/s) after adjusting for confounders in logistic regression models. Conclusion: The combination of plasma tHcy and hsCRP level has a strong predictive value for arterial stiffness.

Clinical impact of dipping and nocturnal blood pressure patterns in newly diagnosed, never-treated patients with essential hypertension

The significance of nondipping and increased nighttime systolic blood pressure (SBP) in established hypertension is well defined. We investigated whether these factors alone or combined correlate with vascular damage in early-stage hypertension. Newly diagnosed, untreated hypertensives were classified as dippers and nondippers according to ambulatory blood pressure (BP). Twenty-four–hour urinary albumin excretion and markers of arterial stiffness (pulse wave velocity, augmentation index, central and peripheral pulse pressure, central BP) and atherosclerosis (carotid intima-media thickness) were assessed. Serum asymmetric dimethylarginine, an index of endothelial dysfunction, was measured in a study subgroup; 10-year cardiovascular risk was calculated. Among 222 hypertensives, only urinary albumin excretion was increased in nondippers, compared to dippers (P = .026). When dippers were further stratified according to nighttime SBP (<120 or ≥120 mm Hg), the first group demonstrated the lowest levels of office, aortic, 24-hour, daytime and nighttime BP, compared to dippers with elevated nighttime SBP and nondippers. Although vascular measurements and asymmetric dimethylarginine were comparable between these groups, dippers with normal nighttime SBP exhibited the lowest cardiovascular risk score (P = .050). In early-stage hypertension, nondipping was accompanied by microvascular, yet not macrovascular and endothelial dysfunction. Dippers with elevated nighttime SBP appear as a distinct group with increased hemodynamic pressure load and cardiovascular risk.

P4786Incremental prognostic value of cardio-ankle vascular index as an arterial stiffness marker in patients with intermediate risk for cardiovascular disease

P4786Incremental prognostic value of cardio-ankle vascular index as an arterial stiffness marker in patients with intermediate risk for cardiovascular disease

Arterial stiffness in elderly patients with normotension and hypertension in Brazil.

Data on arterial stiffness in older populations, according to blood pressure (BP) levels, are scarce in Brazil. The objective of this study was to establish reference values for core measures of arterial stiffness, including carotid-femoral pulse wave velocity (cf-PWV) and aortic augmentation index (AIx), in a cohort of older individuals with normotension (NT) and hypertension. Cross-sectional analysis was performed with applanation tonometry data from 1192 patients aged 60years or older. The authors classified patients according to their BP levels as having NT, controlled hypertension (CH), and uncontrolled hypertension (UH). The cf-PWV values were 9.11±0.16m/s (NT), 9.12±0.18m/s (CH), and 9.42±2.2m/s (UH) (P<0.005; UH vs NT and CH). The AIx was 33.3% for the entire cohort and similar across all groups. The cf-PWV increased with age but reached a ceiling at 75years. Compared with men, women had a higher AIx but similar cf-PWV levels. In conclusion, the markers of arterial stiffness were similar among individuals with NT/CH and higher among individuals with UH.

Age and sex-specific associations of carotid pulsatility with small vessel disease burden in transient ischemic attack and ischemic stroke.

Background Although large artery stiffness has been implicated in the pathogenesis of cerebral small vessel disease, whether carotid pulsatility, a convenient surrogate marker of arterial stiffness, is similarly associated with global burden of small vessel disease is unknown. Aims To determine the age and sex-specific associations of carotid pulsatility with global burden of small vessel disease. Methods We studied consecutive patients with transient ischemic attack or non-disabling ischemic stroke from the Oxford Vascular Study who had a brain MRI and carotid duplex ultrasound during 2002-2014. We determined clinical correlates of common carotid artery (CCA) and internal carotid artery (ICA) pulsatility index (PI) and their associations with the total small vessel disease score on MRI, stratified by age (median = 72). Results In 587 patients, correlates of CCA and ICA-PI were both independently associated with age, diabetes, and premorbid mean pulse pressure after adjustment for age, sex, and cardiovascular risk factors (all p < 0.05). ICA-PI was strongly associated with small vessel disease markers and burden, particularly lacunes, in patients aged<70 (age and sex-adjusted odds ratio of top vs. bottom pulsatility index quartile: 5.35, 1.95-14.70, p = 0.001; increasing small vessel disease score: 2.30, 1.01-5.25, p = 0.048), but not in patients aged ≥ 70 ( p > 0.05). No associations between CCA-PI with small vessel disease score were noted at any age. In 94 consecutive patients who also received transcranial Doppler ultrasound, strong associations between middle cerebral artery (MCA)-PI and an increasing small vessel disease score were noted (unadjusted OR-MCA: 4.26, 1.45-12.55, p = 0.009; ICA: 2.37, 0.81-6.87, p = 0.11; CCA: 1.33, 0.45-3.96, p=0.61). Conclusions ICA and MCA-PI are associated with global small vessel disease burden, especially in individuals aged<70 and may be causally related.

The association between fetuin-A and testosterone levels and markers of arterial stiffness in Saudi subjects with type 2 diabetes mellitus

BackgroundInconsistent results have been described regarding the part of fetuin-A and testosterone in arterial stiffness in type 2 diabetes mellitus (T2DM). AimTo look into the links of serum fetuin-A and testosterone levels with brachial-Ankle pulse wave velocity (baPWV), a marker of arteriosclerosis and common carotid intima media thickness (ccIMT), a marker of early atherosclerosis, in diabetic Saudi men patients. Subjects and methodsOne hundred and fifty adult male patients with T2DM and 60 non-diabetic control subjects were enrolled from different Saudi Arabia Taif hospitals. Biochemical analysis, anthropometric measurements, blood pressure, baPWV and ccIMT were investigated. ResultsStepwise regression in diabetic patients revealed that the most important predictor of ba-PWV was serum fetuin-A followed by serum glucose and the most important predictor of ccIMT was serum fetuin-A followed by serum HDL then serum triglycerides. ConclusionsOnly fetuin-A levels not testosterone are negatively associated with early markers of atherosclerosis.

Improvements in Blood Pressure (BP) and Markers of Arterial Stiffness with Canagliflozin (CANA) in the CANagliflozin CardioVascular Assessment Study (CANVAS) Program

The CANVAS Program demonstrated a reduced risk of cardiovascular (CV) and renal outcomes with the SGLT2 inhibitor CANA vs. placebo (PBO) in adults with T2DM and established CV disease or ≥2 CV risk factors (N = 10,142; mean age, 63.3 y; systolic BP [SBP], 136.6 mmHg; diastolic BP [DBP], 77.7 mmHg). This analysis assessed the effects of CANA on BP, pulse, and markers of arterial stiffness including pulse pressure (PP = SBP-DBP) and double product (DP = pulse × SBP). CANA lowered SBP and DBP compared with PBO over the CANVAS Program (mean differences of -3.93 mmHg [95% CI: -4.30, -3.56]) and -1.39 mmHg [95% CI: -1.61, -1.17]; both P &amp;lt;0.001). There were no meaningful differences in pulse over 104 weeks; a ∼0.5 bpm reduction in pulse was seen with CANA at Week 26, which remained stable over time, while pulse with PBO was similar to baseline over 104 weeks. CANA provided reductions in PP and DP compared with PBO (Figure). There was an initial reduction in PP that increased over time with CANA, but remained lower compared with PBO. CANA also provided an initial reduction in DP that was sustained over time. Thus we observed favorable effects of CANA on BP, pulse, and markers of arterial stiffness in patients with T2DM with CV risk factors or established CV disease, which may contribute to the beneficial effects of CANA on CV outcomes. Disclosure R. Townsend: None. M. Dharmalingam: None. S. Genovese: Speaker's Bureau; Self; Abbott Diabetes Care, AstraZeneca, Boehringer Ingelheim, Bruno Farmaceutici, Bristol-Myers Squibb, Eli Lilly, Janssen, Lifescan, Merck Sharp &amp; Dohme, Novartis, Novo Nordisk, Sanofi, Takeda. Consultant; Self; Abbott Diabetes Care, AstraZeneca, Boehringer Ingelheim, Bruno Farmaceutici, Bristol-Myers Squibb, Eli Lilly, Janssen, Lifescan, Merck Sharp &amp; Dohme, Novartis, Novo Nordisk, Sanofi, Takeda. Research Support; Self; Novartis AG. A. Steele: Speaker's Bureau; Self; Amgen, AZ, Bayer, BI, Lilly, Jansen, Merck, Pfizer, Otsuka, Valeant. Advisory Panel; Self; Amgen, BI/Lilly, Jansen, Otsuka, Shire. J.L. Arenas: None. A. Slee: Other Relationship; Self; Janssen Scientific Affairs, LLC. E. Fabbrini: Employee; Self; Janssen Research &amp; Development. K.W. Mahaffey: Research Support; Self; Afferent, Amgen, AstraZeneca, Daiichi, Ferring, Google (Verily), Janssen, Medtronic, Merck, Novartis, Sanofi, and St. Jude. Consultant; Self; Ablynx, AstraZeneca, BAROnova, Bio2 Medical, Boehringer Ingelheim, Bristol-Myers Squibb, Cardiometabolic Health Congress, Cubist, Eli Lilly, Elsevier, Epson, GlaxoSmithKline, Janssen, Merck, Mt. Sinai, Radiometer, Springer Publishing, The Medicines Company, Theravance, Vindico, and WebMD. Stock/Shareholder; Self; BioPrint Fitness.

Serum Uromodulin (SUMOD) Inversely Correlates with Aortic Stiffness in Type 1 Diabetes (T1D) Youth

Lower SUMOD correlates with decreasing kidney function and atherosclerosis in adults with T1D, but its relationship with markers of arterial stiffness in youth with T1D is unknown. We sought to evaluate the relationship between SUMOD and central arterial stiffness in youth with T1D. Participants (n=49, 12-21 years old, 51% female, BMI 25.2±4.6 kg/m2, mean HbA1c8.6±1.4) were enrolled in EMERALD, a randomized controlled trial of metformin in youth with T1D. Post-hoc SUMOD was measured using Euroimmun ELISA kits from serum from the baseline visit. Ascending (AA) and descending aortic (DA) stiffness (pulse wave velocity [PWV] and strain) were determined by MRI at baseline and 3 months of follow-up. SUMOD positively correlated with AA strain (r: 0.37, p=0.04) and negatively with AA PWV (r: -0.41, p=0.03). According to SUMOD tertiles, participants in the lower tertile had higher AA PWV vs. the middle and high tertiles (Figure). Lower baseline SUMOD also predicted worsening in AA PWV over 3 months (β±SE: -0.04±0.01, p=0.03) adjusting for age, sex, baseline AA PWV, treatment group (metformin vs. placebo) and estimated glomerular filtration rate. In T1D youth, decreased SUMOD is associated with increased aortic stiffness. Further research is needed in T1D youth to understand the pathogenesis of SUMOD in cardiovascular disease. Disclosure P. Wiromrat: None. P. Bjornstad: Consultant; Self; Boehringer Ingelheim GmbH. C. Roncal-Jimenez: None. M. Schäfer: None. A. Baumgartner: None. L. Pyle: None. M. Cree-Green: None. Y. Garcia Reyes: None. L. Browne: None. R. Johnson: Board Member; Self; XORT Therapeutics. Stock/Shareholder; Self; Colorado Research Partners LLC. Consultant; Self; Danone Research Foundation. K.J. Nadeau: None.

RENALASE, BLOOD PRESSURE AND ARTERIAL STRUCTURE AND FUNCTION IN CHILDREN WITH CHRONIC KIDNEY DISEASE

Objective: Aim of the study was to assess level of renalase in children with chronic kidney disease (CKD) and to find the relation between renalase level and blood pressure and arterial structure and function in this group of patients. Design and method: In 38 children (21 boys, 17 girls) aged 12.23 ± 4.19 years with CKD we evaluated serum renalase level (Cloud Corp. WUHAN, China) [mcg/mL], BMI Z-score, arterial stiffness parameters (pulse wave analysis, pulse wave velocity – PWV), peripheral and central blood pressure, intima-media thickness (IMT), medications used, kidney function (GFR ac. to Schwartz formula), and selected biochemical parameters. Control group included 38 healthy children (19 boys, 19 girls) with mean age: 11.79 ± 3.29 years. Results: Glomerular filtration rate was from 4.19 to 85.55 mean 25.74 ± 8.94 mL/min/1.73 m2, 14 children were in CKD stage G2, 11 in stage G3, 6 in stage G4 and 7 in stage G5 (6 children were dialysed); 26 children had arterial hypertension. Renalase level in the study group was from 0.93 to 114.16 mean 59.45 ± 23.25 [mcg/mL] and was higher compared to control group (27.20 ± 5.15 [ug/mL]) (p < 0.0001). In children with CKD renalase level correlated with BMI Z-score (r = −0.36, p = 0.027) and alphacalcidol dose [ug/24 h] (r = 0.41, p = 0.02). In the study group we found correlations of renalase with GFR (r = −0.69, p = 0.00001), hemoglobin (r = −0.48, p = 0.002), phosphate (r = 0.35, p = 0.03), Calcium-phosphorus product (r = 0.35, p = 0.03), parathormone (r = 0.58, p = 0.0001), total cholesterol (r = 0.35, p = 0.03), LDL-cholesterol (r = 0.36, p = 0.03) and triglycerides (r = 0.52, p = 0.01). We found no correlations between renalase and peripheral and central blood pressure and IMT; renalase correlated only with PWV Z-score (r = 0.42, p = 0.043). In control group renalase was dependent only on age (r = −0.37, p = 0.022); such relation was not found in the study group. No other correlations between renalase and analyzed clinical, vascular and biochemical parameters were found in the control group. Conclusions: In children with chronic kidney disease renalase level is higher compared to healthy peers and is highly dependent on glomerular filtration. In children with chronic kidney disease renalase seems to be related neither to central nor to peripheral blood pressure but may be a marker of arterial stiffness.

HIGHER MYOCARDIAL OXYGEN CONSUMPTION DURING SUBMAXIMAL EXERCISE IN SUBJECTS WITH ELEVATED PULSE WAVE VELOCITY

Objective: Blood pressure (BP) during standardized workload has prognostic value regarding future cardiovascular (cv) morbidity and mortality independent of BP at rest. Pulse wave velocity (PWV) as a marker of arterial stiffness has independent prognostic value for future cv events. This study was designed to compare BP response to exercise and myocardial oxygen consumption in subjects with elevated PWV with normal subjects. Design and method: In 103 subjects (72 males, aged 50.4 ± 13.3 years, BMI 25.3 ± 3.4 kg/m2) without antihypertensive medication, PWV was measured at rest and non-invasively by Mobil-O-Graph® (I.E.M. GmbH, GERMANY). During and after standardized exercise (50–100 watts, increments 10 watts/minute) BP was measured with the cuff method and the product of heart rate during exercise and systolic BP at 100 watts (BP100W, HR100W) was calculated as a usual measure of myocardial oxygen consumption. Results: Mean PWV at rest was 7,6 ± 1,7 m/sec and correlated significantly with systolic BP100W (176,6 ± 22,2 mmHg, p < 0.01, r = 0,51) and systolic BP 3 minutes after exercise (146,7 ± 19,7 mmHg, p < 0.01, r = 0,37). In subjects with elevated PWV, both mean HR100W and mean BP100W were higher (p < 0.01) when compared with the normal subjects. Subjects with a pathological PWV presented a 23% (p < 0.05) higher myocardial oxygen consumption than normals. Conclusions: There is a considerably stronger correlation between PWV at rest and systolic BP during submaximal exercise compared to BP measurements at rest. Subjects with elevated PWV as an early sign of hemodynamic alterations, have already a considerably higher HR and systolic BP (sBP) during submaximal exercise. Therefore, the product of both HR and sBP as a measure of myocardial oxygen consumption during submaximal exercise is considerably higher in those with the elevated PWV, thus resulting in a lower total physical capacity.

ASSOCIATION OF NOVEL RISK FACTORS OF CARDIOVASCULAR DISEASE WITH BAPWV IN A LARGE COHORT OF ADULTS

Objective: To clarify the association of triglyceride (TG), high- and low- density lipoprotein cholesterols (HDL-C and LDL-C), blood pressure, fasting plasma glucose (FPG), uric acid (UA), high sensitive C-reactive protein (hsCRP), and urine albumin-to-creatinine (UACR) with brachial ankle pulse wave velocity (baPWV), which has been reported as a potential surrogate marker of arterial stiffness, in the Japanese large cohort of adults. Design and method: A total of 2,645 participants including 1,205 men (61.1 ± 9.9 years) and 1,440 women (61.2 ± 9.4 years) were enrolled in the present cross-sectional study. Systolic and diastolic blood pressure (SBP, DBP) were measured to obtain pulse pressure (PP). baPWV was measured using automatic device (BP-203RPE II form PWV/ABI, Omron Colin, Tokyo). Stepwise multiple regression analyses were performed adjusted for age, BMI, current smoking status, exercise habit, habitual alcohol consumption, and medication for hypertension, diabetes mellitus and dyslipidemia, including all indices shown above. Results: Mean ± SD of baPWV, SBP, DBP, PP, TG, FPG, hsCRP and UA were 1569.6 ± 366.1 (cm/sec), 131.2 ± 17.1 (mmHg), 77.3 ± 10.0 (mmHg), 54.0 ± 12.2 (mmHg), 139.8 ± 113.5 (mg/dL), 100.3 ± 20.3 (mg/dL), 0.09 ± 0.29 (mg/dL) and 5.8 ± 1.8 (mg/dL), respectively, in men, and 1486.6 ± 357.5 (cm/sec), 125.4 ± 18.1 (mmHg), 72.9 ± 10.0 (mmHg), 52.5 ± 12.5 (mmHg), 107.4 ± 68.2 (mg/dL), 94.7 ± 16.5 (mg/dL), 0.06 ± 0.19 (mg/dL) and 4.3 ± 1.3 (mg/dL), respectively, in women. In men and women, PP and FPG were significantly associated with baPWV (P < 0.001). In men, hsCRP showed significant association (P = 0.002). In women, TG showed significant association (P < 0.001). Since habitual alcohol consumption showed significant association in men (P = 0.002), those with or without this habit were analyzed separately. In men who drink alcohol beverage daily, UA showed significant association with baPWV besides PP and FPG (P = 0.008), whereas in men without this habit, hsCRP showed significant association besides PP and FPG (P = 0.011). Conclusions: These results suggest that PP and FPG may correlate with arterial stiffness in both sex, and there may be sex differences in the influence-factors of arterial stiffness.

Increased arterial stiffness – similar findings in patients with inflammatory bowel disease without prior hypertension or diabetes and in patients with well-controlled hypertension

Purpose: Chronic inflammatory diseases are related with earlier onset of atherosclerosis. We hypothesized that inflammatory bowel disease patients with chronic, systemic inflammation have an increased arterial stiffness associated with the disease duration. Also, we wanted to compare arterial stiffness markers between inflammatory bowel disease and well-controlled hypertension patients.Materials and methods: A total of 89 inflammatory bowel disease patients (60 patients with Crohn’s disease and 29 patients with ulcerative colitis, age range 20–64 years) without history of arterial hypertension or diabetes were enrolled and age matched with a control group of patients (73 patients, age range 25–69 years, 41 (56.1%) males) with known history of well-controlled arterial hypertension. We have used a noninvasive device that simultaneously measures brachial blood pressure and estimates PWV and AIx in inflammatory bowel disease and hypertension groups of patients.Results: Patients with pathological PWV values were significantly older, had significantly longer duration of inflammatory bowel disease, higher values of serum cholesterol and HDL-cholesterol, and higher AIx (17.4% vs. 9.8%) (all p < .05). Higher PWV was associated with age and duration of inflammatory bowel disease in the linear regression model. PWV values were higher in hypertensive patients in the first two age quartiles while interestingly, in the last two quartiles, PWV was lower than in inflammatory bowel disease group of patients.Conclusions: Chronic subclinical inflammation is responsible for dyslipidemia and accelerated atherosclerosis which consequently alterates arterial elasticity. Inflammatory bowel disease and its duration should also be considered a risk factor for subclinical organ damage, as well as hypertension.

“Sleep disordered breathing and ECG R-wave to radial artery pulse delay, The Multi-Ethnic Study of Atherosclerosis”

Electrocardiography R-wave to radial artery pulse delay (RRD) represents pulse transit time inclusive of pre-ejection period (PEP) and arterial pulse propagation time. RRD is proposed to largely reflect arterial stiffness when PEP is accounted for (shorter RRD=higher arterial stiffness). Sleep disordered breathing (SDB) causes intermittent hypoxemia and sympathetic activation, which negatively influences vascular function. We aimed to examine the association of measures of SDB with RRD. Our sample consisted of participants in the Multi-Ethnic Study of Atherosclerosis without prevalent cardiovascular disease who underwent a daytime arterial elasticity exam, cardiac magnetic resonance imaging (MRI), and overnight polysomnography. SDB measures of interest included apnea hypopnea index (AHI) and oxygen desaturation index (ODI) (N=1173). RRD was regressed on each measure of SDB separately, with adjustment for other cardiovascular risk factors as well as for correlates of the PEP, another component of RRD, by including cardiac MRI measures of contractility and preload. In multivariate analysis, among measures of SDB, ODI, a marker of intermittent hypoxemia, was inversely associated with RRD (β=-60.2 msec per SD [15.5/hr], p=0.04). No significant association was found with AHI. In gender stratified analyses, ODI and AHI were predictive of RRD in men only (β=-111.3 msec per SD [15.5/hr], p=0.01 and β=-100.3 msec per SD [16.1/hr], p=0.02 respectively). Severity of SDB as measured by ODI was associated with RRD, a marker of arterial stiffness. Thus, association of RRD with measures of SDB appears to be gender-dependent.

Overweight and obese children with sleep disordered breathing have elevated arterial stiffness

BackgroundThe prevalence of obese children with sleep disordered breathing (SDB) is increasing. Obesity and SDB are independent cardiovascular risk factors, of which arterial stiffness is an early sign. Pulse wave velocity (PWV), is a marker of arterial stiffness and central systolic blood pressure (cSBP) is a better predictor of cardiovascular outcome than peripheral blood pressure. Therefore, we aimed to determine PWV and cSBP in overweight/obese or normal weight children with sleep disordered breathing (SDB), and non-snoring normal weight controls. MethodsChildren (3-18 y) with SDB (overweight/obese [BMI z-scores ≥ 1.04], n = 48; normal weight n = 44) referred for clinical assessment of SDB and normal weight non-snoring controls recruited from the community (n = 38) underwent overnight polysomnography. PWV was calculated using photoplethysmography. cSBP was calculated using applanation tonometry in a subset of children older than 8 y (n = 55) who had usable waveforms. ResultsOverweight/obese SDB group had higher PWV (mean cm/s (95% CI); wake: 366 (355–380); sleep: 340 (324–357)), than the normal-weight SDB group (wake: 257 (247–267), p = 0.002; sleep: 255 (242–269), p = 0.005), and non-snoring controls (wake: 238 (226–249), p = 0.002; sleep: 235 (220–250), p < 0.001). The normal-weight SDB group had higher PWV than controls (p = 0.03). Overweight/obese children with SDB had higher cSBP (105 (100–110) mmHg) compared with the normal weight children with SDB (96 (90–102)) and the non-snoring controls (97 (91–104); p < 0.05 for both). ConclusionThis study suggests that overweight/obesity substantially worsens the cardiovascular sequelae of SDB, highlighting the imperative to treat obesity and SDB in children early in order to reduce future cardiovascular disease risk.